Health Coaching for Behaviour Change Maximise your impact as Leaders Senior Operational Leaders and Front Line Leaders Networking Event 8th May 2014

What do you already know about health coaching? 2

What is Health Coaching? In the clinical context “performance”= self-management Health coaching is releasing a person’s potential to maximise their own health Health coaching aims to raise awareness and increase responsibility for health Coaching is about supporting someone to change their relationship to a problem or challenge 3

Behaviour Change Assistance Health Coaching provides Clinical Skills Behaviour Change Assistance Health Coaching 4

Fear as driver of the consultation dynamic? Existential Anxiety ‘If I’m worried about something and I don’t go to the doctors, I might die … but if I do go, they might tell me I’m going to die’. Entitlement Anxiety ‘If I go to the doctors and I’m not ill I might be humiliated. Am I entitled to present myself as ill for this reason, at this time?’. Interactional Anxiety ‘Will I be able to say what I need to say? Will I be able to ask what I need to ask? And will I be heard?’ Existential Anxiety ‘If I miss something vital the patient might die or suffer’ (My professional identity is threatened) Entitlement Anxiety ‘Might I get into trouble if I prescribe/refer… guidelines, targets, budgets, evidence-based medicine, etc., ? Interactional Anxiety ‘Patients are unstoppable and insatiable. Will I be able to get what I need and shut them up. They expect me to solve their problem – will I have to handle disappointment/ anger?' Patient’s Fears Clinician’s Fears Adapted from: When doctors and patients talk: making sense of the consultation, Martin Fischer and Gill Ereaut, The Health Foundation June 2012 5

Different kind of conversation “Instead of treating patients as passive recipients of care, they must be viewed as partners in the business of healing, players in the promotion of health, managers of healthcare resources, and experts on their own circumstances, needs, preferences and capabilities.” Coulter (2011) 6

Health Coaching Skills Development Behaviour Change theory Social Cognition theory Patient Activation Motivational Interviewing Stages of Change Positive Psychology Mindful awareness Cognitive Behaviour Therapy Principles and models from Health Psychology & Behavioural Medicine Health knowledge Health recommendations Diagnostic skills Consultation skills Questioning skills Listening skills Problem solving skills Patient – clinician relationship Knowledge and skills of Health Practitioners Skills & techniques from Performance & Development Coaching Goal setting Coaching models Coaching competencies Range of approaches Awareness & Responsibility Focus on potential & emergence Using Challenge & Rapport Scaling 7

Coaching Mindset How would practitioners need to think differently and what would they need to believe in order to engage with a health coaching approach? 8

How do your conversations lead to outcomes? Working with goals What is the value of setting a goal? Who’s goal? Patient’s or clinician’s? What factors might influence patients’ willingness to set a goal? What factors might influence clinicians’ willingness to work on setting a goal with patients? 9

How do you flex your style for different consultations How do you flex your style for different consultations? A range of approaches TELLING / TRAINING PUSH PULL Solving patient’s problem for them - Offering the clinician’s resources & experiences Enabling patient to solve their own problem - Accessing the patient’s resources & experiences NON-DIRECTIVE DIRECTIVE SILENCE/WITNESS ASKING QUESTIONS THAT RAISE AWARENESS CLARIFYING UNDERSTANDING GIVING FEEDBACK OFFERING GUIDANCE GIVING ADVICE REFLECTING PARAPHRASING SUMMARISING MAKING SUGGESTIONS LISTENING TO UNDERSTAND Telling Asking Notes: 10 10

How do you see your patients? Bi-focal vision What is the problem? (Patient is a problem) What is the potential? (Patient is resourceful and holds the solution) 11 11

How do you reflect on the dynamics of the consultation How do you reflect on the dynamics of the consultation? Karpman Drama Triangle Persecutor Rescuer Victim 12

How do you use challenge with your patients? Challenge / Rapport model Awareness Comfort Exposure Context 13

Sustained High Performance Components of High Performance Achievement Learning Meaning Enjoyment Sustained High Performance Control = HM control over you symptoms Learning = HM are you learning about you health/condition Motivation = HM in touch with your motivation or willingness to address the issue Confidence = HM confidence about your ability to manage your health/condition 14

Components of Managing Health – Diamond model Control Learning Motivation Confidence Managing Health Control = HM control over you symptoms Learning = HM are you learning about you health/condition Motivation = HM in touch with your motivation or willingness to address the issue Confidence = HM confidence about your ability to manage your health/condition 15

Components of Managing Health Using Scales to have a simple coaching conversation: Where are you now and what has contributed to that? Where would you like to be and what are the reasons for that? What can you do that is within your control to move this forward? 16

Discussion What was the impact of using the coaching questions? How did the process raise awareness and increase responsibility?

About the Performance Coach The Performance Coach is proud to offer a range of innovative services to help organisations and individuals with an interest in leadership development, performance coaching and health coaching. We pride ourselves at being the ‘best’ at collaborating with our clients, closing the ‘knowing/ doing’ gap and sustaining performance improvement over time. We offer a range of services across the spectrum of; Diagnosis; Consultancy and Design; Development Solutions; Sustainable Engagement and Evaluation. We pride ourselves on using inventive ways to engage and sustain learning creating lasting impact.   For further information: Dr Andrew McDowell, The Performance Coach M: 44 (0) 7984 464 407 T: 44 (0) 203 637 0790 E: andrew@theperformancecoach.com W: http://www.theperformancecoach.com The Performance Coach, Marble Arch Towers, 55 Bryanston Street, London, W1H 7AA 18