Using Health Coaching in an Acute Trust environment Anna Groom Paediatric Diabetes Specialist Dietician, Colchester Hospital University NHS Foundation Trust Dr Andrew McDowell, Director, The Performance Coach

What we’re going to cover 1.What you already know about using health coaching in an acute setting 2.Key principles acute care clinicians have valued 3.Examples of application 4.Health Coaching technique 5.Summary 2

In what particular circumstances do you think health coaching might be useful in acute settings? What do I think the benefits are for clinicians learning to use a coaching approach in acute settings? Questions 3

The acute setting experience What’s the patient experience here? – Expectation of being told – Easy to go into passive role 4

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 Telling Asking LISTENING TO UNDERSTAND How do you change your default position? 5

Clinical Skills Behaviour Change Assistance Coaching relationship Self determined goals and activation Integrating skills 6

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) 7

How do you use challenge with your patients? Challenge / Rapport model Rapport Challenge Awareness Comfort Exposure Context 8

Source: Prof Judy Hibbard, University of Oregon (2008) Building Activation 9

Low activation signals problems (& opportunities) 10

New mind-sets, skills, and techniques Techniques Specific coaching techniques and frameworks for conversations Skills General coaching skills and concepts Mindset Developing a coaching mindset Useful for specific behaviour change conversations Useful in many clinical interactions to increase awareness and responsibility Useful in most clinical interactions and as a leadership skill E.g., TGROW, ABC model, Managing interferences E.g., Using supportive challenge, listening, empathy E.g., people are more resourceful than they think they are 11

What’s different about using health coaching in an acute setting Perceived Challenges Being part of a multi-disciplinary team – the lone health coach… Time to do it The focus on outcomes and box ticking The need for expert input The expectation of expert input Benefits We are getting outcomes Reduced DNAs Patients respond quite well More engaging for clinician Excellent for transitioning – Child to adult – Acute to community 12

What acute setting clinicians tell us they are using it for DepartmentExample EmergencyManaging frequent attenders Pain Man ClinicChanging conversations about injections (Consultants) Physiotherapyincreasing adherence to exercises in outpatient clinics Stroke WardMore appropriate goal setting RehabilitationAligning clinical objectives with patient goals (small steps) PharmacyMedicines adherence on ward, at discharge, at dispensary SurgerySupporting increase in sense of control after surgery PaediatricsRelevant behaviour change with parent and child 13

Example: Out patient Clinics 17 yr Adolescent with Type 1 diabetes Different conversation – aligning clinical goal with personal ambition Increased awareness of challenges of sustained self care Highlighted fear of transition into adult services Outcome: improved glycaemic control, increased knowledge of self care, improved self esteem and confidence 14

Example: In patient 14 year old Child with Anorexia Nervosa on acute children's ward Provided framework for difficult conversation Encouraged patient to identify own goals to allow sense of increased control of situation upon discharge Feedback from parents very positive re providing structure to treatment and enabling sustained behaviour change 15

Example: Rehabilitation Hampshire Hospitals, Winchester Recovery Coaching Entire Ward trained – all levels Supporting faster and safer transition from recovery ward – Increased in independence (Barthel (ADL) scores) – Increased self-efficacy – Fewer patients required residential care placements at discharge HE Wessex Wonderful Workforce Solution Award Nursing Times national award – Care of Older People – “It’s all about helping patients prepare for life at home. So while we are helping patients with everyday tasks such as washing and dressing, we’re talking to them about how they will cope at home and what support is available to them. This helps our patients take an active role in their recovery and helps them prepare for their return to routine daily life.” 16

Components of Managing Health - Diamond model Control Learning Motivation Confidence Managing Health 17 Questions: 1.Where are you now and what has contributed to that? 2.Where would you like to be and what are the reasons for that? 3.What can you do that is within your control to move this forward? (Source: McDowell, The Performance Coach)

Key Learning Recognising – remembering that people feel vulnerable and passive in acute settings Consciously choosing the opportunities to move from mindset and general skills to specific techniques Flexing one’s default consulting position takes effort When you start changing the way you work you get more from your patients Patients like it – but maybe not initially Its catchy…. Other staff attracted to the approach Its enjoyable – activated clinicians as well as activated patients 18