1. Findings from the Evaluation Dr Alison Carter, IES Associate 11 November 2014

2. Structure of the presentation  Aims and design of the evaluation  Implementation of the intervention at the evaluation sites  Usefulness of health coaching  Local evidence of impact

3. Questions for the evaluation  How has health coaching been implemented locally and within what context?  Is health coaching perceived as useful for clinicians and their patients?  Is there any local evidence of impact - health outcomes and/or consequences for organisations?

4. Evaluation logic model

5. Evaluation methods Qualitative  Scoping Focus groups with 18 clinicians Interviews with 3 experts  Organisational case studies Interviews with 9 co-ordinators & team leaders Focus groups with 41 clinicians Follow up interviews with 20 clinicians & 5 co-ordinators Interviews with 4 stakeholders Quantitative  Patient experience surveys  Analysis of relevant local outcome data

6. Overview of take-up at evaluation sites No of clinicians trainedNo of Internal trainers trained Community services955 CCG commissioner361 Primary care (general practice)00 Mental health services331 Acute services391 Source: HEEE/TPC records

7. Implementation in community services ‘Culture Change’ Process  Wider strategies not as key drivers as culture  Casting the net widely  Clinicians selling the concept to their peers  Getting support from senior stakeholders  Rolling out widely in a priority order  Plans to document the evidence 95 trained + 6 trainers  Sold as more effective way to address old problems  Health coaching-friendly organisation culture  Six trainers provided support and momentum  May have underestimated local resources required

8. Implementation in general practice ‘Research Project’ planned  Drivers were self- management, patient partnership and reduction in appointments  Designed a test pilot  Plans for clinicians to receive training  Support requested from CCG  Plans to review results 0 trained, 0 trainers  Mixed reaction  Accessing 2-days of training can be difficult  Limitations of ten minute appointments  Highly valued by some as an easy to use ’mind-set’  Lots of examples of successes with patients

9. Implementation by CCG Commissioner ‘Project management’  Clear link to commissioning priority of integrated care  Targeting the ‘right’ individuals  Persuading people to participate  Focus now on data and outcome measures  No decision on roll out 27 trained, 1 trainer  High take-up across all 20 practices  Demand for refresher training  Awareness training for non-users would be helpful  Support needed for isolated trainers

10. Implementation in mental health services ‘Skills acquisition’  Clear link to new ways of working and National Recovery model  Targeting nurses and IAPT practitioners  Considering roll out through link into HR strategy 33 trained, 1 trainer  Some difficulties transferring learning : local support may help  Training quality praised  Demand for more ‘Train the Trainer’ places  Difficult organisation context has negative implications for learning

11. Implementation in acute services Training intervention  Seen as tools for self- management  Targeting specialties with longer patient interactions  Booking onto training  Team leaders reviewing whether to adopt  No plans for roll out 37 trained, 1 trainer  Major difficulties in transferring learning to daily roles  Local mentoring or management support needed  Concern over lack of privacy in busy wards

12. Usefulness of the health coaching approach  2/3 clinicians were using health coaching and finding it useful  Spectrum of usefulness from revolutionary ‘light bulb’ moments to supplement to what already doing for greater impact  Used with a wide range of patients and conditions: depression, weight, smoking, foot ulcers, pain, anxiety, COPD, coronary heart disease, poor kidney function, Hypertension

13. Benefits reported – for clinicians  Reduced caseload: expedites discharge  Reduced demand on the service  Less pressure and responsibility for patient progress  Inspirational  Patients say ‘thank you’ more often  Professional pride at making a difference  Tools e.g. for goal- setting  Skill set for everyday holistic treatment

14. Benefits reported – for patients  Increased confidence  Increased patient empowerment  Gives power/control back  More personalised advice/care  Reduces dependency  Increased satisfaction  Enjoy life more  Less medication  Family able to help support & spot future problems  Potential for reduced waiting times  Potential to prevent (re)admissions

15. Benefits reported - for NHS  Higher patient compliance  Reduction in episodes of care  Reduction in appointments per patient  Quality and consistency  Quicker discharge off caseload  Potential to cut waiting list times  Potential for less acute admissions  Less waste from unnecessary tests and medication

16. Local evidence of impact  51% increase in new patients - one clinician

17. Number of appointments by one clinician: comparison before and after training

18. Local evidence of impact (cont’d)  63% indicative cost saving from reduced clinical time when compared to usual non-health coaching approach - one patient  Potential annual saving of £12,438 per FTE - if reduced clinical time replicable across patients & if sustainable over time  Research needed into patient experience, health outcomes and impact on costs

19. Conclusions  Clinicians perceive health coaching is effective and point to multiple benefits  2-day training intervention is working with high levels of usage  There are implementation some issues: organisational culture and work context are key success factors  Mentoring or coaching locally needed to support transfer of learning to daily roles  Too early to see if ‘Train the Trainer’ model and numbers will deliver sustainability

20. www.employment-studies.co.uk Thank you Alison.carter@employment-studies.co.uk Alison.carter@employment-studies.co.uk or alisoncarterdba@aol.com alisoncarterdba@aol.com