cahpo 2016. workshop 4: trudi dunn and nina finlay

Health Coaching for patient centred care and behaviour change

Trudi Dunn & Nina FinlayHealth Coaching Trainers

Clinical Specialist PhysiotherapistsWest Suffolk NHS Foundation Trust

www.hee.nhs.ukwww.eoeleadership.nhs.uk/healthcoaching

What we’re going to cover1. Why health coaching?2. What is health coaching? 3. The EoE project4. The West Suffolk Hospital Experience5. Top tips

2


NHS aspiration includes helping patients take responsibility• NHS Constitution• Renewable Energy –

sustainability• Cost savings


This is becoming more urgent- our growing long term condition challenge

• Lifestyle causation• Multiple comorbidity• Age and poverty related• Unaffordable


The impact is overwhelming


Our current approach isn’t working

• Clinicians are not trained in the science of behaviour change

• Low levels of patient understanding, compliance and behaviour change

• Alignment between what patients want and what is provided is poor - goals, treatment choices, shared decision making

• Poor communication e.g. introductions, interruptions and complaints

• Paternalism breeds dependency… and increasingly affects patient satisfaction

• Bennett H, Coleman E, Parry C, Bodenheimer, 2010 • GMC Annual report 2013, • Rhoades DR, Fam Med 2001. • Wolever R, 2013• Coulter A, 2011 • KPMG Creating value with patients, carers and

communities 2014


Health Coaching – What is it?

Health Coaching is talking to people with LTCs in a way that supports & empowers them to

better manage their own care fulfil their self-identified health goals improve their quality of life move away from a dependent model of care


Health Coaching - East of England• HEEoE• Dr Penny Newman

− Medical Director NCH&C − Clinical lead for HC HEEoE

• Dr Andrew McDowell− Psychologist− The Performance Coach

• 800 clinicians • 20 accredited trainers in EoE• 1of 6 centres nationally

NHS Innovation AcceleratorFellowship - 2015


Reported benefits Patients• ↑ motivation to change• ↑ satisfaction • Improved health/outcome

Clinicians• ↑ effective consultations • ↑ resilience & job satisfaction• Use with colleagues and others

Organisation• ↑ quality of care • ↓ complaints• Meet strategic priorities • Improve multidisciplinary working • Impact on utilisation, costs and outcomes


West Suffolk Hospital Health Coaching Programme

Business case to trust board

Formal sign off

Extensive marketing

Administration

Organise CPD

Evaluation

Report on outcomes


Requires clinicians to be open to change

• Recognise the need for change• Learned behaviour hard to change• Requires complex interpersonal skills• Time pressures• Using a coaching approach when colleagues are not• Contra cultural – very different from biomedical model


Clinician feedback post training•94% strong or very strong

Mind set shift amongst those trained

•97% likely or extremely likelyLikely to recommend training

to others

•100% agree or strongly agreeCoaching helpful for working

with patients with LTCs

•100% agree or strongly agreeHealth Coaching encourages greater responsibility & self-

management

•100% agree or strongly agreeHCPs would benefit from learning something about using coaching

with patients


Clinician reported benefits post clinical application of HC

Clinician feedback 6 weeks

post training

↑ Empowerme

ntImproved listening

skills

↑ patient involvement

Improved communicati

on skills↑ adherence to treatmentPromotes

self management

↑ Motivation

Improved patient

experience

Facilitating not telling

↑ confidence

on discharge

Shared decision making


Clinical Application of

HC at WSH

Women's health

Discharge planning

CHD & Cardiac rehab

Foot ulcers

Relaxation

Voice therapy

Persistent painObesity

Amputee rehab

COPD, asthma

Diabetes

↑Activity

Complex social readmission

Stress

Paediatrics


Top tips

Top down

support

cahpo 2016. workshop 4: trudi dunn and nina finlay

Healthcare