Better Conversations, Better Care

Better Conversations, Better Care:
Health Coaching to promote person-centred care
and behaviour change for people with long-term
conditions (LTCs)
Clinical
Leaders
Health coaching
Impact
Communication
Person-centred Outcomes
Change
Patient activation
Leadership
Better care
Behaviour change
Positive
Innovation
Goals
Self-care
Patient experience
Improvement
Better conversations
Quality
Talking differently
Synopsis of our Health Coaching
Approach in the East of England
eoeleadership.hee.nhs.uk/healthcoaching

What is health coaching?
Health coaching enables people to gain the
knowledge, skills, tools and confidence to
become active participants in their care so
that they can reach their self-identified goals.
By raising awareness and responsibility in
people with long term conditions (LTCs) to selfmanage,
and putting them at the centre of their
care, health coaching training for clinicians can
improve patient outcomes and experience,
reduce costs, address inequalities and enable
behaviour change.
The need to “activate” clinicians
The impact of LTCs on patients’ quality of life
and NHS costs (around 70%) is escalating.
Detrimental health behaviours cause 60% of
deaths.
Informed, empowered patients have the
knowledge, skills and confidence to manage
their own health and they make healthier
lifestyle choices, personally relevant decisions,
adhere to treatment regimes, and experience
fewer adverse events. Activated patients save
between 8% and 21% of costs. However,
although there are many initiatives to empower
patients to self-care directly, and public health
programmes at a population level, there is a gap
in clinician education and hence their approach
to self-care support with individual patients.
Implementation of health
coaching training across
the east of England
Health coaching is used throughout the USA and
has now been rolled out extensively across the
east of England, where it is integrated into
patient’s usual care rather than as a referral
service. Health Education East of England
(HEEoE) commissioned roll out after initial
piloting in 2010 by Drs McDowell and Newman
with practice nurses in Suffolk, which
demonstrated improvements in self-efficacy and
patient satisfaction.
Since 2013 nearly 800 clinicians have attended a
2 day training programme in a health coaching
approach including nurses, doctors and allied
health professionals from 45 organisations across
community, primary care, mental health and acute
settings. Twenty NHS trainers have been trained
through a 10 day training programme (including
co-delivery). A series of workshops and
conferences including national leaders in person
centred care, helped raise awareness and ensure
organisational embedding, including liaising with
individual organisational coordinators.
Now many organisations across the east of
England are exploring further roll out using NHS
trainers and other funding sources e.g. through
CPD, some incentivised by their commissioners
e.g. through a CQUIN. Initial plans are for 800
more clinicians to be trained and organisations
such as Cambridgeshire Community Services
NHS Trust and West Suffolk NHS Foundation
Trust will have trained hundreds of clinicians as
part of their strategies for integrated and person
centred care.
Uptake of Health Coaching in the East of
England 2013-2015
Health coaching training includes behaviour
change theory, motivational strategies and
communication techniques which develop
patients’ intrinsic motivation for change
addressing this gap. It enables a tailored
consultation style that draws on patient’s own
resources, is based on behaviour change
science and augments other approaches to
empowerment e.g. care planning.
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Outcomes and Evaluation
Health coaching training acts in four ways:
• Reducing mortality, poor quality of life, high
health care utilisation (and cost) for people
with LTCs through improving selfmanagement
and health seeking behaviour.
• Reducing the prevalence of LTCs through
coaching for activation, healthy behaviours
and better lifestyle choices.
• Improving decision making where
different treatment options are available.
• Providing training in patient centred care
and improving clinician communication, a
major source of patient dissatisfaction.
The following evaluation reports, commissioned
by Health Education East of England, are
available at eoeleadership.hee.nhs.uk:
1. Interim Progress
Report including
participant feedback
Over 96% of clinicians rated
content, delivery, learning
opportunities and application
to their work as good/very
good. Post training feedback
was of a change in mind set
and belief, move from “fixer”
to enabler, more listening,
and much-enhanced skills in
identifying patient goals and
behaviour change.
2. Institute of Employment Studies (IES)
qualitative evaluation assessed local evidence
of impact and involved focus groups, interviews
and five organisational case studies included a
CCG, a partnership trust, an accute hospital, a
GP surgery, and a community provider.
Overall clinicians perceived the 2-day training
intervention as effective with high levels of
usage with patients of the coaching skills
acquired through training. Organisational culture
and work context were key success factors with
greater local support ensuring transfer of
learning to daily roles.
More specifically the evaluation found:
• Two-thirds of clinicians were using a health
coaching approach with positive outcomes. It
had a wide application in the management of
depression, obesity, foot ulcers, pain, anxiety,
COPD, coronary heart disease, poor renal
function, hypertension, in smoking cessation
and lifestyle.
• Reported benefits in NHS efficiency and
effectiveness included higher patient
compliance; reduction in episodes of care;
reduction in appointments per patient;
improved quality and consistency; quicker
discharge off caseload; potential to cut
waiting list times and for less acute
admissions; less waste from unnecessary
tests and medication.
• Benefits to patients reported by clinicians
included increased confidence; increased
patient empowerment; more personalised
advice/care; reduced dependency; increased
satisfaction and less medication.
• A case study indicated a 63% indicative cost
saving from reduced clinical time post
compared to pre-training, giving a potential
annual saving of £12,438 per FTE if reduced
clinical time was widely replicable and
sustainable over time compared to £400
investment in training per participant.
3. Does Health Coaching
work? - a rapid review by
The Evidence Centre
The review of evidence
included 275 studies of
health coaching principally
as a referral service in the
USA, a standalone
intervention or part of a
system of care, and carried
out by telephone, online or
face-to-face. Methodological difficulties
make comparison of results to the NHS
difficult.
Importantly, the literature indicates that
health coaching works best for people
most in need. Health coaching can support
patients’ motivation to self-manage and
adopt healthy behaviours;
is widely applicable; and can be adopted
by all professionals and peer coaches.
Implementation should be accompanied by
further evaluating the most cost-effective
methods of training clinicians, and patient
outcomes. Health coaching works best
aligned to other management strategies
for people with LTCs.
3

Cost effectiveness
Feedback from clinicians
The cost of each programme delivered by
training providers was £7,100 for up to 18
participants or £400 per participant. Costs are
halved when local trainers co-deliver as part of
their training and are reduced to costs of
training materials when delivered by local
trainers. Although the international literature
reviewed found mixed evidence on costeffectiveness,
with some studies indicating no
financial savings, other studies do show
significantly reduced costs through fewer
consultations, tests, medication and other care
costs, due to improved self-management by
patients. Health coaching is one of a few
interventions that can increase patient
activation which has achieved savings of
between 4% and 21% of costs.
"I feel that health coaching provides a
more inclusive conversation allowing
discussions to be collaborative and
empathetic rather than prescriptive."
"Using a ‘coaching’ as opposed to a
‘telling’ approach increases self-esteem
and ability to work independently in team
members and helps them to feel more
listened to and supported."
Strategic fit
Health coaching:
• Meets the desire of many people with LTCs
to be more involved in their own health and
care.
• Can help manage demand while
simultaneously delivering an improved patient
experience.
• Delivers on the Five Year Forward View
and addresses national priorities including
prevention and management of long term
conditions (e.g. diabetes), transition from
hospital, mental health, medication
adherence and frail elderly.
• Supports creation of a modern workforce
through re-energising clinicians and
providing them with transferable coaching
skills for leadership.
• Creates a social movement through
developing clinician advocates for patientcentred
care.
• Contributes to delivery of the Public Health
Outcomes Framework and NICE Guidance
and the need to educate and train
practitioners on evidence-based techniques.
• Alongside executive coaching training,
contributes to an emergent coaching
culture in the NHS and new leadership
styles amongst managers and clinicians.
"I think through modelling a coaching
conversation others have had the
confidence to roll this out too. Being on the
receiving end of coaching enables you to
see the enormous potential of it and what
a positive, liberating, powerful process it
is."
Next steps
Health Education East of England is now
working with the Coalition for Collaborative Care
and others to enable health coaching techniques
to be built into mainstream practice to support
people with LTCs and behaviour change. In
addition, we are seeking to undertake further
research on cost effectiveness and outcomes as
health coaching is a new innovation in the UK.
Providing information and OD consultancy
support for organisations in east of England on
implementing health coaching, visit:
eoeleadership.hee.nhs.uk/healthcoaching for
more information and resources or contact
Leanne Dellar on leanne.dellar@nhs.net
4

Contacts
HEEoE Project team
Health Coaching Delivery
Dr Penny Newman
Associate and Clinical Lead
penny.newman1@nhs.net
Dr Andrew McDowell
Lead Trainer, Director,
The Performance Coach
andrew@theperformancecoach.com
Karen Bloomfield
Leadership and Organisational
Development Manager
kbloomfield@nhs.net
Ali Demery
Senior Project Manager
The Performance Coach
ali@theperformancecoach.com
Leanne Dellar
Project Support
leanne.dellar@nhs.net
Evaluation
Dr Alison Carter
Lead Researcher and
Principal Associate Fellow,
Institute for Employment Studies
alisoncarterdba@aol.com
Professor Debra de Silva
Head of Evaluation
The Evidence Centre
debra@evidencecentre.com
Success
Potential
Belief
Motivating
Powerful
Inspirational
Resources Refreshing
Collaborative
Energy
Positive
Dedicated
Patient experience
Needed
Transformational
Life-changing
Enthusiasm
Passion
Will
Change
Empowerment
Future
5

Clinicians are now thinking differently about how they talk with patients
using a Health Coaching approach.
"I find myself seeing more potential and possibilities,
which energises my practice and makes me re-evaluate
my approach as a clinician. This has been reinforced
by the incredible results."
"By allowing patients to think about their
problems and not telling them what I think they
ought to do but letting them make their own
decisions"
"Giving the patients the space to create their
own options and ideas of how they will manage
their relationship with their long term condition.
Spend more time exploring their reality."
eoeleadership.hee.nhs.uk/healthcoaching