Health coaching models & case studies
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Health coaching models
Two models of health coaching have been trialled overseas.
The Teamlet model
In this US model, the 15-minute primary care visit is extended to include coaching before and after the physician appointment. Prior to seeing the health practitioner, the coach checks on medication and helps with agenda-setting for the consultation, assists during the consultation and then immediately afterwards assesses whether the patient understands and agrees with the recommended care plan, while also motivating the patient to engage in behaviour change. This is supported by phone calls between visits.
The Hospital-to-Home Model
One widely used programme in the United States reports a 20% to 50% reduction in hospital re-admissions. Their programme focuses on the four pillars of:
having a reliable plan in place to take medications regularly
overcoming barriers to follow-up appointments
having an acute plan and ensuring patients know how to recognise and respond to worsening signs and symptoms
using a personal health record to record 30-day goals, health information and key questions to be shared with the doctor or nurse at the next appointment.
SMILE: Self-Management is Life Enhancing Project
The vision for SMILE is to normalise self-management support in ProCare-affiliated practices in the Manukau
locality. As part of this project, in 2016, ProCare worked in collaboration with the Mt Wellington Family
Health Centre to pilot the health coach model.
This pilot enabled the SMILE team to identify the skills and competencies for the health coaching role and
develop a job description for use by other general practices. They also identified the issues that patients
covered in their health conversation topics.
The most frequent topic was appointment booking, followed by goal setting, healthy lifestyle, nutrition and
whakawhanaunga (nurturing the relationship). Other issues included blood glucose levels and medication.
“The Health Coach helps me to communicate better” ... “I like the brainstorming and decision-making techniques” ... “I don’t like to waste peoples time, I like the fact that we can talk and listen to each other” ... “I can be a stubborn so and so. The coach has helped me get back on track.”
Health coach participants
Source: Manaaki Hauora Supporting Wellness Campaign report, Ko Awatea, Counties Manukau DHB
Tamaki Health – health coaching programme
Building on the success of their peer-led self-management education (SME) programme, Kia Kaha, ETH has initiated a health coaching programme. It has also expanded the original team to include options for self-management education, health psychology, peer support and care coordination.
To support the development of health coaches within their team, they have also been running two-day health coaching workshops as part of the Manaaki Hauora project. These workshops have been attended by primary and secondary care health workers, including diabetes specialists, pharmacists, nutritionists, psychologists, peer workers and volunteers.
Organiser and health psychologist Leona Didsbury says, “We’re very encouraged about the value of health coaching skills as an enhancement of practice for anyone working with patients as it is very patient-centred. We are especially excited about the possibilities of health coaching ‘teamlets’ working together in primary care. Our feedback to date indicates people find this training relevant and useful for their setting.”
Leona is a trained facilitator of the University of California's Centre for Excellence in Primary Care health coaching programme. She has run several training sessions as this is proving to be a popular course for both regulated and non-regulated health staff, both from ETH and other organisations in the Counties Manukau district.
All health coaches working in ETH have regular supervision as well as a weekly mentoring and support session. The health coaches reflect the cultural and linguistic makeup of the enrolled population.
Challenges have included getting the resources to do the training and quality control, the need to maintain and support the lay and volunteer workforce, and referral of patients to the programme.
To overcome these challenges, support from Counties Manukau Health and Ko Awatea as part of the Manaaki Hauora campaign has made a big difference, as well as the seed funding that enabled it to happen. A validated and structured health coaching model has enabled role definition boundaries.
Key lessons that may be useful for other teams who are interested in starting health coaching include to:
build on what works (lessons from the SME implementation informed the model)
apply the improvement science methodology rather than depend on evidence from RCTs
give time to explore ideas and to change and do things differently
use a structured health coaching programme because it makes the idea easier to sell to others in the organisation, particularly clinical staff
include information about the programme in in-house online publications
offer a menu of options.
The model below shows how health coaching fits into the overall SME approach.
(Source: East Tamaki Healthcare (ETH) PHO – Health Coaching Programme)
Report from a health coach
In February, I was introduced to Bob. His wife had just had their first baby, and this had prompted him to look at weight loss and a healthy lifestyle.
It was a very different interaction from the norm. From then until now we have not actually met in person. The beauty of this programme is that we can think outside the box and communicate in the best way possible to accommodate the busy lives of patients.
The constant contact has been virtually based. For example, after liaising by phone and email, I sent Bob a link for the Big Boys Club introduction. His response was very positive – he couldn’t wait to get started, so we organised for him to meet up with a colleague, Edith, at the gym. The meeting went well and Bob was introduced to the team for the Big Boys Club. Bob started the programme and is thoroughly enjoying it.
After three months, Bob is still doing very well. He has lost 17kg and feels great. He will attend the GP for a check in a month and we're hoping for some significant improvements in his baseline results.
*Name changed to protect privacy.
Peer support case study
Theresa's goal was simple. She wanted to take care of her health so that she could better look after her family. She not only achieved her goal, but she also lost 9kg over the 10-week programme.
Theresa knows that she succeeded because of the support and practical help she got from the other programme participants.
This was the second time that Theresa had joined a pool programme. The first time, two years ago, life was different for her. She was pregnant with her fourth child and looking after her partner, who has a serious long-term health condition. These circumstances meant that she couldn’t fully participate in the programme, and when it finished life went on as it had before.
Theresa became lonely and isolated and knew that she needed to make changes. So, with the help of Robyn, she enrolled in a second pool programme.
Part way through this programme, group members started to exchange email addresses and phone numbers.
They messaged each other regularly, which everyone found encouraging. Having this support gave Theresa the confidence to make changes to her personal life.
Group continues meeting
At the end of the 10-week programme, Theresa wanted to stay on her journey. She didn’t want to go back to how she was before, and she wanted to maintain these new relationships. She knew that other members of the group wanted to keep on meeting as well.
So, before the end of the programme, the group decided to continue meeting regularly as a self-sustaining support group. This informal group meets at the pool every Wednesday at 6.30pm. Their main purpose is to encourage people to learn more about health and well-being, and to do more to help themselves.
Group members support each other in many ways. They tap into the resources each of them has, always trying to empower and support each other. For example, one group member teaches Thai cooking, while another has demonstrated mirimiri (Māori massage) and rongoa (traditional Māori medicine).
Knowing how valuable this has been for them, group members are now looking at supporting other groups coming through the programme, as well as organising other activities.
Meanwhile, Theresa now feels more optimistic. She has more energy, prepares better meals for her family and has made friendships that “brighten up my day”.
Lansakara N. Health coaching inspires. Ko Awatea: Health System Innovation and Improvement. 2017 Jan.
Ko Awatea and Counties Manukau Health. SMILE: Self-Management is Life Enhancing. Manaaki Hauora – Supporting Wellness Campaign. 2016 Aug;20–21.
East Tamaki Healthcare (ETH) PHO – Health Coaching Programme.