Originally published by the Royal College of Physicians
Produced by: Future Hospital Partners Network
Dr Penny Newman, medical director at Norfolk Community Health and Care NHS Trust, and Dr Andrew McDowell, psychologist and director of The Performance Coach, discuss the behaviour change techniques that tap into a patient’s intrinsic motivation and explain how health coaching bridges the gap between clinician and patient.
Health coaching is defined as ‘helping patients gain the knowledge, skills, tools and confidence to become active participants in their care so that they can reach their self-identified health goals’. There is growing evidence that health coaching training can enable clinicians to deliver more personalised care to patients. There are also indications that health coaching can help increase patients’ levels of satisfaction, motivation and confidence, which in turn results in changes in health-related behaviours.
There are benefits for clinicians from using these approaches too.
We have all felt overwhelmed by our work in the NHS at some point. We are being asked to care for more and more patients with fewer and fewer resources, and there are times when it can feel as though we’re failing to make the difference we want to people’s lives. There are also times when it can feel like patients’ expectations are at odds with our own, or we sense people could do more to help themselves.
Expectation vs reality
As a clinician, a natural response to these situations is frustration. As a result, we may try to tell patients what to do, make decisions for them, and fall back on the ‘doctor knows best’ model, especially because of the time pressure we experience. But, in the words of Dr Angela Coulter, of the Nuffield Department of Population Health (NDPH) at the University of Oxford, ‘paternalism breeds dependency, encourages passivity and undermines people’s capacity to look after themselves’.
Instead, one option is to ask ourselves whether the way we communicate information could be different. The evidence suggests that only a third of patients take their medication as instructed and only half feel sufficiently involved in decisions about their own care. This suggests there is a mismatch between what patients want, what is realistic within the context of their lives, and what we as clinicians expect from them.
Clinicians who understand the needs, motivations and goals of their patients will be far more likely to be able to identify and tailor support that will be genuinely useful to achieve behaviour change.
The power of effective communication
In our view, effective communication is the most overlooked skill in the clinical workforce. Our work in the East of England has shown that health coaching skills have helped:
- clinicians feel better equipped to structure difficult conversations
- patients and clinicians to share responsibility.
Clinicians who understand the needs, motivations and goals of their patients will be far more likely to be able to identify and tailor support that will be genuinely useful to achieve behaviour change. Equally, patients who are supported to identify their own strengths and resources are more likely to develop the skills, confidence and understanding to become motivated to manage their own health and care – potentially reducing the need to revisit their doctor.
Delivering sustainable behaviour change
Some people think that health coaching is simply about teaching clinicians to do coaching, but it is far more than that. Through our work we are encouraging clinicians to use their clinical skills and abilities in a way that uses coaching to deliver behaviour change. Health coaching should also be considered a component of the leadership toolbox. The skills and techniques can be applied to other situations too, such as with colleagues or in appraisals.
We believe that adopting health coaching approaches can lead to greater satisfaction among clinicians, enabling us to share responsibility with patients and better manage difficult conversations to help patients improve their health. By reframing conversations and getting the most value out of them, we can help patients identify and make the changes that are important to them.
Read Penny and Andrew’s article in June’s Future Hospital Journal.