HEALTH COACHING

1. By
Dr. Mona M. Aboserea
Professor of public health
Zagazig University

2. Rationale
Definition of health
coaching (H.C.)
Goals of HC
Scopes
Types
Paradigm shift
Role of health coaching
Process of HC
Approach of HC
Coaching cycle
Strategies for HC
Models of HC
TEACH
Benefits of HC
Clients report
Medication reconciliation
Medication adherence and
pt trust
Closing loop
Coaching participants
satisfaction
Discussion

4. Health coaching is a patient-centered approach to
delivering care.
Researches have shown that half of patients leave
medical visits without understanding the
clinicians’ advice.
In only 10% of visits the patients are involved in
making the decisions. Patients who are not
involved in decision-making do not follow the
clinician’s advice so they lack skills to manage
their health & prevent disease.
This can lead to poor health outcomes for the
patient and frustration for the clinician
Lack of support to make better choice

5. Health coaching can be 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.

6. Health coaches empower patients
to play a central role in clinical
encounters and to engage in self-
management activities at home,
work, and schools, where they
spend most of their lives.

7. Does your practice “give patient a
fish” or “teach patient how to fish”?
????????

8. The familiar saying
“Give a man a fish, and he eats for a day. Teach
a man to fish, and he eats for a lifetime,”
demonstrates the difference between rescuing a
patient and coaching a patient.
In acute care, rescuing makes sense: surgery for
acute appendicitis or antibiotics for
pyelonephritis.
For chronic care, patients need the knowledge,
skills and confidence to participate in their own
care.

9. Help patients
Clarify personal health goals
Implement and sustain healthy behaviors
Reduce negative impact of chronic disease
Guide patients in self-management
Skill development
Problem solving
It will improve health & quality of life.
To minimize the cost of health services.
10

10. Health coaching is the practice of
health education and health
promotion within a coaching context to
enhance the well-being of individuals
and to facilitate the achievement of
their health related goals.

11. Health Coaching Model:
Client Centric
 Care plan (Action Plan) is Client
driven
 Client collaborates with health
coach
 Health Coach teaches, guides,
supports, links clients to
resources
 Client makes decision on level of
participation (Experiential
learning model)
 Ask clients questions to provoke
creative thoughts
Health Education Model:
Health Provider Centric
 Care plan is prescribed by
health provider
 Health provider is regarded
as the authoritarian memb.,
 The specialist Views patient
as compliant or non
compliant with prescribed
care plan
 Parental attitude “I know
better than you do.”
 Teaching facts Telling what
patient should do

12. Assumes knowledge drives
change
Clinician sets agenda
Goal is compliance
Decisions made by
clinician
Assumes knowledge +
confidence drives change
Patient sets agenda
Goal is enhanced confidence
Decisions made
collaboratively
13
Traditional careTraditional care vsvs coaching carecoaching care
Traditional Care Coaching Care
(Bodenheimer et al, Canadian Association of Health Care Foundation,
2005)

13. Engaging, supporting, assisting and guiding
individuals to optimize their health status
through lifestyle changes.
Rooted in the field of health promotion which is
defined as “The science and art of helping
people change their lifestyle to move toward a
state of optimal health.”

14. Stage of change model or transtheoritical model (as
in REVOLVING DOOR)
11-
17-

15. Primary care,
 Community Health plans,
Population health improvement
settings to support individual
lifestyle change,
Treatment adherence, and self-
care.

16. Coaching involves a paradigm shift from a
directive to a collaborative model so that care
teams and patients follow an active partnership,
instead of patients being passive recipients of
care.
While physicians are well-trained to “give
patients a fish” – curing an acute problem
or prescribing medications for a chronic
condition –
health coaching teaches patients and
families “how to fish”.

17. Patients are Non-
Compliant
To
Patients are
successful at
managing their
own care
Patients are
possible to be
engaged in their
own care

18. How is coaching different from
other helping processes?
Non-directive
Counselling
Coaching
Facilitating
Advising
Mentoring
Guiding
Directing
Directive

19. • Managing : Making sure people do what
they know how to do
• Training : Teaching people to do what
they don’t know how to do
• Mentoring : Showing how those who are
good at doing things do them
• Coaching : Helping to identify skills and
capabilities, and empowering people to
use them as best they can

20. Coaching VS Mentoring
Relationship generally has specific
duration
relationship that can last for a long
period of time
Generally more structured in nature
and meetings are scheduled on a
regular basis
Can be more informal and meetings
can take place as and when the mentee
needs some advice, guidance or support
Short-term and focused on specific
development areas/issues
More long-term and takes a broader
view of the person
Coaching is specific and skills-
focused
Mentor is usually more experienced
and qualified than the ‘mentee’.
Focus is generally on
development/issues at work
Focus is on career and personal
development
The agenda is focused on achieving
specific, immediate goals
Agenda is set by the mentee, with the
mentor providing support and guidance
to prepare them for future roles

21. Counseling Coaching
Stresses on understanding Stresses on actions
Asks why? (e.g. Why can't
we be happy?")
Asks how? (e.g. How can
we achieve happiness?")
Obstacles are prominent in
counseling.
Opportunities are
prominent in coaching.
Psychological. Behavioral.
Therapy. Education.
Cure-oriented. Success-oriented.

22. Questioning to check learning Questioning to raise
awareness
Feedback on
performance
Feedback on awareness
Organizational aspect
considered
Individual aspect
Important
Same Core
Skills
Coaching Counseling

23. Questioning (deep & open questions)
Silence (PROPER listening and wait
time)
Paraphrasing
Summarizing
Non judgmental /non critical support
Positive non-verbal communication

24. 1. Coaching for Individual Change:
focus on skills development, support and
performance feedback (content specific:
academic, behavior).

26. 2-Coaching for Team/Group Change:
focus on collaboration and facilitation, group
dynamics
3-Coaching for Systems Change:
focus on organizational change

27. Collaborative , not directive
Patient-centered
Supports patient autonomy
Empowers patient for self-
management
30

28. Listen to what is important.
Proper Observation.
Allow time for individual reflection and collective
reflection.
Make yourself the most vulnerable person in the
relationship.
Stay constant in looking at the student achievement.
Work from the perspective of building rather than
demolition -think about POTENTIAL.

29. The Coach is a team of health
professionals with backgrounds and
degrees in….
Nursing
Health Promotion
Fitness Training
Nutrition
Health Education
Smoking Cessation

30. Health coaches can be nurses, social workers,
medical assistants (MAs), community health
workers (promoters, for example), health
educators
Trained patients can coach other patients
(Peer coaching)
33

31. Health coaching encompasses five
principal roles:
1) providing self-management support,
2) bridging the gap between clinician and
patient,
3) helping patients use the health care
system,
4) offering emotional support and
5) serving as a continuity figure

32. 1-Providing self-management support.
Coaches train patients in seven domains of self-
management support:
A.providing information,
B.teaching disease-specific skills,
C.promoting healthy behaviors,
D.providing problem-solving skills,
E.assisting with the emotional impact of chronic illness,
F. providing regular follow up and
G.encouraging people to be active participants in their care.
A meta-analysis of 53 randomized controlled trials
concluded that self-management support
improves blood pressure and glucose control

33. 2-Bridging the gap between clinician and patient.
Prescribing medications is one example. It is a two-part
endeavor:
1. writing prescriptions and
2. making sure patients obtain, understand and actually take the
medications as prescribed.
Physicians perform part one but lack time to address the
critical second part.
Health coaches can bridge these gaps by following up with
patients, asking about needs and obstacles, and addressing
health literacy, cultural issues and social-class barriers
Clinician
patient
Health Coach

34. 3-Helping patients use the health care system.
Many patients, particularly the elderly,
disabled and marginalized, need a coach.
Coaches can help coordinate care and speak
up for patients when their voices are not
heard

35. 4-Offering emotional support.
Well-intentioned but rushed clinicians
may fail to address patients' emotional
needs.
As trust and familiarity grow, coaches
can offer emotional support and help
patients cope with their illnesses to
overcome emotional challenges.

36. 5-Serving as a continuity figure.
 Coaches connect with patients not
only at office visits but also between
visits, creating familiarity and
continuity.

37. 19 years of age or over
Have stability in their lives
Participate in a personal interview to assess suitability
Agree to a one year commitment as a Peer Coach
Complete the 2 day training
Complete at least 2 role play sessions with the Coach
Mentor
Attend monthly Community of Learning
teleconferences
Attend ongoing skill building sessions

38. 19 years of age or over
Have stability in their lives
Participate in a personal interview to assess suitability
Be referred by a healthcare professional or can self-
refer
Agree to complete and return feedback surveys as
required

39. Peer coaches support individuals to successfully
make the following healthy living changes:
 becoming more active
 healthy eating
 managing a healthy weight
 reducing/ quitting smoking

40. Coaches call participants on the telephone
Coaches support and motivate participants to set
healthy living goals
Participants receive a maximum of six
coaching sessions
Each coaching session lasts not more than1 hour
3-4 months after last session, there is also an
opportunity for a Booster Session
It should be confidential.

41. Make sure you have the right time and date
of your appointment.
Make a list of any question you want to ask
the doctor.
Take all of your medication bottles with you
to your visit.
Ask a family member, friend or your peer
coach to come to the clinic with you.

42. • Identifying a healthy living goal
• Assessing confidence to change
• Discussing barriers
• Making a plan
• Linking to community resources or professional
services
• Affirmation!

43. Listen: Don’t jump on first things
patients say
Understand behavior change and
motivation
Change clinical visits from “to-do” lists to
helping patients identify and establish
care priorities
Help patients develop a care plan to
improve outcomes (Shared Care Plan)

44. 1. Establish a positive relationship with the patient
• Develop a partnership with the patient
• Explain your role as a coach
2. Elicit the patient’s concerns and issues
• Use active listening skills
• Express empathy
48

45. 3. Set an agenda with the patient for this session
4. Connect the coaching topic to the patient’s
life goals and values
• Focus on the whole person, not just a
specific diagnosis or behavior
49

46. 5. Acknowledge the patient’s likes, dislikes and
preferences
• Empower the patient by reminding him/her
that the choices are his/hers to make
• Offer to help the patient find the answers that
will work best for him/her
50

47. 6. Ask before telling
• Ask what the patient already knows and what
the patient wants to know
• Provide new information and clarify
misperceptions as needed
• Invite the patient to consider a different
perspective
• Confirm the patient’s understanding
51

48. 7. Ask the patient how important he/she
thinks it is to change
8. Help the patient set a goal
• Ask the patient to identify
something he/she can do to improve
his/her health
52

49. 9. Help the patient create an action plan
• Ask the patient how confident
he/she is to reach the goal
• Help the patient modify the action
plan as needed
10.Develop a follow-up plan with the
patient
53

52. 1-Creating awareness
Get to know yourself, find out what is important to you and
how satisfied you are with all areas of your life.
2-Building confidence
Increase your self-confidence, find what motivates you and
decide on your priorities and what adjustments are needed to
live in line with what is important to you.
3-Taking responsibility
Choose your direction and make a commitment to change.
4-Planning action
Agree the next steps to move you towards your goal.
5-Making the change
Get closer to being who you want to be, having what you
want to have and achieving what you want to achieve

55. A collaborative, patient-centered form of
guiding to elicit and strengthen
motivation for change

56. Before offering education or advice, the physician should
first assess the patient's knowledge about the connection
between for example lifestyle choices and reductions in
coronary artery disease (CAD) risk.
The objective of the Elicit-Provide-Elicit (E-P-E) technique
is to find out what the patient already knows, fill in the gaps
or correct misconceptions, and explore how this will fit into
the patient's life.
This is a time saving strategy that both validates patient
knowledge and allows time to address barriers.

57. Elicit: Find out what the patient already
knows by asking him or her directly
Provide: Fill in the gaps and/or correct any
misconceptions the patient may have
Elicit: Find out what this information
means to the patient's life

58. The following is an example of a hypothetical discussion
between a physician and patient using the E-P-E
technique in the treatment of dyslipidemia:
Elicit: “Mr. sameh, I'm interested about what you
already know about reducing your risk of coronary heart
disease. Do you mind telling me?”
Provide (after patient response): “You are exactly right
about diet and exercise playing a big part, even though it
can be hard. I'd like to add how important medications
can be...”
Elicit (after patient response): “Of everything we just
mentioned, what is the biggest challenge for you? What
could help you in this area?”

59. Visit One
“Patient Z is 5 years old and weighs 60 Kg. At the beginning of the session,
things are tense. Mom has lots of sustain talk (against possibility of change)
and states that she can’t do anything for the child because she is hungry all
the time. I realize that Mom has experienced lots of judgment from other
health care practitioners about her parenting skills, so I concentrate on
validating, showing empathy and, in general, engaging her. As Mom starts to
relax, I ask an open question about what she feels her child’s health problems
might be. She admits that it is probably her weight, but shares that she has no
idea how to do anything about it. I resist the righting reflex and, instead of
jumping into the advice mode, I ask another open question about her
daughter’s eating habits and what she feels she could do to help. Her mother
responds that her daughter eats very large portions and a lot of chips and
popcorn. She said that it may be helpful to cut out the chips and pop and
decrease the amount of food that her daughter eats each day. I reflect her
change talk and affirm commitment to her daughter’s health and her plan.

60. Visit Two
“Mom is the only one here this time. She eagerly
shares that she has been limiting Z’s intake of
chips from a daily large bag to a small bag and
she has also cut out all soda drinks. She also
states that when Z demands food, she offers
healthier smaller portions and encourages
the child to play outside. Again, I reflect and
evoke more change talk, provide support and
encouragement, and end with a genuine
affirmation for her efforts and commitment.”

61. Visit Three
“Mom, Dad and Z are here today and there is great news!
Mom has lost 3.5 kg and Z has lost 4.5 kg! The whole family
has been active in the dietary and weight loss program.
Mom has cut down on the portion sizes of meals with
more vegetables. I affirm and ask an open question
about how she is doing this, to evoke more change
talk.
Mom shares that she has bought smaller plates to make her
daughter think she is eating a full plate.
In addition, Dad is very involved in the program now; he
states he is encouraging sugar-free drinks instead of
sugared ones. Lastly, Z’s older sister is not giving out
snacks without first consulting the parents. The whole
family is now more active – walking and playing
outside and working together in an effort to help Z live

63. We can ask the diabetic patient two questions:
1-What do you like about eating chocolate?
2-What don’t you like about eating chocolate?

64. The 1st
question answer will point to healthier
behaviors that can address the same reasons why the
patient eats chocolate to stay alert at work. So the
coach and the patient can brainstorm healthier
alternatives such as going for a walk or doing
exercise or drinking coffee.
 The 2nd
question answer reveals the patient’s
awareness about the effects of eating chocolate. If
the patient aware that this behavior will lead to wt
gain or high blood sugar, then the patient is more
ready to change than a patient who is unaware of
these health effects. So this patient needs a health
education discussion before doing starting an action
plan.

65. Health Coaches are trained and tested in
compliance to ensure all sessions are confidential
and individual information is secure
Optimal Health Coaching is provided
telephonically either at home or in the workplace
Participation and Engagement in Coaching is the
strongest determinant for success
The motivation of the individual is a key factor in
engagement and ultimate goal achievement

67. Two models of health coaching
The health coaching role can be added to a
medical practice in a variety of ways, but two
models have been particularly successful

68. Piloted in 2006 at the San Francisco General Hospital Family
Health Center (FHC), the “teamlet” (small team) model extends
the 15-minute primary care visit by several minutes, depending
on the patient, to include coaching.
In a teamlet, a physician is paired with medical assistant (MA) or
health worker who has received training in self-management
support and specific chronic conditions and speaks the language
of the patients assigned to him or her.
Health coaches conduct a pre-visit for medication reconciliation
and agenda setting, assist during the physician visit and, during a
post-visit, assess whether patients understand and agree with the
recommended care plan and engage patients in behavior-change
action plans. Because regular follow-up improves chronic disease
outcomes, between-visit phone calls are used to check on action
plans and medication adherence

69. Example:
 Mrs. Nawal has hypertension, obesity, osteoarthritis and poor
eyesight. She and her dr used to feel overwhelmed by her medical and
accompanying social problems. Her dr frequently admonished her to
take her medications, but Mrs. Nawal felt confused about her pills and
never spoke up about it. When health coach Nagy was brought in to
assist, Mrs. Nawal was hesitated but willing to participate. Nagy
started by asking questions to better understand Mrs. Nawal‘
concerns, instead of just telling Mrs. Nawal to take her pills. Mrs.
Nawal came to trust Nagy and, over time, became an active
participant in her own care rather than simply a recipient of
information.
 Now, a week after each physician visit, Nagy calls Mrs. Nawal to ask
whether she has picked up her prescriptions from the pharmacy, to
assess her understanding of how to take each medication and to
encourage her to take the pills daily. Nagy always asks Mrs. Nawal to
identify barriers and solutions that fit into her daily routines rather
than doing this for her. He communicates these barriers to her Dr. so
that Mrs. nawal care plan can be readjusted as needed.

70. Patients discharged from the hospital often feel confused about their
new medications and the conditions that they must now learn to
manage. This makes them excellent candidates for health coaching.
The Care transitions interventions is a widely-used coaching
method that imparts skills, tools and confidence to patients and family
caregivers as they move from hospital to home. It is focused on “four
pillars ”:
1. Having a reliable medication management strategy,
2. Overcoming barriers to follow-up appointments,
3. Knowing how to recognize and respond to worsening signs and
symptoms,
4. Using a personal health record to record 30-day goals, health
information and key questions to be shared with the physician at
upcoming health care encounters.

71. The Care Transitions coach (nurse or
social worker) visits the patient once in the
hospital and once at home, and
communicates with the patient three times
by phone. Here's an example:

72. Mrs. Somia was admitted to the hospital
four times in the past three months because
of heart failure exacerbations. Each time,
she required modest medication
adjustment over two hospital days. Upon
each discharge, she was given instructions
and sent home. After her fourth admission,
she was enrolled in the Care Transitions
Intervention.

73. Her coach, Hassan visited her 48 hours after discharge and
encouraged Mrs. Somia to identify a health-related goal for the
next 30 days. Without hesitation, Mrs. Somia stated she wanted
to attend her granddaughter's soccer games. She admitted
missing these games for fear that her urinary incontinence would
embarrass her and her granddaughter. When Hassan said,
“Please show me your medications and how you take them,”
Mrs. Somia revealed she frequently skipped diuretics due to
incontinence.
They then realized that her readmissions were related to
untreated incontinence. Using her new personal health record,
Mrs. Somia wrote down questions for her physician about
incontinence treatments and practiced asking the questions
through a role-playing exercise to build confidence. Finally, Mrs.
Somia and Hassan reviewed signs and symptoms of worsening
heart failure and how to respond.

74. Face to face during a clinic visit
During group visits
In classes, especially self-management
programs
Over the telephone
Via the Internet
83

76. T Tune in to the Patient
E Explore the Patient’s Concerns,
Preferences, and Needs
A Assist the Patient with
Behavior Changes
C Communicate Effectively
H Honor the Patient as a Partner

77. Most effective approaches to build
rapport with patients
How to quickly establish & maintain
effective relationships with patients
Clinician behaviors that help or hinder
effective clinician-patient relationships
Effective listening & questioning skills

78. Components of a learning assessment
How to assess a patient’s level of importance
& confidence for a health behavior
Quick needs assessment method
How to detect limitations to learning

79. Health coaching framework
Elements
Benefits
Process
Health coaching practice

80. How to incorporate tailoring into
communications with patients
How to help patients deal with strong emotions
such as fear
How to deal with patient ambivalence
How to deal with patient resistance

81. Characteristics of effective clinician-patient
partnerships
How to assess clinician & patient preferences for
partnering
How to incorporate both clinician and patient
perspectives in goal setting, decision making, treatment
& learning activities

82. Consistent with Patient Aligned Care Team
(PACT) and Preventive Care Program
Framework for making PACT principles and
goals operational in practice
Strategies are easy to learn and use
Positive effects for both staff and patients
Health outcomes
Satisfaction
91

83. Successful method of eliciting behavior change to
improve health
Personalized, confidential and caring
Seeks to engage, educate, motivate and support
individuals on their timeline throughout the year
Targets prevention for sustainable health behavior
change

84. The coach documents, tracks, monitors,
and measures outcome data.
Client is provided quarterly (every 3
months) reports about their participants.
Coaching outcomes evaluation and
progress is measured and reported in
aggregate form to the client company.

85. Optimal Health Coaching seeks to elicit the best
thinking by:
 Identifying and respecting each individual’s
perceptions, readiness to change, awareness,
skill mastery and ability to apply new
knowledge
Resulting in effective decision making and
sustainable positive behavior change.

86. To achieve and sustain successful behavior
change individuals must be motivated, engaged
and receptive to the coaching process
Identifies individual’s strengths and potential
to achieve their optimal level of health by
engaging in positive lifestyle health behaviors
Optimal Health Coaching offers the right
approach, at the right time in a cost effective
manner.

87. Client Reports
consist of:
Number of calls placed
Number of sessions held
Behavior changes made
Blinded certificates and feedbacks
Goals set and achieved by participants
Referrals made to other resources
Provided to client quarterly (at 12, 24, 36,
48 weeks of coaching).

88. Med. Rec is when a coach compares the
medicines the clinician has prescribed with the
medicines the patient actually taking.
Def. The process of identifying the most
accurate list of all medications that the patient
is taking, including name, dosage, frequency,
and route, by comparing the medical record to
an external list of medications obtained from a
patient, hospital, or other provider
Institute of Medicine

89. Its goals:
1. Educating the patient about their meds.
2.avoid med. Errors e.g. omissions, duplications,
incorrect dose or timing, drug interactions.
Finding out what they are actually taking.
Who can do med rec????
Coaches can do med rec, however , only the
clinician can decide whether a medication
should be stopped, increased, or decreased.

91. Patients don’t always tell the truth.
So the health coach can help
patients to tell the truth,
So the coach can say ’’most people
don’t take all the medicines their
doctor prescribe, And even me. So it
is Ok if you aren’t taken all of
them’’

92. Method to confirm patients
understand their
medication/treatment:
“Tell me why you need this medication”
“Tell me how you take this medication”
Teach Back not a test of patients’
knowledge
Is a test of how well we explain
something

93. It means making sure patients
understand what you said.
By asking the patient to tell
you what they heard.

95. Overall Coaching Experience
92% felt positive in relation to their overall coaching experience.
Overall Experience
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Percentage 1% 1% 2% 4% 31% 21% 40%
1 (Not at all
Positive)
2 3 4 5 6
7 (Very
Positive)

96. Knowledge Level of Health Coach
93% felt their coach was knowledgeable
Health Coach Knowledge
0%
5%
10%
15%
20%
25%
30%
35%
40%
Percentage 0% 0% 3% 4% 29% 27% 37%
1 (Not
Knowledgeable)
2 3 4 5 6
7 (Very
Knowledgeable)

97. Motivation to Make a Health Change
68% said their health coaching sessions motivated them
to make at least one healthy change right now.
Healthy Change Motivation
0%
10%
20%
30%
40%
50%
60%
70%
80%
Percentage 68% 29% 3%
Yes No DK/NA

99. Diabetes coaching
Patients with diabetes who received nurse coaching
demonstrated better self-reported diet compared with
usual care but no significant difference in A1C levels.
Elderly adults with diabetes who received coaching
improved physical activity levels.
African-American adults with diabetes who had peer
coaching by community health workers had non significant
reductions in A1C levels compared with those who had
usual care.
African-American and Latino adults with diabetes coached
by trained community residents had significant declines in
A1C levels compared with a control group.

100. Asthma coaching
Community health workers trained as asthma coaches
reduced asthma rehospitalization among African-American
children compared with a control group.
Inpatient coaching
Hospitalized patients receiving post-discharge assistance from
a “transition coach” were significantly less likely to be
rehospitalized than control patients.
Pain and depression coaching
A Cochrane Review of peer-led coaching for patients with
chronic conditions found small but statistically significant
reductions in pain, disability and depression in the
intervention group. A randomized controlled trial of
medical assistants coaching patients with depression in
primary care practices found a significant improvement in
patients with coaches compared with usual care.

101. Any
question?
????????????