Health & Wellbeing coaching for patient activation

The Blackpool Teaching Hospitals NHS Foundation Trust and (which was part of the Flyde Fylde Coast Vanguard) wanted to support the development of health and wellbeing coaching skills among practitioners in their newly developing Wellbeing Support Services Worker role.  The role was introduced as part of the system’sir New Care Model with thethat aims to support patient activation and behaviour change among people with 2 or more Long Term Conditions.  The staff of within the Wellbeing Support Services Worker role have varying backgrounds, ranging from clinical to non-clinical experience, and some staff will have a counselling background.  These new specialist healthcare roles have been created to focus on prevention, care coordination and patient support with the aim of proactive management in the community and self-care to reduce pressure on secondary care services.

Intervention

TPC Health was initially commissioned to deliver a pilot two day Health Coaching programme to 22 staff in June 2016. A positive evaluation highlighted the value of the approach in supporting practitioners from multiple health and care backgrounds to learn how to structure their conversations more effectively and deliver behaviour change.  The commissioners subsequently decided to roll out the health coaching approach more widely across care pathways through community health services, with the aspiration of involving primary care and hospital based teams,. and commissioned TPC Health were commissioned to undertake a Train the Trainer programme to support them to develop an internal training resource within the Trust, that could independently continue to deliver the 2 day training programme on an ongoing basis.  

The scope of the work involved:

  • Consultation around the design of the programme
  • Delivery of a two day health coaching programme to 20 participants
  • Delivery of an EMCC EQA Foundation Level Accredited Health Coaching programme
  • Delivery of a Train the Trainer programme in order to create internal capacity for the ongoing roll out of the training across the workforce
  • Follow up embedding programme and ongoing Continuous Professional Development

The core skills programme developed specifically for Blackpool/Flyde Fylde Coast included a focus on understanding how to use the Patient Activation Measure effectively and learning how to tailor health coaching interventions to support patient activation.  Through the TPC Health Train the Trainer system, six practitioners have now beenwere developed as internal health coaching trainers.  They have co-delivered the 2 day programme with an experienced TPC facilitator to approximately 200 300 members of staff at the Trust.  Independent delivery is now delivered on an ongoing basis under licence from TPC Health across the Blackpool/Flyde Fylde Coast system. 

Results

Results of the intervention so far are considered to be highly positive, including:

  • Very high satisfaction with the training
  • Increases in practitioner confidence
  • Consistent increases in Patient Activation scores
  • Reduced use of services by patients
  • Measurable behaviour change among patients with long term conditions

In the study of 424 patients with PAM score evaluations undertaken pre and post health coaching over an average period of 18.5 weeks, the average PAM score improvement was 9.9 points (100 point scale); with 54% of patients improving one activation level (there are 4 levels).  A core aim of the intervention was to reduce pressure on secondary care, yielding the following outcomes in the study population:

  • 14% reduction in elective admissions
  • 18% reduction in non-elective admissions
  • 14% reduction in Accident & Emergency attendances
  • 11% reduction in outpatient activity

Verbatim feedback

“valuable training delivered by great people already thinking when speaking to patients how to ask open ended questions and getting them to open up by usuing the TGROW model”

“I feel health coaching will reduce the amount of stress for staff. Before this course I felt I had to try to solve everything for my patients but now I feel I have adopted a different approach and am able to use the health coaching tools to encourage my patients to take responsibility for their own health care needs”

“This training has clearly demonstrated that adopting a coaching approach does not have to be a long process, but that in a short amount of time you can have a high impact on raising awareness and ownership of an individual”