Developed from Sir John Whitmore’s GROW coaching model, TGROW is a way to help you to successfully engage patients in their own treatment. Kate Nash explains the approach.
‘Instead of treating patients as passive recipients of care, they must be viewed as partners in the business of healing, players in the promotion of health, managers of healthcare resources and experts on their own circumstances, needs, preferences and capabilities’ *
So wrote Angela Coulter in 2016. Coulter is, among other roles, senior research scientist for the Department of Public Health at the University of Oxford, so knows more than a thing or two about involving patients in discussing and planning their own care. It’s an approach I obviously agree with. But how can health practitioners help their patients to achieve that level of engagement?
TGROW – an acronym for Topic, Goal, Reality, Options and Way Forward (or sometimes Will or even Wrap up) – draws directly from the coaching model designed by John Whitmore, sometimes called The Godfather of Coaching. Based on observation of how successful coaches work, it opens up a route to help focus consultations with patients, allowing both sides to discuss the patient’s needs and the way in which they can become the kind of ‘partners in the business of healing’ which Angela Coulter outlines.
Stages to success
So just what are the five stages, and how are they relevant? Let’s break them down.
It’s critical right from the off to establish a rapport between the coach or health care practitioner and the patient. This is the moment to start to focus on the specific areas which need attention. What is the patient’s aspiration? What outcome would they like to see? It’s about developing a mutual understanding of both the context and the boundaries of the conversation.
The next stage is to move to focus on what will be the outcome of this conversation. What is to be achieved? This may be a clinical goal or could be a personal one. This can be broken down into short, medium and longer term goals.
We need to understand just where things are right now, and how the present situation relates to just how those goals can be achieved. It’s about creating an awareness, a sense of perspective and responsibility for those goals.
Now we have a goal established, we need to agree just how that can be achieved? What are the obstacles which need to be overcome if the goal is to be reached? Keep in mind there may be more than one way to achieve the goal, so be prepared for the patient to generate a number of options and think about how you might share clinical information that would be useful.
Having explored the goal, now is the moment to confirm that and commit to an action which best achieves that goal within the patient’s own context. What is the next step to be taken? And when. What exactly will the patient commit to?
Putting theory into practice
Such an approach isn’t perfect. There can be, and even will be, set-backs. But by centring on the individual, determining their own goals, by using self-discovery, and having the support, clinical knowledge and experience of the patient’s team behind them, they are far more likely to be fully engaged in achieving the goals they have set. The outcome is also more rewarding for the team themselves, as they work together with the patient to achieve that desired outcome.
So that’s the theory. But just how does it work in practice?
In my next blog I’ll give an example of just how TGROW can deliver in a real clinical situation.
*Angela Coulter, John Oldham 2016 Person Centred care: what is it and how do we get there? Future Hospital Journal 2016 June 3 (2) 114 – 116