Q Exchange
Coaching for Health – embedding health coaching into clinical conversations
- Proposal
- 2024
Meet the team
Also:
- Laura Greene - Head of Volunteering & Community Partnerships
- Caroline Hopper - Chief AHP Kingston Hospital & Hounslow & Richmond Community Healthcare
What is the challenge your project is going to address and how does it connect to the theme of 'How can we improve across system boundaries?
Deconditioning is the loss of physical, psychological & functional capacity due to inactivity & is associated with the loss of muscle mass, increased risk of falls and reduced independence. This leads to a patient requiring physical help to carry out their ‘Activities of Daily Living’.
Once a patient is admitted to hospital deconditioning can be rapid, severe, and often irreversible. Deconditioning starts in ED with lengthy waits for hospital beds. At KHFT data shows that approximately 10% of patients who could get out of bed, are currently not doing so resulting in extra demand on Social Service provisions in Reablement, POC and Nursing home placements.
This affects both patients being cared for in hospital and the community, particularly the frail & elderly, and those less able to freely mobilise.
Reablement colleagues tell us that they struggle to provide adequate provision for discharged patients due to the high functional needs because of ‘hospital acquired deconditioning’.
What does your project aim to achieve?
– Reduce hospital and community acquired deconditioning through equipping all NHS staff across primary, secondary and acute NHS care in Kingston and Richmond with accredited ‘coaching for health’ skills
– Consistent application of a ‘coaching for health’ approach for patient-clinician contact across primary, acute and community partners in Kingston and Richmond boroughs.
– A network of 30-50 Personalisation of Care accredited trainers who can cascade, role model and champion the approach in respective health care settings.
– A robust data and insight evaluation model to measure baseline, control and improvement outcomes in health behaviours, health outcomes, clinical effectiveness and patient/clinical experiences through the ‘coaching for health’ approach.
How will the project be delivered?
Phase 1 will focus on trainer selection & preparation, delivering a taster session and securing Board endorsement.
Phase 2 will include x 2 half-day coaching for health courses for leaders and to begin their qualification as ‘Personalisation of Care’ accredited Coaching for Health trainers.
Phase 3 will cascade knowledge and skills to all staff on up to 2 pilot wards at Kingston Hospital & 2 community services across HRCH including evaluation. This will require collaborative working with L&D colleagues in HR, Nursing and Medical Education.
Phase 4 will evaluate the learning from the pilot wards/services. Where evidence of improvement is gained, metrics such as health behaviours, health outcomes, clinical effectiveness and patient/clinical experiences, we will commence a 12-18 month knowledge cascade & staff accreditation programme.
Phase 5 will be a creation of the ‘Coaching for Health’ Champions role, to embed across system & organisational cultures. We will continue to measure quantitative outcomes for patients and clinicians & staff and patient experiences of the coaching.
How is your project going to share learning?
A robust evaluation has been woven into each phase of the project. We will be working closely with colleagues at SW London NHS and the Primary Care ‘Personalisation of Care’ lead in order to identify and share KPIs and performance metrics from the outset to increase the scale of data available as well as measure system-wide change through our joint adoption of the Coaching for Health approach across acute, community and primary healthcare. We are exited to share our learning at every stage in a transparent and collaborative way with the Q Exchange Community as well as looking for other platforms, including the HSJ Awards, HSJ Patient Safety Awards and other such schemes to share results widely and lobby the ICS for wider adoption of the methodology across both SW London NHS and beyond.
How you can contribute
- Check and challenge to training methodology / knowledge cascade
- Wide scope for evidence base to underpin 'coaching for health' for changing health behaviours; Eat, Drink, Dress, Move in acute and community healthcare settings
- Join our advisory/community interest group - 'Deconditioning Revolution'
Plan timeline
| 30 Jun 2024 | Educational curriculum developed |
|---|---|
| 31 Jul 2024 | Funding agreed |
| 30 Sep 2024 | First 'train the trainer' cascade achieved - first cohort of x10 |
| 31 Oct 2024 | All-staff knowledge cascade commenced |
| 31 Oct 2024 | Baseline metrics taken |
| 31 Mar 2025 | Quarter end 1st Impact/Metrics Report |
Comments
Sinead Creedon 19 Mar 2024
This is a great idea as Owen has already mentioned above and such an important subject matter. Well done to all involved!
I am glad to see that motivational interviewing will be part of the coaching model as in patients with cognitive decline, it is no doubt one of the models of choice.
Is this project aimed at elderly and frail patients or patients of all cognitive abilities? Can I ask how will you decide which patients will/can be included? (in terms of cognitive function). There are of course some studies already conducted, such as the Brain Health Study to support behaviour change in patients with cognitive impairment which show real promise.
My second question: maintaining the changed behaviour is the big challenge, how will this be facilitated longterm, particularly in patients with cognitive decline?
Also, when monitoring progress and considering performance metrics, what tools will be used? (e.g., self-report behavior change questionnaires / fitness trackers / dietary monitoring / family input etc.)
Finally, will the appointed healthcare coaches receive any element of coaching supervision as part of their roles?
That's it, sorry about all the questions. I'm sure you've got them all covered already.
Emma Stinton 19 Mar 2024
Hi Sinead,
Thanks - valid and great questions. Thanks for joining the conversation. This project is aimed at transforming health behaviours for patients of all functional level, age and cognition. Our evidence base draws on Coaching for Health for patients with chronic Long-term conditions as well as the clear evidence for older age and frailty. With regard to our metrics, success will be measured from an impact/outcome perspective as follows;
Increased % eligible patients out of bed in hospital
Increased % eligible patients taking part in structured additional deconditioning provision e.g. meal clubs, exercises classes e.t.c
Integrate ‘Eat, Drink, Dress, Move’ into clinical nursing/AHP functional assessment tools and measure % compliance
Correlation between deconditioning (perceptions of) and patient experience ratings
Measurable change in public perceptions of the good/harms of bed-rest (baseline already taken)
Staff training outcomes – enhanced awareness (baseline already taken) encourages positive risk taking.
Increased number and time invested by Volunteer Deconditioning Champions – year on year comparrison
ROI - join with Kings Fund / Pro Bono economics to do the economic modelling for deconditioning
There’s a whole host of data collection tools to be used here, including existing data such as our End PJ Paralysis Data (ward based), Friends & Family Test data, control groups and self-reported outcomes for our staff and patients.
And…yes, absolutely, our initial cohort of lead coaches (those leading on the championing and knowledge cascade) will receive coaching supervision from Osca, the training provider whom we hope to work with. We also want to embed a culture of health coaching in our approaches to 121s and PRDs. Thanks for your great questions.
Owen Hughes 23 Feb 2024
This looks like a great idea. I'm a big fan of health coaching as a way of changing the conversations health professionals have with the people they are working with. What coaching model do you use?
Emma Stinton 28 Feb 2024
Hi Owen, thanks for your comment. The Coaching for Health theoretical model combines the Communication Ladder, Motivational Interviewing and Transactional Analysis to provide a model for balancing the expertise of patient and practitioner. The model trains clinicians to explore patient responsibility utilising the technique of ‘non-directive to directive questioning’ to help explore ideas and beliefs while still remaining patient-centered. Motivational Interviewing techniques, and a wider exploration of motivation, look at how patient motivations can be first elicited and then built towards the ultimate goal of reducing the risk and occurrence of deconditioning in our acute and community patient populations.
(full disclosure I asked my very knowledgeable colleague Laura Greene to answer)
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