As described in our NWL Coaching for Health programme, we use a model for sustaining impact co-developed with the Tavistock institute – our Delivery Template. This demonstrates the importance of encouraging and supporting Leaders/Champions of this approach. These Champions naturally arise from our core training programmes, when those practitioners most inspired by the approach not only use it with their patients and clients, but also work to embed the principles and tools in their pathways and seek to upskill colleagues.
Hence, as part of our programme across North West London, and also beyond, we have been encouraging the establishment of informal Champion networks. This includes past participants of our courses who are particularly inspired to integrate this approach into their areas of work, normally by supporting colleagues and/or adapting their pathways.
We held our first Champions meeting across the NWL programme in October 2017 and the network decided on the support it would find most useful. This included an annual meeting, a buddying system and the collation of useful resources including team and patient case studies. We have included a Champions team case study below as an example of how Champions can maximise the impact and sustainability of this approach by pioneering solutions themselves.
Example Champion team case study: Coaching for Health in a nutrition and dietetic bariatric surgery service (written by Champion themselves)
Since undertaking the coaching for health course at the end of last year I have been trying to incorporate its principles into my interactions with patients as much as possible. A lot of the content was very relevant as I work within a nutrition and dietetic bariatric surgery service preparing people for surgery and insuring they follow post-surgery guidelines, so plenty of behaviour change based work.
What change are you making / pursuing?
Scaling questions – I’m trying to regularly use these during patient reviews pre-bariatric surgery. They have been really useful as we see patients every 2-3 months, so we are able to look back at their last score and see if this has changed. This helps us to assess how well people are preparing for surgery and gives leverage for further questioning and getting patients to think more/take more ownership of their plans. A general scaling question used regularly is about how confident they feel with certain aspects of their preparations. I have been encouraging my colleagues at our team meetings to use more scaling questions as they fit nicely with the work we do.
Challenge sandwich – this is another tool that has been implemented well. As we are focusing on behaviour change their can be a lot of resistance from patients. This tool allows a non-confrontational way of addressing it. Some uses have been to help address smoking cessation, prioritising their behaviour change in general, to start taking medications or even about attending their appointments regularly and on time. It generally works well as it is a calm approach and puts the onus back on the patient with the “what do you think?” style wrap up at the end.
One tool I intend on making more use of is the decision box listing the positive/negative outcomes of a situation. It can really help to motivate patients by them seeing the potential outcomes if their behaviour change isn’t prioritised. Most of the situations would lead to further serious health problems as they get older, so it’s quite powerful when they have to write down things like ‘my mobility is so poor now that if I don’t make ‘X’ change then I will likely be in a wheelchair this time next year.
What’s the learning been?
- That you can employ different parts of the coaching principles in snippets and still be effective, for example only using some parts of the TGROW model if time is tight. I perceive it to be the same idea as brief interventions which fits perfectly into our clinic set up.
- These tools can take time to perfect through practice, so don’t be too disheartened if it takes a few attempts to get things right initially.
- Being aware that these tools will not always work, and that’s ok. BUT it is worth reflecting on elements that perhaps haven’t worked so well to see if they need any refinement.
What’s your intended / observed impact (on patients, staff, the pathway)?
- It’s generally a fine balance between getting through a lot of set information with patients in a short clinic time but also helping them to take ownership of ideas and plans. Taking coaching principles on board has definitely empowered me and given me more confidence in being able to effectively help patients to do this. I don’t have any physical data to prove this but I feel that coaching has had a really positive impact on patients, so I intend to continue honing my skills and incorporating coaching principles where possible.
- Further intended impact will be to continue to engage with colleagues via staff meetings to upskill/spread the work on coaching, encouraging more staff members to take on board the principals where applicable. (Luckily dieticians are well trained in behaviour change so this can add to their expertise)
Colleagues have also voiced an interest to receive coaching themselves after finding out I have been on some training, which could further demonstrate its usefulness and spread its principles.