Comment: Empowering patients, improving outcomes and saving money: the rise of health coaching

At a time when the NHS is under enormous pressure in the wake of rising demand, the need to reconfigure healthcare services using innovative models of care is intensifying. In this article, DR JO GARLAND, GP and clinical lead at Totally Health, and WENDY NORTON, registered nurse and head of health coaching at Totally Health, outline how integrated health coaching programmes can transform services and deliver significant cost and health economic benefits

To progress, commissioners and clinicians must consider making the move away from the old-fashioned patriarchal model of healthcare delivery, and instead develop fully-integrated services that empower patients to play a greater role in the management of their disease, reducing their default dependency on NHS services

It is widely accepted that the current demands on NHS resources are unsustainable. The UK’s ageing population is placing intolerable pressure on healthcare services, as evidenced by the ongoing scrutiny of A&E and out-of-hours care.

Shifting care out of hospitals and nearer to patients’ homes has been a consistent aspiration for successive governments, with healthcare professionals continually encouraged to develop more innovative services that improve patient pathways and create much-needed capacity in secondary care.

Despite this, NHS services remain heavily dependent on traditional methodologies. To progress, commissioners and clinicians must consider making the move away from the old-fashioned patriarchal model of healthcare delivery, and instead develop fully-integrated services that empower patients to play a greater role in the management of their disease, reducing their default dependency on NHS services. One option would be the adoption of innovative programmes that combine health coaching and telehealth. Increased use of such programmes, not least in treating patients with long-term conditions, could transform patient care. Where they are already in place in the NHS, they are driving major cost savings, delivering significant return on investment and improving health outcomes within a matter of weeks.

Managing long-term conditions

The management of patients with long-term conditions (LTCs) has long been identified as one of the NHS’ key priorities – with around 70% of the health and social care budget spent on treating these patients. In 2012, the UK government mandated the NHS Commissioning Board to do more to help people with LTCs manage their conditions optimally and avoid unnecessary hospitalisation. The NHS mandate urged clinicians to provide joined-up care to ensure that patients with ongoing health problems live healthily and independently, with much better control over the care they receive. This builds on proposals to ‘liberate’ the NHS by putting patients first and delivering a ‘no decision about me, without me’ culture within the health service, driven by the widespread adoption of shared decision-making.

While telehealth has been identified as a key component in helping people manage their conditions at home, and reduce the need for avoidable emergency exacerbations, it is unlikely to work on its own

By March 2015, the NHS is expected to have made real progress in involving people in their own care and to have facilitated the optimal use of technology and better integration of services. Underpinning this is a clear objective to ensure patients are empowered to make informed decisions about their own care, and develop the knowledge, skills and confidence to manage their long-term conditions effectively. A central aspect of this will be the collaborative development of personalised care plans that reflect patient views and preferences.

Technology has a major role to play in delivering change. But, while telehealth has been identified as a key component in helping people manage their conditions at home, and reduce the need for avoidable emergency exacerbations, it is unlikely to work on its own.

The most-effective approaches are likely to be more holistic, integrating case management, telehealth and health coaching, and will be facilitated by digital technologies that allow for the fast and secure exchange of information to empower patients and inform clinical decisions. Underpinned by highly-experienced healthcare professionals, health coaching programmes can transform services, empower patients and deliver huge patient and health economic benefits.

Health coaching

Health coaching is a relatively new concept for the NHS, though it is well established in other parts of the world where data shows it to be a highly-effective model of care. Health coaching programmes carried out by highly-experienced nurses provide a powerful means of motivating patients to change thinking patterns and behaviours to drive better health outcomes. Health coaches act in a non-directive manner to empower individuals to take an active role in managing their health, educating them about their condition, treatment and prevention. One-to-one telephone dialogue between patients and their individual health coach, free from the common constraints of clinical consultations, can help patients discuss how lifestyle changes can positively impact their health status, set goals to change behaviours and provide mentoring to support achieving those goals.

Integrated health coaching services that are conducted among targeted cohorts of patients, following risk stratification exercises to identify the most-appropriate individuals, and supported by telehealth, can be hugely beneficial. Research continues to question the effectiveness of stand-alone telehealth initiatives, with critics claiming that telehealth reinforces patients’ dependency on healthcare professionals to manage their care. However, in combination with targeted health coaching programmes, patient interaction with health coaches encourages individuals to take greater responsibility for the management of their condition, and empowers them to engage in decisions about their care. Integrated health coaching programmes that take an individual case management approach not only complement telehealth, they add significant value and enhance health outcomes.

Integrated health coaching programmes that take an individual case management approach not only complement telehealth, they add significant value and enhance health outcomes

Health coaching does not compromise the clinician-patient relationship, it supports it. Dialogue is non-directive; coaches do not give clinical advice, they simply mentor patients to help them understand their disease so they can more easily determine when they are able to self-manage, and when they may need to return to their clinician. A health coach is not another healthcare professional telling patients what to do. Health coaches, instead, can discuss the different treatment options with the patient and help them towards making a decision about which treatment option is right for them at that time, even if it may not be the most medically-effective option. In doing so, health coaching helps create patients who are more engaged with their care, and better outcomes as a result. Of course, although programmes are designed to adhere to best practice local care pathways, clinical accountability remains with clinicians, who have access to information about the patient interactions.

Moreover, health coaching is not about introducing another level of NHS Direct, where patients with long-term conditions can call for advice at any time of the day. This would merely shift reliance from one place to another. Health coaching is not a responsive service, but a pro-active one that aims to help patients stay one step ahead of a crisis and teach them how to respond before an emergency arises. It is about educating patients and supporting them so that each time they have an interaction with their health coach, they become better-placed to make informed decisions, rather than always revert back to their healthcare professional or A&E. /

Nor are health coaching programmes designed to remind patients to take their medicines, as is the case with many stand-alone telehealth systems, but instead to set up ways to enable patients to think for themselves. Through mentoring and support, health coaches can discuss individual barriers and anxieties that may, for example, be preventing patients from taking their rescue medications, and help build patients’ confidence to manage their condition pro-actively. With misuse of medicines a major driver of avoidable hospital admissions, the economic and patient benefits of improving patient compliance alone can deliver significant gains. But health coaching offers much more.

In areas of the NHS where coaching has been introduced as part of an integrated approach it has demonstrated a clear ability to empower patients to have the confidence to self-manage their disease, ask the right questions without reverting to an healthcare worker every time, and reduce avoidable hospital admissions. For example, at Leicester City CCG an integrated health coaching and telehealth service delivered in collaboration with the CCG and supporting the management of 150 COPD patients has saved more than £540,000 since December 2012. In this period alone, the programme averted 134 hospital admissions among patients registered with the service. The CCG had originally set a target of 70 unscheduled admissions to be averted during the first 12 months. The service has delivered, and continues to deliver considerable savings. It has also led to a demonstrable improvement in patient satisfaction. As a consequence, Leicester City CCG is now extending the programme further.

As the UK grapples with the challenge of managing LTCs, it’s clear that health coaching can make a major contribution in helping patients to understand their conditions more effectively and in supporting wider moves towards shared decision-making

As the UK grapples with the challenge of managing LTCs, it’s clear that health coaching can make a major contribution in helping patients to understand their conditions more effectively and in supporting wider moves towards shared decision-making. As the cost of managing LTCs escalates, integrated health coaching can play a pivotal role in relieving the pressure on NHS resources by empowering patients to be more accountable for their health, have greater control of their condition and, as a consequence, less dependent on NHS services for reassurance or emergency care.

At a time when healthcare professionals are being encouraged to innovate, the wider adoption of health coaching programmes into clinical practice is worth serious consideration. With the return on investment significant and the patient benefits clear, a resource-starved NHS can no longer afford to ignore it.