COMMENT
Editorial Board Palo Almond, Academic and Research Consultant, Anglia Ruskin University Irene Anderson, Prinicipal Lecturer and Reader in Learning and Teaching in Healthcare Practice, University of Hertfordshire Russell Ashmore, Senior Lecturer in Mental Health Nursing, Sheffield Hallam University Steve Ashurst, Critical Care Nurse Lecturer, Maelor Hospital, Wrexham Christopher Barber, Residential Nurse Dimitri Beeckman, Lecturer and Researcher, Florence Nightingale School of Nursing & Midwifery, King’s College London Ruhi Behi, Head of School, School of Healthcare Sciences, University of Wales, Bangor Dr Lizzy Bernthal, Research Fellow and lead nursing lecturer, Medical Directorate, Birmingham, Honorary Research Fellow University of Southampton. Martyn Bradbury, Clinical Skills Network Lead, University of Plymouth Alison Coull, Lecturer, Department of Nursing and Midwifery, University of Stirling, Scotland Willie Doherty, CNS Continence Care, Park Drive Health Centre, Baldock, Hertfordshire Jane Fox, Independent Consultant, Derbyshire Alan Glasper, Professor of Child Health Nursing, University of Southampton Angela Grainger, Assistant Director of Nursing, King’s College Hospital NHS Trust, London Michelle Grainger, Ward Manager, Moseley Hall Hospital, Birmingham Helen Holder, Senior Lecturer, Nursing Studies, Birmingham City University Mina Karamshi, Specialist Sister in Radiology, Royal Free Hospital, Hampstead Andrew McVicar, Reader, Dept of Mental Health & Learning Disabilities, Anglia Ruskin University Danny Meetoo, Lecturer in Adult Nursing, University of Salford Mervyn Morris, Director, Centre for Mental Health Policy, Birmingham City University Aru Narayanasamy, Associate Professor, University of Nottingham Ann Norman, RCN Criminal Justice Services Nursing Adviser and Learning Disability Nursing Adviser (U.K) Joy Notter, Professor, Birmingham City University, UK & Saxion University of Applied Science, NL Lynn Parker, Independent Educational Adviser, Infection Control, Sheffield Hilary Paniagua, Senior Lecturer, School of Nursing & Midwifery, University of Wolverhampton Ian Peate, Head of School, Nursing, Midwifery and Healthcare, Thames Valley University Bernadette Porter, Nurse Consultant, Multiple Sclerosis, National Hospital for Neurology and Neurosurgery, UCLH NHS Trust Jo Sharman, Operational Commissioning Manager, University Hospitals Birmingham NHS Foundation Trust John Tingle, HRS Reader in Health Law, Nottingham Law School, Nottingham Trent University Catherine Whitmore, Research Nurse, Diabetes and Endocrinology, University of Liverpool Jo Wilson, Director, Wilson Healthcare Services, Newcastle Cate Wood, Lecturer, Bournemouth University, PhD student at London School of Hygiene and Tropical Medicine Sue Woodward, Lecturer, Specialist and Palliative Care, Florence Nightingale School of Nursing and Midwifery, King’s College London
1152
A
t a time when the NHS faces enormous pressure from rising demand, the need to reconfigure healthcare services by using innovative models of care is intensifying. We will outline how integrated health coaching programmes can transform services and deliver significant cost and health economic benefits, especially in the critical area of helping patients with long-term conditions. It is widely accepted that the current demands on NHS resources are unsustainable. Shifting care out of hospitals and nearer to patients’ homes has been a consistent aspiration for successive governments. Yet, NHS services remain heavily dependent on traditional methodologies. To make progress, especially in the key area of long-term condition management, commissioners and clinicians must 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. The management of patients with long-term conditions (LTCs) has been identified as one of the NHS’s key priorities, with around 70% of the healthand social-care budget spent on treating patients with chronic conditions. In 2012, the Government mandated the NHS Commissioning Board to do more to help people with LTCs manage their conditions optimally and avoid unnecessary hospitalisation. Technology has a major role to play in delivering change. However, while ‘telehealth’ has been identified as a key component in helping people manage their conditions at home, 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 a fast and secure exchange of information to empower patients and update clinical decisions. Underpinned by highly experienced health professionals, health coaching programmes can transform services, empower patients and deliver huge patient and health economic benefits. Integrated health coaching for 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; critics claim that telehealth reinforces patients’ dependency on healthcare providers (HCPs) 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, but also add significant value and enhance health outcomes.
Health coaching does not compromise the clinicianpatient relationship—it supports it. Dialogue is nondirective; coaches do not give clinical advice, they simply mentor patients to help them understand their disease so that they can determine when they are able to self-manage, and when they may need to return to their clinician. 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. Health coaching is not a responsive service but a proactive one that aims to help patients stay one step ahead of a crisis and teaches 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 reverting back to their HCP or accident and emergency (A&E) department. In NHS areas where coaching has been introduced as part of an integrated approach, a clear capacity to empower patients to have the confidence to selfmanage their disease; ask the right questions without reverting to an HCP every time; and reduce avoidable hospital admissions has been shown. For example,at Leicester City Clinical Commissioning Group (CCG), an integrated health coaching and telehealth service, delivered in collaboration with the CCG, and supporting the management of 50 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 just 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. The CCG is now extending the programme further. As the UK grapples with the challenge of managing LTCs, it is clear that health coaching can help patients understand their conditions better and support wider moves toward 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 be less dependent on NHS services. At a time when health 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 resourcestarved NHS can no longer afford to ignore it. BJN Jo Garland GP and Clinical Lead at Totally Health
Wendy Norton Head of Health Coaching at Totally Health
© 2013 MA Healthcare Ltd
The rise of health coaching
British Journal of Nursing, 2013, Vol 22, No 20
British Journal of Nursing. Downloaded from magonlinelibrary.com by 193.061.135.112 on October 26, 2015. For personal use only. No other uses without permission. . All rights reserved.
Editorial Board Palo Almond, Academic and Research Consultant, Anglia Ruskin University Irene Anderson, Prinicipal Lecturer and Reader in Learning and Teaching in Healthcare Practice, University of Hertfordshire Russell Ashmore, Senior Lecturer in Mental Health Nursing, Sheffield Hallam University Steve Ashurst, Critical Care Nurse Lecturer, Maelor Hospital, Wrexham Christopher Barber, Residential Nurse Dimitri Beeckman, Lecturer and Researcher, Florence Nightingale School of Nursing & Midwifery, King’s College London Ruhi Behi, Head of School, School of Healthcare Sciences, University of Wales, Bangor Dr Lizzy Bernthal, Research Fellow and lead nursing lecturer, Medical Directorate, Birmingham, Honorary Research Fellow University of Southampton. Martyn Bradbury, Clinical Skills Network Lead, University of Plymouth Alison Coull, Lecturer, Department of Nursing and Midwifery, University of Stirling, Scotland Willie Doherty, CNS Continence Care, Park Drive Health Centre, Baldock, Hertfordshire Jane Fox, Independent Consultant, Derbyshire Alan Glasper, Professor of Child Health Nursing, University of Southampton Angela Grainger, Assistant Director of Nursing, King’s College Hospital NHS Trust, London Michelle Grainger, Ward Manager, Moseley Hall Hospital, Birmingham Helen Holder, Senior Lecturer, Nursing Studies, Birmingham City University Mina Karamshi, Specialist Sister in Radiology, Royal Free Hospital, Hampstead Andrew McVicar, Reader, Dept of Mental Health & Learning Disabilities, Anglia Ruskin University Danny Meetoo, Lecturer in Adult Nursing, University of Salford Mervyn Morris, Director, Centre for Mental Health Policy, Birmingham City University Aru Narayanasamy, Associate Professor, University of Nottingham Ann Norman, RCN Criminal Justice Services Nursing Adviser and Learning Disability Nursing Adviser (U.K) Joy Notter, Professor, Birmingham City University, UK & Saxion University of Applied Science, NL Lynn Parker, Independent Educational Adviser, Infection Control, Sheffield Hilary Paniagua, Senior Lecturer, School of Nursing & Midwifery, University of Wolverhampton Ian Peate, Head of School, Nursing, Midwifery and Healthcare, Thames Valley University Bernadette Porter, Nurse Consultant, Multiple Sclerosis, National Hospital for Neurology and Neurosurgery, UCLH NHS Trust Jo Sharman, Operational Commissioning Manager, University Hospitals Birmingham NHS Foundation Trust John Tingle, HRS Reader in Health Law, Nottingham Law School, Nottingham Trent University Catherine Whitmore, Research Nurse, Diabetes and Endocrinology, University of Liverpool Jo Wilson, Director, Wilson Healthcare Services, Newcastle Cate Wood, Lecturer, Bournemouth University, PhD student at London School of Hygiene and Tropical Medicine Sue Woodward, Lecturer, Specialist and Palliative Care, Florence Nightingale School of Nursing and Midwifery, King’s College London
1152
A
t a time when the NHS faces enormous pressure from rising demand, the need to reconfigure healthcare services by using innovative models of care is intensifying. We will outline how integrated health coaching programmes can transform services and deliver significant cost and health economic benefits, especially in the critical area of helping patients with long-term conditions. It is widely accepted that the current demands on NHS resources are unsustainable. Shifting care out of hospitals and nearer to patients’ homes has been a consistent aspiration for successive governments. Yet, NHS services remain heavily dependent on traditional methodologies. To make progress, especially in the key area of long-term condition management, commissioners and clinicians must 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. The management of patients with long-term conditions (LTCs) has been identified as one of the NHS’s key priorities, with around 70% of the healthand social-care budget spent on treating patients with chronic conditions. In 2012, the Government mandated the NHS Commissioning Board to do more to help people with LTCs manage their conditions optimally and avoid unnecessary hospitalisation. Technology has a major role to play in delivering change. However, while ‘telehealth’ has been identified as a key component in helping people manage their conditions at home, 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 a fast and secure exchange of information to empower patients and update clinical decisions. Underpinned by highly experienced health professionals, health coaching programmes can transform services, empower patients and deliver huge patient and health economic benefits. Integrated health coaching for 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; critics claim that telehealth reinforces patients’ dependency on healthcare providers (HCPs) 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, but also add significant value and enhance health outcomes.
Health coaching does not compromise the clinicianpatient relationship—it supports it. Dialogue is nondirective; coaches do not give clinical advice, they simply mentor patients to help them understand their disease so that they can determine when they are able to self-manage, and when they may need to return to their clinician. 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. Health coaching is not a responsive service but a proactive one that aims to help patients stay one step ahead of a crisis and teaches 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 reverting back to their HCP or accident and emergency (A&E) department. In NHS areas where coaching has been introduced as part of an integrated approach, a clear capacity to empower patients to have the confidence to selfmanage their disease; ask the right questions without reverting to an HCP every time; and reduce avoidable hospital admissions has been shown. For example,at Leicester City Clinical Commissioning Group (CCG), an integrated health coaching and telehealth service, delivered in collaboration with the CCG, and supporting the management of 50 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 just 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. The CCG is now extending the programme further. As the UK grapples with the challenge of managing LTCs, it is clear that health coaching can help patients understand their conditions better and support wider moves toward 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 be less dependent on NHS services. At a time when health 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 resourcestarved NHS can no longer afford to ignore it. BJN Jo Garland GP and Clinical Lead at Totally Health
Wendy Norton Head of Health Coaching at Totally Health
© 2013 MA Healthcare Ltd
The rise of health coaching
British Journal of Nursing, 2013, Vol 22, No 20
British Journal of Nursing. Downloaded from magonlinelibrary.com by 193.061.135.112 on October 26, 2015. For personal use only. No other uses without permission. . All rights reserved.
