Bid to improve health care through ‘better conversation’

Bid to improve health care through ‘better conversation’


 A campaign is being launched to improve the way health professionals talk to their patients.

It is based on research which shows that patients often don’t take their medications or change their lifestyle after visiting a doctor or nurse, while only about 60 per cent of patients feel they are sufficiently involved in decisions about their care.*

A new set of ‘Better Conversation’ resources for clinicians and commissioners offers information, evidence and tips on how to introduce health coaching, so that patients are treated as partners in their care rather than passive recipients.

It has been described by NHS Medical Director Professor Sir Bruce Keogh as an essential part of the plan to transform the way health care services are provided, to make them sustainable.

A pilot programme of health coaching was rolled out to nearly 800 clinicians across the East of England and is now ready for national adoption. The work is driven by Dr Penny Newman and backed by the NHS Innovation Accelerator initiative to achieve the aims of NHS England’s Five Year Forward View.

The purpose is to give clinicians the tools to help patients to feel more motivated, confident and in control of managing their health and care through better conversations. These health coaching skills can also be used by lay people.

Dr Newman said: “The conversation between any clinician and patient is paramount. I am passionate about us having conversations that enable people to thrive by feeling more motivated, confident and in control of managing their own health and care.

“Only by putting patients more in the driving seat can we enable them to better manage their own health and adopt more healthy behaviours. Since 2010 I have been gathering the evidence and developing resources in health coaching to support colleagues to work more in partnership with patients.

“If we ask patients and really listen to what matters to them, and work together to create plans that motivate them, we will improve their health and wellbeing. Behaviour change science shows that just telling people what to do often doesn’t work – we have to become more empowering. People themselves want to be more in control, listened to and heard.

“A different or health coaching approach is essential to delivering care that fits in with the individual and what’s important to them, as well as achieving efficiencies. It is my ambition and that of all our partner organisations to transform health care through enabling better conversation through health coaching.”

NHS Medical Director Professor Sir Bruce Keogh said: “For the NHS to be sustainable, people need to become more active in managing their own health, wellbeing and care. They need to be supported to make good choices and more equal conversations, based on a strong partnership between clinician and patient, are vital for achieving this.

“Heath coaching supports the NHS values of care, listening and personal responsibility. By providing clinicians with new skills that help patients identify what’s most important to them, and tapping into their own internal motivation, evidence shows health coaching can also address health inequalities, improve health behaviours and reduce avoidable admissions.”

Examples of impact

  • An evaluation in an older persons rehabilitation ward found that, by using the techniques of health coaching, patients became more engaged in their recovery. The local service provider’s data showed the resulting average length of hospital stay was reduced by 17 hours per patient, while eight per cent of patients in the intervention group were discharged to residential care homes, compared to 27.3 per cent in the control group.
  • Using these findings an economic evaluation found the intervention to have been very cost effective with a net benefit value per patient of £4,973 or about £3 million over a one year period for the rehabilitation ward.
  • Other examples include hospital pharmacists who after training in health coaching significantly reduced the number of people returning due to medication problems such as drug reactions. Health coaching has also been shown to reduce smoking and increase physical activity, weight loss and mood in Salford when used by practitioners in the community and outside hospital settings.

What patients say

Evidence of the need for health coaching came from an analysis of patient feedback on the public website Patient Opinion. (full report available)

One hundred and sixty two stories reported over a two year period between January 2014 and December 2015 were analysed and key themes identified to understand what happens when people feel listened to and involved in their care, and when they don’t – and how this impacts on their health and wellbeing, and future use of services.

The vast majority of stories – 84 per cent – recounted positive experiences of being listened to, empowered or engaged in decision-making about the patient’s health care.

Of the remaining 16 per cent, the negative experiences were categorised under the following headings: a felt lack of respect; having one’s own concerns and priorities ignored, dismissed or contradicted; and a lack of involvement in decisions about one’s care.

The mother of a 16 year old boy with cystic fibrosis, Mandy Rudczenko said: “Health coaching has enabled myself and my son to find ways of managing his relentless treatment regime, without the negative baggage which comes with telling someone what to do.

“Health coaching isn’t a luxury or an extravagance. It’s the only option for positive, humane health and care relationships.” (full version of A carer’s story is below)

Patient Opinion Chief Executive Dr James Munro said: “The stories that people share with us online give a rich insight into the issues that matter most when using healthcare. Communication with health professionals is by far the most important.

“When communication works well, people feel treated as equals, their knowledge and experience is respected, and they are given clear and relevant information. The result is trust, confidence, better decisions – and people feeling more in control of their health.

“But when a person’s concerns are ignored, and their experience is dismissed or contradicted, they become excluded from decisions about them. This leads to a loss of trust, less interest or confidence in maintaining their own health, less adherence to medication, and poorer health.

“Better, more equal and respectful conversations between clinicians and patients are essential to improving care.”

The campaign, ‘Better Conversation’ is supported by Health Education England, the NHS  Innovation Accelerator programme, three Academic Health Science Networks – in East of England, North West Coast and Yorkshire & Humber; and the Coalition for Collaborative Care.

Launch events are taking place on 19th September in Cambridge and 26th September in Liverpool.

A carer’s story

Mandy Rudczenko said:

“As a carer for my son with cystic fibrosis, I used to see this as a passive role, in which I was the mechanism by which the  treatment decided by clinicians was carried out. Health coaching has come as a breath of fresh air, which has enabled me and my son to engage with the management of his condition in a much more positive way.

“Cystic fibrosis requires a heavy, relentless treatment burden to stay alive. Traditional methods of ensuring treatment adherence include nagging, criticism, bullying, threats of hospitalization, and a default mode of assuming non-adherence.

“These approaches create dysfunctional working relationships between clinicians and families, resulting in resources being wasted on over-medicalisation and misdiagnosis. The critical patriarchal approach also disengages children and teenagers, often resulting in declining health during adolescence.

“I instinctively knew this approach wouldn’t work for my son. I also know that I don’t want to go to my son’s funeral – the average predicted survival age is 41 according to the CF Trust.  When health coaching came into my life I knew I had found the answer. Health coaching has given me permission to do what I had always wanted to do, but thought that it wasn’t allowed.

“I allow myself to listen to my son and enable him to set his own treatment goals. The traditional fear is that the patient, especially a child or teenager, will opt for low or zero goals; this is a myth. My son wants to carry out treatments in ways which mean something to him. He uses a nebuliser three times a day. The relentless burden of doing this every day means that the average adherence is 40 per cent. Factors affecting adherence are obviously very complicated.

“My son’s average adherence is 80 per cent because he set himself a goal to avoid having intravenous antibiotics – a regular treatment for CF – as long as possible. He knows that one way of avoiding this treatment is to keep up with the nebuliser which prevents chest infections, thus giving him the internal motivation.

“People with cystic fibrosis struggle to put on weight and are often threatened with tube feeding. They are often given a target weight to achieve by a certain date. This target can then become a disempowering obsession. Instead, my son set his own goal of taking a certain number of digestive enzymes a day, which translates into eating a certain number of grams of fat per day. He has managed to stick to this without developing an unhealthy relationship with the bathroom scales.

“Health coaching has enabled myself and my son to find ways of managing his relentless treatment regime, without the negative baggage which comes with telling someone what to do. Health coaching isn’t a luxury or an extravagance. It’s the only option for positive, humane health and care relationships.”

Her son Leo said: “I think the most helpful thing a health professional can do in a conversation is listen to me and believe what I say.”

Only about 60 per cent of patients feel they are sufficiently involved in decisions about their care:

* Responses from 83,116 people and 159 Trusts indicate only 60% were definitely involved as much as they wanted to be in decisions about their care and treatment and 9% felt that they hadn’t been involved at all.

Source: CQC in-patient survey 2015