Improving Health Care Through Better Conversation

Research shows that people often don’t take their medications or change their lifestyles after after visiting a doctor or a nurse, while only about 60 per cent of people feel they are sufficiently involved in decisions about their care.

A campaign is being launched to tackle this issue and improve the way in which health professionals and people talk.

‘Better Conversations’ looks at how clinicians and commissioners can introduce health coaching and will provide  information, evidence and tips on how to have a more equal conversation with people and 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 people to feel more motivated, confident and in control of managing their health and care through better conversations.

Dr Newman said: “The conversation between any clinician and person 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.”

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 and Humber; and the Coalition for Collaborative Care.

A carer’s story

Mandy Rudczenko, C4CC Co-production Group member and mother to a 16-year-old  boy with cystic fibrosis explains the impact health coaching has had for them both:

“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.”

For more information on the Better Conversation campaign, click here.


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