This project supports staff who are trained in health coaching but are not providing it to patients on a regular basis. It also introduced an evaluation framework to continually assess the training and support needs of staff in South Eastern Sydney Local Health District (SESLHD).
View a poster from the Centre for Healthcare Redesign graduation, May 2018.
Aim
To increase the translation of health coaching training into everyday clinical practice, from 56 per cent to 75 per cent by April 2019.
Benefits
- Empowers patients and improves their health outcomes and experience.
- Provides staff with ongoing training and support in health coaching.
- Helps staff understand what health coaching is and why it is used.
- Delivers a better return on training and development investment.
- Aligns clinical practice to the SESLHD Integrated Care Strategy 20151.
Background
An estimated 21 per cent of the SESLHD population has multiple morbidities, or more than one disease1. If not managed well, this has the potential to add pressure to the healthcare system and impact patient experience. SESLHD have defined health coaching as ‘a person-centred approach to goal-setting, active learning and self-management that guides, empowers and helps the individual connect to their own motivation to change their behaviour’. There is evidence to show that health coaching can improve self-management and health outcomes of patients, including physical function and quality of life2. Health coaching has also shown to reduce costs for the healthcare system and the consumer. Due to these benefits, health coaching is a key priority in the SESLHD Integrated Care Action Plan3.
Since 2011, the SESLHD Integrated Care Unit has commissioned Health Change Australia to train over 750 staff, general practitioners and practice nurses in health coaching. However, prior to the project there was anecdotal evidence that suggested a disparity between the training provided and the techniques used in the clinical setting. This was confirmed in a survey conducted in June 2017, where results showed that 44 per cent of staff who had attended Health Change Australia training were not translating the knowledge and skills acquired during training into their clinical practice. This represented a significant number of missed opportunities to improve patient care and experience, staff experience and population health.
Implementation
A project plan was developed to define the problem, goals, objectives and anticipated benefits. It included governance, timelines for major deliverables, communication plans, identification of risks and issues, and a proposed budget. Diagnostic activities were then undertaken, to ensure all factors impacting the translation of health coaching training into practice were considered. These included:
- a survey of staff who had completed Health Change Australia training, to explore their understanding, translation and support of health coaching
- focus interviews with staff, managers and patients to identify their needs
- workshops with staff and managers, focusing on issues and root causes.
The barriers to translating knowledge and skills into practice were found to be: a lack of ongoing support and information resources; staff not feeling confident that their level of skills and knowledge were sufficient for implementation; and a misunderstanding about what health coaching is and how it can be used.
Solutions
Following consultation with staff and patients, the following four solutions were proposed.
1. Develop and spread a definition of health coaching
In 2017, the NSW Ministry of Health released a working definition of health coaching, which was explored and tested with the project steering committee, SESLHD staff and local experts in health coaching. Minor changes were made to capture the broad scope of health coaching and ensure it was technically correct. This definition will be circulated to health coaching training participants, and through district newsletters and resources developed for health professionals, managers and patients.
2. Provide face-to-face support for staff already trained in health coaching
Face-to-face support sessions were developed and implemented by the Organisational Development and Learning Unit. These incorporate a short review of health coaching techniques and focus on issues experienced by participants. Issues are discussed as a group and participants are given time to practise their skills in groups of three. After the workshop, the Integrated Care and Organisational Development and Learning Units continue to engage with the groups of three and facilitate opportunities to continue practicing health coaching skills in a safe environment, using valid and reliable feedback tools. Ongoing evaluation will determine the frequency of these sessions and how many support sessions are required for individuals.
3. Provide online health coaching resources for staff
During the consultation phase, staff indicated the types of resources that would help them translate their training into clinical practice, including tools, templates, literature and frequently asked questions. These resources are currently in development in consultation with the Organisational Development and Learning Unit and will be tested by staff before they are published on a new ‘Centre for Coaching’ page within the SESLHD website in May 2018.
4. Develop a process to ensure regular review of training and support needs
A review and evaluation framework was developed, with items in this framework expected to be in place by April 2018. This includes:
- surveys and focus groups to assess the effectiveness of workshops and solutions implemented
- an annual evaluation of the status of health coaching within SESLHD, including staff and patient needs, the frequency and quality of health coaching provided and a snapshot of how normalised health coaching has become as a way of working.
Status
Implementation – The project is ready for implementation or is currently being implemented, piloted or tested.
Dates
March 2017 - April 2019
Implementation sites
South Eastern Sydney Local Health District
Partnerships
- Central and Eastern Sydney Primary Health Network
- NSW Agency for Clinical Innovation
Evaluation
A full evaluation will be undertaken in April 2019, incorporating an annual coaching survey that will measure the translation of health coaching training into everyday clinical practice (target 75 per cent). Each of the four solutions will also be evaluated via surveys, workshops and focus groups.
Lessons learnt
- Make sure you understand the problem, by spending time on diagnostic activities.
- It is important to revise project goals and activities as new information becomes available during the diagnostic phase.
- The delivery of health coaching training is not enough to translate the knowledge into practice. Post-training support and resources are required to achieve culture change.
- In retrospect, a definition of health coaching needed to be developed earlier in the project, as the perceived definition and benefits varied among staff.
- Regular meetings along with supportive and active sponsors is essential to maintain project timelines.
References
- NSW Health. Integrated Care Strategy 2015. Kogarah, NSW: South Eastern Sydney Local Health District; 2015.
- Kivela K, Elo S, Kyngas H. The effects of health coaching on adult patients with chronic diseases: a systematic review. Patient Education Counselling 2014:97(2):147-57.
- NSW Health. Integrated Care Strategy Action Plan 2015-2018. Kogarah, NSW: South Eastern Sydney Local Health District; 2015.
Further reading
- ACI Patient Experience and Consumer Engagement
Contacts
Brendon McDougall
Integrated Care Projects Manager
South Eastern Sydney Local Health District
Phone: 02 9540 8171
Brendon.McDougall@health.nsw.gov.auAnna McGlynn
Innovator Program Coordinator
South Eastern Sydney Local Health District
Phone: 02 9540 8172
Anna.McGlynn@health.nsw.gov.auAmy Young
Manager, Primary Care Development and Quality Improvement
Central and Eastern Sydney Primary Health Network
Phone: 02 9330 9930
a.young@cesphn.com.au
