Active participation by patients -- achieved by asking patients what they think and what they have set for personal goals -- is associated with better health outcomes compared with telling patients what to do, which makes them passive bystanders in their care. A participatory relationship between the patient and the care team is one of the most decisive factors in promoting healthy behaviors. 

Asking open-ended questions helps to identify challenges that the patient is dealing with regarding his or her health. Once you know the challenges, you can help the patient identify potential solutions.

You, as a health couch, can help patients participate in their care plan by using the Ask-Tell-Ask health coaching technique.

Ask

First ask permission to discuss a topic:

• Ms. Jones, can we talk about your _____? (e.g., BMI, HbA1c, blood pressure)

Then begin the conversation by asking an open-ended question such as:

• What’s your number one health concern?
• What did your provider tell you about your ____? (e.g., BMI, HbA1c, blood pressure.)  
• What do you think you could do to improve your health?

Tell

We tell after we ask. 

If the patient needs more information about his or her health challenge, then you can tell the patient in a way that is easy to understand.  

Telling can also just be reinforcing what the patient has told you when more information isn’t needed.

Ask

After telling, the coach asks the patient to retell the information to confirm that the patient correctly understands the additional information. This technique is an example of closing the loop. 

A suggested phrase is: 

• Just to make sure I was clear, can you tell me …? 

Ask-Tell-Ask continues until the coach is confident that the patient correctly understands the information that was shared. 

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Four ways all patients can improve their health are: 

1. eat a healthy diet
2. get regular physical activity
3. take medications as prescribed for their health condition
4. quit smoking

You can use the Ask-Tell-Ask technique or the four questions to coach around these topics and to help patients create their care plan or action plan. Here’s an example:

A medical assistant (MA) is weighing a patient as part of the rooming process. The MA is also documenting the patient's BMI in the EMR.

• Coach: Mrs. Smith, would it be OK if we talk about your weight or BMI?
• Patient: Sure.
• Coach: What do you know about your BMI? (Question #1 of the 4 questions/Ask)
• Patient: I don’t know much, but I think it has to do with my weight.
• Coach: Yes, you are correct. It is a measure of body fat based on your weight and height. Your BMI is 30. (Show the chart. Question #2 of the 4 questions/Tell. You might need a few more words of explanation here.) What would be your goal? (Question #3 of the 4 questions/Ask)
• Patient: I would like to lose some weight but it’s been a challenge for me.
• Coach: Yes, it’s a challenge for a lot of us. What do you think you could do to lose weight? (Question #4 of the 4 questions)
• Patient: Well, one thing I could do is to stop snacking in the evening.  
• Coach: That sounds like a great idea. Maybe I can help you make a plan to do that. 

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