The Health Coach newsletter winter 2018

Hennepin County, Minnesota sent this bulletin at 01/24/2018 10:57 AM CST

January 2018

This quarterly newsletter will provide tips and resources about health coaching to help you keep patients engaged in their care.

Action plans — patients active in their care

An action plan is an agreement between the patient and the care team that specifies a behavior change the patient is willing to make. Engaging patients in their care and allowing patients to choose lifestyle changes they want can achieve longer-term health and well-being, and decrease risk factors for chronic disorders.

For patients with a chronic condition, the areas of self-management to focus on for improved health are physical activity, healthy eating, smoking cessation, and medication adherence.

Health coaches first help the patient identify what they want to do to improve their health, and then help the patient create a realistic action plan that is concrete and specific. Coaches can help patients problem-solve and trouble-shoot barriers that may get in the way of accomplishing their action plan. Once details of the action plan are finalized, the coach does a reality check with the patient. Using a 0 to 10 scale, 10 being very confident, the coach asks the patient how confident they are about completing the action plan. A score of 7 or above indicates the patient believes they can do it. (Download My Action Plan off San Francisco General Hospital's Center of Excellence in Primary Care website.)

A behavior change can be a small change. It doesn’t matter how small, as long as the patient thinks they can do it and be successful. The patient can build on small successes, gaining the confidence needed for incremental changes that result in improved health and well-being. The coach is supportive and encouraging along the way.

Steps to creating an action plan

1) Ask the patient if they would like to create an action plan to improve their health.

2) If the patient agrees, ask the patient what they would like to work on, e.g., get more active, improve their diet, stop or cut back on smoking, or take their medications as prescribed.

3) Using My Action Plan, help the patient define the details of their action plan. As the patient thinks about the details of their plan, barriers are often identified. The coach can brainstorm with the patient to work through the barriers.

4) Measure the patient’s confidence using the scale of 0 to 10. If the patient’s confidence level is less than 7, revisit the plan and make changes until the confidence level for completing the action plan is 7 or above.

5) Congratulate the patient on their commitment.

6) Ask the patient for permission to follow up with them in a week to see how things are going. This is an opportunity to troubleshoot barriers that surfaced or to reset the action plan.

An example of creating an action plan with the patient:

Coach: Hello Mr. Jones. How do you feel about discussing things you could do to help lower your blood pressure?

Mr. Jones: That’s fine.

Coach: OK. What do you think you could do to lower your blood pressure?

Mr. Jones: I’m not too sure, but I know too much salt in my diet isn’t good.

Coach: Yes, that’s correct. There are three things you can do to lower your blood pressure and improve your overall health. They are being more active, eating a healthy diet, and taking your medications as prescribed. Quitting smoking is another one, but you did that a few years ago, which is great!

Mr. Jones: Hmm ... In addition to watching my use of salt in my food, I’d like to improve my physical activity.

Coach: Perfect! I can help you create an action plan to increase your physical activity. When do you want to start?

Mr. Jones: I’d like to start Monday next week.

Coach: OK. What would your plan look like? What would be your activity, when could you do it, and for how long?

Mr. Jones: I can start with walking for 30 minutes 3 to 4 times a week. The best time of day for me to do this would be after dinner or during the day on weekends.

Coach: Great! I suggest you plan for three days and see how that goes. On a scale of 0 to 10 with 10 being very confident, how confident are you that you can do this plan?

Mr. Jones: Oh, I’d say 8.

Coach: Great! Sounds like your plan will work for you. Can I call you in two weeks to see how things are going?

Mr. Jones: Yes. I’d like that. Knowing you’re going to call will help me stay committed to the plan.

Ask the health coach

Question

What should the health coach do if the patient creates a plan, doesn’t have much success, and gives up?

Answer

Help the patient reestablish a simpler plan that is more realistic. Troubleshoot barriers in the plan. Then follow up with the patient to see how things are going. A coach should listen and be supportive of how the patient is feeling and what other events are happening in their lives. If the patient expresses no interest in continuing at the time, be accepting of their decision and ask permission to talk about a plan later. Tell the patient the care team is here to help when they are ready. Be understanding and nonjudgmental.