Transforming conversations and relationships using health coaching

Personalised Care Institute Ambassador, Dr Aicha Bouraoui, is supporting Health Coaching Awareness Week this week, by sharing her experiences of health coaching and how she has built it into her day-to-day practice and service delivery.

Dr Bouraoui is a clinical research fellow in adolescent rheumatology and an ST7 in rheumatology and general internal medicine. She has a keen interest in health coaching and personalised care more broadly, as a means to transform relationships with patients. She is also passionate about driving service improvement and creating meaningful change in the health and care system through a range of mechanisms including co-production.

It was early in my career that I learnt about the importance of personalised care. I realised there was more I could do to support patients to self-manage the day-to-day realities of living with a long-term conditions. As professionals, our training programme is primarily shaped around the biomedical model of care. Psychosocial determinants of health, including health related behaviour, which have a huge influence on people’s outcomes, are rarely covered in postgraduate training. Health coaching is one way we can start to address these issues and unlock people’s potential to become experts in their own care.

This Health Coaching Awareness Week, I wanted to share my experiences of health coaching and the opportunities it presents. So how did I start this journey to embed health coaching in my practice? My interest was sparked through the Darzi Fellowship programme, which taught me about system leadership, improvement approaches, coproduction and working with patients as equal partners. I realised at that time that I needed to develop my capabilities beyond the biomedical model of care and embrace holistic approaches. To overcome a gap in personalised care, within my training programme, I undertook my initial training in health coaching and started trying to integrate it into my consultations with patients, starting with what mattered to them. It took time to refine and hone my skills but with practice and a little trial and error I started to have a different type of conversation – one that was more meaningful and empowering.

Over time, my health coaching experience has evolved and I’m currently working in a service embedding this approach. At the Adolescent and Young Adult (AYA) Rheumatology department at University College London Hospitals (UCLH), we wanted to provide more holistic support and empower young people to take ownership of their health and wellbeing, and health coaching is one of the ways we’re doing this.

Early adulthood is generally characterised by instability, as young people go through critical physiological, emotional, educational and social transitions. At the same time, the day-to-day management of their long term condition largely relies on the commitment and organisation of the individual, particularly as young people move away from the protection of the paediatric model of healthcare. The need to cope with multiple demands and take responsibility for their health can result in individuals struggling to develop and maintain self-efficacy and self-confidence in their treatment. At UCLH, we saw health coaching, in tandem with clinical enquiry, as an opportunity to explore the unique biopsychosocial impacts of chronic disease on an individual, to enable tailored interventions to improve health outcomes by aligning treatment with self-identified goals based on individual needs and motivation.

By shifting the dynamic of our clinical conversations using a health coaching approach, we focus more on what matters to the young person, including their life goals, and increase their ability to problem solve and improve self-efficacy. Through experience we know young people have the innate capacity to develop and grow; with the right support they can make more informed and conscious choices and reach their own solutions.

We’ve been taking a health coaching approach to our consultations for over a year now and our whole MDT is committed to this approach. Everyone has undergone PCI accredited health coaching training, from our consultants to the admin team, and we have evidence that it’s being gradually integrated into conversations with young people. Our journey is still in its infancy and we’re learning and evaluating as we go. But the more we practice these skills, the more effective we’ll become at treating young people as equal partners and building their capacity to self-manage issues such as medicine adherence and pain management.

We’re aiming to create, a consistent and sustainable approach; and feedback so far shows that health coaching is valued by staff to engage young people in their care.In order to sustain behavioural change, between consultation we are setting up young people led peer support drop-in session. Following a successful Q-Exchange bid, we will be using health coaching approach to facilitate peer to peer coaching for young people and their parents; and importantly create sense of community in young people with long-term conditions.

Supporting young people to self-manage is the cornerstone of long-term condition management. Helping teams to develop health coaching capabilities, along with peer to peer support scheme, are vital not only to prevent escalation of conditions and poor health outcomes but crucially in shifting the paradigm from a national illness focused system to a national health system enabling health promotion and activation.

So, this Health Coaching Awareness Week, if my experiences have sparked your interest, why not find out a bit more about health coaching? You can join the online conversation #HealthCoaching You can also speak to your colleagues and patients and consider what part it could play in your service. Or reflect on your skills and whether some health coaching training could play a part in transforming your conversations. The training and education section of the PCI website includes details of accredited training providers.

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