Evidence-Based Health Coaching
Evidence-based Health Coaching (EBHC), as ascribed to by the National Society of Health Coaches, uses Miller and Rollnick's work(3) in motivational interviewing (MI) to guide the provider's conversation with the patient about health behavior change. These conversational skills are used to tap into the patient's own motivation or desire to change.
Instead of telling the patient what to do as many clinicians still do, the conversational skills of the clinician health coach helps the patient to identify any ambivalence to behavior change that exists. This conversation will include many of the following attributes as well as many others:
• What is most important to the patient about his/her health?
• How will their lifestyle be affected?
• What will the benefits be for them/their family/significant other?
• The confidence they have in making a change.
• The importance they place on the change they want to make.
• What concerns them about making the change?
Consider a patient's medications for example. In that discussion, most commonly the patient shares the list of meds they're taking followed by the provider giving a changed or new prescription. Yet, how often does the provider ask the patient what the patient thinks about this change. Doable? Reasonable for them? Anticipated difficulty in obtaining; taking?
EBHC and Motivational Interviewing
The use of evidence-based health coaching and motivational interviewing to engage the patient and family/significant other place the patient clearly as a 50/50 partner in the relationship. Elevating the patient to this level empowers the patient, shows respect for the patient, and recognizes the patient as an important decision-maker in the relationship.
Based on the characteristics described here, self-evaluate the kind of conversations you currently have with your patient’s day in and day out, and what your discussions consist of. Would you describe your style primarily as "Do this" or "Do that"? Directing and telling instead of engaging?
Now, clinicians have training and education available to us that elevates every patient beyond that of a "guest in the boardroom" to their rightful place in the patient-provider relationship resulting in better outcomes, increased satisfaction, and overall lower costs. Consider the use of shared decision making and Evidence-based Health Coaching in your daily practice. It does make a difference!
(1) From: https://www.healthit.gov/sites/default/files/nlc_shared_decision_making_fact_sheet.pdf
(2) Elwyn, G. et al. (2012). Shared decision making: A clinical model for pracrtice. Journal of General Internal Medicine, (27)
(3) Rollnick. S., Miller, W.R., and Butler, C.C. (2008). Motivational interviewing in health care: helping patients change
behavior. The Guilford Press: NY, NY.