Patient Engagement and
Coaching Models
Rebecca Durham
Project Coordinator, HealthInsight
Incorrect Assumptions
Incorrect Assumptions
• Patients want to
change behavior
• Advising optimal
health is motivator
for change
• Patients are either
motivated to
change, or not
Change Our Thinking
From
• Patients are
Non-Compliant
To
• Patients are
unsuccessful at
managing their
own care
• Patients are not
yet engaged in
their own care
Consider…
• Chronically ill patients make many
daily health decisions
• Sometimes make unwise decisions
• Don’t fully understand implications
of particular health decisions
• Lack support to make better choice
• 9/10 patients lack skills to manage
their health/prevent disease1
1. Advocate for Health Literacy in your organization (n. d.). Quick
Guide to Health Literacy. Retrieved from http://HHS.com
How to Not Engage Patients
• Tell patients what to do (give advice)
• Misjudge sense of importance
regarding behavior change
• Use scare tactics, argue, blame them
for no willpower and self-concern
• Overestimate readiness to change
and degree of confidence
• Take away control, generating
resistance
How To Engage Patients
• Listen: Don’t jump on first things
patients say
• Understand behavior change and
motivation
• Change clinical visits from “to-do”
lists to helping patients identify and
establish care priorities
• Help patients develop a care plan to
improve outcomes (Shared Care Plan)
Can We Be Engaged?
• 23% adopted new health behaviors (but
unsure could maintain if stressed)
• Remaining 77%:
-- Remain passive recipients (12%)
-- Lack basic facts to follow treatment
recommendations (29%)
-- Have facts, no skills/confidence (36%)
Hibbard, J. H., Mahoney, E. R., Stock, R., & Tusler, M. (2007). Do increases in patient activation
result in improved self-management behaviors? Health Services Research, 42, 1443-1463.
Polling Question
What is the most
important
determinant to
advance patients’
with diabetes
healthy behaviors?
1. Increasing patient
education
2. Spending more
time with patients
3. Developing a
shared
relationship
between patient
and provider
Norris, S. L., Engelgau, M. M., & Narayan, K. M. V.
(2001). Effectiveness of self-management training in
Type 2 diabetes. Diabetes Care, 24, 561-587
Ideal PCC Approach
Tennison, J. (2012)
Education
+
Self-Management
• Information,
technical skills
• Problems due to
poor disease
control
• Disease-specific
knowledge
• Goal is behavior
compliance to
improve outcomes
• Skills to act on
problems
• Patients ID problems
in self-management
• Improving patient
confidence to change
• Goal is increased
self-efficacy to
improve outcomes
Bodenheimer, T., & Abramowitz, S. (2010). Helping patients help
themselves: How to implement self-management support.
Oakland, CA: California HealthCare Foundation.
The Facts
• 40-80% medical information given
forgotten immediately; half retained
is incorrect1
• Physicians thought 89% of patients
understood medication side effects,
only 57% of patients understood2
1. Kessels, R. P. (2003). Patients' memory for medical information. Journal of Social
Medicine, 96(5), 219-222.
2.Training to Advance Physicians‘ Communication Skills. (n. d). Retrieved from
AHRQ Website.
Medication Adherence?
Take 3 tablets by mouth 2
times per day, with food for 14
days, then take 2 tablets 2
times per day with food for 14
days, then take 1 tablet every
morning, 30 minutes before
meal for 14 days, then take ½
tablet every morning, 30
minutes before meal for 14
days
Teach-Back Method
• Method to confirm patients understand
their medication/treatment:
– “Tell me why you need this medication”
– “Tell me how you take this medication”
• Teach Back not a test of patients’
knowledge
• Is a test of how well we explain something
Kessels, R. P. (2003). Patients' memory for medical information. Journal of Social
Medicine, 96(5), 219-222.
Health Literacy
• The capacity to
obtain, process,
and understand
basic health
information and
services needed to
make appropriate
health decisions.
Healthy People. (2010). Cited in What is Health
Literacy? Retrieved from www.chcs.org
• Only 12% of adults
have proficient
health literacy
• Lower literacy =
more admissions,
ER visits, costs,
higher risk of poor
health
Advocate for Health Literacy in your organization (n.. d.)
Quick Guide to Health Literacy. Retrieved from
http://HHS.com
Keep Your Glucose in
Normal Range
Watch Your Words
Problem Word
Ailment
Adverse
Benign
Condition
Lesion
Oral
Vertigo
Consider Using
Sickness, illness
Bad
Won’t cause harm, isn’t
cancer
How you feel; health
problem
Wound, sore
By mouth
Dizziness
Ask Me 3. Retrieved from www.npsf.org.
What is Coaching?
• Managing: Making sure people do
what they know how to do
• Training: Teaching people to do what
they don’t know how to do
• Mentoring: Showing how those who
are good at doing things do them
• Coaching: Helping identify skills and
capabilities, and empowering people
to use them as best they can
Motivational Interviewing
A collaborative, patient-centered
form of guiding to elicit and
strengthen motivation for change
Miller, W. R. & Rollnick, S. (2009). Ten things that Motivational Interviewing
is not. Behavioural and Cognitive Psychotherapy, 37, 129- 140.
Motivational Interviewing
• Non-judgmental, non-confrontational,
non-adversarial
• Explore and resolve ambivalence
• Help patients envision a better future,
and become increasingly motivated to
achieve it
Miller, W. R. & Rollnick, S. (2009). Ten things that Motivational Interviewing
is not.. Behavioural and Cognitive Psychotherapy, 37, 129- 140.
Four Principles of MI
1. Express empathy (not pity)
- Put yourself in patients’ shoes
2. Develop discrepancy (ambivalence)
- Explore how they want their life
to be and how it is now
3. Roll with resistance (expect it)
4. Support self-efficacy (empower)
OARS
•
•
•
•
Open-ended questions
Affirmations
Reflections
Summaries
Care Transitions Coaching
Model
• Improve transitions of care
• Transitions Coaches encourage
patients and caregivers to take a
more active role in their own selfcare
• Not doing for, but empowering
patients to do for themselves
• Involves pre-discharge and then
follow-up, in-home visits
Transitions Coaching in
Your Practice
• A tool everyone can use
• Patients engaged in coaching have
better outcomes
• Effective to avoid downward trends, or
keep patients at new “normal”
• Program consistently reduced 30-day
hospital readmissions and costs, and
180-day hospital readmissions
Discussion Question #1
How will I use patient
engagement techniques to
improve patient outcomes?
Discussion Question #2
Name two times during an
encounter when you might
engage a patient using a
patient engagement or
coaching model