Health Coaching

BY Victor S. Sierpina, MD, ABFM, ABIHM Director, Medical Student Education Program, WD


Laura Nell Nicholson Family Professor of Integrative
Medicine, Professor, Family Medicine University of Texas Distinguished Teaching Professor

In the emerging healthcare scenario, the health coach is becoming an increasingly significant player.

Health coaching can be defined as helping patients gain the knowledge, skills, tools and confidence to become active participants in
their care so that they can reach their selfidentified health goals.

The fact of the matter is that behavioral and lifestyle change is hard for our patients. If a patient has asthma, diabetes, obesity,
or other chronic condition or is just having problems setting or achieving wel lnessoriented goals, a health coach may be appropriate.

If, for example, an audit of your medical records determines you are below an expected national benchmark for HbgA1C for a certain percentage of your diabetic patients, a health coach may be the way to help to more effectively manage those patients who are significantly above target. Regular lifestyle tips, closer glucose monitoring, feedback, patient education, nutritional advice and so on between quarterly office visits can help move the
needle on diabetic control. Rather than feeling frustrated with such patients, or even worse, blaming them for non-compliance, providing a practical intervention such as coaching can make a big difference in their lives and disease management skills. Health coaches can help identify goals,
create and achieve small steps toward goals, improve self-management, and help sustain motivation.

The average brief physician office visit cannot possibly effectively address all important health issues. Such visits include updating current vaccines, addressing new and chronic complaints, ordering and reviewing tests, refilling medications, generating referrals, and managing paperwork associated with multiple health issues. Thus the important time and effort required for effective health care counseling and motivation are often squeezed into just a few moments at the end of the visit. What happens between office visits is what truly matters in helping patients make significant and enduring changes to their health-related behavior such as activity, nutrition, stress management, and more. Health coaches can be nurses, social workers,
medical assistants (MAs), community health workers such as promotores, other health educators, or even other patients in group visits or peer-peer interactions if they are given appropriate training and support. A health coach is not just a personal trainer or fitness instructor, though these people
can play an important role in helping in supporting optimization of health. Medical Assistants (MA’s) are often a good choice for filling the role of a coach in the primary care office. While their scope of practice prevents them from making medical assessments, MAs are ideally suited to provide between office visit coaching. Working closely with clinicians or RNs, they can address medication adherence and lifestyle changes and alert other team members when an assessment or visit may be needed. This use of MA’s and other team members as health coaches is a foundational
strategy in the Patient Centered Medical Home. MA’s can support patients working on smoking cessation and other tough to change habits that benefit from regular contact, tips, and encouragement. Motivational interviewing skills are key to effective behavioral change and coaches from any background must be skilled in this communication approach.

Registered nurses (RNs) are well trained to impart skills, build confidence and provide tools for patients, particularly for patients discharged from the hospital or with multiple chronic conditions. They are not usually a part of the team in most physicians’ offices however.

A new book, Nursing Coaching: Integrative Approaches for Health and Wellbeing by Barbara Dossey, Susan Luck, and Bonney Schaub, (Miami: International Coach Association, 2015) is an in depth guide to how nurses can be our best allies in the coaching realm. It is a must read for nursing
educators who wish to keep abreast of this dimension of nursing scope of practice and is a how-to, evidence-based guide on how to implement such training. It includes background, theories, actionable objectivesand communication skills, practical case studies, self-development tools, research
and leadership guidelines, and many patient assessment instruments all related to making nurses skilled coaches. This textbook is also a beautifully synchronous thematically with the principles of nursing laid down well over a century ago by Florence Nightingale. Because of their advanced training and clinical expertise, nurse coaches are uniquely positioned to coach and engage individuals, families, and communities in the process of meaningful and healthpromoting strategies for behavioral change.

Nurses are well respected and trusted by both the public and physicians. As longterm partners with physicians, nurse coaches are a natural choice for leadership in health coaching. Even physicians not particularly familiar with the health coaching field can feel confident in well-trained nurse coaches
as interprofessional partners.

An Integrative Nurse Coach Certificate Program is recommended and appropriate for all registered nurses in any health sector. It is an excellent pathway for nurses seeking new professional challenges and work opportunities. It is offered through the International Nurse Coach Association at Other health care team members can develop the skills it takes to become an effective health coach as well. There are a number of certification programs leading to the skills to become a health coach, for example, the National Society of Health Coaches at certification.

As we are increasingly held to metrics for improved control of chronic diseases in accountable care organizations (ACO’s), reimbursement is being tied to achieving these goals. In this setting the nurse coach or other team member who provides health coaching will increasingly become a cost-effective, core component of the interprofessional healthcare team.