Feature Article:

Supporting Patients to Achieve Their Health Goals

By Shelley Simon, RN, DC, MPH, EdD
Founder, Beyond Practice Management

If you’ve been reading Practice Your Way for even a few months, you’ve likely noticed that many issues of the newsletter are — directly or indirectly — about how to engage in effective communication. I spend a lot of time writing about communication and talking to my clients about this vitally important topic for one simple reason: practices succeed or fail based on the practitioner’s ability to communicate effectively with prospective and active patients, staff, colleagues, and business associates.

In order to successfully market your practice, you must be able to clearly express your value to others. If you desire positive clinical outcomes it’s imperative that you develop the skills to present complex information in a manner that can be understood by non-clinicians. And if you expect to have a cohesive team working in your office, you must learn to communicate in a manner that demonstrates good leadership.

In this article we’re exploring how healthcare practitioners partner with patients to support them in achieving specific health goals. And, once again, the focus is on communication — listening without judgment, asking questions that engage patients in a positive way, and coaching (rather than advising) to help patients reach their most important goals.

As the “health coach” your role is to make it clear that you are willing and able to be a member of the patient’s support team and that you stand ready to work with them toward success. The first step in supporting patients to achieve their health goals is trusting that they know what they want. A patient’s desire to achieve immediate pain relief instead of addressing the underlying cause of the pain may seem short sighted to you. But being free of pain may be the only thing that matters to the patient, at least for the moment. Coaching involves honoring that patients understand, if not what’s “best” for them, what is important to them. Setting aside judgment and bias requires being curious about what a patient wants, what they are and are not wiling to do to improve their own health, and what their beliefs and preferences are as well.

When it comes to helping patients reach their health goals, practitioners can borrow a page from the world of professional coaching. When coaching a patient, the focus should stay on the needs, desires, and goals of the individual being coached. As practitioner/coach, your job is to set aside judgment and help your patient achieve whatever it is that they want, even if you don’t necessarily agree with their goal. For example, you have a patient who is 40 pounds overweight and suffers from chronic low back pain. In your professional judgment, this gentleman should lose the excess weight as part of a comprehensive plan to improve his back pain. You’ve mentioned this to him, but for reasons that are unclear to you, losing weight is simply not a priority for this individual. What he has clearly stated, however, is a desire to get back out on the golf course. Instead of spending time and energy and annoying the patient by harping him about his ample belly, focus your attention on the patient’s primary goal: playing golf.

Coaching patients, as opposed to advising them, isn’t easy when you are in the expert position and posses information that if only the patient would listen, take your suggestions, and accept what you say as fact would make a difference in their lives. Staying with a patient’s agenda and keeping the focus on their goals sometimes requires restraint. The best way to illustrate the difference between coaching and advising (or telling) is by example:

Patient states: I don’t have time to exercise. I know I should, but I have three kids and a job.
Advising: I hear you. I have two little ones myself. Here’s what I do . . . just get up an hour earlier and get in your workout before anyone else wakes up.
Coaching: Most of my patients have a hard time making time for exercise. If you were to make it a priority, what would be the most likely time of day that you could fit it into your schedule on a reasonably regular basis? (Note: This question is designed to help the patient see new possibilities and tap into their own creativity and ideas for solving the problem of not enough time.)

Patient states: I know I should keep my chiropractic appointments, but I get busy and then just wait until the pain gets bad again.
Advising: We’ve discussed this before. You know that keeping on schedule is the only way to prevent these problems from recurring.
Coaching: You’ve said your goal is to be able to count on your back to be stable so that you can do the activities you enjoy. Given that, what would help you to be more consistent with keeping your appointments? (Note: This question helps the patient refocus on their own goals and connect achieving those goals with the benefits of treatment.)

Patient states: I know I should take my supplements every day, but I forget or just get lazy and don’t do it.
Advising: Put your supplements in one of those day-of-the-week type boxes and keep a log to bring in for your next appointment.
Coaching: What do you understand about the benefits of taking these particular supplements? (Note: This question should reveal whether the patient even sees the value of taking supplements of if they simply need a better system or routine for taking them.)

Patient states: I don’t want my teeth x-rayed. I’m afraid of the radiation and I don’t have dental insurance any longer. Let’s just skip it this year.
Advising: It’s standard practice that all my patients get x-rays every year and you don’t need to worry about the radiation. It’s very minimal.
Coaching: What is your main concern about x-rays? Is it the cost or the radiation exposure? Is there anything else that concerns you? (Note: This question will uncover more detail about a patient’s assumptions or biases.)

Having illustrated the importance of staying focused on the patient’s vision for themselves by coaching rather than advising, it must be said that the coach/practitioner’s role is also to help the patient embrace a vision for themselves that may be larger than what they can see in the immediate future. An example of this might be the patient who has a short-term goal of just being well enough to get back to work. Certainly this is worthy goal and one that you would support. It might also be useful to ask about other meaningful goals the patient might have as a strategy to help them see even greater possibilities.

It’s not uncommon for patients to get excited about achieving a health goal only to face internal resistance when it comes right down to working toward achieving the goal. The patient who stands in your office and commits to a home exercise program will come back at the next visit saying that they’re too busy or that they’ve decided the exercise program is not important to them after all. Dealing with resistance with a patient requires very simply going back to the beginning of the process by asking patient-focused questions: What do you want? Why is that important to you? What would be the benefit of working through this? What could you do? What will you do?

Remember that you can’t force or cajole a patient into doing anything they don’t want to do. It’s human nature that we all think our own ideas are the best ones. We like to be right and we tend to act on and follow through with our own ideas more readily than on the ideas of others. Let the patient come around to deciding whether or not they want to re-commit to a goal, modify the goal to be more achievable, or abandon the goal altogether.

For an in-depth discussion on how to manage resistance on the part of patients, refer to my article “How to Diagnose and Manage Resistance in Others” that was published in Dynamic Chiropractic on 4/8/08. Read it online here.

You do not have to drop what you are doing and go back to school to become a full-fledged coach in order to develop many of the competencies associated with quality coaching. Good coaching is about being fully present and curious, asking meaningful questions, staying focused on the goals of the patient you are working with, and being careful not to let your own biases cloud the encounter. Much of this can be learned by regularly engaging in patient-focused dialogue. Over time, shifting from advisor/expert to health coach will become natural.

The International Coach Federation (ICF) certifies both coach training organizations and coaches. The core coaching competencies put forth by the ICF include creating a foundation for the coaching relationship, establishing trust, being present, effectively communicating with active listening and powerful questioning, designing action plans and setting goals, and establishing accountability. If you are interested, you can read about these competences in greater detail at the ICF website.

Patients clearly stand to benefit greatly from achieving their goals in terms of better health. But there is also a clear advantage to the practitioner who helps his or her patients achieve their important goals — it’s a practice builder. If you can get your chubby, golf-loving patient with low back pain back out on his favorite course, he will have achieved his goal and will sing your praises to his golf buddies on every other hole. Partner with a patient to help her regain her beautiful smile and she will no doubt share her story with others. Help a grandmother experience the joy of being able to pick up her grandchildren without pain and her friends and family will be sure to hear about it.

You may be the best clinician in your community, but most patients have no way to measure your technical or clinical ability. What they can measure — and what they talk about — are their outcomes and how much they feel cared for. Being genuinely interested in helping patients achieve goals that are important to them demonstrates a level of caring that goes far beyond what most patients expect. And, exceeding expectations is an excellent marketing strategy.

Book Recommendations:

Develop Coaching Competencies

Practitioners interested in developing their coaching skills might benefit from these books, some of which are used as texts in formal coach training programs

• The Skilled Helper: A Problem-Management Approach to Helping, by Gerard Egan
• Co-Active Coaching: New Skills for Coaching People Toward Success in Work and Life, by Laura Whitworth, Henry Kimsey-House, and Phil Sandahl
• Masterful Coaching: Extraordinary Results by Impacting People and the Way They Think and Work Together, by Robert Hargrove
• Nonviolent Communication: A Language of Compassion, by Marshall Rosenberg
• Working with Emotional Intelligence, by Daniel Goleman
• The Thin Book of Appreciative Inquiry, by Sue Annis Hammond
• The 7 Powers of Questions: Secrets to Successful Communication in Life and Work, by Dorothy Leeds
• Crucial Conversations: Tools for Talking When Stakes are High, by Kerry Patterson, Joseph Grenny, Ron McMillan, and Al Switzler

An Opportunity:

Need Support to Achieve Your Own Goals?

Supporting patients to achieve their goals is an excellent step toward building and maintaining a healthy, profitable practice. For most healthcare practitioners, that is an ongoing goal – one that must be attended to year after year. I’d wager that you have other goals as well. Perhaps creating a more cohesive team in your office or finding better work/life balance. Or maybe you want to pursue an interest outside of practice or identify and launch a side business to generate additional income. Whatever your goals happen to be, coaching can support you in achieving them. Just as you can learn to coach your patients to reach their health goals, you can benefit from professional coaching to help you achieve your practice, financial, and personal goals.

The first step in deciding whether coaching would be effective for you is to request a complimentary, introductory consultation. When you schedule this session online you’ll be asked to answer several through provoking questions as a way for you to: (a) become clear on what your most pressing issues are; (b) think about what you would like to get out of our conversation; and, (c) convey to me how I can best help you. To request your consultation, please click here.