As anyone who has ever raised a teenager knows all too well, telling someone to do something because it's "good for them" can feel like so much wasted breath. Chiropractors also can find themselves winded from exhorting (encouraging, cajoling, threatening, nagging, etc.) patients to persist with their programs of care and enhance their overall well-being with more frequent chiropractic visits, better nutrition, more sleep, stress management and exercise.
Recent health care trends and research are supporting what you may have already suspected from years in practice: Simply telling people what to do often does not lead to them actually doing it. Showing them how and leading them through it stands a much better chance of working.
Patient Education vs. Coaching
Traditional patient education – loading people up with facts and figures and sending them home with a stack of brochures to tackle on their own – often doesn't empower patients with the true understanding and skills they'll need to persist and succeed with a health care regimen. Health coaching leaves less to chance. A health coaching approach provides a more interactive consultation model whereby the coach and patient work together to map out care plans. The coach proactively monitors progress, provides counseling and new strategies for navigating through rough patches, and holds the patient accountable to agreed-upon goals.
Embraced today as a way to both improve health and lower costs, health coaches, also known as wellness coaches, help people set and meet health goals, overcome health-related obstacles and aid patients in setting up support systems. Many patients today expect a personalized model of care organized around their unique needs and want to explore a wide variety of options. A health coach (much like an athletic coach or personal trainer) walks the road with patients, helping them actually apply information to everyday life and aiding them in removing and minimizing setbacks along the way.
Health coaches are also particularly helpful in guiding people through information overload. The Internet is a great resource for researching health-related questions, but it can also present patients with more data and/or highly conflicted data that is difficult to turn into useful insights. Health coaches can guide people toward trusted resources and help them evaluate a broad range of care options.
Health coaches work with people one-on-one in person, over the phone or online, or with a small group of individuals who share similar concerns or health goals. Health coaching can help people in a broad range of situations, but is often especially valuable to people who have difficulty understanding their care plans, lack motivation or discipline, or require a personalized plan established especially for their needs.
There is growing research showing better outcomes with the use of health coaches rather than traditional patient education. The Agency for Healthcare Research and Quality of the U.S. Department of Health and Human Services completed a study in 2008 in which high-risk chronic disease patients at the Dartmouth-Hitchcock Clinic were assigned health coaches. The coaches, integrated into the clinic's primary care practices, provided evidence-based information to patients by telephone, during office visits, and in group class settings, with the goals of improving patient self-management skills, better preparing patients for their physician office visits, encouraging physician-patient communication and engaging patients in their care plans.
The coaching program attracted more patients than the clinic's typical, outsourced disease management program, with 77 percent of potential participants enrolling compared to the group's usual 7-13 percent enrollment rate. In addition, the readmission rate of the targeted patient group dropped from 15.6 percent to 13.7 percent and saved the Centers for Medicare and Medicaid Services $2.7 million while meeting quality measures of those organizations.
But research is also finding that serving as an effective health coach requires a broad range of skills. In "Integrating a Health Coach Into Primary Care: Reflections From the Penn State Ambulatory Research Network," published in the Annals of Family Medicine, researchers found health coaches were often confronted with myriad issues in patients' lives and needed strong grounding in counseling skills. The study involved lay health coaches in assisting obese adults with weight loss. Although the model led to nearly 50 percent of patients initiating behavior changes in eating habits and physical activity, the health coaches sometimes struggled with how best to address patients' complex psychosocial issues.
Implications for Chiropractic
As a profession, chiropractic has long struggled with how to best educate patients and the general public to help them understand the pervasive and long-term value of ongoing chiropractic care. And each of us has strived in our offices to increase compliance among patients in maintaining office appointments and following through with improved lifestyle behaviors.
Chiropractors need the techniques of an effective health coach within their own skill sets and consider "hiring" and "training" those skills within their office staff members. How much more impact might we have as individual practitioners and a profession if we effectively coached people toward better health choices and the vitalistic chiropractic lifestyle? A coach can serve as a facilitator and mentor, helping people take responsibility for their own health, completely in harmony with the chiropractic view of true health care.
The job title is relatively new, but a growing number of organizations have begun utilizing health coaches to help patients manage chronic conditions, improve overall health and reduce costs. Recently advertised positions include a wellness consultant for Humana Inc., a health education professional for Health Fitness Corporation, a health coach for Johns Hopkins Healthcare LLC, and lifestyle health coaches for WellCorp.
Let's not let this opportunity pass chiropractic by or see this wellness-oriented practice subsumed within the disease care paradigm. Coaching people toward a fuller expression of their optimum performance and health dovetails beautifully with chiropractic practice.
Throughout chiropractic's history, we've focused on helping people reach more of their inborn potential for true health. The use of health coaches and coaching strategies provides another vehicle for chiropractors to help people reach their peak performance goals.
Life University recently introduced a Bachelor of Science in Health Coaching for individuals who want to pursue a career in the field and for chiropractic students interested in a health coaching foundation for their undergraduate studies. Core courses are provided in nutrition, exercise science and psychology, as well as a clinical practicum and optional business minor.
Dr. Guy F. Riekeman, current president of Life University in Marietta, Ga., has held leadership positions in chiropractic education essentially since his graduation from Palmer College of Chiropractic in 1972. He was appointed vice president of Sherman College in 1975 and has served as president of all three Palmer campuses and as chancellor of the Palmer Chiropractic University System. In 2006, he was elected to the board of directors of the Council on Chiropractic Education.