| Julie: | Hi Twila. Tell me a bit about your position and your role in your clinic. |
| Twila: | Currently, I am one of the health coaches in the clinic and my title is Health Care Home Health Coach Coordinator. I am at Northside Medical Clinic in Ortonville, MN. |
| Julie: | Can you tell me about the patients that you see and what your schedule is like with them? |
| Twila: | We actually started our health coach program this past fall and actually spent the first part getting the foundation laid. I’ve been coaching patients for the last 6 weeks or so. Right now, we are targeting our diabetic patients and patients that have cardiac hypertension, depression as well as congestive heart failure and patients who are asking that a health coach be part of their care. We have 15 patients that are fully registered and are in progress. In May, we are having the State of Minnesota come out and hopefully we will become a certified healthcare home. |
| Julie: | How often do you get to see your patients? |
| Twila: | The initial appointment is about 1 hour face to face. That gives us the opportunity to get to know them and their preferences. We also review their health history. From there, the patients are variable. I have some patients who are wanting weekly contact. Mostly over the phone, but I have one patient who prefers face to face. I have half of them who are on an every other week who would like to have some extra accountability as they are starting their lifestyle changes. I have 1 or 2 that are wanting monthly contact via the phone or to be seen after their regular doctor visit. |
| Julie: | You mentioned you have about 15 patients who are in the program. How many patients are you hoping to see in the program in the future? |
| Twila: | We haven’t really set a real target number. It started out a little slow because people weren’t really sure. We are doing some education. The State of Minnesota calls this service a Health Care Home so we get a lot of confusion with home health. We have been trying to do some extra education with staff to explain the difference and also some community education. The clinic nurses will also introduce us to patients and the physician will often do a warm handoff. The physician’s warm handoff has been our most successful way to recruit some of our patients. We are also located in the same building as our hospital. I had the discharge planner talk to the patients and so I have gone over to the hospital to do follow up. We have been so busy with the start-up and certification that I haven’t set a target goal. |
| Julie: | What have you seen in health coaching that excites you? |
| Twila: | The spark for me is watching them have their “aha” moments. When they realize that it doesn’t have to be a major thing. If they start slow and find that they can do what they set out to do. This is a motivator for me and them. It’s them engaging and realizing they can do things to help in their own care. |
| Julie: | How has the health coach training altered or changed the way you work with your patients? |
| Twila: | Realizing that each person’s circumstances are unique even though there may be some common themes. The thing I took away from training was Flex Care and being able to explain more towards the patients understanding rather then what I would prefer or what my style is. I have had a couple “aha” moments where I realized I have to change my approach. |
| Julie: | Can you think of a success story using this approach? |
| Twila: | This was cute. I had one patient that started 2 1/2 weeks ago and was on the fence, cancelled a couple times and finally decided to come in and talk. So we had our face to face and set up our care plan and I think I met with him at 10:00 a.m. He wanted me to make goals for him but I wasn’t willing to tell him what to do. So, finally after a period of time, he made a couple of goals and we were going to follow up the next time. About 2:30 p.m. that afternoon he called as said, “I just called to tell you that I made it around the block one time without stopping. Goal one met!” I just laughed. |
| Julie: | How are you equipping your clinic to play a role in the world of population health? |
| Twila: | We are starting to go in this direction. When I trained last April, there were two of us. Since then, she had decided to leave which just left me. At that point, I was also the nurse manager, so we spent some time talking with administration and our health care board showing them the statistics of our own patient population through our Minnesota community measurements. We showed them that if we look at building this health coach service, it will be self-sustaining and it can improve our patient outcomes. So we had backing from our health care board to go ahead and hire someone, which in the end ended up being me. We hired another nurse manager that took management, so now I’m just focusing more on building the health coaching. As soon as we hit a certain point, we will hire another coach. |
| Julie: | How are you tracking and measuring results? |
| Twila: | We are starting small. Since we only have 15. Most of our diabetics come in every 3 months or 6 months for follow up A1C’s. We will be looking at whether the patient is engaged or not engaged. What is their lab work showing? We will be reflective in our Minnesota community measurements which are transparent to everyone online as far as our optimal care for our diabetics, hypertension, etc. We will be looking further into other measurements techniques. We do have registries and databanks within our electronic medical system, where I can go in as a health coach and run reports. |
| Julie: | It’s nice that you have a small base of 15 to work with right now. |
| Twila: | The 15 that we do have are a nice mix because a lot of them are open transparent, so they are providing feedback as we go because they know it’s a new program. It’s nice to have some honesty from the patients as well. They are coaching me along the way too on what works and what doesn’t. |
| Julie: | Can you share a couple of important skills that you developed as a result of your training? |
| Twila: | The Flex Care was the biggest piece for me. I came from a mental health background, so the motivational interviewing has been a big thing. It’s not what I want a patient to do, it’s what they want for themselves and how can I come along side you and support you. Using the ruler was also a lightbulb moment for patients. It’s been interesting to hear their numbers and then we adjust and target what they are more motivated to do. I want them to start out and have success. I don’t want them to pick out so big of a goal that they can’t accomplish anything and then they get frustrated and don’t want to do anything. |
| Julie: | Sounds like you are having some great successes. Can you share some advice for someone just entering the field with their new health coaching skills? |
| Twila: | Keep an open mind to how you are wanting to do things. You need to have some structure for what you are wanting to do, but the key thing for me is being able to adapt according to that individual and who they are. I think that is where you are going to get the most bang for your buck. You need to be able to look at it from their perspective and take off the nurse hat. We still need to be health care professionals, but you still need to look at it from the patient perspective. A lot of times the patients don’t feel comfortable asking their providers questions because they don’t want to feel stupid. We can’t make assumptions for what the patient knows or doesn’t know. Allowing them the opportunity, with some open ended questions, when you are first meeting them to get an idea of where they are currently at with their understanding and what motivates them as well. A lot of patients know what WE want to hear, but they may not be motivated themselves for that. Also, I would suggest networking with other individuals that have had health coaching. Sometimes, they can offer tips or insights on how they have done things. |
| Julie: | Do you have another success story? |
| Twila: | One of my other success stories was with a female diabetic who has had diabetes for a long time. When we first met, she had never taken her own blood sugar. She grew up with a mom that was diabetic and she herself is in her 60’s now. She said she vividly remembers her mom taking out her insulin and checking her blood sugars. She was needle phobic. So, we met the first week and we talked about it. I brought in some of the new needles and glucometers and showed her how tiny they were. We started out by setting a goal for her the first week to go pick up a glucometer. The next week, she came back in and I used one of our clinic glucometers to test myself as she was testing herself. By the end, she said that wasn’t hard or scary at all. So now, she’s taking her own blood sugars. She thanked me for taking the time to sit with her. She knew the way she was thinking probably wasn’t rational, but she was scared. Taking the time to sit with her and actually test with her and uncover her feelings was very helpful to her. |