| Emily: | My name is Emily Barkley, and I have been a nurse for almost 10 years. I live in Salt Lake Tahoe, California and I am employed by Barton Health Care System for about 8 years now. I did a lot of work on the floor in the ICU and then started working 4-5 years ago in Early Transitions and Care Program. That settled me in to the line of work that I am in now which is Care Coordination and Chronic Disease Management. Barton Health started working with an ACO and I had received some guidance from them as they introduced me to the Clinical Health Coach® program. I have been in this role for a little over a year. We are all rural hospitals in our ACO and we all have similar populations to work with. I am kind of a one man band. There is nobody else at this facility that incorporates health coaching and chronic disease management. Sometimes it makes it challenging that I don’t really have anyone to bounce a lot of ideas off of or say, “How should I carry out chronic disease management?” |
| Amy: | Sounds like you are forging your own path. That could be daunting-but also exciting! |
| Emily: | It may sound cheesy but I have sincere belief and interest in coaching patients and helping them set their care pathways. |
| Amy: | How did you become interested in Clinical Health Coach training? |
| Emily: | About 5 years ago, our hospital started a Transitional Management Program, which I helped to implement. I became interested in how to address patients as far as understanding their level of comprehension of disease processes. Also, what happens when they are at home and what kind of behaviors do the patients have to help them to take care of themselves or prevent them from taking care of themselves. I realized I didn’t have the right ammunition or skill set to help me with that process. I always had interest in Motivational Interviewing, but never had been formally trained. I love acute care… it is so much fun. But I always felt like I was putting a band-aid on things and you have such a limited amount of time to educate patients, plus they’re sick and don’t always feel well enough to be open to letting you educate them. I realized there was a need for a continuum in care for these patients throughout our healthcare system. That was what got me interested in developing a formal skill-set in coaching. |
| Amy: | What Clinical Health Coach training did you participate in? |
| Emily: | I went through the online training program. I loved that it was self-paced! |
| Amy: | How have you implemented coaching in to your practice? |
| Emily: | There is always this huge window of opportunity to really capitalize on health coaching. Right now we are still in the early developing phases of all of this. The physicians have been great, but it has taken some time to get buy in. There is a shared care plan (for the patient) that I work off of and I share it with everybody else in the care team. I work outside of the physicians’ offices so they don’t see how I work with the patients all of the time. Although I have had several educational opportunities to share with them my role…the opportunity for collaboration is huge! My goal is to marry the coaching with the time the patients spends with the physician in the office. Much of the coaching I do (with chronic disease management) is done over the phone. The physicians have been making more referrals which is great! Everything I do is based off of the physician’s suggestions and guidance. The goals that the nutritionist’s set I will work off of as well. Sometimes with health coaching the goals that are set for the patient are as simple as just getting out of bed in the morning, brushing their teeth and getting dressed. |
| Amy: | You mentioned most of your coaching happens over the phone? We featured a recent webinar on our Clinical Health Coach Learning Community that addressed how to overcome the barriers of tele-phonic coaching that I think you would find really helpful. |
| Emily: | I would love that- thank you! |
| Amy: | How has your coaching resulted in behavior change with your patients? And perhaps you could share a success story? |
| Emily: | Absolutely! I worked with this one particular gentlemen as one of my first patients. He was a Vietnam War Veteran and was suffering from PTSD…years later he was in a happy marriage and then later lost his wife. He started drinking heavily and was injured resulting in a subdural hematoma. When I met him he was very depressed and was on a ton of medication for depression and anxiety. I worked with him (initially as an advocate) to connect him with specialists, create some common goals and reduce his medication to get him more engaged. I started with bi-weekly visits helping him with his medicine and working with the physician to get him on a plan. By January, he started becoming more engaged with his life and was off a lot of his medication. I was able to start coaching him more. He started being able to identify some of his own motivators in his life. We worked on behavioral goals: stop smoking, going for a walk, seeing family members on a regular basis and working on his hobbies. He started taking showers, putting his dentures in and making small (but huge) strides when I saw him. It was so neat to see that the coaching was working! However, after a while he started to hit a plateau. I had to have him re-visit where he had come from in a years’ time. I reached out to my coaching resources and colleagues that supported the fact that plateauing is normal. I reminded him to focus on what his motivator is; to wake up every morning. |
| Amy: | It sounds like he persevered once you pointed out something very simple. The plateau was expected and he couldn’t let it push him backwards. |
| Emily: | He attributed a lot of his success to me. That was kind of a slippery slope…I didn’t want him to get too dependent on me. I would try to show him that his successes were attributed to himself- not to me. |
| Amy: | What advice might you have for someone who is just beginning their journey in health coaching? |
| Emily: | I would say “real time” practice with patients and co-workers is key. Also, to visit the material (CHC training material) every once in a while, then take a break from it. Establish your own style, see what works with the patients. Then re-visit the material and see how your style works within the guidance of the training. It comes off more genuine with the patient and you have this really nice frame work in the back of your mind when you’re with your patients. I am more comfortable in my role now with the more patients I have worked with and the practice I have had. This training has changed how I address so many people and situations in my life differently and effectively. Even with my own son. |
| Amy: | Tell me how that has worked to change that relationship? |
| Emily: | The generalized concept as a care giver and as a parent, your work is not to fix the child’s problem or the patients. Your job is to help them help themselves. I have realized it is my job to help them identify what it is within themselves to make them more successful. It’s the same with my patients. In particular, the Myers Briggs test helped me realize a lot of things. I used to take it personally when people didn’t respond to my style of care. I learned it wasn’t me, but who they are. I learned to change the way I approach them. |
| Amy: | You have taught me a lot today. Thanks for visiting with me. |
| Emily: | Thank you! I truly loved the training so much! |
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