Interview: Joan Parker, RN, BSN, Ambulatory Clinic Coordinator, Health Coach
| Amy: | Hello Joan, please tell us a bit about yourself and your current position. |
| Joan: | I am a registered nurse and health coach. I work at Cornerstone Family Practice located in Guttenberg, Iowa (population 1,840). We are a department of the Guttenberg Municipal Hospital and I have worked here for 30 years. My department works on doing a lot of collaboration and care with our patients. I went through the Clinical Health Coach® Training Online (CHCTO) in 2015, so I have been health coaching for 3 years now. I first got involved with the CHC program because the organization I work for could see the wave of the future was not going to continue as “fee for service”, but it was going to be directed at quality of care and what we can provide for our patients – helping them get on board with their health for better understanding of their disease processes. Also, we were looking for ways to encourage them, find their motivation and really help them plan their health, with them leading their own health charge. |
| Amy: | How did your leadership work to support that decision? |
| Joan: | Dr. Andrew Smith was our Medical Director, and he started looking at this approach. We knew that health coaching was going to be a new, upcoming and inspiring type of education. It was my responsibility to beef up the program and start working with patients, specific chronic disease processes and best practices. We first looked at the guidelines through the American Heart Association and the American Diabetes Association. We needed to implement the guidelines and best practices for our patients and needed to get them more involved in understanding their disease process and healthcare choices We devised a “Reducing Readmission Pit Team,” because the hospital looked at Medicare’s future. We knew that Medicare wasn’t going to reimburse us for readmission and that it would be detrimental to patients. I was part of that pit team, also included were people from the care centers, assisted living, visiting nurses, pharmacists, and a person from the quality department. We explored how to avoid readmission for these chronic conditions. When patients were discharged from the hospital, they faced a lot of barriers that were preventing them from successfully managing their condition at home. Our team came up with several ideas. “ Zones” were developed for each chronic condition as well as recommendations to guide patients in daily activities to maintain good, healthy behaviors. We created infographics so that the patients could easily visualize (it looked like a stop light) and understand what they should be doing to feel good. As an example, a green zone indicated that symptoms were under control, patients were taking their medication and feeling good. The yellow zone was a caution area- perhaps their symptoms were changing and this is when we wanted them to contact us. The red zone listed symptoms that meant patients were most likely needing an immediate trip to the ER or hospitalization (readmission). This is what we were working to avoid. As coaches, we talk about these zones to patients every day, multiple times a day, to enforce the importance and understanding of these zones. This was getting the patients engaged in their own health, their own body, and their own symptoms. |
| Amy: | Have you collected data to see how this program is playing forward? |
| Joan: | Yes! We have collected data and have seen our number of readmissions decrease. From 2013-2016 we reduced our same diagnosis admissions from a 2.2 % to a .3 % and our all cause readmission rate from a 5.6 % to a .94 %. |
| Amy: | Those are remarkable results! How did your coaching come in to play with the roll out of this program? |
| Joan: | It really helps to understand many of the coaching aspects- that it’s not “me” that has to make the difference, it is the patient! We coach them to make it “theirs”. The more I push on them the more they resist. I would turn it around and say, “So, you have this disease process, how do you think we can help you manage that? What’s important to you? How can you manage it day-to-day?” Health coaching has been an eye opener with a lot of my patients because they didn’t think they had the power to make those decisions. So many times they were used to the physician giving them the direction and they would just have to go along with it – knowing that it was the right thing to do. Now, it’s changed. If a person comes in and says, “I don’t want to have that x-ray- can I try this first?” We are empowering the patient to help make their health related decisions and to have more accountability. |
| Amy: | What was one aspect that you pulled from the Clinical Health Coach training that you have most utilized? |
| Joan: | Definitely, the hardest thing for me was sitting back and listening. As nurses we are trained to be educators. In the training, we were taught to put on a different hat. It taught me the importance of listening to the patients more because they would put more trust in me. This eventually helped the patients form their own goals. It is so important that you strive to be that person that they trust and can go to. I had a young lady in the office one day, she was having trouble affording the medications she needed and was struggling with depression. She confided that she had 3 young kids and didn’t ever have any time to herself for respite. She had primary responsibility and day-to-day it was extremely challenging. I worked with her to set goals that were realistic with her everyday life- trying to take some time for herself. After a few short weeks, the physician and I noted that her mood had lifted, she was more engaged, more productive and overall a much happier mom. We worked diligently together and found a way for her to help herself. Since our community is very rural- we often times have to be very creative in helping these patients (mental health) get the help/ support they need. |
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