Research Paper By Cate Baio
(Transformational Coach, CANADA)
Using Coaching to Create an Exceptional Patient Experience
I am about to reveal to you one of my dark secrets. I am one of those people who leaves the office of the TCM, Naturopath, Chiropractor, Physio (you name the health practitioner), with loads of info, exercises, diets and suggestions, just to let them pile up in my office (potentially) never to be seen again. I often feel embarrassed, dare I say shameful, to return to my next appointment only to report that I didn’t follow through with what will ultimately lead to healing my body. I have even resorted to cancelling an appointment or two because of this and I am guessing that I am not alone.
It occurred to me at a recent appointment, that although I could coach myself between appointments in order to find the motivation to commit to my suggested tasks (I could even hire a coach to support me in following through), what if I left my appointments feeling that I partnered with my practitioner in finding out what would work best for me and choosing what I felt I could accomplish? I imagine feeling motivated, empowered and more likely to hold myself accountable. The result: I would actually be taking steps to improve my health versus paying lip service to it. How powerful.
By understanding the coaching process, I believe that health practitioners may be able to incorporate tools that will empower their patients and motivate them to create the change that they seek.
Part One- What is Coaching?
Before we dive into how you could use a coach approach, let’s get a clear picture of what coaching entails. Coaching is a client-led process where the coach has a deep belief that the client holds the key to unlock their potential. Coaches are there to shine light on the lock so that the client can get the key in the lock with more efficiency and clarity. Although there are many different coaches out there with many different niches, there is a general framework that is followed in order to help clients get results. This framework includes four main competencies outlined by the International Coaching Federation: Setting the Foundation, Co-creating the Relationship, Communicating Effectively, and Facilitating Learning and Results.
Setting the Foundation
The client-coach relationship starts with establishing a strong foundation. It is important that both the coach and client have a clear understanding of the structure of the relationship. Expectations of both parties are outlined in a coaching agreement or contract. This is also the time that the coach ensures that the client has an understanding of the professional conduct of the coach, and sometimes shares the International Coaching Foundation’s Code of Ethics with the client.
Co-creating the Relationship
Next, it is important for the coach to build a trusting relationship with the client. It is through the coach’s honesty and integrity that they create a presence which can facilitate a powerful place of change for the client. They show the client that they can be trusted by being true to their word, showing understanding and empathy for the clients’ perspective and learning style, and they ask for permission to explore sensitive topics with the client so that the client always feel that they are in the driver’s seat.
Coaches use intuition and follow their ‘gut’ when they sense something may be out of alignment for the client. They demonstrate confidence in both themselves and the client as they investigate these new areas; are able to hold space for the client with a strong sense of self so that the client is able to safely explore areas that may invoke strong feelings or emotions.
The coach possesses many tools in order to communicate effectively with the client. They demonstrate a strong sense of presence and they actively listen to their client in order to help create awareness. Active listening includes noticing what the client is not saying, the tone of their voice and body language. It also includes showing the client that they are right there with them along the way; the coach uses eye contact, gestures or verbal acknowledgement that they hear the client. This is a place free of judgement which gives the client permission to unload in order to move on. Furthermore, the coach can re-frame what they heard in such a way as to create new insight and learning for the client.
The coach also asks powerful questions to help move the client forward. The questions are open-ended and reflect an understanding of the clients’ perspective. They assist the client in finding insight, clarity and possibility. They challenge the clients limiting beliefs in order to create new awareness on how to best support themselves.
Direct communication is the last aspect of communicating effectively in the coaching relationship. From the start, the coach will ensure that the agenda is not only the client’s but it is clear to both what the client wants to achieve. The coach uses respectful language that is appropriate to the client, and speaks in a succinct, articulate way when giving feedback or reflection. They ask permission to use certain tools or exercises and explain them before using with clients. They can also use analogy and metaphor to provide even more clarity.
Facilitating Learning and Results
Lastly, the coach brings all of these aspects together so that the client can get results! Coaches identify and highlight the clients strengths, they assist the client in identifying patterns and separating the ‘big stuff’ from the ‘small stuff’. They challenge perceptions and help the client to create new thoughts and beliefs that will serve them; they share insights in a meaningful way so as to further move the client towards their goal.
The coach then helps the client to use these new discoveries, ideas, and thoughts to create specific action steps. The coach may share ideas and thoughts that are in alignment with the client’s goals or even brainstorm with the client as to how to get results. The coach is always honoring the client’s pace of learning and change and celebrates the client not only as they move forward, but acknowledges their potential for further growth, as well.
In assisting the client to create a plan, the coach helps to ensure that it is attainable, measurable, and has specific time targets. They help the client to explore all the possible resources and support available so that the client has everything that they need to succeed. They are understanding and flexible and go with the flow of the client’s journey and help to adjust plans and goals as the client changes. The coach also encourages the client to find ways to identify and acknowledge steps along the way that indicate that they are on the road to success.
The final part of facilitating learning and results for the client includes holding the client accountable and assisting in managing their progress. The coach ties in the clients’ discoveries from previous sessions to help solidify new patterns and learning. They acknowledge the progress the client makes in between sessions, as well as, confronts them in a positive way when action items they have committed to were not completed. The coach maintains the ‘big picture’ of where the client wants to go and uses this in the context of each session to continue to move the client forward. Reflection is a key tool that coaches use to help the client bring awareness to the affects that these changes have on their life; how to repeat what is working and acknowledge what the client has done to create the change and how to tweak what isn’t. By focusing on the clients’ plans, commitments and outcomes, the coach can support the client in reaching their goal.
When the client/coach relationship is created with mutual respect and trust, the client feels safe to explore and discover what is holding them back from fulfilling their potential. With support and encouragement, the coach invokes courage within the client to start to move in the direction that they have always wanted to go. The coach acknowledges and celebrates these new changes and helps the client ensure that they have what they need to sustain this new way of being. It is an empowering process in which the client does the work. They discover what needs to be done, choose the best way to get themselves there, decide what behaviors that are working for them, and what needs to be tweaked in order to increase their success! Amazing.
Part Two- How could coaching improve the practitioner/patient relationship?
So how can a ‘coach approach’ bring value to what you have to offer your patients? Well, let me take you on an imaginary journey of what an amazing experience would look like to me…
I hear that there is a new health practitioner in town. She is getting rave reviews and I notice change in my friends who have used her services. I’m intrigued. I book an appointment. I was given the option to print off intake forms, fill them out at my leisure and bring them with me to the appointment or arrive 15 minutes early to fill them out. I loved the option of sitting with a cup of tea to fill them out. Not rushed, thoughtful. I chose option A.
As I sit reviewing my forms, I notice some questions I have never seen before on a health history form. They really got me thinking.
- What does perfect health look and feel like for you?
- On a scale from 1-10 (10 being perfect health), how close are you to that vision?
- What do you think would move you closer to a 10?
- What do you expect to receive from our work together?
- How do you hope to feel at the end of your treatment today?
- How much time are you willing to dedicate to improving your health per week? Per day?
Interesting. Good questions. I answer them as thoughtfully as I can and realize it was good to reflect on what I feel could move me forward and become aware of what I expect out of my treatments. I take a quick look at my schedule and figure out how much time I could dedicate to improving my health and I am guessing about 1/2 hr per day. Great. Let’s get started!
I arrive at my appointment and my practitioner looks over my information. She takes a little time to tell me about herself and how she came to her practice. Wow, I can really sense her passion. She gives me an opportunity to ask any questions I have of her and also to clear up any expectations I have of her services or of myself that may be unrealistic. I am really getting the sense I am in thoughtful hands…
We dig into our session and she gives me an examination to assess where I am at while asking me some more questions. I notice when I tell her what I am doing (and not doing), she asks me how that makes me feel, being sure to highlight any differences between the two. She also asks clarifying questions and digs a little deeper by asking, “tell me more about…”. I can tell that she is really listening and picking up on some key words I am using.
She completes her assessment and comes up with some strategies that would help me move forward. Before she gives me her advice, she refers to my questionnaire and asks, “on a scale from one to 10, how likely are you to spend 30 min/day on this particular problem?” I laugh. “Um, 2?”
“Ok! What’s the magic number that would bring you to a 10?”
“5 min. But what can I do in 5 min?”
“You’d be surprised! I am going to show you several exercises and I want you to pick two that you could commit to doing. How does that sound?”
She laughs. She shows me some exercise and I pick the the two that (to be honest) look the easiest. She asks again if I am willing to commit to those two exercises from now to our next appointment. I’m in! She also asks if I would like any more information about the issue I am facing. “Sure”, I say (with the devil on my shoulder chuckling away, knowing full well that the reading material will sit around for days before getting thrown out). BUT, then she asks if I am more likely to listen to, read or watch something. OH! Easy. Watch. She gives me a list of you tube videos and other internet resources that helps explain what I am dealing with and ways to help. So cool! I can’t wait to look these up!
As we wrap up, she circles back on her original questions as a check in. She asks me if I feel my exercises will help me move closer toward the vision I have of my self in perfect health. YES! Then she asks, “In what way?” As I giver her my answer I realize this is helping it sink in that if I do these exercises, they will increase my mobility which will get me closer to my end goal. Neat. Then she asks if there is anything I can think of that would stop me from doing my exercises. I list a few. She asks what I need to do to ensure that these things won’t become barriers and I come up with some solutions. Her response, “GREAT! I can really hear how important this is to you and I acknowledge your creative solutions on ensuring that you follow through with these exercises. Is it ok with you if I check in next time to see how they went?” Totally. Lastly, she asks if my expectation of today’s appointment was fulfilled. YES! I feel like I can really do this!
I leave my appointment feeling empowered. I am confident that I can not only do my exercises but that if something stands in my way, I am prepared to deal with it. Pretty amazing. We book our next session and I’m off!
In this example, the practitioner uses some coaching tools to help empower the client. First, she finds out what the client’s expectations are and makes sure that they are both clear on what to expect out of the session(s). She also takes some time to let the client get to know her a little bit and vice versa, establishing trust.
As the session continues, she really takes the time to listen to the client. She doesn’t interrupt and she leaves space after the client has finished speaking before she jumps in in case the client has something to add (which they often do!). She provided the client with choice; not only did she ensure that the client is committing to a realistic amount of time to dedicate to her exercises, the client has made the choice as to which exercise would work best for her. She also asks the client powerful questions both before and during the session in order for the client to dig deeper, learn a little bit about herself, and recognize what she can do to facilitate her success. Overall, the client leaves feeling motivated to use the tools provided by her practitioner.
Part Three- Tools for Success
Now that you have had a glimpse of what a practitioner/patient consultation could look like, here are some specific tools you can use to help you get there.
In 15 minutes or less, you can establish a trusting relationship with a patient. By taking a few minutes to tell your story and taking the time to allow your patient to ask you any questions that they may have, you are giving them the space to get comfortable with you. This is also the time to let your patients know what they can expect from you and your treatments as well as discovering what their expectations are. It can be eye opening to know what they expect from you. By being on the same page you can move forward together with clarity knowing that you are in this together for the same purpose.