Applications & Limitations of Traditional Coaching Approaches in Health Care

Health coaching appeals to many health care professionals because it puts the focus squarely on the patient. This is different from the traditional medical model in which health care professionals who “know best” define the agenda, terms, and the goals of care. Many clinicians assume patients who neglect their health or are nonadherent, “don’t see (are in denial or lack insight), don’t know, don’t know how, or don’t care.”4 Based on these assumptions, health care professionals often rely on teaching, instructing, directing and advising patients to support behavior change. However, for less motivated patients, traditional health education approaches are generally ineffective and may lead to negative clinical outcomes.5,6 This is not surprising considering that patients are often less concerned with their medical condition(s), than the daily problems that these medical conditions cause or the threats that medical conditions pose to important life goals or activities.

In most encounters between clinicians and patients, patient goals and motivational issues are not identified or addressed. And while the popular health coaching models and approaches based on the life coaching model represent an appealing alternative to traditional medical approaches, they are incomplete.

Health care professionals are bound by specific ethical and practice standards, as well as accountability requirements, beyond what is required in traditional business or life coaching setting. Those standards are summarized below:

Applications & Limitations of Traditional Coaching Standards
Ethical Standards	Clinicians are held to a higher level of ethics than professionals in business and many other non health care settings. These standards, some of which are codified in legal statute, are necessary because clinicians frequently serve individuals who are vulnerable due to medical, cognitive or psychological conditions. Health coaching must fit these specific ethical guidelines.
Evidence-Based Practice	Most health care professional practice guidelines and standards include the imperative that services be evidence-based. These guidelines are derived from peer-reviewed research studies and expert consensus. Unless health coaching can demonstrate that interventions and programs are evidence-based, the impact and value of health coaching services will be suboptimal.
Training and Competency Development	It would be difficult to train clinicians in the types of informal or intuitive practice models used in traditional coaching settings. Evidence-based health coaching competency models must be used to define the critical competencies necessary to deliver best results. And advanced learning curriculums, methods and modalities must be used to develop these new competencies.
Accountability for Results	Today health care purchasers expect measurable value from health care providers and organizations. To succeed in the new health care environment, clinicians must transition from a focus that emphasizes production (time spent doing) to one that is concerned with effectiveness (results achieved). Evidence-based health coaching approaches are designed and validated to support effectiveness.
Reduction of Risk Across the Continuum	Traditional coaching models and approaches have been designed for individuals who are usually healthier, better engaged and often more motivated to change. Individuals at risk of, or affected by, chronic conditions are often among those who are the least engaged or prepared for change. Poor patient engagement continues to be a major barrier to population health improvement.
Shared Team and Program Practice Platform	Evidence-based health coaching provides the interdisciplinary care team with a common, more actionable health care improvement platform. A shared health coaching platform supports better alignment of activities and avoids the pitfall of health coaching becoming a loose collection of random self-help theories, approaches and interventions subject to individual interpretation.
Application of Evidence-Based Medical and Wellness Guidelines	Established guidelines exist for effective medical care, disease self-care, diet, physical activity and weight management. These guidelines must be the foundation for all wellness and health coaching services. If health coaches are unfamiliar with these guidelines, they will not be prepared to advocate for effective care or to guide patients in taking the steps necessary to improve their health.
Cultural Competence and Health Literacy	Non-majority populations are at increased risk of health care disparities. Health care services, communications, educational materials and outreach must be tailored to address unique health literacy, knowledge, and adherence gaps. Health coaches need to help patients identify goals, self-care, and lifestyle management plans consistent with their cultural and ethnic beliefs and preferences.

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