Transcript www.camdenhealth.org

C-O-A-C-H
C-O-A-C-H
Connect tasks with vision and priorities
Observe normal routine
Assume a coaching style
Check backwards plan
Highlight progress with data (“I can”)
KEY POINT
Patients need us to assume
different coaching styles
depending on the situation, and
the patient’s level of
independence
ASSUME A COACHING STYLE
THE “I DO” PATIENT
▪ After multiple open
ended questions,
patient is unable to
name a first step to the
task
▪ Patient is in a fragile
state with limited or no
support system
▪ The task involves a
highly bureaucratic
system
Model the skill
while the
patient watches
“I DO” EXAMPLE
You are at a patient’s home with the intention of making a cardiology appointment.
When you sit down by the phone, the patient states she lost the cardiologist’s phone
number, and she doesn’t have the internet at home. Then, the following dialogue takes
place:
CHW: “What would you normally do in this kind of a situation?”
Patient: “ I just wouldn’t make the appointment, or I’d have to wait until I
went to another doctor’s office and ask them for the number.”
CHW: “In the past, it’s worked for you to use other people to get the
information you need. Can you think of anyone we could call right now
that would have the cardiologist’s phone number?”
Patient: “No. All my neighbors go to Cooper for cardiology, and I go to
Lourdes.”
Please take out the pink “I
DO” (purple sticker in
corner)scenario strips.
Please list examples on the
right and non-examples on
the left
You are at a patient’s home with the intention of making a
cardiology appointment. When you sit down by the phone, the
patient states she lost the cardiologist’s phone number, and
she doesn’t have the internet at home. Then, the following
dialogue takes place:
HC: “What would you normally do in this kind of a situation?”
Patient: “ I just wouldn’t make the appointment, or I’d have to
wait until I went to another doctor’s office and ask them for the
number.”
HC: “In the past, it’s worked for you to use other people to get
the information you need. Can you think of anyone we could
call right now that would have the cardiologist’s phone
number?”
RESPONDING
TO “I DO” SITUATIONS
▪ Losing things is a fact of life. Let’s look at this stack of business cards you have and see if
Example
there’s anyone we can reach out to that would have your cardiologist’s phone number.”
▪ “On all of your medication bottles, your pharmacist’s number is listed. I bet he can help. Let’s
call him.” You make the call on speaker phone while the patient listens.
▪ Stop by, or call the pharmacist afterward and state that you are coaching X patient to selfadvocacy. Ask if he/she would mind being a permanent resource to call for help if the patient
gets stuck managing an aspect of her health.
Non-Example
▪ Take out your IPAD. Google the cardiologist’s phone number. Write the number down and
hand it to the patient.
▪ Once you get the cardiologist’s number say, “Great. Now that we have the number, you can
take it from here. I’ll follow up with you next week to see how it went.”
▪ Without asking ANY open ended questions, pick up the phone and call the patient’s PCP
while the patient watches.
▪ Make a judgment statement like, “You really should be more careful with important
information like that.”
▪ First, create an organization system so that the patient never loses information again.
“I DO” EXAMPLE
Ms. Smith has liver failure, and has been readmitted 3 times since she first joined the
patient panel. She lives in an apartment with her daughter. You are not sure the cause,
but the relationship is very strained, and the daughter is resistant to helping her
mother. You are in the hospital with her and she hands you 5 follow-up appointments
she needs made. She asks you to make them for her. How do you proceed?
RECALL ‘I DO’ CRITERIA
• After multiple open ended questions, patient is unable to name a first step to
the task
• Patient is in a fragile state with limited or no support system
• Task involves a highly bureaucratic system
Ms. Smith has liver failure, and has been readmitted 3 times
since she first joined the patient panel. She lives in an
apartment with her daughter. You are not sure the cause, but
the relationship is very strained, and the daughter is resistant
to helping her mother. You are in the hospital with her and
she hands you 5 follow-up appointments she needs made.
She asks you to make them for her. How do you proceed?
Take out the pink “I DO” scenario
strips. Please list examples on the
right and non-examples on the
left.
RESPONDING TO “I DO” SITUATIONS
Example
▪ “Ok. I’ll call while I’m here with you. I am always happy to help with whatever you need, but I want
to make sure you have a long term support in place after I leave to help you. Do you feel
comfortable if I brainstorm with your daughter? ”
▪ Update the patient’s care plan to note that outside supports will be necessary to get to “you do”
before the intervention is finished.
▪ If the patient agrees, propose a meeting with patient's daughter to discuss care options
Non-Example
▪ Wait until you’re back in the office to make all of the appointments. Write them all down, and give
them to the patient the next time you see her.
▪ Make a judgment statement like, “You really need to learn to do this for yourself. I am not always
going to be here.”
▪ Close your body language
▪ Check your watch
THE “WE DO” PATIENT
▪Patient starts the
task, but gets stuck at
an intermediary step,
and can’t finish
▪Patient has a system
in place, but it’s
ultimately ineffective
• Do the skill together, while
filling in the gaps when the
patient gets stuck
“WE DO” EXAMPLE
You are at Jose’s home on a Monday afternoon. Almost immediately
when you walk in the door, he tells you he is sure he has a podiatry
appointment this week, but can’t remember the date or time. You
watch him call the podiatrist’s office, but as soon as he is placed on
hold, he becomes very agitated and hangs up the phone. He says, “I
can’t stand it when they put me on hold like that. I’m not going to
that appointment.”
Take out the orange “WE DO” scenario
strips. Please list examples on the
right and non-examples on the left.
RESPONDING
TO “WE DO”
Examples
▪ “In the hospital, you said
that you wanted
to be the kind
of dad that
runs around with your kids,
Don’t
expect
Jose
will
SITUATIONS
and isn’t sick all the time. I know healing your foot wound is important to you so you can be
make it through the entire
skill in one home visit!
More often then not, “we
do” takes MULTIPLE visits
of active prompting before
the patient achieves ‘you
Non-Examples
do’
▪ Call back on speakerphone, and make the appointment while the patient listens.
the kind of dad you want. Why don’t you call back on speaker phone and I’ll sit here with you
while you’re on hold?”
▪ During the hold, when the patient becomes agitated, you’re going to actively prompt him with
techniques:
▪ “Healing your foot wound is important to you. Take deep breaths with me. Don’t hang
up.”
▪ Turn the phone on speaker. Ask the patient if he would like to watch some TV while you
wait in order to make the experience less frustrating.
▪ When finished successfully, ask: “What worked for you this time? What could you use in the
future to stay on the phone during holds?”
▪ Schedule multiple practice sessions of waiting on hold before graduation to make sure the
patient achieves ‘you do’ for this skill
▪ Instruct the patient to call the podiatrist back without reorienting to his vision/priorities
THE “YOU DO” PATIENT
▪Patient consistently
completes the task,
but lacks confidence • Allow the patient to lead on
problem solving & completing the
and requires
skill
reinforcement
• Support and acknowledge
strengths
“YOU DO” EXAMPLE
Bernard calls you after he takes his insulin out of the
refrigerator. He tells you the name of the insulin, and
describes that it’s usually clear, but now he sees “little
floaty things in it.”
LPN: “You are really paying attention to your medication! Who
would you call next if I didn’t pick up the phone?”
Bernard: “Well, I guess I could walk to the pharmacy. It’s only a
block away. I could show them the bottle.”
Bernard calls you after he takes his insulin out of the
refrigerator. He tells you the name of the insulin, and describes
that it’s usually clear, but now he sees “little floaty things in it.”
LPN: “You are really paying attention to your medication! Who
would you call next if I didn’t pick up the phone?”
Bernard: “Well, I guess I could walk to the pharmacy. It’s only a
block away. I could show them the bottle.”
Take out the yellow “YOU DO” scenario
strips. Please list examples on the right and
non-examples on the left.
RESPONDING TO “YOU DO”
SITUATIONS
Example
▪ “That’s a great idea. Please give me a call back after you visit the
pharmacy to let me know how it goes.”
Non-Example
▪ “Hold on, let me ask one of our nurses. There are three sitting right
here.”
▪ “Great idea. Good luck, Bernard. You’re doing great. See you next
week.”
EXAMPLES
Get your paddles ready!
1) One of your patients is a diabetic who is also an
amputee. She needs to arrange transportation to get to
one of her appointments. When you ask her how she’s
arranged appointments in the past, she doesn’t
remember. After re-framing the question a few times, the
patient is still unable to provide an answer. How do you
proceed?
A)“I can help you. I'll call logisticare
and put the phone on speaker so
you can become familiar with the process and the information that's
needed to make the reservation.”
I DO
B) “It sounds like arranging transportation is something you haven't
done in awhile and you might need some help. Here is the number for
logisticare. You can call and put the phone on speaker. If you get
stuck I will be here to answer any questions you may have.”
C)” It sounds like you've probably arranged transportation in the past.
Here is the number for logisticare. I'll call you tomorrow to make sure
you've made the reservation?”
2) One of your patients who suffers from severe anxiety wants to
apply for assistance to help pay her utilities. She needs to apply
in-person at a office and bring the necessary documentation.
When you review the process with her at a home visit, she says
that she understands and has all the necessary paperwork, but
she is worried about driving on busy roads to a new place. The
patient does have access to a vehicle. She asks you for help. How
do you proceed?
A)“It sounds like you have all of your paperwork together, but you are
worried about driving to a new place. Let's talk about the route you'll take
to get there and I can call you tomorrow to see how it goes. “
WE DO
B) “It sounds like you have all of your documentation together, but you are
worried about driving to a new place. I can drive to the office and you can
follow me so that you won't have to worry about directions.”
C)“It sounds driving to a new place will be a challenge for you. I'll call a cab
for you and meet you at the office.”
3) You are working with a patient who is unable to read
and therefore has a lot of trouble managing her pillbox.
She is HIV positive so it is very important for her to take
several medications daily. When you visit her at home,
the patient admits that she hasn’t been taking her
medication. When you ask her how she’s remembered
to take medicine in the past, she is unable to provide an
answer.
Howmedication
do youon
proceed?
A)“It sounds like you've
taken your
time in the past and are
comfortable with contacting your pharmacist. Do you have any questions before
you make the call? I can follow up with you tomorrow to see how the phone call
goes.? “
I DO
B)”It sounds like you are familiar with taking your medication. Why don't you
contact your pharmacist while I'm here and put the phone on speaker. I can help
you if you have any questions.”
C) “It sounds like remembering to take your medication is challenge. I can help
you. I'll call your pharmacist and put the phone on speaker to see if we can come
4) One of your patients needs to pay their electric bill. You meet
them at the PSE&G office in Camden in the morning to help them
through the process, but it is extremely busy when you get there.
After talking with your patient, she says that she doesn’t feel like
waiting and will come back later in the afternoon after the rush is
over. Later that day, the patient calls you and says that she is
getting ready to leave to pay her bill. You review what she needs
and she has everything in order, but she asks if you can meet her
at the office. How do you proceed?
A) It sounds like going to the PSE&G office has been a
challenge/frustrating/etc. I can help you.”
YOU DO
B) “It sounds like you’re familiar with paying your bill at the PSE&G office, but
you might need some help. I can help you.”
C)“It seems like you have all your documentation in order. I think you will be
fine going yourself. I’ll give you a call later to see how it goes.”
5) You are working with a patient who gets several medications
delivered to her home monthly from Miguel’s pharmacy. At a
home visit (a few days before her medication is scheduled to
arrive), she states that she’ll be unable to afford her medication
this month because she needed to buy school supplies for her
son. She states that she wants to the ask the pharmacy if she can
pay a portion of her bill and pay the rest back later, but she’s
worried that Miguel will say no and she’ll be viewed as a poor
customer. How do you proceed?
A) “It sounds like paying for several medication has been a
challenge/frustrating/etc. I can help you.”
WE DO
B)“It sounds like you’re familiar with Miguel’s pharmacy but you might need
some help speaking to the staff. I can accompany you to the pharmacy and help
fill in any gaps that may come from the conversation.”
C)“It sounds like you’ve spoken to the staff at Miguel’s pharmacy before. Do you
have any questions about the process from last time?
6) One of your patients is enrolled in the MANNA food delivery
program and gets food delivered every Tuesday morning. Your
patient calls you on Tuesday afternoon saying that he missed his
food delivery because he was at a Dr.’s appointment and is
unsure what to do. When you ask the patient if he’s ever
contacted MANNA in the past, he says that he contacted them
recently about his change of address. How do you proceed?
YOU DO
A)“It sounds like you're familiar with contacting MANNA, but you might need
some help. I can help you. If you want to call MANNA while I'm here and put the
phone on speaker, I can help if you need me.”
B) ”You’ve contacted MANNA before. I think you will do fine calling yourself. Give
me a call when you’re finished”
C)“It sounds like contacting MANNA will be challenging for you. I can call for you
while I'm here..”
7) You are at a home visit with a patient and they explain to you
that they have run out of pain medication. When you last were at
a visit with this patient and their PCP two weeks ago, they were
prescribed a month’s supply. This patient has a history of opiate
addiction and IV drug use. However, they have been sober for a
few years. When you ask the patient about his pain levels, he
describes that his pain has been higher than normal which is why
he’s been taking more medication. You have noticed at previous
appointments that the patient will ask the doctor some questions
concerning things other than his previous addiction. He has said
to you, however, that he is worried that the doctor will think he’s
addicted again. He asks you for help. How do you proceed?
WE DO
8) One of your patients is primarily Spanish-speaking
and usually has her son translate for her at Dr.’s
appointments. She has an appointment coming up in a
couple of weeks, but she’s unsure of what to do since
her son will be away on vacation. When asked what
she’s done in the past if her son has been unavailable,
she says that her son has always gone with her. What
should you do?
I DO
9) You have been working with a patient for a
couple of months. Because of your coaching, he
is now able to navigate the prescription refill
process with ease every month. At the next home
visit, the patient tells you that his dog chewed all
of his medication bottles and his refills aren’t due
for another two weeks. How do you proceed?
WE DO
10) A patient you are working with has to fill out a new
patient packet for a specialty appointment since she’s
never been seen there before. At a home visit, the
patient says she hasn’t filled out the packet because it’s
too long and overwhelming. When you ask her how
she’s filled out forms like this is the past, she said that
her daughter normally fills in the places she gets stuck.
She asks for your help. What do you do?
WE DO
11) You have been working with a patient who suffers for
schizophrenia for several months. Due to his condition, you’ve
found that he often mistrusts the advice of others. You have
connected them with a local pharmacy that packs and delivers
pillboxes on a weekly basis. During a home visit, you notice that
the patient has taken a certain medication out of the box and put
them into a single slot. When you ask the patient why, he
responds by saying that those pills make him “too tired.” When
you discuss the possibility of discussing this side effect at his
next follow-up appointment, he implies that he doesn’t trust the
doctor and that he thinks he’s being overmedicated anyway. How
do you proceed?
I DO
12) You are working with a patient who is able to
schedule transportation for her medical
appointments. On the day of her appointment, the
patient calls you saying that her ride is late, and
she is unsure of what to do. How do you
proceed?
YOU DO
13) You are at a patient’s home discussing upcoming specialty
appointments. The patient doesn’t want to forget about scheduling the
appointment, so he calls to make the appointments while you are there.
While he’s on the phone, you can tell that he’s frustrated with being on
hold and also displays annoyance with the receptionist who is
attempting to schedule the appointment and ends up hanging up. The
patient asks you if you can make the appointments for him. How do you
proceed?
WE DO
14) You are working with a patient who has been prescribed an
anticoagulant and her PCP has ordered regular blood draws to
test the patient’s “blood thickness.” You know the patient hasn’t
gotten their blood drawn in a month, thus posing a health risk.
This patient has verbalized that she hates “getting stuck” every
week and she don’t see the point of the test. When you discuss
the situation further, the patient admits that the doctor never
explained the point of the test to her. When you ask the patient if
she would be comfortable asking the doctor about the purpose of
the test, she says she is afraid that the Dr. will be upset with her.
In the past, you have noticed that the patient completely shuts
down at PCP visits, and doesn’t ask her doctor any questions
during the visit. How do you proceed?
I DO
15) One of your patients needs to get blood work drawn
before one of her specialty appointments. A week
before her urology appointment, you ask the patient if
he’s gone to the lab and he says no. When you discuss
why he didn’t get his bloodwork done, he says that last
time he went, he got lost at the Cooper complex and the
blood work didn’t end up showing anything anyway.
When you reframe the question, he says that he
reiterates that getting lost at Cooper was really
frustrating. How do you proceed?
WE DO
16) A patient who suffers from pancreatitis has health
insurance, but it does not cover prescriptions.
Therefore, she cannot afford an expensive medication to
treat her pancreatitis. When asked if she’s had a
conversation with her doctor about prescription
assistance or if cheaper options are available, she says
that she’s doesn’t feel like her doctor listens to her and
she doesn’t want to bother him anyway since he always
seems so busy. When you re-frame the question, she
says that she “doesn’t want any favors.” How do you
proceed?
I DO
17) You are working with a diabetic patient who is also
socially isolated. When on a home visit, you discuss
diabetes self management classes as an opportunity for
her to learn more about her condition and interact with
others. She says she likes the idea, but she’s nervous
that she’ll be judged based on her bad habits. How do
you proceed?
WE DO
18) You are visiting a patient at home for the first time
and you learn that she has a lot of upcoming
appointments. When you ask how the patient keeps
tracks of appointments, she remarks that she keeps
them all in her head and admits that this isn’t a good
system. She asks for ideas as to how she can better
keep track of her appointments. How do you proceed?
WE DO
EXCEPTIONS: WHEN NOT TO COACH
You and a fellow staff member coach arrive at a Pedro’s
home. He says he is having chest pain, and appears very
distressed. He has a phone in his hand, and tells you he is
calling 9-1-1. You know that chest pain has resulted in many
ER visits for Pedro in the past. Often, when goes to the
emergency room, they do an entire work up, only to find that
he is experiencing acid reflux. Pedro is in the
“experimental” group for the Coalition’s randomized
controlled trial, and you know readmissions and ER visits
detract from the results. How should you proceed?
EXCEPTIONS: WHEN NOT TO COACH
Example
▪ “You are the expert of your body. I will wait with you until the ambulance gets here.”
▪ Immediately call the RN manager, and inform them of the situation
▪ Update the patient’s care plan to note that we need to work with him on recognizing
emergency symptoms vs. regular symptoms of his chronic disease
Non-Example
▪ “You told me you wanted to stay out of the hospital. Do you really
need to go to the ER?”
▪ “Before you call 9-1-1, let me call the nurse and see if she can talk to
you.”
EXAMPLES
Use the folders to separate the examples into
two piles (COACH or EXCEPTIONS)