Health Coaching –

Quality Framework

This Quality Framework seeks to inform the commissioning of high quality

training programmes aimed at developing coaching skills for health
professionals to support patient activation and self-management
Health Coaching has been defined as a patient-centred process that is based upon behaviour change
theory and is delivered by health professionals with diverse backgrounds [1]. There is increasing
interest in training health professionals in the conversational and behaviour change skills to support
health coaching conversations.

Why Health Coaching? indicates the benefits of health coaching programme? This quality framework
and related interventions, in bringing is a synthesis of available research and If reading online,
Good communication is the bedrock
about greater patient satisfaction and best practice findings from a number of simply click on the
to building trusted relationships and is
adherence, improved health behaviours health coaching programmes around underlined reference
therefore vital to realise person centred
and outcomes, as well as potentially the country. It aims to be of use to all numbers to be taken
care. With the inexorable rise of people
improving care cost efficiencies [4]. those seeking to commission health to the associated
living with long term conditions and a shift
Individual studies show improved health coaching training and development
towards proactive and preventive health paper or website.
outcomes when incorporating health programmes within their organisation or
systems, supporting patients to self-care is
coaching in the care of patients with a locality. It covers the training of healthcare
a priority for the National Health Service.
number of the most prevalent long term professionals to use conversational skills
For example, the Five Year Forward View
conditions (diabetes [5]; cardiovascular in their day to day work with patients,
emphasises the importance of doing more
disease [6]; and pain management such and can be seen as complementary
to ‘support people to manage their own
as in cancer or rheumatoid arthritis [7]); with numerous other self-management
health – staying healthy, making informed
in changing certain behaviours, including support programmes like care planning
choices of treatment, managing conditions
weight management, diet, nutrition and and personalised care budgets. It is not
and avoiding complications’ [2]. Providing
smoking cessation [8]; as well as having informed by, and therefore does not
training and support for staff in the use
benefits for staff in terms of improved cover, programmes involving the informal
of coaching skills is one way in which
morale, particularly with primary care workforce and the use of health coaching
this can be achieved and health coaching
workforce vulnerable to ‘burn out’ [9]. as a referral pathway, but there’s likely
has been identified as one of the five key
More information on this evidence is to be significant overlap which further
interventions by NHS England in their 2016
provided throughout this framework (in research could identify.
substantial self-care programme. Health
the ‘Examples’ column) and in a short
coaching can equip staff with additional
section at the end of the document.
conversational skills, techniques and
the mind-set to support and empower
patients toward their own goals and
aspirations [3]. However, communication A Health Coaching Quality
training and education for the workforce Framework For more details on
the background to this
in such approaches is variable, limited Given the relevance and growing
Framework, please see the
and even lacking for many staff groups. evidence base, what makes an bottom of this document
There is an emerging evidence base which effective health coaching development

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The framework is divided into the four following sections:

1. Programme Design
This concerns the background work on which a training
programme is based, including the curriculum design, the
identification of appropriate participants and the fit with other
self-management programmes and pathways

2. Programme Delivery
This concerns the practical aspects of delivery: the timing,
length and accessibility of sessions

3. Monitoring and Evaluation

This concerns the effectiveness of the training programme.
Has it achieved its aims?

4. Sustainability
This concerns the ongoing usefulness of coaching skills within
the health professional workforce and their embedding into the
‘culture’ of healthcare in a given area

To view a summary of this

framework, and a Delivery
Template which examines
how a coaching approach
to healthcare can be
supported across an area,
please [click here]

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1. Programme Design
Standard Strategies and Approaches Examples
The training is:

Evidence-based Design and content draws on previous Systematic data collection: A number of organisations have systematically
research and case studies of what works collected pre and post questionnaire data for all coaching training programmes
l Programmes
for healthcare professionals offered. This data is qualitative and consistent and
draw on available Providers have either a strong track record
tracks impact data over time
evidence with available evidence of successful past
delivery available to a reasonable standard Chance UK are participating in a Randomised Control Trial to assess the
l Programmes
(see example) and/or are drawing on an effectiveness of their mentoring programmes [10]
draw on patient
existing and empirically tested approach
experience to MECC (Making Every Contact Count) have drawn on behaviour change research to
inform design Patients are involved in the development design their interventions [11]
of training, their experiences and views are
Health Education East of England co-created training with The Performance Coach
directly integrated where relevant
on the basis of a review of international evidence related to health coaching [12]
Barts and the London School of Medicine and Dentistry have created a Patient
Forum where patient citizens attend medical students training to share perspectives
on how care should be delivered [13]. This idea could be extended to health
coaching training
The Evidence Centre’s rapid review of the empirical evidence for health coaching
found that training that includes a practical element (observation, role play) are
associated with positive outcomes [14]. The studies reviewed included the use
of audiotaped sessions with patients [15]

Integrated Clear objectives are set, with regards Identify objectives: The AQuA team in the North West of England support
to the intended outcomes for patients, teams embarking on shared-decision making activities [17], to identify the
l Training is
practitioners and the system, and these are changes they’re seeking to make, the associated levers, necessary learning
integrated into
linked to learning objectives and evaluation objectives and appropriate indicators to measure
the needs of local
systems and care Connections are made between local Aligning strategic objectives: The Health Education East of England Health
pathways [16] strategic objectives and likely outcomes Coaching programme [18] engaged leaders from all organisations across the
from training programmes to maximise region through identified co-ordinators, workshops and conferences to
leadership buy in determine how the health coaching training could align with and add value
to existing strategic objectives to maximise leadership buy-in and resulting
Local pathways are mapped to identify

4
Standard (cont.) Strategies and Approaches (cont.) Examples (cont.)
Integrated those audiences who would benefit most attendance and local capacity building
from the training
(continued) The REFOCUS programme was a 5 year research study which aimed to find
Introduction of organisation or service ways to increase the recovery support offered to service-users by community
changes are used as opportunities to train adult mental health services. As part of this, staff were trained in coaching
new colleagues together skills to support staff behaviour change with respect to understanding values
and treatment preferences of service users, assessing strengths and supporting
Supported patient self-management saves
goal striving. This was evaluated in an RCT in South London and Maudsley NHS
resources when training is targeted at
Trust and 2gether Partnership NHS Foundation Trust, and the wider use
appropriate staff members
of coaching was recommended in addition to a team based approach to support
recovery [19]
Multi-disciplinary: Ealing CCG are building in Coaching for Health training for
all members of their new Joint Care Teams, with ongoing Action Learning Sets to
aid reflection [20]
Integrated care sites: The integrated care agenda often requires holistic care
plans and person-centred conversations. Hence a number of new Pioneer and
Vanguard Sites [21] (for example in Tower Hamlets and Islington) are examining
these workforce development activities for new teams
New care pathways: Some 3000 practitioners in 26 communities have begun
to introduce the House of Care Model via the Year of Care Programme [22]
which achieves patient personalised care planning via actions such as goal setting
and action planning. Clinicians modify consultation times to fit patient need (20-
40 minutes), in cases of cardiovascular, chronic pulmonary obstructive, and older
patients with complex conditions. Health care teams are incentivised to make the
system changes through local payment systems
Existing care pathways: At Barnet, Enfield and Haringey Mental Health Trust,
coaching is being taught as a tool to staff working on the ‘Patient Enablement
Programme’ (in line with the Care Act and the national policy context)
Cost saving: Hampshire Hospitals NHS Foundation Trust UK designed a training
intervention to achieve ‘coaching conversations’ between patients and staff (the
Wessex Coaching Initiative) [23], and found more elderly patients returned home
with the same level of care as on admission (compared to the expected decline),

5
Standard (cont.) Strategies and Approaches (cont.) Examples (cont.)
Integrated and fewer required residential care placements on discharge
(continued) Totally Health provides a number of CCGs, GPs, Trusts and other providers with
tele-coaching services delivered by trained nurses to support patients’ long term
conditions management. They provide evidence of client ROI (e.g. cost-savings)
and positive patient outcomes (e.g. reduced hospital admissions), and cite
empirical studies of cost reductions resulting from other similar telephone-based
chronic disease management programmes [24]

Targeting the Audiences are prioritised based on: Voluntary: Many larger programmes, such as those run originally by the London
right people Deanery and consequently by HEE NCEL [25], and the Health Education East of
l Time and continuity working with
England training [26], have been made available to health professionals across all
l Training meets patients with long term conditions (LTCs)
settings on a voluntary basis because of the importance of willingness amongst
the needs of a l Willingness to get involved participants
defined group
l Time and space to practice and embed Teams: The Wessex coaching initiative used training by The Performance Coach
l Thought is given
the skills to maximise value for money as developed in the Health Education East of England model to train all staff on a
to the effective
Leaders are engaged (and ideally experience rehabilitation ward (“recovery coaching”)
engagement of
that group the training) to maximise the engagement Consultation length: Year of Care [27] implementation in Tower Hamlets
of others and help institutionalise / integrate invested in longer consultations to support person-centred conversations,
the approach resulting in higher satisfaction levels on the part of practitioners (as well as better
Training content is matched to the reality health outcomes for patients)
of health contexts for both patient and Flexibility: Health coaching courses run in areas of London have made coaching
clinician - this might include factors such as models flexible for use in limited time (e.g. from a few questions over 30
patient expectations, cultural considerations seconds, to 10-15 minute conversations) and also across multiple conversations
and clinician time constraints (e.g. using to support a deepening of patient engagement. The Bridges Shine project funded
coaching approaches when supporting by the Health Foundation adapted training to the reality of working in an acute
disempowered groups, when working cross- environment with patients with traumatic brain injury (TBI) [28]
culturally, or where language or other social
Criteria: Yorkshire and the Humber Leadership Academy [29] use the following
factors may be at issue)
criteria to select participants: congruent values, existing use of skills/approaches,
capacity, line manager support
Influence: The London Deanery coaching programme targeted GP trainers,
senior staff or practice nurses, Trust education leads and senior professionals (e.g.

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Standard (cont.) Strategies and Approaches (cont.) Examples (cont.)

Targeting the medical consultants or therapists) who have a regular teaching component in
right people their job plan and interest in education to maximise buy in [30]
(continued) Engaging leaders: Islington CCG sought leadership buy in for its Year of Care
training by engaging leading GP practitioners as trainers and champions [31].
Bridges Self Management have found it important that leaders are not only
engaged, but need to attend the training itself to be suitably engaged [32]
Trainees: Imperial College piloted a health coaching training and an ongoing
reflection programme for trainee doctors and nurses, using longer ‘home visit’
consultations
Qualifications: Where possible and useful, training contributes to qualifications
and continuing professional development (CPD)

Well structured A minimum of one and normally two International evidence of health coaching is that two days training is a minimum
days training is provided initially as part requirement to achieve a mind-set shift and necessary competencies
l Sufficient time
of the core offer (defined as immersive –
for an immersive A number of studies now indicate that short workshops may not enable
away from ‘day to day activities’) which is
experience healthcare professionals to achieve proficiency in health coaching and other
integrated with ongoing activities
behaviour change skills [33]
l Provides
The sessions are divided up to provide
participants Time: The Performance Coach [34], Osca [35] and other health coaching training
participants the opportunity to practice in
opportunities programmes are all two days in length, separated by one to two weeks to enable
between with reminders as appropriate
to practice the sufficient practice in between
techniques
Reflection: Bridges Self Management [36] encourage participants to complete a
case reflection, and to develop an individual and team action/sustainability plan
based on their learning

Ongoing The activity does not stop after the Examples of ongoing reflection and practice activities: The Performance Coach
training. Evidence and experience suggest [37], Osca [38] and other training providers run a range of ongoing activities,
l Opportunities to
that follow up is necessary for behaviour including online webinars, action learning sets, refresher courses, the opportunity
revisit skills are
change interventions in order to embed for buddying up of trainees and online support. Detailed course handbooks or
available
change. Appropriate reflection and ongoing other relevant reading materials are provided for course participants to support
l Follow up sessions training activities are provided, based on ongoing learning and reflection (see for example [39])
are offered the local setting and participant needs,

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Standard (cont.) Strategies and Approaches (cont.) Examples (cont.)
Ongoing and participants engage with them on an
ongoing basis
(continued)
These activities are supported by qualified
experts (including local assets) and are
ideally linked to monitoring activities

Maximising Target audiences are consulted to identify Examples of effective recruitment techniques include: keeping email messaging
attendance the most appropriate messaging and short and to the point; identifying those key individuals responsible for decisions
recruitment avenue prior to recruitment concerning workforce availability and seeking to understand and meet their
l By an effective
needs; engaging leaders (as mentioned elsewhere); establishing strong networks
use of a range Leaders and managers are engaged early on
and using representatives of different sectors to publicise the opportunity to their
of recruitment to maximise the outreach to colleagues
colleagues; using existing events to publicise and provide tasters where possible;
avenues
using word of mouth as the most effective technique of all. Multi-year health
l By engaging coaching programmes in London have used past participants to market the
leaders and activity to colleagues to build up teams using similar approaches for consistency
managers to and mutual-support
engage others
Tasters: North East London Foundation Trust uses tasters effectively to engage
l By targeting participants for longer trainings
approaches to
Accreditation: A number of programmes have sought accreditation from
appropriate
relevant health bodies to increase the appeal of their training courses
patient groups
who are likely
to benefit from
coaching

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2. Programme Delivery
Standard Strategies and Approaches Examples
The training is:

Well-planned Busy times of year are avoided for certain Timing: Certain courses avoided the winter period because of the challenge
audiences of vaccinations, school holidays should also be avoided, and whilst Quality and
l Consideration
Outcomes Frameworks (QOF) periods may be a challenging time for GPs to give
is given to time Long-lead times (minimum of six weeks) are
time to training, QOF periods may also represent an opportunity to take up
and availability of provided to maximise communications and
training, as the end of the financial year can be a time when budgets need to
audience enable participants to organise cover where
be spent
necessary
l Communication
Half-days: Co-Creating Health ADP (Advanced Development Programme) [40], for
is transparent, Reminders are provided to maximise ease for
example at the Whittington Hospital [41], run their courses over a series of half-days
timely and busy professionals
to make this easier for clinicians to attend
accurate
l Reminders are
issued and
followed up as
necessary

Practical Experiential learning is the foundation of Practice inspired: Many courses provide numerous opportunities for practice
all training, to be able to challenge existing and observation in any half day or single day course. This includes observing
l It provides
conceptions, and raise awareness of how demonstrations from trainers, and each other, as well as coaching and being
practical
important and difficult it can be to place the coached by them
demonstrations of
person at the centre of the conversation.
skills Up to date: Materials used in course design and distributed during courses and
This only really happens through ‘seeing and
follow up are kept up to date with relevant developments in the field
l It enables doing it’
opportunities for Embedded: Work shadowing and opportunity for feedback on language and
Face to face training should be restricted to
each participant to interactions used with patients can be integrated in order to give further first
a maximum of approximately 20 participants
discuss and reflect hand experiential learning
per course to ensure there’s an opportunity
l It draws on skills for meaningful discussion, supervision and
and knowledge questions
already developed
by participants

9
Standard (cont.) Strategies and Approaches (cont.) Examples (cont.)
Practical
(continued)
l Well-designed,
practical and
useful materials
are provided in
support of training

Delivered by High quality trainers are recruited Patient involvement: The Health Foundation Practitioner Development
experts Programme suggests the involvement of actors, lay tutors or patient volunteers
Consideration should also be given to
(suitably trained and supported) to simulate patients in role play activities
l High quality the presence of health and social care
trainers are used professionals as trainers. A partnership Health professionals: Health coaching training programmes require the
from health and between a health professional and an participation of high quality trainers that are also practicing health professionals,
wider backgrounds experienced coach can offer different and with a number (e.g. the London Deanery) prioritising health professionals with
who have both important contributions credibility amongst, and of the same discipline as, the participants
appropriate
Local assets: UCL have developed a programme where they identified clinical
qualifications and
psychologists who are already skilled in the desired conversational skills, and are
experience
also embedded in the target team, to deliver training and provide ongoing support

Consistent Across methodologies core principles are Accreditation bodies: Certain training providers link the competencies developed
covered [42] to coaching bodies (e.g. the European Coaching and Mentoring Council) [43]
l Common
principles are Competency frameworks: UCL have developed a (comprehensive and relatively
covered and complex) competence framework for health professionals working with people with
a core set of persistent physical problems [44]. The Health Foundation have a simpler framework
competencies [45], involving only four dimensions: care and support planning; collaborative
developed agenda setting; recognising and exploring ambivalence; and goal setting, action
planning and follow-up. The NICE Prevention and Lifestyle Framework also
incorporates relevant competencies [46]

10
Standard (cont.) Strategies and Approaches (cont.) Examples (cont.)

Immersive Sufficient time is provided for participants Open programmes: Voluntary participation across an organisation or setting
and safe to ‘open-up’ about their own practice and can enable more objective reflection, as it is away from the participant’s place
challenges of work. Participants may also feel they can be more open about their current
l It provides a
approaches without colleagues present. Many health programmes are run
safe space for Trainers create safety with ground rules and
in this way, e.g. The Performance Coach [47], Co-creating Health Advanced
challenging encourage active participation from the start
Development Programme (ADP) [48]
existing practice
Consideration is given to training amongst
and developing Team programmes: The Bridges Self-Management Programme [49] delivers
colleagues, which may give rise to perceived
new approaches workshops throughout the UK, training members of healthcare teams in
‘safety’ issues
supporting the self-management of people with long term conditions. Each
training is contextualised to target patient group and the service context of
participating teams. The facilitation methods of the trainers aim to promote a
safe and interactive environment in which a team explores current practice, and
creates a shared understanding of best practice in self-management support,
and a shared action plan for its implementation

11
3. Monitoring and Evaluation
Standard Strategies and Approaches Examples
The training is:

Monitoring
Tracked Training is monitored for accountability and
to ensure that participants access the full
l Attendance is recorded
course according to the principles of design
l Attrition is noted and delivery

Process Evaluation - assessing the quality of the training delivered

Quality assured Assessment is made of the training delivery For example: The Advanced Development Programme for clinicians
to ensure that it is of high quality run through Whittington Health [50] provides a questionnaire to
l Quality of training is
complete before and after three half day sessions, each delivered one
systematically assessed using Feedback is sought from participants on the
month apart. This includes a mix of Likert scales and open ended
clear criteria by peers or quality of the training
questions, evaluating participant experience, confidence and perceived
independent reviewers
Learning is shared across networks to build usefulness in using health coaching skills following the training
l Learning is integrated for up the evidence for good practice
In the US, the Centre for Employment Opportunities [51] have
consistent improvement
introduced a trial measure using the Net Promoter System to assess
l Learning is shared with wider their effectiveness with their service users. This is systematically
health networks embedded and regularly analysed to check that those accessing the
programme agree that it is a high quality programme that effectively
meets their needs

Faithful to its premises Programmes are assessed by commissioners The aim of this document is to give commissioners and providers
and providers against quality guidelines a framework for reviewing both the evidence base and experience
l Delivery is in line with
grounded in evidence from current practice, so they can ensure training commissioned is
programme premises and
of high quality
design, and integrates Providers are bought into the measurement
evidence wherever it is process, understand why it is important, and Programmes ensure that feedback is integrated so that training is
available are systematic in implementing its use assessed effectively against evidence-based guidelines

12
Standard (cont.) Strategies and Approaches (cont.) Examples (cont.)

Impact Evaluation - short and medium term outcomes

Feedback Qualitative feedback is sought on the The London Deanery commissioned the Tavistock Institute [52] to
training delivered – wherever possible this develop a three questionnaire methodology (pre-training, post-
Organised to seek systematic
data is comparative i.e. the same tool/ training and three month follow up) which could be used by various
feedback from participants
instrument is used across different forms of training providers, e.g. [53], to enable comparable analysis
to establish immediate and
training
intermediate outcomes – Health Education East of England commissioned the Institute
training is understood and Feedback is sought at follow up stage to of Employment Studies to evaluate a two day health coaching
being put into practice by learn how training becomes embedded education intervention across five pilots, by conducting qualitative
practitioners following the end in practice – this should ideally be sought ‘deep dive’ case studies, using a range of methods including
of the ‘immersive’ experience through self-report and patient feedback interviews and focus groups [54]
l At baseline and end point
l At a follow up stage to check
it has been embedded

Proxy measures Use supervision and shadowing to give Supervision: Many of the organisations that have most effectively
participants opportunities to reflect upon integrated a ‘coaching approach’ have formalised supervision into
Evaluated using proxy measures
and assess the quality of their resulting their structures, providing training for supervisors in addition to
to assess that the training is
conversations with patients the core coaching training. Yorkshire and the Humber Leadership
being implemented effectively
Academy [55] offer supervision for health coaches and are
and has been well understood Monitor the quality of shared-decision
developing awareness of health coaching and of coaching
by participants making outputs, such as care-plans
supervision in existing clinical supervisors
Feedback and quality assurance data is
Shadowing: Bridges Self Management [56] provide opportunities
considered and included in follow up training
for experts to shadow participants in their work with patients, to
for continual improvement
provide feedback
Care planning review: In Tower Hamlets (and in planning in
Islington) staff have carried out anonymous audits of care plans as
reflective exercises at individual practices, to identify how ‘person-
centred’ the resulting plans are. This can be complemented with
peer observation and reflection

13
Standard (cont.) Strategies and Approaches (cont.) Examples (cont.)

Impact Evaluation - short and medium term outcomes (cont.)

A shared measure A straightforward integrated measure such The Research into Recovery and Wellbeing Centre at Nottingham
as that used by Alcoholics Anonymous University have developed the INSPIRE measure [57] to track the
Integrated with a shared
(number of consecutive days of sobriety), support that a service user receives from a mental health worker. The
measure to track patient
could generate a consistent understanding measure assesses the quality of support and the relationship between
progress following healthcare
of the benefits of coaching approaches the worker and service user. An online version of the tool allows for
practitioner training to establish
across services from trainers to patients entering scores and analysing responses
long term outcomes – trained
practitioners are seeing better The POET measure of personal health budgets aims to assess the use
outcomes for their patients: by service users and carers of their budgets. It has only been used
with a small sample so far, but aims to determine the effectiveness of
l Consistently through all
budgets in practice through systematic measurement [58]
training and at follow up
l Using findings to make
improvements
l Sharing findings with wider
healthcare networks

Impact Evaluation - longer term impact

Using existing measures Relevant clinical measures are identified, The AQuA team have introduced a four part evaluation system
collected and analysed for service for their Shared Decision Making intervention [59] that integrates
Designed to draw on measures
improvement training, measurement, feedback and analysis for service
that are in use across the
improvement. The measures used are patient feedback measures
healthcare system and Systematic patient feedback is collected
using the CollaboRATE and SURE measures, qualitative feedback,
triangulate relevant findings to using a validated tool
biometric data and a longitudinal survey of staff (based on a Health
establish long term outcomes.
Staff measures are systematically collected to Foundation developed questionnaire). Analysed data is fed back to
These might include:
assess how embedded training approaches each participating clinical setting and is integrated into training
l The Patient Activation have become and to note any changes in
Health Education East of England co-created training with The
Measure (PAM) staff wellbeing
Performance Coach [60] and commissioned three evaluations of
l Patient satisfaction measures Qualitative and anecdotal data is collected training provided to over 800 clinicians. The pilot, comprising19
for case studies and training practice nurses and 290 coaching appointments, adapted the
l Longitudinal staff survey
Stanford Self Efficacy score to measure patient confidence and

14
Standard (cont.) Strategies and Approaches (cont.) Examples (cont.)

Impact Evaluation - longer term impact (cont.)

Using existing measures motivation to self-care, and patient satisfaction following the training.
Five of the pilot’s sites were evaluated qualitatively [61]
(continued)
Recovery coaching in Wessex also used Bartel scores and residential
home placement to evaluate impact on rehabilitation [62]
l Biometric data from
e.g. National Diabetes Audit Patient voice: Bridges Self Management [63], in one project, asked
patients three simple questions relating to confidence to self-manage,
l Practitioner wellbeing
distributed in a leaflet by health care professionals

Feedback loops Patient feedback for service improvement Examples of effective ‘closing of the feedback loop’ for
is collected and information on subsequent empowerment of service users exist in International Development
Set up to share improvements
changes to services are communicated back contexts, e.g. Integrity Action use a measurement ‘fix rate’ in their
based on feedback with
to patients to generate ownership work in Nepal which is relayed back to participants so they can
patients ie. the feedback loop
understand which parts of their services have been ‘fixed’
is closed

15
4. Sustainability
Standard Strategies and Approaches Examples
Sustaining and
building impact is
considered by:

Developing local Programmes encourage developing ‘champions’, advocates Practitioner pathway: Evaluation of the Health Foundation’s ‘Co-
capacity. This can for the approach who: present at relevant events, lead creating Health Improvement Programme’ [64] found that courses
include: by example, support fellow practitioners and influence should have a tiered structure – from an entry level up to a more
colleagues in their organisations. It can be an informal or advanced course – the level being selected in terms of who is more
l Developing local
formal role, and active engagement and ongoing support likely to use skills in day-to-day practice [65]
champions
is provided
Health Education East of England Health Coaching programme
l Train the trainer
Sustainability is supported via a ‘train the trainer [66] involved the development of local capacity through a train the
programmes
programme’. This involves building the skills in existing trainer programme with ongoing CPD for continued development
l Building a professionals, and supporting them to run ongoing and quality assurance
participant training and reflection activities to embed the skills
Barnet, Enfield and Haringey Mental Health Trust trains cohorts
pathway among colleagues. Success criteria for this approach
of staff to create an internal coaching network of around 20 staff
include:
(including clinicians, community nurses, occupational therapists and
l Trainers must be carefully selected and given sufficient mental health professionals) who coach each other within teams.
time to become familiar with the material and as a One cohort is managerial staff, to establish a coaching culture at
facilitator a leadership level. This coaching training is supported by 3 or 4
cultural and organisational change programmes
l The role of trainer must be built into their job
descriptions with allocated time (not an ‘add-on’) Raising awareness: Bridges Self Management [67] support
participants to run brief sessions to communicate the main
l The ongoing training needs to be a part of the
messages from their training to other staff unable to attend, to
organisation’s existing Learning and Development
familiarise them with the approach
curriculum (e.g. for a GP trainer)
l Trainers need logistical support to co-ordinate the
trainings
l Trainers need to complete a certain number of ongoing
Continuing Professional Development (CPD)

16
Standard (cont.) Strategies and Approaches (cont.) Examples (cont.)
Developing local An eventual ‘pathway’ or ‘tiered structure’ for participants
capacity. This can might include:
include: l Online material – written and video – to raise awareness
(continued) and inspire further interest
l Talks at educational events and relevant meetings

Developing With regards to the different leadership roles, the For example, health coaching has been chosen as an intervention
leadership: following stratification is useful: of proven value to scale through NHS England’s National Innovation
Accelerator Programme (NIA) with Dr Penny Newman leading work
l Filling each role l ‘Leader’ – one or more individuals in leadership
to create a social movement in adopting a coaching approach to
useful to pursuing positions, who continue to raise the profile of the
healthcare practice through a series of design workshops and other
this approach approach, establish and organise the systems which
processes for engagement, supported by NHS England, the Health
encourage it, and persuade other leaders
l Connecting Foundation and UCL Partners [68]
leaders into wider l ‘Champions’ – who are applying the approach in their
Many examples of health coaching champions exist nationally, such
networks beyond day to day work, and are able to make the case to
as in the Yorkshire and Humber LETB and in Wigan’s implementation
the area colleagues at events and in their day to day work, to
of Making Every Contact Count (MECC)
build credibility and convince others
For example, the RCGP Care Planning Champions network [69]
l ‘Co-ordination’ – the role of maintaining the system
for practitioners and managers from across the country, is active in
of, for example: ongoing communication, events, CPD
pursuing person-centred care planning, to learn from each other
Linking in leaders and champions with the numerous and share good practice
networks existing across the country that are pursuing
this approach

Including Consideration is given to managing patient expectations Joint: Haringey CCG ran a joint programme targeting both health
complementary to increase the openness to, and understanding of, their professionals and patients (see also Wong-Rieger and Rieger (2013)
activities for role in a person-centred conversation about their health [70] for a case study showing that health coaching interventions
patients: may work better when combined with patient focused self-
management approaches).
l Managing
expectations St. John’s Way Practice in Islington uses posters and screens in waiting
rooms to communicate messages that raise patient expectations of
their involvement in subsequent health conversations

17
Standard (cont.) Strategies and Approaches (cont.) Examples (cont.)
Using existing Consideration is given to existing system frameworks, Year of Care [71]: where data is shared with patients in advance
systems: for example care planning, and to how synergies can be and more time is given to a person-centred care planning
created to maximise the mutual benefits conversation
l Maximising
complementarity Personal health budgets [72] where co-produced personalised
care and support planning helps people to identify their health and
wellbeing goals, together with their local NHS team, and sets out
how the budget will be spent to enable them to reach their goals
and keep healthy and safe
Integrated personal commissioning (IPC) where people, carers
and families are enabled to blend and control the resources available
to them across the system in order to ‘commission’ their own
care through personalised care planning and personal budgets.
In tandem, IPC also supports people to develop their knowledge,
skills and confidence to self-manage through partnerships with
the voluntary and community sector (VCSE), community capacity
building and peer support

Exploring longer Longer term funding (e.g. 3 years) would give training The Co-Creating Health ADP (Advanced Development Programme)
term funding time to be embedded into practice and yield results, has been run at the Whittington Hospital for a number of years,
thereby building the evidence base. A single year is training health care professionals from across Islington as well as
unlikely to produce significant results and potentially teams within the hospital [73]
valuable methods may be abandoned prior to an evidence
base being properly established

Using data Encouraging the use of standardised measures to The website for Making Every Contact Count includes a databank
compare outcomes across training sites for resource materials [74]
l Sharing data
and resources, and Creating a resource bank of materials, videos and
developing a data experiences to encourage continued upskilling and self
infrastructure for study and to share good practice
communication
training

18
Background and
Acknowledgements
Commissioned by Health Education England
– North, Central and East London (HEE NCEL),
this Framework brings together the insights
gathered from fifty or so conversations
between the Tavistock Insititute (www.
tavinstitute.org) and Osca (www.osca.co)
with commissioners, providers, champions
and experts, and builds on complementary
work done by a range of organisations both
inside and outside of the North, Central and
East London area. It has also been developed
following feedback from 30 or so contributors
from around the country. It includes explicit
references to particular examples of delivery
around the UK. This is to be as transparent as
possible about the examples that have been
shared with us, to allow anyone interested
to follow up on these examples, and to
encourage anyone running a health coaching
training programme to contribute new
examples to the document. This framework
is not intended to be a finished product. It is
a snapshot of health coaching training and
its application to healthcare practice at the
present time. We expect it to evolve. Indeed,
this evolution is what will make it most useful.

19
Endnotes
To view a summary of this framework, and Coaching Improves Medication Adherence: [12] Newman, P. and A. McDowell (2016)
a Delivery Template which examines how A Pilot Study’ Am. J. of Lifestyle Medicine ‘Health changing conversations: clinicians’
health coaching training can be supported 2: 187-194; Wolever, R. Q. et al (2010) experience of health coaching in the East of
across an area, please visit: https://hee. ‘Integrative health coaching for patients with England’, Future Hospital Journal ‘Person-
nhs.uk/hee-your-area/north-central-east- type 2 diabetes: a randomized clinical trial’, Centred Tools for the Clinician’ Vol. 3 (2):
london/our-work/attracting-developing-our- Diabetes Educ. 36 (4): 629-639 147-51; www.theperformancecoach.com/
workforce/multi-professional-workforce/ uk/services-and-courses/coaching-for-health/
health-coaching [6] Vale, M. J. et al (2003) ‘Coaching patients health-coaching
On Achieving Cardiovascular Health (COACH):
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Review of the Literature on Health and with Coronary Heart Disease’ Arch Intern wellbeing/patient-involvement
Wellness Coaching […]’, Glob Adv Health Med. 163 (22): 2775-2783
Med. 2 (4): 38-5 [14] https://eoeleadership.hee.nhs.uk/
[7] Sjoquist, E. S. et al (2010) ‘Physical-activity sites/default/files/Does%20health%20
[2] NHS England (2014) ‘Five Year Forward coaching and health status in rheumatoid coaching%20work%20-%20summary.pdf
View’, p.12 www.england.nhs.uk/wp-content/ arthritis: a person-oriented approach’ Disabil
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‘Cancer Health Empowerment for Living ‘Strengthening motivational interviewing skills
[3] Newman, P. and A. McDowell (2016) without Pain (Ca-HELP): effects of a tailored following initial training: a randomised trial
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uk/sites/default/files/Does%20health%20 women with mobility disabilities and severe rehabilitation and patient education
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21
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