Implementation of Oral History by Health Coaches
Introduction
Literature has demonstrated that an interdisciplinary approach to care is crucial to positive patient outcomes. As of late, trained health coaches have been integrated into this model of care, providing a wide array of services that have further enhanced patient outcomes and satisfaction. Interventions by this member of the healthcare team currently range from motivational interviewing and facilitating collaboration among the healthcare team to counseling and goal setting. In hopes of complementing the current practices upheld, oral history is recommended as an additional tool for health coaches. This technique may be used to explore the health – and life – of a client through his/her perspective by means of inviting free-flowing speech, which results in the exposure of unscripted information (ex: client values, beliefs, concerns, strengths and weaknesses, barriers, gaps in care, etc.). Unlike a traditional medical-interview, which involves closed-questions posed by a health professional that is received by a patient who responds with a closed-answer, oral history transfers the power from the healthcare personnel to the patient. This patient empowerment fosters an open relationship with the health coach (and thus healthcare professionals), which elicits information that may not have been uncovered in a more formal interview.
Initial Appointment: Oral History
Specifically relating to the Cabin Creek Healthcare System (CCHS), oral history employment is recommended during the initial (in-person) patient appointment with the health coach, as this early interaction is predicted to improve the quality of the rapport(s) developed, mutual care determined, and outcomes yielded. The encounter begins with the proposal of an open-ended question, which is intended to extract a lengthy and thoughtful response from the patient. Therefore, it is imperative this technique is conducted in-person and preferably in a comfortable space (i.e., home visit, uninterrupted office in a clinical setting, etc.). The following are suggestions of an opening question when initiating an oral history:
Ideally, the opening question posed by the health coach draws an uninterrupted, unprompted, and uninhibited response from the client that results in both a comprehensive understanding of the patient’s life and health as well as the development of a strong rapport between the two participants. Unlike most patient-health personnel interactions, listening to -- not speaking at -- the client is the key action involved with the successful implementation of oral history. As listening has almost become a forgotten art in the world of healthcare, it is likely this practice will be challenging to conduct initially. Thus, the following is a list of key points that may facilitate the conduction of a successful oral history:
When a full oral history has been received, the health coach will use a transcription sheet to document and organize the client’s strengths, challenges, and background/historical information related to his/her health and life (as well as themes, insights, poignant statements, etc.). This document may also be used in any fashion the health coach deems appropriate. This recorded information will be used by the health coach to assist with structuring of the next steps in patient care.
Follow-Up Appointments: Motivational Interview
From the described initial appointment (above), a strong foundation and rapport between the health coach and the patient will have been developed. The visions and fundamental themes collected from the patient’s oral history lay the groundwork from which motivational interviewing (MI) may take flight in subsequent appointments. As stated, MI serves as a fundamental tool to assist patients in goal-setting and determining a plan of action that yields successful, desirable, and sustainable changes in health management (ex: healthier diet, exercise, medication adherence, etc.). Therefore, it is suggested that through the implementation of oral history, MI and other techniques currently employed by the health coach will become stronger and more effective due to the initial (and extensive) insight, knowledge, and relationship gained from this proposed technique. Through the implementation of oral history and MI, both the client and the health coach are embarking on a unique journey, one that will end - and begin - with sustainable changes and positive patient outcomes.
The following is a general outline regarding how oral history may be integrated into CCHS’s current system:
Literature has demonstrated that an interdisciplinary approach to care is crucial to positive patient outcomes. As of late, trained health coaches have been integrated into this model of care, providing a wide array of services that have further enhanced patient outcomes and satisfaction. Interventions by this member of the healthcare team currently range from motivational interviewing and facilitating collaboration among the healthcare team to counseling and goal setting. In hopes of complementing the current practices upheld, oral history is recommended as an additional tool for health coaches. This technique may be used to explore the health – and life – of a client through his/her perspective by means of inviting free-flowing speech, which results in the exposure of unscripted information (ex: client values, beliefs, concerns, strengths and weaknesses, barriers, gaps in care, etc.). Unlike a traditional medical-interview, which involves closed-questions posed by a health professional that is received by a patient who responds with a closed-answer, oral history transfers the power from the healthcare personnel to the patient. This patient empowerment fosters an open relationship with the health coach (and thus healthcare professionals), which elicits information that may not have been uncovered in a more formal interview.
Initial Appointment: Oral History
Specifically relating to the Cabin Creek Healthcare System (CCHS), oral history employment is recommended during the initial (in-person) patient appointment with the health coach, as this early interaction is predicted to improve the quality of the rapport(s) developed, mutual care determined, and outcomes yielded. The encounter begins with the proposal of an open-ended question, which is intended to extract a lengthy and thoughtful response from the patient. Therefore, it is imperative this technique is conducted in-person and preferably in a comfortable space (i.e., home visit, uninterrupted office in a clinical setting, etc.). The following are suggestions of an opening question when initiating an oral history:
- Today we will be talking about your health, life, and body. Please tell me what you would like me to know.
- Tell me about yourself -- your life and your health.
- I’d like to hear about your life and your health. What do you want me to know? Or, what should I know?
- We are here to talk about how your life impacts your health. Let’s start with your life.
Ideally, the opening question posed by the health coach draws an uninterrupted, unprompted, and uninhibited response from the client that results in both a comprehensive understanding of the patient’s life and health as well as the development of a strong rapport between the two participants. Unlike most patient-health personnel interactions, listening to -- not speaking at -- the client is the key action involved with the successful implementation of oral history. As listening has almost become a forgotten art in the world of healthcare, it is likely this practice will be challenging to conduct initially. Thus, the following is a list of key points that may facilitate the conduction of a successful oral history:
- The goal of the interaction is to establish the relationship and foundation
- The emphasis should always be listening
- Learn to be comfortable with silence
- Digressions do not exist; affirm the participants' stories
- Utilize neutral facial expressions/avoid nodding/verbalizations
- Avoid the urge to use “teachable moments”; mentally note the statement for later follow-up or motivational interviewing
- Keep follow-up questions or statements succinct and open
- Be present; focus on the client
- Respect time limitations
When a full oral history has been received, the health coach will use a transcription sheet to document and organize the client’s strengths, challenges, and background/historical information related to his/her health and life (as well as themes, insights, poignant statements, etc.). This document may also be used in any fashion the health coach deems appropriate. This recorded information will be used by the health coach to assist with structuring of the next steps in patient care.
Follow-Up Appointments: Motivational Interview
From the described initial appointment (above), a strong foundation and rapport between the health coach and the patient will have been developed. The visions and fundamental themes collected from the patient’s oral history lay the groundwork from which motivational interviewing (MI) may take flight in subsequent appointments. As stated, MI serves as a fundamental tool to assist patients in goal-setting and determining a plan of action that yields successful, desirable, and sustainable changes in health management (ex: healthier diet, exercise, medication adherence, etc.). Therefore, it is suggested that through the implementation of oral history, MI and other techniques currently employed by the health coach will become stronger and more effective due to the initial (and extensive) insight, knowledge, and relationship gained from this proposed technique. Through the implementation of oral history and MI, both the client and the health coach are embarking on a unique journey, one that will end - and begin - with sustainable changes and positive patient outcomes.
The following is a general outline regarding how oral history may be integrated into CCHS’s current system:
- Initial Contact with the Client: Telephone intake
- First Appointment: Personal interview with the implementation of oral history
- Follow-Up Appointments: Personal interview with motivational interviewing and other current techniques
Recommended Target Population for Piloting Oral History in a Clinical Setting
To pilot these recommendations and implement oral history in the clinical setting, a specific patient population should be targeted to determine the effectiveness of this technique; thus, a discussion involving all members of the healthcare team, with significant input from health coaches, should be conducted. Within CCHS, it has been suggested that oral history may be especially useful in individuals facing congestive heart failure as well as those recently discharged from an acute-care setting that are experiencing challenges associated with new health management responsibilities. Both of these populations require strict and continual self-management that mandate rigorous goal-setting, behavior changes, and encouragement, which may be strengthened with an initial oral history conducted by a health coach.
Transcription Sheet
oral_history_transcription_sheet.doc | |
File Size: | 31 kb |
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oral_history_transcription_sheet.pdf | |
File Size: | 41 kb |
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