coaching science in motion

Margaret Moore, MBAExecutive coachCo-Founder, Chair, Institute of Coaching, McLean Hospital, Harvard Medical School affiliateFounder, CEO, Wellcoaches CorporationCo-Founder, National Board for Health and Wellness Coaching

disclosuresFounder, CEO, Wellcoaches CorporationSchool of Coaching for health professionals

what I am going to talk about

20-year journey of coaching science to practice in healthcare

science that underpins coaching competencies

2000Wellcoaches School

of Coaching founded

202013,000 coaches

trained in 50 countries

2009

Institute of Coaching

co-founded

McLean HospitalHarvard Medical School affiliate

2010National Board for Health & Wellness

Coaching co-founded

2016Led partnership with

NBME

2020AMA launched

coaching CPT codes

2021NBHWC Healthcare

Reimbursement Commission

Wellcoaches Digital to support coach on primary care team

evidence-based coaching protocol

coaching science and research

national standards and certification

coach joins the healthcare team

VISION: new coaching profession in healthcare

MINDFULNESS

E M OT I O N A L I N T E L L I G E N C E

P O S I T I V E P S Y C H O L O G YA P P R E C I AT I V E I N Q U I R Y

C H A R A C T E R S T R E N G T H S

C U R I O S I T YT R A N S T H E O R E T I C A L M O D E L

WELL-BEING

SELF- DETERMINATION

R E L AT I O N A L F LO W

15 theories & domains

PERSONALITYM O T I VAT I O N A L I N T E R V I E W I N G

C O A C H I N G P S YC H O LO G Y

S O C I A L C O G N I T I V E T H E O R Y

R E L AT I O N A L C U LT U R A L T H E O R Y

HOPE PSYCHOLOGY

S E L F C O M PA S S I O NN O N V I O L E N T C O M M U N I C AT I O N

N E U R O S C I E N C E

evidence-based coaching protocol1. Edman et al (2019). 54 healthcare employees

with chronic disease

2. Guthrie et al (2019). 172 participants using coaching and digital therapeutics for blood pressure control

3. Berman et al (2018). 118 participants with Type 2 diabetes complete 12 weeks of health coaching

4. Djuric et al (2017). 82 patients in primary care

5. Roy et al (2017). 1,306 chronic disease patients in medical fitness facility

6. Sherman et al (2017). 271 obese patients at MGH primary care practice

7. Eisenberg et al (2017). Teaching Kitchen project for 40 CIA employees

8. Sherman (2017). 17 pre-diabetes patients at MGH primary care practice

9. Hackshaw et al (2016). Intensive coaching for fibromyalgia - 9 patients

10.Long et al (2016). 19,800 coaching clients in employee wellness

11.Sforzo et al (2014). 161 patients coached on smoking cessation

12.Galantino & Schmid (2009). 30 cancer survivors

Systematic Review Defined Common Elements of Health & Wellness Coaching

Coaches trained in behavior change, motivational techniques

Patient-centered (guided by patient values)

Patient determined goals

Self-discovery

Accountability

Combined with education

Ongoing relationship

Wolever et al. Systematic Review of the literature on health and wellness coaching. Global Adv Health Med J. 2013; 234-53

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2000-2004 2005-2008 2009-2012 2013-2016 2016-20182000-2004 2005-2008 2009-2012 2013-2016 2016-2018

H e a l t h & We l l n e s s C o a c h i n g R C T P u b l i c a t i o n s

Sforzo GA et al. Compendium of Health & Wellness Coaching: 2019 Addendum Am. J Lifestyle Med.

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Evidence of Positive Outcomes from Health & Wellness Coaching Literature

• literature screened using systematic review definition• compendium – 2000-2016, addendum – 2016-2018• 2 meta-analyses in 2018 – diabetes and hypertension show statistically significant positive outcomes• 108 randomized controlled studies; 82.4% of RCTs show statistically significant positive outcomes

2017 2019

Volume of HWC visits: 2015-2020

• In April 2021, NBHWC surveyed 30 healthcare organizations that employ teams of HWC in 38 states

• Includes VA, UPMC, MGH, Mayo, Duke, UCSD, Cleveland Clinic, Intermountain, Indian Health Services, OSU, University of Vermont

• Estimated total HWC visit volume:• Individual: 1,061,262• Group visits: 110,000

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CPT options for HWC

health and well-being coaching – 0591T, 0592T, 0593T

annual wellness visits – Go438, G0439

depression & alcohol screening – G0444, G0442

obesity counseling – G0477

chronic care management – 99487, 99489, 99490

remote physiological monitoring – 99453-8 – bp, weight

phone/online assess and manage – 98966-8, G2061-63

chronic pain management – preventive medicine + opioid treatment – 99401, 99402, 99409, G0397

HWC on Clinical Team

Physician/NP refers patient to HWC for obesity, metabolic

health, other health risks and chronic

conditions.

Physician/NP and HWC

may complete Annual Wellness Visit

HWC delivers health and well-being coaching,

individual or group

HWC delivers obesity counseling,

individual or group

HWC delivers RPM, chronic care

management, individual or group

Physician + HWC deliver preventive medicine visits, individual or

group

HWC delivers communication and management visits

science that supports coaching competencies

1. self-determination theory2. transtheoretical model3. positive psychology4. adult development5. relational flow6. multiplicity of mind

autonomy is the strongest primary drive

Deci, Ryan, (2000).The What and Why of Goal Pursuits. Psychological Inquiry. Vol 11. No. 4. 227-268

judge

rescuefix

autonomy

competencerelationship

expert prescribing coach facilitating

which kind of motivation leads to the cleanest kitchen?

Autonomous• Present – I’m cleaning up the kitchen because it’s fun

and challenging

• Future – I’m cleaning up the kitchen because it makes me feel good about my contribution to my marriage and family

External

• Inner critic – I am cleaning up the kitchen because I should – I will feel like a bad spouse if I do not

• External – l am only cleaning up the kitchen because my spouse will be angry if I don’t

draw forth autonomous motivation

envision one’s future self

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PC Cont PR Action Maint

ProsCons

~ 80% Need to ImproveMotivation (Increasing Pros) & Confidence (Decreasing Cons)

readiness stage prevalence estimate 40% 40% 20% Data from Hall, K. L. & Rossi, J. S. (2008). Meta-analytic examination of the

strong and weak principles across 48 health behaviors. Preventive Medicine, 46,266-274 . https://bit.ly/2SgB08o stage prevalence estimates from James

Prochaska, 2018.

Moore, 2008

Positive EmotionsBroaden Thinking

awarenessopen-minded

flexiblecreative

adaptableperipheral vision

big picture

Fredrickson (2013). Updated Thinking on Positivity Ratios. American Psychologist vol. 68 (9); 814-822

psychological capital - HERO

hope

efficacy

resilience

optimism

Youssef-Morgan, C. M., & Luthans, F. (2015). Psychological capital and well-being. Stress and health: Journal of the International Society for the Investigation of Stress.

wisdom & knowledge Creativity, Curiosity, Open-mindedness, Love of learning, Judgmentcourage Honesty, Bravery, Perseverance, Zesthumanity Kindness, Love, Social Intelligencejustice Fairness, Leadership, Teamworktemperance Forgiveness, Humility, Prudence, Self-regulationtranscendence Appreciation of beauty, Gratitude, Hope, Humor, Spirituality

CHARACTERVALUES in ACTION

www.viacharacter.org

How Coaching Works @ YouTube

SUB JECT

object

Subject Object Theory

A mind once stretched by a new idea or understanding will never fully return to its original dimensions....

Oliver Wendell Holmes, Sr. Physician1809-1894

create new connections

assumption

transcend

GROWTH EDGEBlog: Hello. I am your growth edge.

three levels of insight

learning: new skill

perspective shift: beliefs, values

quantum shifts: self-identity shifts

Clancy, A. L., & Binkert, J. (2016). Pivoting: A Coach's Guide to Igniting Substantial Change. Springer.

growth edge higher wisdom

I have too much to do I am grateful to serve

no time for open questions listening gets more done faster

I focus on what’s wrong I build on what’s good

I am critical of you I accept that you are doing your best

I judge you I notice my biases

I feel sorry for you I understand what you feel

I am frustrated with you I am open and curious about you

I label you I see you as unique

I am better than you I am a work in progress

I don’t value you we are equals, doing our best

stop resisting me I triggered your resistance

get your act together you are doing your best

creativity: generative moments

imagine a new brain-wide network

intuitive dance: a peak coaching experience

• masterful coaches dance more and better than novice coaches

• masterful dancing delivers better results

Moore, et al. (2005) Relational Flow: A Theoretical Model for the Intuitive DanceInternational Coach Federation Coaching Research Symposium Proceedings

relational flow

• sense of zest and vitality

• empowerment; response-ability

• increased knowledge of self and others

• increased sense of worth

• desire for making more connections

Adapted from Jean Baker Millers “What Do We Mean by Relationship”Relational Cultural Theory

key outcomes of relational

flow

1. self-discovery: I know myself better

2. more positive energy and positive emotion:I feel energized and more positive

3. more confidence (self efficacy): I believe I can do it

4. more readiness: I am ready to go

a Harvard Health book published by William Morrow (2016)

inner family

confidence

standard setter

body regulator

autonomythinker

meaning maker

creative

relational

adventurer

core self

Carl Jung mental processes

Enneagram typecore drive

Myers Briggs1st brain function2nd brain function

Inner Family (Moore)

introverted feeling 1 reformer INFP, ISFP, ENFP, ESFP autonomy

extraverted feeling 2 helper ENFJ, ESFJ, INFJ, ISFJ relational

introverted intuition 9 peacemaker INTJ, INFJ, ENTJ, ENFJ meaning maker

extraverted intuition 4 individualist ENTP, ESFP, INFP, ISFP creative

introverted sensing 6 loyalist ISFJ, ISTJ, ESFJ, ESTJ regulator

extraverted sensing 7 enthusiast ESFP, ESTP, ISFP, ISTP adventurer

introverted thinking 5 investigator INTP, ISFP, ENTP, ESFP thinker

extraverted thinking 3 achiever ENTJ, ESTJ, INTJ, ISTJ standard setter

confidence 8 challenger confidence

brain breaksgo no go

Moore. Brain Breaks Elude Me. (2016) Psychology Today.

thank you