Shifting the power dynamics in healthcare through COACH

Care management & redesign Quality improvement

With the launch of our online COACH course on the Camden Coalition Learning Center, we wanted to dig deeper into the framework that our care teams use to form authentic healing relationships and support sustainable behavior change with participants in our care management programs.

Renee Murray, RN, BSN, FNE-CSA, BA, has been at the Camden Coalition since 2012, joining the organization as a Nurse Care Coordinator and eventually becoming the Associate Clinical Director of our care teams. In her current role as the Director of Teaching & Training, Renee has trained over 900 individuals at 20 organizations across the country on implementing COACH on their teams, and she now leads our virtual trainings. 

“COACH is a set of techniques and tools, a philosophy, a noun, a verb,” says Renee. “It equips those doing direct participant care with the skills, knowledge, ability, and spirit necessary to have a lasting impact on the lives of the people they work with.”

Renee helped design and implement COACH at the Camden Coalition in 2014, and has helped lead its ongoing evolution. COACH, she says, came from a realization that, despite the strong relationships that care team members were building with participants in the Camden Core Model and other programs, and the progress care teams were making in connecting participants to primary care and community resources, participants’ behavior change didn’t always last.

“It was frustrating for the team,” she says. “They would say, ‘We’re doing so much good work, but now I see a participant that I graduated [from our program] six months ago no-showing appointments again because they couldn’t arrange transportation for themselves.’ We realized something was missing in the way that we were operating.”

COACH was created so that participants would be able to better manage their health once their care team was no longer there to help them. The framework helps care team members walk alongside participants as they build the power and trust in themselves to gain control of their health and navigate complex systems.

The five components of the COACH framework are:
   C: Create a care plan
   O: Observe the normal routine
   A: Assume a coaching style
   C: Connect tasks with vision and priorities
   H: Highlight effort with data

With COACH, care plans are co-created with participants, and are built around participants’ own goals, priorities, and needs. COACH guides care team members to observe participants’ problem-solving processes before rushing in to help, and to identify and strengthen participants’ current and potential sources of ongoing support.

Participant engagement as laid out in the COACH framework is radically different than traditional patient engagement within healthcare. “Healthcare is very directive,” says Renee. “Providers tell patients what should be important in their lives, and what they should prioritize — and if you don’t follow the plan you may be labeled non-compliant and even fired from a practice or program.”

“With COACH, the engagement begins with building authentic healing relationships, and the patient or client then sets the goals and priorities. There’s a shift in power and control dynamics because it’s a collaborative conversation. It allows individuals to take the time to understand what’s happened to them, historically and currently. Things like historical trauma, drivers of health, medical and social barriers — oftentimes that big picture is not being looked at in healthcare.”

Without a framework like COACH, addressing a patient’s bigger picture can be overwhelming. “In this work, the weight of the burdens and barriers and problems that care teams are working on with individuals can get transferred to the staff member,” says Renee. “The COACH framework doesn’t alleviate all of that — in this work you’ll never eliminate all of that — but it does equip frontline staff with a framework that helps them build the patient’s skillset instead of attempting to fix their problems for them. This helps participants get from where they are now to where they want to be, and ultimately, it helps frontline workers have meaningful engagements that lead to higher quality of life for their participants.” 

With burnout among healthcare and social service providers skyrocketing, seeing that they’ve made a meaningful impact can make a huge difference in staff morale. 

To larger health systems and organizations that may be hesitant to change their approach to care, Renee says, “Look at the data you have [on patient outcomes] based on what you have been doing. Is it time to shift?”

To learn more from Renee and her team about COACH or to see the schedule of upcoming online COACH trainings, check out the Camden Coalition Learning Center. For information for organizational or system leaders looking to train their whole frontline staff, check out our technical assistance page.