The Camden Coalition developed COACH as its framework for building authentic healing relationships with individuals to help empower them to take control of their health.
Over the years, the Camden Coalition has partnered with organizations, including government agencies, health systems, community-based organizations, universities, and county school districts, to train their frontline staff in our COACH framework.
In 2018, we partnered with a network of health facilities in the western U.S. to train 300 of their practitioners in multiple locations. The system was composed of over 50 hospitals and 900 clinics, and offered a range of health services including specialized services, primary care, and care management.
The case for COACH
Prior to our engagement, leaders at the health system were faced with a challenge: How could they create a Medicaid strategy to improve their financial and health outcomes performance?
For them, improving care required a deep dive into their patient data to define their complex health and social needs population. Through this process, they discovered the Camden Coalition’s early work in “healthcare hotspotting” and the criteria we used to identify complex populations from hospital data. As the two organizations began to build a connection, we shared the COACH framework with them and subsequently developed a partnership to train their practitioners in this patient-centered approach to care. The hope was that improving how practitioners deliver care for individuals living with complex needs would be an investment in a sustainable, long-term solution for reducing health costs.
Over the course of our engagement, the original high-level metrics objective turned into an opportunity for practitioner skill development through COACH, which has been implemented among entry-level employees and managers across the health system network.
The training experience
Current structure: Instructor-led synchronous training delivered in 4, 2-hour sessions. Learners also have the opportunity to participate in 3 case conferencing calls after the COACH training sessions are completed.
The training included singular or, in some cases, recurring monthly case conferences which provided learners with an opportunity to discuss the field application of the COACH material and receive feedback on how COACH could be used with patients to enhance engagement. The calls helped to reinforce and routinize COACH into practice and also created a space for the staff to meet other practitioners in the network and cultivate a culture of support within their work, which learners called an extremely meaningful experience.
The ongoing case conferencing calls for a year afterward were really good as a support for each other as a system. There were other groups and teams that attended our COACH training outside of our facility, so we got to know a lot of other care managers within the health system network. I think those calls were nice because you got to hear these incredibly complex situations that others were working with.Care management supervisor
The trainers made COACH come alive
The trained staff members overwhelmingly named their connection with Camden Coalition instructors, Renee Murray and Gladys Antelo-Allen, as one of the main highlights of their COACH training. As nurses themselves, Renee and Gladys were able to engage, motivate, and support the trainees, providing case study examples and experiences that were real and resonated with the learners.
Renee and Gladys were amazing presenters, so it went by so fast, it was very enjoyable... For me, and for some of our experienced RN managers, it was great to have a nurse doing the training. It’s not something that I commonly see in complex case management.Community outreach supervisor
People really love the interactions with the Camden team. I think it gives them hope. I think it makes them feel that they are not alone. That the challenges they face are not uncommon. That there are people who have been studying this and thinking about it and doing this work for a long time and that gives them a lot of positives.Executive leader
COACH learners have highlighted that information about building authentic healing relationships, prioritizing patients’ goals, aligning the mismatch between care expectations and experiences, and reducing burnout were some of the topics that stayed with them the most in their time after the trainings.
Authentic healing relationships
The COACH model emphasizes the need and provides the tools for practitioners to build authentic healing relationships, which are secure, genuine, and consistent relationships between patients and practitioners. Learners felt the COACH training provided them with tangible and concrete examples of what authentic healing relationships look like in practice and taught them how to build these authentic relationships with the individuals they serve.
The concept of authentic healing relationships stuck with me. If we don’t have that with the people we are serving, no matter what their socioeconomic status is, we’re not going to get far with that case. There has to be a level of trust and rapport, so authentic healing relationships is something we really believe in.Community outreach supervisor
Aligning with patients’ goals
COACH reminded practitioners about the necessity to connect their goals for the patient with the patient’s own goals and priorities. The practitioners felt that the ability to meet individuals where they are and align on goals led to patient empowerment and ownership of their health.
“I’ve had some pretty intense conversations with a couple of our nurses who initially were like ‘I made all of these appointments for the client and they didn’t show up to half of them.’ They were so angry in the moment, and then it’s like, let’s step back, this is a patient who is living out of their car and we made an appointment for a nutritionist. This may not be something the patient is ready for. I kind of have to pull apart a situation that has got them really wound up. You can tell they’re disappointed. The client is going to do what they are ready for, so I think regardless of how much we are scheduling, circling back to the staff to say what could have been done differently? Or just pointing out what is the client’s goal? What do they want to focus on? Did they ask for this nutrition appointment or is this what the provider asked us to help with? It’s teasing out what is a priority and what is not.” -Community outreach supervisor
COACH fills a mismatch between care management expectations of staff and their actual experiences in the field.
The training recognizes the frustrations of practitioners whose job descriptions outline specific responsibilities but who are often confronted with complex situations providing care to individuals with compounding health and social needs — requiring them to take on additional challenges.
I think the approach really resonates with care managers who often feel very frustrated by the mismatch between the cut-and-dry expectations of care management and what they actually face when they talk with people who are experiencing challenges.Executive leader
Content on burnout, compassion fatigue, and self-care is woven throughout the COACH training. In some cases, the health system staff felt the training acted as a centering exercise that encouraged them to refocus on the purpose of their role as a practitioner and their capacity to solve problems in their position. COACH encouraged them to think about actionable ways to reduce burnout and compassion fatigue, such as through boundary-setting.
What I like about the Camden Coalition and COACH is by the time it came around for me, I was, I don’t know, three or four years working and getting kind of burned out and frustrated, so it was a great refresher to remember who you are doing this for. You have to remember it’s not your problem to solve. You are trying to get to know the patients — who they are and what they want — and trying to remove barriers. So, COACH was a good reminder of how to create better boundaries around the work we are doing and continue to make it patient-centered.Case manager
How does the health system use COACH in their work?
COACH is now a foundational programmatic and educational tool in the health system network and is adapted to the specific needs of a program.
Integrating COACH into new hire curriculum
It is a foundational starting point for new staff, where each added team member has the opportunity to learn about the COACH principles and language during onboarding and orientation. The COACH training is an organizational cornerstone to teach new network practitioners how to care for individuals in a more holistic, person-centered way.
Training trauma surgeons on how to intervene for behavioral health and social needs
The health system has used the COACH framework as a seed to grow a trauma support program to assist trauma surgeons with addressing medical as well as social needs — a requirement for a level-2 trauma designation.
Adapting COACH for ambulatory care case management
The system’s ambulatory care case management teams are charged with discharge planning because their services are not designed to be long-term supports for patients. Thus, due to the nature of the setting, case managers have found ways to adapt COACH to maintain person-centered and relationship-powered care in their short-term engagements.
Want to know more about COACH training?
The COACH training is a valuable experience for staff members and organizations seeking to improve their practices and relationships with the individuals they serve. The program provides learners with opportunities to gain new perspectives on their role as a practitioner and tangible tools they can routinize in their practice long after they have finished the trainings.
To learn more about the COACH framework, meetings, course descriptions, and instructors, visit our website at www.camdenhealth.org/COACH. We regularly offer COACH as a virtual 5-week course for participant-facing staff through the Camden Coalition learning center at www.courses.camdenhealth.org. If you are interested in developing a technical assistance program to deliver an organization-wide COACH training, email us at [email protected]