As the pandemic continues to unfold, the value and dedication of nurses is more apparent than ever. Nurses have always been the backbone of Health Dialog’s population health services, providing medical knowledge, empathy and a trusted “bedside” manner gained through their years of nursing experience. Transitioning from working with patients in a clinic setting to working with members over the phone, as Health Dialog’s nurses do, brings unique opportunities and challenges.
Health Dialog’s Health Coaches are nurses who are extensively trained in skills and tools that allow them to effectively engage with members in a new way that differs from traditional in-person care. Following are four essential skills that our nurse Health Coaches learn that help them make a meaningful impact on member care:
Skill 1: Listening and Clarifying
In order to provide care, support and guidance over the phone, Health Coaches must learn to engage and collaborate with members through verbal communication and careful listening. With telephonic coaching, they can no longer provide comfort through a smile, read and react to a person’s body language, or physically examine them.
“Out in the clinic setting, our eyes are our biggest assessment tool,” explained Mirna Caudillo, RN, one of Health Dialog’s learning and development specialists. “Now, it’s really about training our ears to become that assessment tool.”
When on a call, it’s important for the Health Coach to be mindful of the member’s tone of voice, as well as their own. A member’s tone can help the coach know how to respond appropriately and gauge a person’s emotional state. Knowing how to ask the right questions and listen closely to the answers is more important than ever.
“What puts a member at ease when talking to a Health Coach is listening and clarifying,” said Linda Powers, RN, a health coach community leader at Health Dialog. “When you listen to what someone has said and you clarify it back to them, they know they’ve been heard, and then that can open the door for the coaching process to continue.”
Skill 2: Empowering Members
One of the core tenets of Health Dialog’s population health management programs is that Health Coaches educate members based on prioritized interventions backed by evidence-based information from our proprietary Care Pathways approach. With this approach, we use the Pathways Engine, our predictive analytics and machine learning platform, to pinpoint where an individual is in their health and wellness journey.
This allows us to assess every member’s clinical needs and long-term disease trajectory. Health Coaches can then tailor every interaction to incorporate the member’s unique health journey, to ultimately guide individuals to make informed and empowered decisions about next steps, such as which tests to schedule, medications to refill and questions to ask their provider. This directional approach helps members take action with confidence and the support of a trusted Health Coach.
Skill 3: Using Digital, Evidence-Based Resources
The job of a Health Coach is to ask open-ended questions that allow a member to tell their story and share their medical concerns. As a Health Coach learns about an individual’s situation, they use a digital platform to quickly find evidence-based information about their concern and the most up-to-date recommendations for care.
“Using their nursing judgment—along with reliable, vetted clinical information—is critical,” Caudillo said. “Coaches must learn how to use trusted resources and understand the most current protocols so they can provide members with evidence-based options. And they need to be able to translate this information to members using plain, understandable language.” Additional considerations include being sensitive to cultural, linguistic and disability differences.
Skill 4: Helping Members Reach Their Goals
In addition to Health Dialog’s inbound Nurse Advice Line, Health Coaches also reach out to members in our Chronic Care Management, Shared Decision Making and Wellness programs. These members often have long-term health conditions and need help finding the motivation and confidence to reach specific goals. For instance, they may have diabetes and be working to lower their blood sugar levels, or be dealing with knee arthritis and are working on chronic pain management, or trying to lose weight to prevent chronic disease.
For these members, the coaching relationship may be ongoing—lasting from a few weeks to a few months—and, as in all coach-member relationships, must be built on trust. The same baseline strategies of listening, clarifying and using directional communication apply.
To make these calls effective, Health Coaches collaborate with members to identify concrete goals, find their motivation, and build the confidence needed to take action and follow through with behavior change plans. As members work toward reaching their goals, coaches regularly check in to support their progress.
This type of coach-member interaction may be rather different than the interactions nurses would typically have in a clinic setting. While nurses in the clinic tend to focus on treating immediate patient needs, telephonic coaching in population health management programs focuses on empowering members to become active healthcare consumers through education, support and behavior change methods.
Preparing for the Transition with Comprehensive Training
For some nurses, telephonic coaching skills learned through Health Dialog’s comprehensive training programs may be relatively new.
On the job, Health Coaches encounter a variety of call scenarios, ranging from symptoms that can be treated at home to emergency situations, or information deficits for someone trying to achieve a certain health goal. “We expose nurses to as many of these scenarios as possible—while also not overwhelming them—but at the end of the day, listening, asking the right questions, showing empathy, using up-to-date resources and helping people understand their options are the key skills needed to handle any conversation,” Caudillo explained.
As with developing most new skills, it comes down to practice. “We do a lot of role playing, teach-back exercises and mock calls,” said Ruth Ann Bloor, senior director of quality and training. Nurses new to Health Dialog are given the time, space and support to become excellent Health Coaches. “Once new Health Coaches are ready for their first calls, they know we are here for support,” Caudillo said. “Taking Nurse Advice Line calls too soon could compromise a member’s safety, so we don’t let anyone start until we are sure they can handle everything and put all the pieces together.”
“Our ongoing training process was key when we needed to quickly educate our Health Coaches on COVID-19 signs, symptoms and pandemic preparedness,” Bloor said. “As COVID-19 guidelines changed and new information was released, we had the systems in place to provide these critical updates to our staff, so they could continue to support members with accurate, evidence-based information and clinical resources.”
Through training, nurse Health Coaches are able to master the techniques that allow them to bring that innate sense of compassion to Health Dialog, to the Nurse Advice Line, to population health management programs, and ultimately—to our members.