OA38 Health coaching and co-production from self efficacy to service improvement: using a system thinking approach to embed coaching and improvement science in service delivery
Authors: Mavrommatis Sophia , Bouraoui Aicha , Fisher Corinne , Ahmed Ishaaq , Burman Rhea , Celik Nazlisu , Shah Aisha , Smith-Junkere Keldra , Al-Sulaim Toka , Begum Sultana , Ciurtin Coziana , Seegoolam Shamila Devi , Gupta Joanna , Harvey-Regan Ruth , Leandro Maria , Meyer Stephanie , Williams Ellie , Williamson Luke , Sen Debajit 
Published: April 2023

Abstract

Background/Aims
In long-term conditions like rheumatic diseases, medical interventions are estimated to account for only 10-20% of the factors that impact on health outcomes. Social determinants of health and health-related behaviours account for 80-90%. While our department has a long history of embedding patient and public involvement and engagement (PPIE) in research, it is still a relatively new way of working in health service improvement. PPIE allows us to involve patients in what we do based on the principle of “no decision about me without me”. In 2021, a year into the pandemic, our Adolescent & Young Adult (AYA) Rheumatology team planned for our service improvements strategy. We aimed to engage service users using a co-production model.

Methods
Following two funding awards, we started the implementation of this project with the aim to enable young people (YP) and clinical staff to sustainably co-produce individual health outcomes and service improvement. Our baseline data identified significant variations in clinical consultations with no standardised approach to supporting YP with self-management, and a third of clinicians knew about health coaching (HC). HC is a technique that aims to “help patients gain the knowledge, skills, tools, and confidence to become active participants in their care so that they can reach their self-identified health goals”.

Results
We built our HC core capabilities for the whole AYA rheumatology multidisciplinary team. Four staff members completed European Mentoring & Coaching Council accredited HC training. A follow-up survey identified that clinicians started to embed HC into clinical consultation in 30% of our consultations with YP. We developed and embedded HC tools in our electronic health records to improve efficiency and standardisation in clinic consultation. We are piloting a dedicated HC clinic for YP with complex needs. We engaged with our service users, conducted one-to-one meetings with them, and organised workshops. We selected activities that matched our engagement aims. We used system thinking, structured coaching conversation, and quality improvement methodologies. Discussion between service users and clinicians fed into our two key projects: co-producing healthcare consultations, and setting up a peer support scheme. We now plan for three YP to participate in an internship scheme and work with us to deliver these projects. They will be part of our journey in co-creating health and service improvement for service users.

Conclusion
In this project, we aimed to embed co-production in the clinician-patient relationship using health coaching conversations and extended this approach into co-creating services with users. Like many other services, we are still learning from our improvement journey. Building relationships with YP and treating them as equal partners enables alignment of the service and its intended impacts with what matters most to the YP we serve.
Disclosure
S. Mavrommatis: None. A. Bouraoui: None. C. Fisher: None. I. Ahmed: None. R. Burman: None. N. Celik: None. A. Shah: None. K. Smith-Junkere: None. T. Al-Sulaim: None. S. Begum: None. C. Ciurtin: None. S. Devi Seegoolam: None. J. Gupta: None. R. Harvey-Regan: None. M. Leandro: None. S. Meyer: None. E. Williams: None. L. Williamson: None. D. Sen: None.