Best Practices for Implementing Health Coaching into an Employee Health and Wellness Program

Merrimack College Merrimack College

Merrimack ScholarWorks Merrimack ScholarWorks

Health Sciences Student Work Health Sciences

Spring 2018

Best Practices for Implementing Health Coaching into an Best Practices for Implementing Health Coaching into an

Employee Health and Wellness Program Employee Health and Wellness Program

Caryn Bettencourt

Merrimack College

, bettencour[email protected]

Follow this and additional works at: https://scholarworks.merrimack.edu/hsc_studentpub

Part of the Community Health and Preventive Medicine Commons

Recommended Citation Recommended Citation

Bettencourt, Caryn, "Best Practices for Implementing Health Coaching into an Employee Health and

Wellness Program" (2018).

Health Sciences Student Work

. 12.

https://scholarworks.merrimack.edu/hsc_studentpub/12

This Capstone - Open Access is brought to you for free and open access by the Health Sciences at Merrimack

ScholarWorks. It has been accepted for inclusion in Health Sciences Student Work by an authorized administrator

of Merrimack ScholarWorks. For more information, please contact [email protected].

Running head: BEST PRACTICES FOR IMPLEMENTING HEALTH COACHING 1

Best Practices for Implementing Health Coaching into an Employee Health and Wellness

Program

Caryn Bettencourt

Merrimack College

BEST PRACTICES FOR IMPLEMENTING HEALTH COACHING 2

Abstract

Background: Many employers, from all different types of industries, offer wellness programs

for their employees. The goal of these “worksite” wellness programs is to give their employees

access to health programs to help them improve their health status. Through these worksite

health initiatives the employers have been able to realize an increase in productivity through

decrease in both absenteeism and presenteeism. The employers offer a diverse array of programs

to reduce health risks or support healthy choices. Health coaching is often included in these

worksite offerings. Health coaching is a partnership between the employee and the health coach

to work collaboratively to achieve their health goals. The purpose of this study is to determine

best practices for implementing health coaching into a worksite wellness program. Methods: A

thorough Internet search of award winning hospitals was conducted; ten hospitals throughout the

United States were selected. Each hospital participated in a telephonic interview and answered

eleven preselected standard questions developed from a comprehensive review of literature. A

qualitative analysis was used to evaluate the data. Results: The following four best practices

emerged from interviewing award-winning hospitals. 1. Allow an employee to choose what

health area to work on, 2. Sessions should be over the telephone or face to face, 3. The same

health coach should be used each session, and 4. The number of session should be twelve or

more. Discussion: The results provided evidence that correspond with previous literature.

Conclusion: Implementing the four best practices would conceivably increase employee

engagement in health coaching.

Key words: Worksite wellness, health coaching

BEST PRACTICES FOR IMPLEMENTING HEALTH COACHING 3

Introduction

Health

Health can be described in a number of different ways. In 1946 the World Health

Organization (WHO) defines health in a broader sense as “a state of complete physical, mental,

and social well-being and not merely the absence of disease or infirmity.” (WHO, n.d. Para.1).

Whereas, a Medical dictionary defines “ health as more than the absence of disease in realizing

that humans are dynamic beings and their state of health can change from day to day or hour to

hour thus looking at health on more of a continuum ranging from dire illness through the absence

of discernible disease to a state of optimal functioning in every aspect of one’s life. High level

wellness is described as a dynamic process in which the individual is actively engaged in moving

toward fulfillment of his or her potential.” In the United States, chronic diseases are the

fundamental source of poor health, disability, and death, and account for most of health-care

expenditures. (Bauer, 2014)

Wellness

Wellness is the process of being attentive to making observant decisions regarding one’s

health; and not just an individual’s physical health; but rather is a combination of physical,

mental, and spiritual well-being. This includes seven dimensions: social, emotional, spiritual,

environmental, occupational, intellectual, and physical. “ Wellness requires a disciplined practice

to become holistic through moving toward balance in all dimensions of wellness.” (Abbott,

2015).

Although, health is looked upon differently among the population, there is one unifying

thought: an individual’s responsibility to maintain one’s health. Although the individual is the

responsible party, the health industry is comprised of people wanting to help these individuals in

BEST PRACTICES FOR IMPLEMENTING HEALTH COACHING 4

their journey to maintain and/or improve their health. There is a multitude of different types of

professionals that have dedicate their lives to helping individuals stay or become healthy. The

healthcare and health related industry is a multi-billion dollar industry with a myriad of different

programs, processes, and professionals vying for business. This can make it difficult for someone

to know who to choose when looking for help. To support the following statement regarding

health choices, (Judith Hibbard, 2016) explains; “Efforts to support informed consumer choices,

have largely been a ‘one size fits all’ approach. Understanding consumers, and trying to meet

them where they are, is likely to be the focus of the ‘next generation’ of interventions to support

informed consumer choices. Research that informs how best to do customize information, for

different settings, will be needed to guide these efforts.” It is challenging for employers to

consider all research when cultivating a well-rounded presentation for their consumers.

Worksite Wellness

The definition of worksite wellness according to the Wellness Council of America is “An

organized program in the worksite that is intended to assist employee and their family members

in making voluntary behavior changes which reduce their health and injury risks, improve their

health consumer skills and enhance their individual productivity and wellbeing” (WELCOA,

2017).

According to Pescud et al., (2015) “Unhealthy lifestyles in the workplace has shown to

reduce productivity and increase absenteeism and presenteeism. The workplace covers a

considerable proportion of the adult population and is an optimal setting for health promotion

initiatives. Improving the health of a workforce is done by the following: health risk assessments,

vaccinations, wellness activities to improve healthy eating, physical activity, tobacco use,

alcohol consumption, and mental health outcomes.” Worksites offer ideal settings for reaching

BEST PRACTICES FOR IMPLEMENTING HEALTH COACHING 5

adults, including those at higher risk for chronic diseases” Polacsek et al., (2006). Another very

important point for an effective health and wellness program is the atmosphere or culture in

which individuals work. “A culture of health supports and encourages healthy lifestyles by

providing all employees with ongoing opportunities to maintain or improve their health status

across a variety of interventions” Grossmeier et al (2010). When the executives promote health

and wellness they provide a higher level of motivation for their employees to engage in the

program. Churchill et al., (2014).

One way to accomplish a successful health and wellness program according to (Putnam,

2017) is to:

1. Design and implement a health strengths assessment - Help people to

identify and celebrate what they are doing right.

2. Launch “start with what’s right” campaigns - Create excitement using

positivity to build a more resilient mindset.

3. Rename the program using uplifting themes such as “Winning Teams” -

this will generate good feelings that can motivate employees.

4. Make it fun - will help employees feel good which is a powerful

motivator.

5. Build a culture of health and learning - build an environment that helps to

support health and learning.

Applying this process will help to empower your employees and help them to believe in

themselves to make a change in their health.

BEST PRACTICES FOR IMPLEMENTING HEALTH COACHING 6

Health Coaching as Part of a Comprehensive Worksite Wellness Program

Employers are recognizing the value of offering worksite health and wellness programs.

These programs are aimed at developing a health conscious work environment. They take on

different forms but as a rule a comprehensive worksite program involves risk stratification, using

a self-reporting of health issues and concerns, a health risk assessment (HRA), behavior

modification programs, and health education for the employees. The organization benefits from

these programs by not only having a healthy workforce which decreases financial losses

associated with absenteeism and presenteeism. Their action shows the employees that the

organization values them and cares about their health and wellbeing. When the employer

commits to the development of a comprehensive worksite program they are showing that they

value and promote an environment of health in the organization. With the development of a

health and wellness committee the leadership provides a vehicle for the employee to make a

difference in the organization. This commitment serves to increase employee engagement in the

organization. The employee sees that the employer has aligned with them on health. This occurs

through these programs and incentives to encourage enrollment in the programs. The employee

then is more open to and can appreciate the mutual benefit of aligning with the employer on

other organizational goals. Therefore, these programs have a multifaceted value to the

organization and the employee. Health Research & Educational trust, (2016).

In looking at boosting employee empowerment, many worksite wellness programs

include the ability for employees to use the guidance of a health coach. Health coaches partner

with employees to move them forward toward living a healthier lifestyle. The National Society

of Health Coaching (NSHC) definition states that “health coaching is a framework of scientific

concepts that engage and guide individuals as they tap into their own inner motivation to better

BEST PRACTICES FOR IMPLEMENTING HEALTH COACHING 7

manage their own health conditions” (Huffman, 2011). Thus, this field came out of motivational

interviewing from the 1990’s and has continued to grow into a certified employable position.

Health coaches are used in many different settings including, but not limited, to communities,

primary care, worksites, and individual populations Butterworth et al., (2007). “Primary

objectives of health coaching are to educate the patient regarding self-management and to

encourage patients in taking a more proactive role in staying healthy” (Buckley, 2010). Health

coaching provides an approach that can meet the unique needs of an individual. This type of

program can therefore meet the specific needs of employees.

Impact of Coaching

A health coach can work with individuals on a variety of different health related lifestyle

issues including: self-managing chronic conditions, starting an exercise program, smoking

cessation, increasing energy, managing stress, sleeping better, incorporating a better diet and

nutrition, and pain management. In working with a health coach, individuals have shown

improvements in their health behaviors, self-efficacy, and goal setting skills. Participants

implemented positive lifestyle changes and learned skills to maintain these positive changes

Clark et al., (2016). In a study that followed patients for twenty-four months looking for the

lasting effects of health coaching, documenting results at twelve months and twenty-four months,

they found that their results at the end of the study had been maintained which predicted lasting

effects from health coaching. Sharma et al., (2016). In look looking for the lasting at the

effectiveness of a health coaching intervention, there are four things to look at: health related

behaviors, health status, productivity, and healthcare utilization Butterworth et al., (2007). The

value for the employer is also obvious, as described by (Ashworth, 2017) in five top reasons why

a company would want to hire a health coach:

BEST PRACTICES FOR IMPLEMENTING HEALTH COACHING 8

1. Health coaches can work with individuals to improve overall company health.

2. The personal one-on-one interaction can allow employees to feel engaged in the wellness

program.

3. The health and wellness coaches can serve as independent spokespeople.

4. The employees can demonstrate the benefits they receive from coaching.

5. Health coaches can collect feedback from employees.

In a study conducted at Mercy Clinics on the value of health coaching results showed that

“overall the health coach activities improve compliance and documentation for chronic patients,

enable higher level billing, and increase clinician productivity.” Lanese et al., (2011).

Engagement

Employee engagement refers to the emotional connection that an individual feel

toward his or her employment organization. Communication between management and

employees is the basis for creating employee engagement. There are many benefits that occur

when engagement is high, companies will see lower turnover, higher productivity, a better

atmosphere will develop, and the company will see greater profitability. Motivating employees

can come with its challenges, for example, employers sometimes focus on the bottom line and

not their employees or the leaders are not inspiring to their employees. In building employee

engagement there are several ways this can be done. First, trust must be developed among

management and employees, then, management must establish clear expectations, and finally,

management needs to show appreciation.

One must consider the following when choosing a health coach:

BEST PRACTICES FOR IMPLEMENTING HEALTH COACHING 9

they need to have trust and the right contact information must be provided, they must be able to

leverage the teachable moment, be timely and effective in responding to employees, use

personalized messaging, and when necessary, relevant incentives can be utilized.

Incentives

An incentive can be defined as a thing that motivates or encourages an individual to do

something. In a worksite wellness program different forms of incentives are used to increase

program participation and encourage positive employee health behavior. There are different

strategies for incentives, which are either participation-based, outcome-based, or progress-based.

Wellness Connector, (2017) An example of an incentive would be receiving fifty dollars for

completing a biometric screening.

Financial incentives are used in a worksite wellness program to motivate participation. Does this

work for health coaching? One study found that offering financial incentives for health coaching did

show a higher completion rate, but improved health does not necessarily follow (Gingerich, 2012).

Another study suggests that financial incentives need to be clarified to see if they are effective in

driving deeper engagement in coaching programs, besides just the enrollment (Grossmeier, 2013).

Yet another study states that financial incentives are effective for short-term behavior such as

completing an HRA rather than a more complex outcome such as weight loss Churchill et al., (2014).

Choice Architecture

In thinking of engagement, one theory looks at an individual’s ability to choose or make

decisions. “Choice architecture can be used to help nudge people to a make better choice (as

judged by themselves) without forcing certain outcomes upon anyone.” Thaler et al., (2008). In

one study “authors examined the use of coaching for participants with diabetes, asthma or

cardiovascular disease. Given the choice, 80 percent of these consumers with chronic conditions

BEST PRACTICES FOR IMPLEMENTING HEALTH COACHING 10

selected a lifestyle topic as their coaching focus. The net impact of providing choice was delivery

of three times as much condition-relevant coaching than they would have received in a

traditional disease management model.” Barleen et al., (2015). A traditional disease

management model focuses solely on the health risk of an employee and not providing them with

the opportunity to make choices.

Coaching Design

Health Coaching Models

There are several different coaching models, similar in structure, which follow these

steps.

1.Pre-coaching phase includes reviewing an assessment and building relationships.

2. Active Coaching phase where the purpose and goals are clarified, and a plan is

developed with a commitment to act.

3. Follow-up phase the plan or new behaviors are enacted and coaching feedback is

provided. Dyess et al., (2017).

In coaching building a trusting relationship is the foundation that provides the basis for success.

Thom et al., (2016).

Delivery of Coaching

The process of health coaching can be delivered in a couple of different models including

the transtheoretical model and collaborative care model. . The Transtheoretical Model of

Behavior Change assesses an individual's readiness to act on a new healthier behavior, and

provides strategies, or processes of change to guide the individual through the stages of change

to Action and Maintenance. (“Transtheoretical Model,” n.d.). One of the strengths of this model

is that it is a comprehensive theory of change that can be applied to a variety of behaviors. A

BEST PRACTICES FOR IMPLEMENTING HEALTH COACHING 11

limitation of this model is that this theory ignores the social context in which change occurs,

such as income. The next model the collaborative care model is one that is team driven,

population focused, measurement-guided, and evidence based. A strength of this model is that it

is a multidisciplinary group of healthcare delivery professionals providing care in a coordinated

fashion and empowered to work at the top of their professional training. A limitation of this

model is management turnover can impede the process of the collaboration of healthcare teams.

American Psychiatric Association, (2017).

The components of a successful coaching model blend the following self-efficacy and

risk participation, values, experiences, barriers, and resources. (Reed, 2009).

Traits of Coaching

A health coach should possess the following qualities first he or she must be empathetic,

a good listener, be trustworthy, non-judgmental, honest, and can motivate another individual.

Health coaches do not diagnose, interpret behavior or beliefs, or clinically advise patients on

what to do Wolever et al., (2016).

Empathy is especially important when working as a health coach this quality is the one

that can allow you to be present in the moment and truly listen to your client.

The process of health coaching can be conducted in several different forms; face to face,

telephonically, e-mail, or internet (Skype would be an example). “Generally, the in-person or

telephonic formats are favored because they are more compatible with the interactive, non-

scripted motivational interviewing-based approach” Butterworth et al., (2007). Another article

quoted, “When I would get a call it would be a different coach each time who didn’t know me.

That was very frustrating.” Hill-Mey et al., (2013). A coaching program should provide the

participant with access to the same coach for the duration of their participation. A relationship

BEST PRACTICES FOR IMPLEMENTING HEALTH COACHING 12

should be built with the coach and participant. Unfortunately, this cannot be done if each

coaching session you have a different coach.

Training

The journey to become a health coach begins with enrolling in a training program that

can last up to several years. The growth process of becoming a health coach is continually

evolving. “A joint volunteer effort is underway to develop a national standard for training and

certification of health and wellness coaches in the United States.” Smith et al., (2013).

When an employer is looking to add health coaching to their health and wellness

program, they need to select coaches who are certified. One must have one of the following in

order to sit for the certification exam: Clinical license, bachelor’s degree or higher in a health

related domain, bachelor’s degree or higher in a non-health related domain plus 2000 hours work

experience in health, allied health, and wellness, those who have accredited fitness certification,

ministers, hospice workers, pastoral counselors, teachers, healthy food chef, whole foods

advocates, and coaches credentialed by the International Coaching Federation. Training

programs should assess practical skills, performance, and require the demonstration of safe, basic

competency before individuals may graduate from their program. Jordan et al., (2015).

Health coaches are required to submit thirty-eight hours of continuing education credits

within a three year period. This can be completed by taking online webinars, readings, quizzes,

and seminars.

Barriers to Participation

The following are some barriers that employees cited as reasons for not participating

● Time restrictions

● Feeling the program was a low priority

BEST PRACTICES FOR IMPLEMENTING HEALTH COACHING 13

● Distance problems

● Professional and personal responsibilities getting in the way

● Confidentiality concerns or worries about strange people calling

and asking questions about that individual’s health.

● Keeping one’s own health records

● Already knowing they are healthy

● The incentives not being enough

● Feeling the program was irrelevant because they were on their

spouse’s insurance program. Hill-Mey et al., ( 2013) .

Summary

Health coaching within a worksite wellness program can add another option for

guiding their employees toward living a healthier lifestyle. Employers are showing their

employees the level of commitment they have in facilitating behavior change. Worksite wellness

programs have the ability to allow coaches to work with their employees in an effort to create

productive and effective staff members.

What Is Benchmarking

Primarily to identify the best practices adopted in world-class companies which leverage

them to high-level performance and leading position, and implement such practices in one's own

company. This is a continuous learning process that will bring about a pragmatic search of new

ideas. This process takes time and the work requires discipline. Once completed this is a

powerful tool that delivers useful information for a sustainable improvement of the maintenance

organization. Business dictionary, (2017).

BEST PRACTICES FOR IMPLEMENTING HEALTH COACHING 14

Benchmarking provides a information that can identify where a company is doing well

and where they need to make changes. The process of benchmarking is a more efficient way to

make improvements.

This project will contact ten to fifteen hospitals in an effort to hear what is working or not

in reference to health coaching.

Methodology

Participants:

Ten to fifteen hospitals that offer health coaching as an option in their health and

wellness program. The hospitals have been contacted from all over the United States and were

willing to participate in a phone interview.

The inclusion criteria is:

1. The facility must be a hospital.

2. They must have a health and wellness program.

3. They must offer health coaching as part of the health and wellness program.

The exclusion criteria is:

1. The facility is not a hospital.

2. The hospital does not offer a health and wellness program.

3. The hospital does not offer health coaching.

4. An employee from the hospital’s Human Resources or employee wellness department has

been contacted and he or she must be familiar with their health coaching program.

Procedure:

A thorough internet search was completed and twenty-five hospitals from around the

United States were identified and each one has a health and wellness program. Healthcare

BEST PRACTICES FOR IMPLEMENTING HEALTH COACHING 15

Business & Technology, (2012). The next step was calling these hospitals and creating a list of

the hospitals that has health coaching as an option.

The list of hospitals that have a health coaching option was documented and from this list ten to

fifteen hospitals was chosen based off of the willingness to participate in a phone interview. The

finalized list of hospitals that agreed to participate was recruited by January 2018. There will not

be an incentive provided for participating in this study.

A phone call was placed to ten to fifteen hospitals that have agreed to participate in a

thirty minute interview. Prior to the interview verbal consent was given by each hospital

participant.

Measures:

An interview was developed for this study to document information from hospitals about

their health coaching and wellness program. These questions include:

1. Does their wellness program include participation in a health assessment and/or biometric

screening?

2. Do you have a health coaching program?

3. Is the coaching program integrated with the health assessment and/or screenings? (same

vendor, data shared).

4. If so, what is the model telephone, face to face, or virtual?

5. Who is eligible to participate in this program? (All employees, only high risk employees)

6. Are participants allowed to select what health risk/area they would like to work on?

7. How many calls are they allowed?

8. Are they assigned a dedicated coach or does the coach vary session to session?

9. Do they provide incentives for participation in health coaching?

BEST PRACTICES FOR IMPLEMENTING HEALTH COACHING 16

10. What percentage of employees participate?

11. Do you have the ability to measure the success of health coaching? If so, what is the

measurement?

Data Analysis:

The qualitative interview data was analyzed to identify themes related to the role of

health coaching in a health and wellness program. The information was read and assigned coding

categories. The information was analyzed that the following information was found.

Results:

In order to determine the best practices for health coaching within a hospital employee

health and wellness program other hospitals were interviewed on the details of their program.

The hospitals were determined using the following protocol.

Each year the Wellness Counsel of America (WELCOA) produces a list of their employee

health and wellness award winning hospitals. The participants for this interview were chosen

from this list. There were twelve hospitals contacted all agreed to participate in the interview.

Two interviews were with the health and wellness director, three were with the health and

wellness coordinator, and seven hospitals I interviewed the health and wellness manager. These

hospitals were located throughout the United States including California, Ohio, Oregon,

Wisconsin, Massachusetts, New Jersey, Missouri, Colorado, and Florida. The demographics of

the hospitals interviewed include; five hospitals with less than 2,500 employees, five that has

between 2,500 and 5,000, and two with more than 5,000. The number of beds in each hospital

ranged from 25 – 1440.

BEST PRACTICES FOR IMPLEMENTING HEALTH COACHING 17

Demographics:

Table 1 Demographic Information for Participants

Hospital

Number of Beds

Number of Employees

814

253

4600

259

3080

493

3850

1440

40000

293

7400

353

2053

100

1108

1076

139

980

450

284

2600

Table 1 above shows the number of beds and employees for each hospital that was interviewed

Health Coaching

Figures 1-3 represents a sampling of questions from the interview of hospitals throughout the

United States.

Figure 1 provides information on participation and health coaching in United States Hospitals

BEST PRACTICES FOR IMPLEMENTING HEALTH COACHING 18

In evaluating the data, it was revealed that all twelve hospitals participated in a health

assessment and biometric screenings. Health coaching was offered in all of the hospitals but only

eight hospitals integrated with the health assessment and screenings.

Figure 2 represents the design of health coaching

This study provided information on the design of coaching 90% of hospitals responding

stated they offered health coaching to all employees’ not just employees with a high-risk illness.

When asked if employees were allowed to focus on the health area of their choice 80% of the

respondents stated yes. Sixty-four percent (64%) of the hospitals allowed an unlimited number

of calls or sessions with the coach. Eight-two percent (82%) of the participants had the

opportunity to meet with the same coach each session.

Another important area that was looked at is the modality of health coaching.

The model of health coaching offered within the employee health and wellness programs are

telephonic, face-to-face or online. Telephonic includes coaching over the telephone, face to face

BEST PRACTICES FOR IMPLEMENTING HEALTH COACHING 19

is when coaching is conducted in person, and online uses a program where you can see each

other over the computer. The percentages for each type of coaching if represented below.

Figure 3 highlights the different models of coaching from eleven of the twelve hospitals.

Figure 4 represents health coaching engagement

BEST PRACTICES FOR IMPLEMENTING HEALTH COACHING 20

Figure 4 represents whether the hospital offers incentives for employees who participate in

the health coaching program and Figure 5 goes into more detail about what types of incentives

were offered across respondents. The following metrics are used health screening and

biometrics, claims data, the health coach’s data or health plan data to assess if the hospital’s

health coaching program is successful

Figure 5 Incentives offered for health coaching

Incentives within an employee health and wellness program include earning points that can be

utilized for prizes, cash, or a discount toward health insurance.

There were eight hospitals that provided points that could be used toward cost savings, four

hospitals did not offer any incentives, and one hospital took thirty percent (30%) off of the

employee’s insurance premium.

Finally, when asked about the percent of employee’s who participant in health coaching the

response from many of the hospitals was that it is low or unknown. The few hospitals that did

track this data expressed that there was 2-3% participation in their health coaching program. The

BEST PRACTICES FOR IMPLEMENTING HEALTH COACHING 21

highest involvement for health coaching within an employee health and wellness program was

10%. I did have two hospitals state that this was an area they wanted to start tracking this data.

Discussion

The current study was to 1.) Assess current practices of health coaching in award winning

hospital employee health and wellness programs. 2.) A telephonic interview was used to acquire

the information using specific questions on how the hospitals incorporate health coaching into

their program. 3.) The hospitals that participated were selected using the criteria that they were

located in the United States and must offer health coaching to their employees. The major

finding to foster employee engagement in health coaching are as follows: That choice is an

important factor, the mode of coaching does make a difference, using the same coach each

session has a significant impact on an individual’s progress, and the number of sessions allowed

with the coach should not be limited. Employee Benefit News, (2017) states that “by offering

health and wellness coaching services, it shows that the company is invested in the health of it

employees.” underscores the importance of implementing health coaching into an employee

health and wellness program.

The results from the benchmarking process with hospitals across the United States has

provided information to develop four best practices for implementing health coaching into an

employee health and wellness program, that are well supported by previous literature.

Allowing an employee to make a choice and recognizing humans as individuals and

providing dignity will allow an individual to achieve their full potential. As human beings we

have a superior capacity for making decisions, they can be emotional or rational. Choice is

extremely important when developing an employee health and wellness program. As stated

“Choice is a key engagement element for consumers with a health condition.” Barleen et.al.,

BEST PRACTICES FOR IMPLEMENTING HEALTH COACHING 22

(2015) Individuals feel better off when they are allowed to make a choice, and research supports

equal or greater outcomes when choices is allowed.

When working with a coach their needs to be trust and a relationship built. According to

Thom et al., (2016) in coaching building a trusting relationship is the foundation that provides

the basis for success. Building this relationship takes time and effort. The coach also needs to

show empathy and hold the individual accountable for their goals. The employee needs to

become comfortable with his or her coach. This is why the employee should meet with the same

coach each session. Seeing the same coach will allow the employee to build trust and rapport. If

the employee is not allowed to meet with the same coach, then his or her progress will not

continue to move forward. Eighty-two percent of the hospitals interviewed had provided that

their coaching participants meet with the same coach throughout the program.

Coaching takes time, availability, and accessibility. The mode in which someone

participates in health coaching is also very important. This study found that health coaching

should be offered either face to face or telephonically. It was found that individuals do their best

work with a coach when they can sit across from them and have a conversation. If they are

coached over the phone the process does work just as well and can be easier to schedule, and less

expensive to implement.

The number of sessions the coach and employee meet should not be pre-determined

because each individual is unique. The number of sessions varies for each person it is not a one

size fits all type of process. Therefore, in a health and wellness program the number of health

coaching sessions should be as many as the employee needs to make progress. They should work

with the coach enough to assist them in managing their health until they can do it on their own.

BEST PRACTICES FOR IMPLEMENTING HEALTH COACHING 23

The United States Preventative Task Force states that intensive intervention to drive behavior

change is twelve or more sessions. (United States Preventative Task Force, 2017).

Employers offer incentives that help to motivate employees to participate in the health

and wellness program. Incentives work to bring someone into the program, but they are not able

to change the behavior of an employee. Behavior change requires effort and time to build the

new way of doing something. There are a number of theories that a coach can use when working

with someone to change their behavior. (Gingrich, 2012) stated that financial incentives for

health coaching did show higher completion rate but improved health did not follow.

Application and Implications

According to the current study, the information provided did correlate with prior

literature. The data from interviewing hospitals throughout the United States provided enough

information to determine four best practices for implementing health coaching. These best

practices are allowing choice, offering coaching telephonically or face to face, having the same

coach each session, and providing twelve or more sessions. Implementing these practices should

produce a greater increase of engagement in health coaching.

Limitations

A limitation of the present study is the insufficient data on the percentage of participation

in health coaching among hospital employee health and wellness programs that were

interviewed. Another limitation is the data on the overall effectiveness of coaching was too

varied to develop a comprehensive picture on the impact of coaching from this benchmarking.

One final limit is that this study was limited to hospitals. The results of this study could

potentially be implemented into other settings such as corporations.

BEST PRACTICES FOR IMPLEMENTING HEALTH COACHING 24

Future Directions

It would be interesting to further explore the role of health coaching in an employee

health and wellness program other than hospitals. In looking at other worksite wellness settings a

study could be conducted to compare the different settings and look for the differences and

similarities between them. Also, in looking at the mode of coaching with the further development

of technology, virtual physicians, and apps for phones this advancement could help to add

another option for health coaching.

Conclusions

In summary the most important finding in this study is that there are specific practices

that will allow health coaching to be used as a valuable resource for behavior change within an

employee health and wellness program. Implementing and following the best practices can

potentially increase participation. Hospital employers can use this information to implement

health coaching into their employee health and wellness program. Thus, their employees can use

health coaching to make the changes they need to lead a healthy lifestyle and perform their duties

at work to their fullest potential.

BEST PRACTICES FOR IMPLEMENTING HEALTH COACHING 25

References

Abbott, R. A., & Baun, W. B. (2015). The multi-dimensions of wellness: The vital role of terms

and meanings. American Journal Of Health Promotion, 29(5), 8-10.APA-APM-

Dissemination-Integrated-Care-Report%20(2).pdf

www.psychiatry.org/psychiatrists/practice/professional-interests/integrated-care/get-

trained/about-collaborative-care

American Journal of Health Promotion July 2017, Vol. 31 Issue 4, p361 4p.

Ashworth, D. (2017). Can health coaching increase employee engagement? Employee Benefit

News (Online), Retrieved from http://proxy3.noblenet.org/login?url=https://search-

proquest-com.proxy3.noblenet.org/docview/1918885318?accountid=40663

Barleen, N., Ph.D., Higgins, A., Dr.P.H., Dobro, J., M.D., & Zimmerman, E., M.P.H., M.B.A.

(2015). Impact of Choice-Based Design on Population Health. RedBrick Health,1-28.

Retrieved October 10, 2017, from http://home.redbrickhealth.com/results/white-papers

Bauer, U. E., Briss, P. A., Goodman, R. A., & Bowman, B. A. (2014). Prevention of chronic

disease in the 21st century: elimination of the leading preventable causes of premature

death and disability in the USA. Lancet (London, England), 384(9937), 45-52.

doi:10.1016/S0140-6736(14)60648-6

Bauer, Ursula E et al.

benchmarking. BusinessDictionary.com. Retrieved November 20, 2017, from

BusinessDictionary.com website:

http://www.businessdictionary.com/definition/benchmarking.html

Buckley, Patrick T,M.P.A., I.H.C. (2010). Health coaching good for your patients and

your practice. Medical Economics, 87(22), 60-70. Retrieved from

BEST PRACTICES FOR IMPLEMENTING HEALTH COACHING 26

http://proxy3.noblenet.org/login?url=https://search-proquest-

com.proxy3.noblenet.org/docview/818553352?accountid=40663

Butterworth, S., Moore, M., Stolzfus, J., & Walkup, R. B. (2014). Coaching Experts Discuss the

Relationships Between Coaching, Culture, and Health Outcomes and for What Coaches

Should Be Held Accountable. American Journal Of Health Promotion, 28(6), TAHP-3-

TAHP-7.Hibbard, J. H. (2017). Patient activation and the use of information to support

informed health decisions. Patient Education And Counseling, (1), 5.

doi:10.1016/j.pec.2016.07.006

Can health coaching increase employee engagement? (2017, July 14). Business Insights:

Essentials.

Clark, M. M., Bradley, K. L., Jenkins, S. M., Mettler, E. A., Larson, B. G., Preston, H. R., . . .

Douglas, K. S. (2015). Improvements in Health Behaviors, Eating Self-Efficacy, and

Goal-Setting Skills Following Participation in Wellness Coaching. American Journal of

Health Promotion,30(6), 458-464. doi:10.4278/ajhp.140627-qual-304

Churchill, S. A., Gillespie, H., & Herbold, N. H., EdD. (2014). The desirability of wellness

program and incentive offerings for employees. Benefits Quarterly, 30(1), 48-57.

Retrieved from http://proxy3.noblenet.org/login?url=https://search-proquest-

com.proxy3.noblenet.org/docview/1512705068?accountid=40663

Crabb, S. (2011). The use of coaching principles to foster employee engagement. Coaching

Psychologist, 7(1), 27-34.

Dyess, S. M., Sherman, R., Opalinski, A., & Eggenberger, T. (2017). Structured coaching

programs to develop staff. The Journal of Continuing Education in Nursing, 48(8), 373-

378. doi:http://dx.doi.org.proxy3.noblenet.org/10.3928/00220124-20170712-10

BEST PRACTICES FOR IMPLEMENTING HEALTH COACHING 27

Gingerich, S. B., Anderson, D. R., & Koland, H. (2012). Impact of Financial Incentives on

Behavior Change Program Participation and Risk Reduction in Worksite Health

Promotion. American Journal of Health Promotion,27(2), 119-122.

doi:10.4278/ajhp.110726-arb-295

Grossmeier, J., Terry, P. E., Cipriotti, A., & Burtaine, J. E. (2010). Best Practices in Evaluating

Worksite Health Promotion Programs. American Journal of Health Promotion,24(3).

doi:10.4278/ajhp.24.3.tahp

Grossmeier, J. (2013). The Influence of Worksite and Employee Variables on Employee

Engagement in Telephonic Health Coaching Programs: A Retrospective Multivariate

Analysis. American Journal Of Health Promotion, 27(3), e69.

https://medical-dictionary.thefreedictionary.com/health

Health Research & Educational Trust. (2016, October). Health and wellness programs for

hospital employees: Results from 2015 American Hospital Association survey. Chicago,

IL: Health Research & Educational Trust. Accessed at www.hpoe.org

Hibbard, J. H. (2017). Patient activation and the use of information to support informed health

decisions. Patient Education and Counseling,100(1), 5-7.

doi:10.1016/j.pec.2016.07.006

http://hin.com/blog/2009/10/1/3-health-coaching-models-for-behavior-change

Hill-Mey, P. E., Merrill, R. M., Kumpfer, K. L., Reel, J., & Hyatt-Neville, B. (2013). A Focus

Group Assessment to Determine Motivations, Barriers and Effectiveness of a University-

Based Worksite Wellness Program.

Home - US Preventive Services Task Force. (n.d.). Retrieved from

https://www.uspreventiveservicestaskforce.org/

BEST PRACTICES FOR IMPLEMENTING HEALTH COACHING 28

Huffman, Melinda H., BSN, MSN,C.C.N.S., C.H.C. (2010). Health coaching. AAOHN Journal,

58(6), 245-50; quiz 251-2. doi:http://dx.doi.org.proxy3.noblenet.org/10.3928/08910162-

20100526-02

Jordan, M., Wolever, R. Q., Lawson, K., & Moore, M. (2015). National training and education

standards for health and wellness coaching: the path to national certification. Global

Advances In Health And Medicine, 4(3), 46-56. doi:10.7453/gahmj.2015.039

Lanese, B. S., Dey, A., Srivastava, P., & Figler, R. (2011). Introducing the health coach at a

primary care practice: impact on quality and cost (Part 1). Hospital Topics, 89(1), 16-22.

doi:10.1080/00185868.2011.550207

Matthews, M. (2009). 3 Health Coaching Models for Behavior

Change.http://hin.com/blog/2009/10/01/3-health-coaching-models-for-behavior-change/

[Accessed 16 Nov. 2017].

Patricia E., H., Ray M., M., Karol L., K., Justine, R., & Beverly, H. (2013). A Focus Group

Assessment to Determine Motivations, Barriers and Effectiveness of a University-Based

Worksite Wellness Program. Health Promotion Perspectives, Vol 3, Iss 2, Pp 154-164

(2013), (2), 154. doi:10.5681/hpp.2013.019

Pescud, M., Teal, R., Shilton, T., Slevin, T., Ledger, M., Waterworth, P., & Rosenberg, M.

(2015). Employers' views on the promotion of workplace health and wellbeing: a

qualitative study. BMC Public Health, 15(1), 1-10. doi:10.1186/s12889-015-2029-2

Prevention of chronic disease in the 21st century: elimination of the leading preventable

causes of premature death and disability in the USA

Polacsek, M., PhD, MHS, O'Brien, L. M., PhD, Lagasse, W., MSB, CHES, & Hammar, N.

(2006). Move & Improve: A Worksite Wellness Program in Maine. Preventing Chronic

Disease Public Health Research, Practice, and Policy,3(3), 1-8.

BEST PRACTICES FOR IMPLEMENTING HEALTH COACHING 29

Putnam,, L., MA. (2017). Positive Thoughts, Positive Results: Jumpstart Your Worksite

Wellness Initiative by Starting With What's Right. American Journal of Health

Promotion,31(4), 361-364.

Reh, F. J. (2017). Benchmarking Overview, Practices and Approaches in Business. Management

& Leadership. Retrieved from http://www.thebalancecareers.com/overview-and-

examples-of-benchmarking-in-business

Richard H., T., Cass R., S., & John P., B. (2010). CHOICE ARCHITECTURE 0.Gingerich, S.

B., Anderson, D. R., & Koland, H. (2012). Impact of financial incentives on behavior

change program participation and risk reduction in worksite health promotion. American

Journal Of Health Promotion, 27(2), 119-122. doi:10.4278/ajhp.110726-ARB-295

Sharma, A. E., Willard-Grace, R., Hessler, D., Bodenheimer, T., & Thom, D. H. (2016). What

Happens After Health Coaching? Observational Study 1 Year Following a Randomized

Controlled Trial. Annals Of Family Medicine, 14(3), 200-207. doi:10.1370/afm.1924

Smith, L. L., Lake, N. H., Simmons, L. A., Perlman, A., Wroth, S., & Wolever, R. Q. (2013).

Integrative Health Coach Training: A Model for Shifting the Paradigm toward Patient-

centricity and Meeting New National Prevention Goals. Global Advances in Health and

Medicine,2(3), 66-74. doi:10.7453/gahmj.2013.034

Susan W., B., Ariel, L., & Wende, M. (2007). Health Coaching as an Intervention in Health

Management Programs. Disease Management And Health Outcomes, (5), 299.

T.M. (n.d.). In Wikipedia. Retrieved December 7, 2017, from

http://en.wikipedia.org/wiki/transtheoretical model.

Thaler, R. H., & Sunstein, C. (n.d.). Choice Architecture. PsycEXTRA Dataset.

doi:10.1037/e722852011-067

BEST PRACTICES FOR IMPLEMENTING HEALTH COACHING 30

The Lancet , Volume 384 , Issue 9937 , 45 - 52

Thom, D. H., Wolf, J., Gardner, H., DeVore, D., Lin, M., Ma, A., & ... Saba, G. (2016). A

Qualitative Study of How Health Coaches Support Patients in Making Health-Related

Decisions and Behavioral Changes. Annals Of Family Medicine, 14(6), 509-516.

doi:10.1370/afm.1988

What is benchmarking? (2014, December). Fleet Maintenance. Retrieved from

http://go.galegroup.com.proxy3.noblenet.org/ps/i.do?p=ITOF&sw=w&u=9211haea&v=2

.1&it=r&id=GALE%7CA407184799&sid=ebsco&asid=6fbe3f525498bf290b2d9cde3eab

cd5e

Where Are America's Best Hospitals? (n.d.). Retrieved from http://health.usnews.com/best-

hospitals

Wolever, R. Q., Jordan, M., Lawson, K., & Moore, M. (2016). Advancing a new evidence-based

professional in health care: job task analysis for health and wellness coaches. BMC

Health Services Research, (1), doi:10.1186/s12913-016-1465-8

http://www.wellnessconnector.com/overview

World Health Organization. (n.d.). Frequently asked questions. Retrieved from

http://www.who.int/suggestions/faq/en/