Farming ideas to health care: practice coaching

I was at the Institute for Healthcare Improvement (IHI) a few years ago, completing their Breakthrough Series College. This program provides training on how to design and lead a quality improvement learning collaborative, the IHI term for a network of health care teams who share learning and receive coaching on improving quality in a defined area of focus.

A recent issue brief from the Commonwealth Fund looks at the effectiveness of practice coaching or practice facilitation in primary care. Essentially, this innovation involves helping practices redesign the clinical care they provide. Practice coaching has been effectively used in primary care settings to improve access to care, chronic disease care, preventive services, electronic health record use, patient-centered care, cultural competence and teamwork.

The article likens clinical practice coaching to the Agricultural  Extension Services (now the Cooperative Extension Services), created by Congress in 1914 to help farmers increase yields and profits. The authors describe the goal of practice coaches as "empowering practices to become their own agents of change".

It was interesting to read about diverse organizational models from the U.S., U.K., Canada and the Netherlands. It is clear that practice coaching comes in all sorts of flavors. In some organizations, it was conducted by nurses and in others by physicians. The intensity of coaching varied and so did coaching styles. Some practices relapsed to old patterns of care once the coach left. But some practices held their gains.

Scaling up this strategy from just a few early adopters to larger numbers of practices needs to be accompanied by testing various models of practice coaching in order to figure out how to use it most efficiently.

- Ulfat Shaikh