Know Your Own Health

The Coaching Conversation Flow

Kate Henry, Know Your Own Health
21st September 2022

The Conversation Conversation Flow can be used by those in any role to enable them to have ‘Better Conversations’ with patients to support self-management and patient activation

The structure also forms the basis of the Structured Agenda-free Coaching Conversation (‘StACC’) model. This model uses the Coaching Conversation Flow as a programme, or intervention, aimed specifically at increasing patients’ levels of activation while supporting self-management.


The Coaching Conversation Flow is an established evidence-based coaching approach that evolved out of the Health Foundation’s Co-Creating Health Self-Management Programme (“SMP”) that ran from 2007 to 2012.

Co-Creating Health involved three training and information programmes that were delivered across all sites (Health Foundation, 2012):

  • Self Management Programme (SMP) – supported people with long-term conditions to develop the confidence, knowledge and skills they need to manage their condition while working in partnership with their clinicians.
  • Advanced Development Programme (ADP) – supported clinicians to develop the skills required to support and motivate people to take an active role in their own health.
  • Service Improvement Programme (SIP) – supported the Co-creating Health sites to change and improve the way their health services are designed and operated.

Each of these information and training programmes focused on ‘three enablers’: shared agenda setting, goal setting, and goal follow up.

The original three enablers were joined during the course of delivering the programme by three other ‘enablers’ that were incorporated into the programme to create the five steps in the Coaching Conversation Flow.

Two of the features were introduced via the ADP stream from Motivational Interviewing, as developed by clinical psychologists William R Miller and Stephen Rollnick.

These were Eliciting the Story and Establishing Importance.

The third additional feature was problem-solving.  This was introduced from the Stanford Model via the SMP stream and was incorporated into Goal follow-up.

The Coaching Conversation Flow therefore combines elements of different approaches, bringing them together into a single universal structure designed to support self-management. See diagram below:

Agenda setting - Exploring patient's story- Identifying what's most important to them right now- Goal setting and exploring confidence to achieve each step - Following up, identifying any barriers and problem solving

Evidence from the Health Foundation’s Co-creating Health Programme (Health Foundation, 2013) showed that this also helped to increase patients’ levels of activation as measured by Insignia's Patient Activation Measure ('PAM') (Health Foundation, 2018).

Using the Coaching Conversation Flow

To use the Conversation Flow, practitioners first need to know how to use a range of coaching skills, including: active listening skills; exploring ambivalence; rolling with resistance; goal-setting; using importance and confidence scaling, and a number of others included in the PCI Core Curriculum skills for health coaching.

It’s then a case of knowing how and when to use the skills.

The Coaching Conversation Flow supports ‘Better Conversations’ by providing a guide to answer the question:

‘What sort of conversation am I having with the patient now and what skills do I need to be using to support their effective self-management?”

It’s also essential to be able to remain non-judgmental and to have an understanding of what it means to support self-management – adopting a ‘facilitating’ rather than a ‘fixing’ mindset.

All these skills are universal and can be used by people in all roles and in all contexts, including with colleagues, friends, and family.

People who are self-managing more effectively are shown to have better health and wellbeing outcomes and to show increases in patient activation. Higher levels of patient activation are correlated to improved outcomes and decreased reliance on clinical services.

The StACC model takes the approach a step further in terms of focusing on increasing patient activation as its main purpose. Evidence to date shows this leads to greater and more sustained changes than approaches that focus on supporting self-management alone.


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