BackgroundHealth coaching is a new intervention offering a one-on-one focused self-management support program. This study implemented a health coaching pilot in primary care clinics in Eastern Ontario, Canada to evaluate the feasibility and acceptability of integrating health coaching into primary care for patients who were either at risk for or diagnosed with diabetes.MethodsWe implemented health coaching in three primary care practices. Patients with diabetes were offered six months of support from their health coach, including an initial face-to-face meeting and follow-up by email, telephone, or face-to-face according to patient preference. Feasibility was assessed through provider focus groups and qualitative data analysis methods.ResultsAll three sites were able to implement the program. A number of themes emerged from the focus groups, including the importance of physician buy-in, wide variation in understanding and implementing of the health coach role, the significant impact of different systems of team communication, and the significant effect of organizational structure and patient readiness on Health coaches’ capacity to perform their role.ConclusionsIt is feasible to implement health coaching as an integrated program within small primary care clinics in Canada without adding additional resources into the daily practice. Practices should review their organizational and communication processes to ensure optimal support for health coaches if considering implementing this intervention.

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Objective: The objective of this study was to describe outreach facilitation as an effective method of assisting and supporting primary care practices to improve processes and delivery of care.Methods: We spent 4 years working with 83 practices in Eastern Ontario, Canada, on the Improved Delivery of Cardiovascular Care through the Outreach Facilitation program.Results: Primary care practices, even if highly motivated, face multiple challenges when providing quality patient care. Outreach facilitation can be an effective method of assisting and supporting practices to make the changes necessary to improve processes and delivery of care. Multiple jurisdictions use outreach facilitation for system redesign, improved efficiencies, and advanced access.Conclusions: The development and implementation of quality improvement programs using practice facilitation can be challenging. Our research team has learned valuable lessons in developing tools, finding resources, and assisting practices to reach their quality improvement goals. These lessons can lead to improved experiences for the practices and overall improved outcomes for the patients they serve. (J Am Board Fam Med 2012;25:232-237.)

This article aims to provide an overview of a collaborative service improvement project that was undertaken by midwives at the Royal Berkshire NHS Foundation Trust to improve services for women in early labour. The labour triage line was set up to increase the consistency of information and advice provided to women in early labour and to enable women to feel confident in using coping strategies to help them remain at home during early labour. It was hoped that this would reduce the number of women attending the labour ward for early labour assessment and increase both Women's and midwives' satisfaction with the service provided. A review of early labour services was initially undertaken to inform the project. This revealed that most women in early labour telephoned and were assessed on the labour ward with only a small proportion receiving advice about coping strategies. A survey of postnatal women found that the provision of calm, friendly advice over the telephone was reassuring, with more than half of the women surveyed stating that their experience of early labour could be improved through good telephone advice from a midwife. Following this, the telephone labour triage line was implemented and evaluated following a 6-month pilot. Feedback from women suggested a high degree of satisfaction with the service and a significant improvement in midwives discussing coping strategies with women in early labour. Other findings included an increase in the use of the midwifery-led unit and normal birth rate for low-risk first-time mothers. The triage line has now been extended to 24 hours and will move to the new midwifery-led unit that is being built this year where the outcomes will continue to be monitored.

Newly qualified midwives highlight the lessons they learnt during their final year of training during the global pandemic