Healthcare Intelligence Network

This month’s inside look at a health coach, the choices she made on the road to success, and the challenges ahead.

Alexis Koutlas, BSN, CCM, CHC, specializing in women’s, children’s and health professionals’ wellness

HIN: Tell us a little about yourself and your credentials.

(Alexis Koutlas) After graduating with my BSN, I started my professional career in women’s and children’s services. Over time I shifted roles from the bedside to referral and case management for high-risk obstetric patients and pre-term infants. Wanting to understand how these children progressed and what their needs were, I then transitioned to the outpatient arena in pediatric medicine. Once there, my interest led me to preventative medicine, which led me to the discovery of health coaching. Since receiving my Certified Health and Wellness Coaching certification from Vera Whole Health, I look at my nursing role as promoting and supporting wellness, rather than treating just the illness. I’m passionate about supporting children and colleagues, helping them to engage in their own health and well-being, and learning to be the best selves they can be.

What was your first job out of college and how did you get into case management?

Out of school I jumpstarted my career in a neonatal intensive care unit (ICU). What a fantastic opportunity that was! I worked in an academic care facility and had the opportunity to work with some very well-respected practitioners. To keep up with changes in the environment of care, the medical leadership created a position for a case manager, which I accepted, working directly for the physicians who were part of the Division of Perinatal and Neonatal Medicine. It wasn’t a traditional case management position; actually, our approach was quite unique. Rather than try and cut length of stay, we looked at the positives for increasing the length of stay of the mom, to decrease the infant’s length of stay and morbidities that occur from prematurity. There was no certification for this at the time. Working together for the best outcome for high-risk obstetric patients, we were able to expand the role to include referral management, supporting patients across the Pacific Northwest, Montana and Alaska.

When did you decide you wanted to go into health coaching?

The transition from treating illness to preventing illness was an entirely new concept that I discovered as I moved into the outpatient arena. Along with focusing on patient wellness, the care environment supports nurses’ own self-care. Better work hours and shorter shifts allow nurses to balance a personal life. My newfound schedule allowed me to engage with my own fitness and health regimens. And along the way, I met such fantastic, energetic experts who see and support the movement of wellness, and I am excited to return that gift to others.

How has your medical and case management background impacted your career as a health coach?

Understanding the physiologic ramifications (medicine) of the lack of wellness — the mental, physical and emotional components — is like the slab of foundation for a home. Understanding the financial ramifications and the necessity for conscious spending (case management) is that budget we maintain to build that home. Health coaching, however, is the covering; the roof, walls, windows and doors. If the roof leaks, the budget will be affected by the cost of repairs and your foundation will be destroyed from mold. Health coaching is the natural progression. Having a background in disease management enables me to help clients explore their own processes and circumstances with a deeper level of understanding.

In brief, describe your organization.

I’m an independent practitioner and specialize in two dynamic groups.

• The first: families affected by pediatric obesity. Pediatric obesity is not just a child’s problem. It’s a family’s problem, and working with getting these children to engage in their health takes more than working with them independently.
• My second area of focus: healthcare professionals. I work to get them to explore their own health needs and their role and responsibility as representatives of health, not just disease management.

What are two or three important concepts or rules that you follow in health coaching?

• Never have a road map for your client.
• The client has the answers, the client has the answers, the client has the answers. My job is to coach them, weed through all the mush to get to the answers that only they have and know are best for them.
• I cannot successfully coach someone else if I am not working to care for myself.

What is the single most successful thing that your organization is doing now?

Health coaching is new. Independent practice is newer. The greatest most effective thing I can do at this time is promote the movement, help people understand why it’s important, and get them to engage in it in a different way. This is trailblazing and so with the weed eater in hand, I keep moving forward.

Do you see a trend or path that you have to lock onto for 2013?
Recognition of the wellness movement. On the West Coast, we are last to catch up to other parts of the country. Defining wellness, making it a household term, is progress in itself. Taking it into western medicine and proving its worth is monumental and will continue to be a work in progress backed by data acquired over time. Unfortunately, automated health coaching set us back from this goal. Two steps forward, one step back.

What do you mean by automated health coaching?

Automated, or scripted coaching from computer generated scripts. For example, you have this diagnosis, and the script encourages such and such questions. Hospitals have purchased the automated heath coaching for their employees. All the employee has to do is click here that they are getting their BP checked, and click there that they walked three times this week. For this, they receive a nominal bonus. The incentive is the bonus. Many employees participate. Many employess punch the buttons. Many employees do not make the changes that are necessary. I had the fortunate opportunity to have an informational interview with the person who has championed getting this service into a local hospital facility for their employees. She agrees, the true success behind this method will be to engage employees without significant issues or the ‘low hanging fruit’. The fact is, nothing replaces one-on-one personal coaching. But for right now, it isn’t a covered benefit, and if it was, would people value it the same way? I liken it to paying for a fitness trainer. The fact is, it’s personal service. It’s expensive. But when I pay for it, I am engaged with it. If someone else was paying the bill, I may show up, but would I engage?

What is the most satisfying thing about being a health coach? How is it different from case management?

As a coach, when the client discovers their sense of direction, that sense of self, that “aha” moment that is life changing, it reaffirms what I love about healthcare. It supports the notion of supporting health and allows the patient to design, dream and discover for themselves. Case management sets up a series of rules, set by a governing body with a focus on finances and limits the patient’s ability to be independent in their choices for improving their care. Although the goals are similar, i.e. patients who are not dependent upon the healthcare system, the methods to acquire the goals are in opposition.

What is the greatest challenge of health coaching and how are you working to overcome this challenge?

Understanding and engagement. People are naturally skeptical. They are unsure what they are getting with health coaching. It’s new. For those who have had exposure, they get it. They understand they have been beneficiaries of the inherited ‘wealth of health’ through their hard work. For others, it is an unknown. The most effective health coaching happens when the person is invested. Not only emotionally, but financially. Since this is not a covered service by insurance, it requires private funding. That can be costly, but the return on the investment is ten-fold. In short, people NEED to pay for the service, for their own sake, to reach success and stay motivated. But by the same token, it’s a cost that many are unwilling to pay if they are unsure of what it can do for them.

What is the single most effective workflow, process, tool or form health coaches are using today?

• For the client: Getting them to a state of awareness at the beginning of each meeting. We so often go through our days as robots. We eat because it’s time to eat. We make lists and try and accomplish the items on the list. But are we ‘present’ with ourselves? Getting the client to ‘be’ for the coaching time allows them to process on a deeper level.
• Processes for me as a coach: Working with clients to clearly define, describe, dream and design their goals and utilize both motivational interviewing as well as appreciative inquiry as tools to help clients separate out the mush and reach their own personal levels of success.

Where did you grow up?

I grew up in a little town just north of Seattle, Washington.

What college did you attend? Is there a moment from that time that stands out?

I attended college at Marquette University in Milwaukee, Wisconsin. It’s hard to pick one moment that stands out because there are so many memorable events in college. However, if I have to pick one, I’ll choose the moment I arrived at the school of nursing. Growing up in the country, arriving at an inner city university was culture shock. Add to that the moment when I sat in nursing orientation and heard the dean speak. “Look to your left and look to your right. One of you won’t be here when you graduate.” I remember thinking – “what am I going to do to be here? What qualities do I have to help me get through this?”

Are you married? Do you have children?

Unfortunately I have never married and do not have children. I believe that this is in part one of the reasons I have always enjoyed working in pediatric medicine. I like to say “even when I’m in a bad mood, somewhere during the day, some child will make me smile.”

What is your favorite hobby and how did it develop in your life?

Designing my own fitness routines and attending fitness classes with my favorite trainers. After years of being a couch potato, when I took stock in my own health, I realized that I needed to make changes to not only be a healthier person, but a better person, a happier person, a better employee and health coach. Throughout my learning, I found great trainers, and have met great friends. I’ve learned what motivates me and what keeps me engaged. I now look forward to creating my workouts and challenges.

Is there a book you recently read or movie you saw that you would recommend?

Ok, this is not a good movie. Not noteworthy in the sense that anyone with great intellect would feel compelled to watch. But for me, I loved “Step Up” – the original with Channing Tatum. Why? Pure and simple, the dance. I am both inspired and enamored with the physical strength, endurance and flexibility of dancers. To me, their movement is its own form of expressive art. I’ve worked with dancers in some of my personal training modalities. Those experiences have led me to appreciate the true talent and physical discipline that each and every move requires. However, buyer beware, this really is a B movie at best. If you choose to enjoy it, think about it from the perspective I’ve shared and see if it doesn’t improve the enjoyment factor.

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