Managing the Patient Relationship with Twine

Continuous coaching with Twine allows targeted conversations to occur around real-time health actions.

With this new coaching capability, you may find your patients need to connect for real-time coaching, by phone or in-person, will change. This article will help you consider how to blend Twine with your existing coaching practice.

Introducing Patients to Twine

Depending on the complexity of the patient, coaches find initial encounters ranging from 15 to 60 minutes are enough for them to achieve the following: 

  • Build rapport between patient and coach: define a vision, identify patient strengths, and values with a Purpose Statement 
  • If part of your practice, use the Health Profile in the Me section of the patient application to support your patient in identifying potential areas for health behavior change. 
  • Establish a starter Health Action Plan for your patient:
    • Include a 3-month outcome goal as a Health Action (Example: Weight, 1x/week - Goal: 10 lbs.)
    • Include a weekly or 1 month stepping-stone process goal as a Health Action (Example: Grocery Shopping, 1x/week)
    • Establish tracking preferences to guide Display Settings and Notifications
    • Identify patient-centered expectations for communication via the messenger between visits
  • Orient patient to Twine and support mobile application download
  • Using the Calendar Tab, create a Plan Check-In in 1-4 weeks to review and iterate upon how the Health Action Plan is working towards goals. This may be conducted via the Twine messenger, over the phone, or at an upcoming coaching visit. 

Following-Up with Twine

Most patients choose to track and message using Twine, especially if you practice these tips when introducing them to the tool. 

In addition to holding formal Plan Check-In with your patient, you may provide coaching or iterations to the Health Action Plan with your patient ad-hoc via the messenger. The formal Plan Check-In allows you to define progress-to-goals and make adjustments in a more structured setting. Here are some suggested guidelines for Plan Check-Ins:


What to Do:

Plan Check-In Goals

How to Check-In:

Keep a Flexible Format

  • Review the History Tab and discuss progress to Goals
  • Discuss perceptions of change and progress.
  • Identify what's going well: strengths and values that maintain motivation
  • Discover new areas for behavior change, or, renew commitment to the current Health Action Plan                                                                                  
  • 15-30 minute scheduled coaching conversation by phone or in-person, or via video conference.
  • Asynchronous conversation via the messenger - send a few open-ended questions aimed at supporting reflection. This may be enough to achieve one or all of the goals for the plan-check in.
  • Live chat via the messenger (Patients may benefit from using the browser in this specific instance for access to a keyboard.) 

Some patients may ask or benefit from more (or less!) frequent check-ins. They are never meant to replace the spontaneous, generative learning that comes from between visit communication in Twine!

If patients don't want to track behavior or don't have technology

Here's how to modify usual care for patients who aren't quite ready for Twine:

  • Set up a Health Action Card Anyway. The Health Action card is the  patient's care plan, regardless of their tracking. Even if not connected to a patient's device, it should reflect your coaching as much as possible.
  • Enter data for patients if they meet you in person or if they report it over the phone to model the use of tracking. Once entered, you can use this information to maximize use of the sort filters and show patients visuals to help them understand their progress. If patients start reporting data through the messenger, ask permission to teach them how to track data on their own.
  • Use the "Not Tracking" button on the Enrollment Dashboard to view and manage your patients who aren't using technology.  Then Use the "Plan Updated" and "Plan Created" filters to identify individuals with recent changes who may need more support. 

  • Continue to schedule Plan-Check Ins (or reminders) through Twine's Calendar, even if your patient can't see it. This keeps patients not using technology as visible to you as those who are. 
  • Always keep the door open for Twine. You may notice it is more difficult to evaluate your coaching impact with patients who are not tracking. Share this discrepancy, while maintaining choice, by sharing the ways in which you feel Twine may benefit the patient. Partial tracking or just using the messenger are often places to start with patients who aren't sure about Twine. 
  • Open your patient's account whenever you are working with them. This will log time spent with your patient and prompt you to document care using the Notes and Coaches' Notes features. If your patient is messaging but not tracking with Twine, send a summarizing note after any face-to-face work through the messenger to model and encourage its use.

We've seen patients change their minds about technology as they become more rooted in their change process. When patients become ready or able to use Twine for the first time, they log-in to see their entire history and the acts of collaboration coaches have been taking on their behalf. This moment often turns into one of inspiration as patients dive right in and continue growing their care plans with you by their side!

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