On Coaching and Diagnosing
For a few months now our team has been running a programme about one-to-ones and appraisals at a London hospital. The programme provides managers, both clinical and non-clinical, with coaching skills and a framework for having one-to-one meetings with their staff.
The rationale for the programme is the growing body of evidence led by Professor Michael West, showing a clear link between people management practices, employee engagement and quality of care. The main finding is that the more engaged health professionals are, the higher the quality of care they provide to their patients and the happier these patients are with the care they receive. The findings are quite astonishing and in particular the fact that high staff engagement is linked to lower patient mortality rates (in the acute sector).
It is also not surprising to find that the quality of leadership is linked to the quality of care. When managers create a positive environment for their teams, people feel engaged. Creating an environment where people are open, kind and appreciative can help raise the level of trust and engagement. In such an environment caring for patients comes naturally because staff feel they have the emotional capacity to care for others. The more you feel you are cared for, the more you feel capable to care for your patients.
When we talk about a coaching approach to management, we describe a relationship in which the employee owns their own performance and the manager helps the employee develop by providing feedback and direction. Objective setting and planning are normally agreed on in a conversation with the employee. When problems arise, the manager helps find solutions by thinking together with the employee. By looking at all the possible ways of action and then choosing the one that feels right for them. The role of the manager is to develop and mentor the employee. When using a coaching approach, a manager can create a real change in the engagement and motivation levels of their team.
The coaching conversation between a manager and an employee is often full of open questions. Rather then having all the answers and providing directions, the coaching manager is curious to find what they do not yet know. The employee is the owner of the task and has all the answers. The manager’s job is to allow the space to discover them together. If the manager quickly provides answers, the employee will lose an opportunity to develop. This position of “not knowing” can be quite frustrating for a professional who is used to have all the answers as part of their job, who believes it’s their job to “know”.
An interesting thing we’ve noticed while teaching health professionals how to use a coaching approach with their staff is that a coaching approach doesn’t always come naturally. In their work, they are expected to quickly diagnose what they see in front of them. This means that the nature of the questions they are used to asking patients, and also the way they frequently think, has to do with quickly narrowing down the options until they find the answer – a diagnosis. This is how the “good doctor” always knows what’s wrong with you. Furthermore, you don’t need to know because the doctor knows and you are in their safe hands.
But when a manager coaches they need to do the opposite. “Not knowing” is perhaps one of the best state of minds you can be in. You need to remember that the other person often has the answers they need. They just need your help in realising that and retrieving the answers which they can then continue to own. Your job as a manager is to listen patiently while they find out the answers in the coaching conversation with you. If you push for a “diagnosis” and a “cure” in a coaching conversation, many of the symptoms will soon repeat.