Thursday, May 2, 2013

Tip 19: Coaching: The path to patient safety

Coaching: The path to patient safety

Bobby KnightIn our last issue we discussed how to navigate medical hierarchy in the most difficult of circumstances and shared a proven coaching tool for defusing potentially harmful conversations among physicians. The safety challenges that medical hierarchies present are no surprise to the physicians at the Bedside Trust. What is surprising to them and most of us, was just how effective a question like "what matters most to our patient this moment?", could be at disarming unsafe exchanges among providers. One reader commented, "You know... it's one thing to sit in the boardroom and discuss putting the patient in the center, and it's another to have physicians asking each other the same questions at the bedside where it really counts." In her recent New Your Times article, "Afraid to Speak Up to Medical Power", Pauline Chen, MD discussed her personal experience in dealing with the all too common unsafe medical hierarchy that is endemic of our current healthcare culture. I'm glad to see such well respected physicians confronting these "old rules" that have such a profound impact on patient safety.

But what's keeping patients from consistently experiencing the benefits of physician coaching every time unsafe exchanges arise? I use the term "physician coaching, not just because it's more relevant to physicians than the concept of leadership, but because coaching offers the tools that keep patients safe. Chances are you have heard talk about having a coaching culture or a coaching style of management.

A client recently sent me Atul Gawande's article Personal Best, published in The New Yorker September, 2011. Gawande makes the general case for coaching by offering this statement " No matter how well trained people are, few can sustain their best performance on their own. That's where coaching comes in." He also pointed to a limitation of coaching saying, "The concept of a coach is slippery." The concept of coaching is slippery because it lacks definition in most organizations. Coaching is one of those concepts where definitions vary according to who you ask. Can you think of other terms in healthcare that are hard to grasp: patient-centered, leadership, physician leadership (if you really want to confuse physicians), even the concept of accountability and culture requires context to truly understand the concept. 
When I first begin to talk about coaching to most leaders in healthcare they immediately think of the context of a sports coach. As spectators, the camera often pans to the angry coach on the sidelines yelling orders to his players. You might categorize this best as a directive style of coaching. For those leaders that feel the need to show authority, the non-directive style can appear soft or weak. And yes, telling people what to do is often perceived as quicker and more effective on the field or in the ED, but only in the very short-term. In other words, if you're a coach of a professional football team or a physician needing to improve the performance of your ED staff, you'll recognize that directive styles have considerable limitations long-term. If we are going to achieve sustained excellence in patient safety, we healthcare leaders need to practice and emphasize our long-game coaching tools.

Tip19: A culture that rewards and recognizes coaching is a safe culture.

Coaching can involve a range of styles and techniques with a directive approach at one end of the spectrum and non-directive at the other. If a first year ER resident is learning a new technique for intubating a patient and has no idea what he is doing, then clearly the Resident needs to be given instructions and shown what to do, requiring a directive approach.

Even in healthcare, which can often feel like the ultimate sport, leaders and physicians have ample opportunities to offer non-directive coaching to staff. Take a very well trained nurse manager who may be experiencing a period of less than stellar patient satisfaction results.This person has the skills to do her job, so taking more of a non-directive approach to improve performance may be required. While a directive approach relies heavily on giving answers, non-directive coaching emphasizes questions designed to get the team member to explore previous experience for solutions. Listening and properly reinforcing their confidence and ability is more likely to get the engagement required for the results you expect.

Non-directive coaching tools can be very effective for the development of people and when behavior change is required. And I don't have to remind you that these are the issues that most challenge leaders and cause harm to patients. For example, if someone is unsure about a decision they need to make or how to handle a problem, is just giving them your answer the most effective way of teaching? I suppose if the decision was urgent as in some healthcare situations, then maybe you would have to. However, if it wasn't, for improved personal development, you could ask them what they would do and get them to think of other options?

Look no further than the all too familiar example provided in our last Coach+Leader. Two physicians, one afraid to approach the other, due to the unsafe conditions created by medical hierarchies. In many of the cases we see, the physician has ample time but fails to act simply due to the fact that the medical staff does not emphasize coaching as a core component of it's culture. Open ended questions like the one we shared are perfect coaching tools to combat medical hierarchies as they redirect the physicians in question to focus on what matters most to our patients, rather than trying to determine the smartest person in the room.

If you're a leader, a physician, or in a management position, you are in the right place to start thinking like a coach. In the case of coaching, there needs to be a top down approach, because leaders have the most impact on building a Patient Accountable Culture. As healthcare leaders, coaching must be viewed as a primary tool not just for improving team performance, but for improving patient safety. Our patients expect us to work as teams... patient-centered teams need coaches, and every leader has a coaching role.

Stay tuned to Coach+Leader as we continue to build the case for how leaders and patients benefit from organizations that make coaching a priority.

Email me or share your thoughts on our Facebook page.

Brian WongDr. Brian Wong's highly anticipated book,'HEROES NEED NOT APPLY' releases this spring.

Listen to Dr. Wong as he discusses Heroes Need Not Apply: A Unique View on Accountable Culture Click here to listen>>

Brian WongCheck out the new video interview with Brian Wong, M.D.
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