A coach is focused on building capacity in the person being coached, whether that person is a patient, student, or team member. A coach uses artful questions to clarify the goals of the person being coached, help align their aspirations with personal values, increase their commitment to action, and hold them accountable to their intentions.
Whether you are managing patients, trainees, peers, or whole programs and departments, communicating in a way that inspires and enables behaviour change is a useful skill. Whenever you are faced with a person who wants things to change, there is an opportunity for coaching. Top
Coaching is not the same as mentoring. A mentor is someone who has traveled the path that the mentee is on or wants to be on. The mentor shares experiences and offers wisdom, advice, and connections that accelerate the mentee’s achievements. A coach is focused on building capacity in the person being coached, such that the achievement of their goals is fully credited to their own commitment to action. A coach uses artful questions to clarify the person’s goals, help to align their aspirations with personal values, increase their commitment to action, and hold them accountable to their intentions.
Unlike some other tools physicians are trained to use, coaching is not therapy. “Coaching is a creative partnership with your client, focusing on designing and implementing specific, meaningful changes in your client’s personal and/or professional life.”1 In the world of medicine and leadership, your “client” may be a patient, a trainee, a colleague, or someone who reports to you as their boss or leader.
The fundamental premise of coaching is that the coach believes that the person being coached is fully capable of managing their own life and circumstances. The person is asking the coach to help them, and the coach takes a positive, appreciative, and curious approach to how the person is pursuing their goals. Top
Coaching session versus traditional medical encounter
In any kind of “helping” encounter, the consent of the person being helped is essential and should be explicit. Confidentiality is respected, and both parties are committed to working toward the agreed goal of the session. The three “Cs” — consent, confidentiality, and commitment — are common to clinical work and coaching.
Using the “SOAP” format for a traditional medical encounter, the clinician gathers subjective information by asking specific questions to elicit and understand the patient’s complaint. The questions are structured to add to the history of the complaint with pertinent positive and negative details. Generally, the clinician is using information to narrow down possible causes and form a differential diagnosis. Objective input is obtained by physical examination, observation, and various investigations as appropriate. The assessment is reached by the physician using information, diagnostic acumen, and experience. A plan is proposed to the patient, and the next step is agreed to, including who will do what and how follow up will occur. In the sometimes hectic pace of clinical encounters, the rhythm of the cycle is often very rapid, but identifiable. Top
Figure 1. Similarities and differences between a traditional medical encounter and a coaching session.
In a coaching conversation, the cycle is also identifiable and can be closely aligned to the clinical skills physicians use every day. The person being coached brings a concern. The coach must focus very carefully on what the person wants and help them frame it as a goal. If the goal is not clear, the rest of the conversation will not likely yield a fruitful next step or plan. The clinician, in coach mode, uses questions to clarify the person’s goal, and to help insights emerge from the person. Artful questions will cause the person to reflect on what they need to do and what needs to be different to make progress toward their goals.
The coach keeps a firm attitude of non-judgemental belief that the person can make choices and take action on their own issues. The coach ensures that the person, at all times, maintains ownership of the issue, the potential solutions, and next steps. The plan belongs entirely to the person, who takes away the tasks necessary to achieve the next step toward their stated goal. Top
The coach ends the encounter by establishing how the person wants to be held accountable for their commitment to next steps, and may participate in some way, such as agreeing to another session, or receiving a message about tasks accomplished.
In a traditional medical encounter, the clinician has most of the responsibility for flushing out the likely causes of the patient’s complaint, for knowing the possibilities that need to be investigated, and for proposing plans of treatment. The clinician is the expert and is focused on finding the right answers. In coaching, the patient or person is the expert, and the coach’s job is to ask the right questions. The responsibility for progress toward the person’s goals rests completely with the person. Top
Coaching in practice
There is no need to spend excessive amounts of time to use the coach approach. It is just a different way of managing the structure of the conversation, and brief interactions no longer than the average office appointment can create the right atmosphere for change.
Our adaptation of coaching competencies to the clinical setting has a place in your toolkit of behaviour modification techniques, in the management of situations that depend on the patient or person making choices, decisions, and changes. The goals and the solutions are theirs. By acting as a coach when people bring you problems that are within their control, not yours, you build their capacity for problem-solving. Further, the relationship is clarified and strengthened, whether it is doctor–patient, teacher–student, or leader–team member.
Try these questions to change the conversations you have with people about their goals. Notice the coach generally does not ask why, as this requires the person to justify their approach. The best non-judgemental, open-ended questions start with what and how. Top
Sample coaching questions
What will get you moving on this?
What is getting in your way?
What is keeping you from acting on this?
How important is this to you on a scale of 0 to 10?
How confident are you that you can make this change on a scale of 0 to 10?
How can you clarify what you need to know?
What resources will you need?
What would change your attitude about this?
What would make it easier for you to take risks?
What do you believe will happen if you make this change?
What would be different if you resolve this?
What is the worst thing that could happen if you do that?
What three things could you do to manage that scenario?
Is there another way?
What is most uncomfortable about this change?
What if nothing changes?
What is one decision you can make to get things going?
What is one thing that would make the biggest difference in your life?
What support do you have to address this challenge? Top
Batson VD, Yoder LH. Implementing transformational leadership and nurse manager support through coaching. Periop Nurs Clinics 2009;4(1):57-67.
Sabo K, Duff M, Purdy B. Building leadership capacity through peer career coaching: a case study. Nurs Leadersh 2008;21(1):27-35.
Waddell DL. Peer coaching: the next step in staff development. J Contin Educ Nurs 2005;36(2):84.
O’Keefe M, Lecouteur A, Miller J, McGowan U. The colleague development program: a multidisciplinary program of peer observation partnerships. Med Teach 2009;31(12):1060-5.
Maynard L. Using clinical peer coaching for patient safety. AORN J 2012;96(2):203-5. Top
Coaching in education and training
Schwellnus H, Carnahan H. Peer- coaching with health care professionals: what is the current status of the literature and what are the key components necessary in peer-coaching? A scoping review. Med Teach 2013;36(1):38-46.
Régo P, Peterson R, Callaway L, Ward M, O’Brien C, Donald K. Using a structured clinical coaching program to improve clinical skills training and assessment, as well as teachers’ and students’ satisfaction. Med Teach 2009;31(12):e586-95. http://tinyurl.com/zzeufxs
Coaching in patient care
Garland J, Norton W. The rise of health coaching. Br J Nurs 2013;22(20):1152.
Moskowitz D, Thom DH, Hessler D, Ghorob A, Bodenheimer T. Peer coaching to improve diabetes self- management: which patients benefitmost? J Gen Int Med 2013;28(7):938-42. http://tinyurl.com/jg95v47
Bennett HD, Coleman EA, Parry C, Bodenheimer T, Chen EH.\ Health coaching for patients with chronic illness. Fam Pract Manage 2010;17(5):24-9. http://tinyurl.com/zk9g59e
Note: The content of this article was part of a workshop at the 2016 Canadian Conference on Physician Leadership in Toronto. Dr. Merrow co-created and presented it along with Dr. Cecile Andreas, a family physician and certified executive coach in Cranbrook, British Columbia, and Dr. Jamie Read, a family physician and certified executive coach in Toronto, Ontario.
The Coach Approach workshop will also be presented at the 2017 CCPL in Vancouver.
Nancy M. Merrow, MD, CCFP(PC), FCFP, G(CEC), is chief of staff and VP Medical Affairs at Orillia Soldiers Memorial Hospital. As a trained and certified executive coach, she promotes coaching as a skill that can be learned and as a competency that improves communication on every level making leadership and management roles more fun, enjoyable, and sustainable.