More coaches needed to advise physician executives.

Never in the history of health care has the need for physician leaders been greater. Yet our medical education system has not been geared to teach the thinking, collaboration and decision making skills required for effective leadership in today's complex business environment.

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In fact some of the skills that make us excellent clinicians, such as differential diagnosis and rapid, independent decision making, are essentially the opposite of those required for leading successful health care organizations.

Executives need to consider multiple perspectives, rely on collaboration and make decisions with a much longer range view. Executives also need other important skills that are not being taught in most medical schools. These include:

* Taking ownership of results (accountability)

* Self-awareness and self-management

* Time management

* Delegation

* Presentation skills

* The ability to drive values and objectives throughout the organization

* Complex decision making & broad perspective taking

* Effective communication for collaboration and consensus building

* Managing difficult conversations with colleagues and subordinates

* Learning to tap one's innovation and creativity in times of great challenge

* Giving and receiving constructive feedback that promotes growth

* Performance management and developing others

While some of these leadership skills can be learned by taking courses or reading, the attributes characteristic of star performers at the executive level such as self-awareness, self-management, social awareness and relationship management are not readily acquired through this type of learning. These are skills best learned over time through practice. (1)

However in today's unforgiving business environment, both seasoned executives and physicians coming into new leadership roles need to hit the ground running, or at the very least come up to speed quickly.

Organizations often spend huge sums of money and other resources recruiting or promoting new physician leaders, but then fail to offer the physician adequate support or assistance in coming up to speed in his or her new role.

A rocky start, or even worse a failure requiring a replacement of the leader, can be disastrous for both the physician and the organization. As an executive coach, I have helped physician leaders develop the necessary skills, smooth the transition process and protect both the physician's and the organization's investment.

As the health care challenges continue to grow more complex, there's a need for even more physician executives to get involved in coaching. It's a career path you might want to consider.

What does a coach do?

A trained coach uses powerful questions that challenge the client to stop and think in different ways--to consider issues from a different perspective. The coach may give feedback, participate in brainstorming, model behaviors and give suggestions. Many coaches use assessments to provide personal data for the client to consider.

Assessments such as the Myers Briggs Type Indicator, Thomas-Kilmann Conflict Mode Inventory and Learning Styles Inventory give clients a better understanding of how they make decisions, take in and process information, re-energize, handle stress, deal with conflict and manage change.

A 360[degrees] feedback assessment such as the Emotional Competence Inventory give clients an opportunity to see how colleagues, superiors and subordinates view them. These instruments provide an opportunity for the client to test his or her own self-perception against objective data.

But most importantly, an experienced executive coach provides a safe, objective and confidential environment for the executive to talk through problems, brainstorm possible solutions and even vent frustrations without fear of judgment or reprisal.

A coach helps the executive develop capability in decision making, goal setting and all of the other skills necessary to succeed as a leader. These skills, once developed, will serve the executive both in the current situation as well as throughout his or her entire career.

Is coaching worth the investment?

To calculate the return on investment of executive coaching, Anderson (2) surveyed 43 executives of a Fortune 500 telecommunications firm who participated in an executive coaching initiative and 97 percent of the respondents stated they had gained critical insights into personal changes required for them to become more effective. These included:

* Insights on how to improve communication and collaboration (93 percent)

* Better understanding of how to work with peers to accomplish business objectives (83 percent)

* Greater understanding of their personal impact on others (77 percent)

* Increased capability at finding new ways to look at business situations (77 percent)

Overall, 73 percent of the clients stated that they had learned to be better leaders.

Learning is important, but what about application?

In this same study, 70 percent of the respondents said they were better able to handle real-life business situations, 70 percent said they were able to apply what they learned from coaching to positively influence a business situation. Over half said they were better able to motivate others, 47 percent said they had improved the quality and/or speed of decision making and 27 percent said they were better able to utilize people and money.

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Sixty percent were able to identify specific financial benefits that came as a result of their coaching. The return on investment for this particular company was 788 percent and clients characterized the coaching interactions as "rich learning conversations that fostered self-examination."

Coaching examples

A physician executive at a large academic medical center who serves as the liaison between the medical center and regional physicians often felt split between the sometimes divergent priorities of the leadership of the medical center and those of the hospital.

He had received feedback that he needed greater focus and also needed to manage his time more effectively, especially in creating better work/family balance. Due to downward budgetary pressures, he was concerned that his position might be eliminated, especially if he was perceived as being ineffective in his role.

Through coaching, he learned to focus on the responsibilities of his position and to clarify his own personal objectives. This involved defining clear goals for the calendar year and creating buy-in from the leadership of both the medical school and the hospital.

He learned to enhance his internal motivation by checking for alignment between his personal objectives and his professional responsibilities, a critical step that greatly increases the likelihood of success.

He also learned to sharpen his focus and attention by implementing a new system for prioritizing and managing time in such a way that he was successful at creating a block of time to devote to catch-up and weekly planning. This freed up time on the weekends that he could devote to spending more time with his family and other rejuvenating activities.

Three months after going through this process, the physician noted that he has become so much more efficient in the use of his time that he rarely works on weekends and he has successfully clarified his role and responsibilities to the point that he is feeling much more effective as a leader in his organization.

Another client, managing partner of a busy practice, wanted to expand the scope of services the practice delivered and this involved taking on additional office space. Mired in the day-to-day responsibilities of running the practice on top of a busy clinical load, he was having difficulty getting the project off the ground.

With some coaching, he learned to examine the profitability of the concept to see whether it actually made business sense, then developed a vision based on core values of the practice. He uncovered potential obstacles to success, outlined strategies to overcome the obstacles and then defined the steps required for launching the project.

He used the coach to help him develop a plan for delegating the required tasks and working through how best to communicate with his staff to create buy-in and enthusiasm for the new project, even though it would require extra work on their part.

By year end, the project was successfully completed and the practice increased its net revenues, expanded its ability to service more patients and cut down on wait times for scheduling elective surgery.

Though these two physicians live in very different worlds and, on the surface, their challenges seem to be quite different, in fact, many of the underlying issues in both of these cases were similar. Both of these physicians are dealing with busy clinical schedules, conflicting demands and are working under time pressures that make it difficult to stay focused and to think and act strategically. Working with a coach helped these two physicians clarify what was most important so they could focus their efforts, delegate appropriately, communicate more effectively and achieve the results they were looking for.

Choosing a coach

There are three main factors to consider when selecting a coach.

1. Chemistry -- Chemistry is an ethereal quality that may be hard to describe. You may not know exactly what it is, but you usually know pretty quickly whether you have it or not. One of the factors that contributes to chemistry is a sense of safety and trustworthiness. During the course of coaching, a client may need to share personal and highly confidential information. The integrity of the coach is critically important in helping to establish a safe environment where the client has permission to work through tough issues without fear of reprisal or negative judgment.

You don't have to have matching personality types to work effectively with a coach. Experienced coaches understand how different personality types interact and are skilled at managing themselves so they can stay focused on the needs of the client. It's much more important to look for a coach who has done extensive work on his or her own personal mastery, including self-awareness and self-management than to find someone who is an exact match with your personality type.

2. Background and experience -- Some people believe that to be effective a coach must have the same or more experience in the client's field than the client. While this is true of a consultant, it isn't necessarily true in coaching. A coach's real job is to help clients learn to access their own knowledge and wisdom, to help expand their problem-solving abilities and to access their own creativity in developing solutions. However, a coach who is working with executives must have a good grasp of the industry and a clear understanding of business. All that being said, if you do find a coach with a background and experience similar to your own, this can enhance the coaching relationship.

3. Formal training -- In addition to chemistry and experience, an executive coach should have formal training on how to create a powerful coaching interaction through special listening and questioning techniques. Coaches who work with executives at higher levels or in larger organizations should also be well grounded in systems thinking, change management, leadership development, adult developmental theory and adult learning theory.

Today, there are very few physicians who have made the transition from clinical or administrative work to executive coach and even fewer who have had formal coach training. The need for coaches who either are physicians themselves or who have experience in working with physicians will increase during the coming years as the business of health care becomes even more complex.

Recommended Reading

* Jay M, edited by Volckman R. "The Business Case for Coaching. Coaching as a Transformational Leadership Competency": An executive white paper series. 2002. On the World Wide Web: http://www.coachingedge.com/ctlc.

* Olivero G, Bane KD and Kopelman RE (Winter, 1997). "Executive coaching as a transfer of training tool: Effects on productivity in a public agency." Public Personnel Management, Winter, 1997, (26)4, 461-469.

References:

1. Goleman D, Boyatzis R and McKee A. Primal Leadership: Realizing the power of emotional intelligence. Boston: Harvard Business School Press, 2002.

2. Anderson M. Bottom-Line Organization Development: Implementing and evaluation strategic change for lasting value. Burlington, Mass.: Butterworth-Heinemann, 2003.

By Jane L. Thilo, MD, MS

Jane L. Thilo, MD, MS, CBC, is an executive coach with Encompass Health, LLC. She is based in the Seattle area and can be reached at 425-641-8775 or [e-mail].