Health coaching - improving relationships and encouraging innovation

Personalisation… Patient Activation… Self-Care… No decision about me without me… Increasing responsibility… Long Term Conditions… Shared Decision Making…

With three quarters of all deaths predicted from chronic disease by 2020 and long-term conditions accounting for 50% of all GP appointments, 70% of all inpatient bed days and 70% of NHS spend, new approaches to working with patients are required to address the challenges associated with increasing patient confidence, decision making, adherence and lifestyle change. 

There is little doubt that achieving these outcomes will require a different kind of approach to how the health workforce is developed, and the kind of interactions that health practitioners have with patients. The Secretary of State for Health recently stated the innovation that will transform the health service is “a conversation” between clinician and patient.

At The Performance Coach we believe that “health coaching” conversations can significantly contribute to designing and educating a workforce that can deliver safe, effective and responsive services that can address the significant challenges that the health system now faces. 

There is compelling evidence and a strong business case to demonstrate that coaching interactions with colleagues and patients can raise awareness and increase levels of responsibility, thereby improving relationships and encouraging innovation and efficiency gains. 

The Performance Coach is leading the way in developing coaching programmes that can be applied to - and help improve - patient care.

For further details about our Health Coaching and Coaching for Clinicians programmes, please see our coaching for health section.

Coaching investment - top ten critical success factors

By Damion Wonfor

Do you want to make the most of your investment in coaching?

Over the past 10 years, whilst working within organisations across the private and public sections, we have seen coaching grow rapidly.

Because of these experiences we were keen to explore and identify critical success factors to enable organisations that we work with gain the most return on their investment. This work has resulted in the identification of critical success factors, which we use when helping organisations set up a coaching proposition to deliver results.

Here are our top 10:

• Coaching strategy – a coaching strategy has been developed to link coaching not only to the HR and L&D strategy but also the business strategy
• Definition of coaching exists – the purpose and use of coaching has been clearly defined. This includes the expected outcomes too, e.g. coaching being linked to high potential development so it is not seen as remedial. The organisation has also made a clear decision on the type of coaching they will use, e.g. external, internal or line manager as a coach
• Triangular goal setting – goals for a coaching programme have been agreed between the manager, client and coach. Coaching is therefore seen to support the achievement of business goals.
• Learning culture – the learning culture of the organisation is strategically focused on workplace development rather than classroom so is conducive to coaching.
• Sponsorship – leaders of the organisation sponsor coaching activity and role model coaching behaviours; they are coached and coach others. There is also a senior figure head sponsoring the coaching proposition.
• Alignment with other people processes – mentoring, development programmes, performance management, reward and talent management systems and processes have been aligned and reinforce coaching activity.
• Coaching framework – the organisation has developed a framework and or processes for the induction, selection, matching and evaluation of internal and external coaching activity.
• Resources for internal coaches are in place – resources are in place to enable internal coaches to effectively coach in the workplace and further develop their capabilities. Examples include supervision, development centres and continuing professional development events.
• Coach assessment – robust and objective assessment processes are in place for internal and external coach selection.
• Management of coaching provision – the organisation has dedicated staff responsible for the coaching provision. These members of staff have high levels of knowledge regarding coaching practices.

If you manage a coaching provision – how many of the above do you have in place?

We have now taken this research further with the development of our online diagnostic tool and consultancy service, "Coaching Effectiveness" - as we know the impact coaching can have on the quality of conversations and the performance and development of the people within an organisation. 

What is 'personal impact'?

The dictionary defines impact as “The action of one object coming forcibly into contact with another: to have a marked effect or influence; a strong effect”

Today’s leaders seem to recognise that part of their essential leadership toolkit is the ability to create a strong impression and that how they connect with people says much about their ability to implement strategy, inspire vision, sell, persuade, convince, motivate and draw people together to achieve their goals. In fact, as Williams, Binney et al comment in their book ‘Living Leadership’, today’s leaders are ‘on stage’ and the persona they create, the impact that they have is constantly exposed and is responsible for so much of their personal and professional success.

Many leaders achieve their professional success because they have been able to demonstrate skill in their chosen career – lawyers, actuaries, scientists, medical professionals, engineers, accountants etc. can find themselves promoted into leadership roles because they are brilliant at their jobs. But their role as a leader may involve very little time spent on their original skill set; their leadership role is most likely to involve the skills already mentioned – largely those of winning the hearts and minds of internal and external stakeholders…the art of creating a powerful, effective and memorable personal impact.

What's the solution?

Personal impact, personal presence, charisma etc is difficult to define. If there were an absolute set of criteria that could be learned, we would be living in a world as odd as ‘The Stepford Wives’ or some nightmarish futuristic vision of the future created in space-age movies.  But there are skills and behaviours available to us all that we can learn and develop to maximise our power in the personal impact ‘space’. As Prof. Richard Wiseman suggested in his study on Charisma (Famelab 2005), 50% of charisma is innate, but 50% is learned behaviour and as leaders we could – and should – recognise the value of this and make sure that those skills that can be learned are.

We need to take an emotionally intelligent approach – increasing our self-awareness, understanding how we are perceived by others and managing our ‘performances’ with people so that we are in control and feel confident to shine. This is no ‘one-size-fits-all’ solution, but an opportunity to recognise our individual strengths in communication and develop them fully.

Personal impact training should be run by somebody who has an effective combination of teaching and coaching skills. The aim is to stretch and challenge the client and to give sensitive, clear and constructive feedback.

There is no doubt that looking to those with training in theatre, performance or acting can offer a fantastic solution. Inevitably, acting skills form an essential part of the leader’s toolkit – the ability to control a range of emotions from stage fright to anger; to mask good news until it’s appropriate to deliver it or to delay bad news until the time comes to announce it. Nobody wants to see Barack Obama having a panic attack!

The Performance Coach Associate – Janie van Hool – is a RADA trained Actress with an MA in Voice. She has taught actors in training and in theatre productions around the country and worked over the last 12 years in business with leaders from a wide range of organisations. She specialises in helping leaders understand their impact and its potential for development. She provides workshops and one-on-one sessions offering practical tips and tools that make an immediate difference, raising confidence and skill. Janie believes that impact has three main areas of focus, namely:

• What others see
• What others hear
• What others feel

Focusing on ‘others’ is a critical element of the impact process. Whilst self-awareness is key to understanding how we respond to audiences in a range of situations, any act of influencing, persuading or inspiring in the hope of making an impact requires us to understand exactly what our listeners need in order that we may flex our style to satisfy them. Although there are some fundamental or basic behaviours that we expect to experience in a confident leader with presence, there will usually be opportunities to develop skill in one of the main areas of focus, if not all three.

The Performance Coach approach is practical – applied skills supported by relevant theory and this fits the personal impact development model perfectly. While theory may reassure the client or group that any advice is not simply the opinion of the coach, the important focus needs to be practising and implementing new behaviours. This makes sessions fun and energising, which is a great way to learn. For a group, the experience as a team can be very bonding and help forge a way of communicating effectively following the programme that benefits everyone. For individuals, an expert view of the person – and a ‘fresh pair of eyes’ - can both reassure and reinvigorate the individual and their approach to communicating with confidence.

Neuroscience and coaching

Article by Virginia Brown

The brain is a fascinating thing and recent decades have seen an exponential development in our understanding of brain science – brought in part by new technologies that allow the brain to be scanned “in action”. 

If you delve into the literature, as I have, it can be immensely confusing at first. With different terminology and different ways of distinguishing between locations, functions, systems and circuits – from lobes, gyri and sulci to the triune brain, hemispheres, and Brodman areas. Necessarily then this short series will be somewhat reductionist in the interest of communicating the broad ideas of how and why coaches should have some interest in neuroscience.

The thinking goes that if, as coaches, we develop a better understanding of how the brain works (both our clients’ and our own) then we will be more effective at what we do. As coaches we should be working with our clients, using brain stuff to help them understand why they’re doing what they’re doing – you could look on it as an extension of their self-awareness.

From a coaching perspective, our current understanding of all things neuro does, I think, many things:

• It reinforces what many of us already know to be good practice
• It adds some new perspectives that might help us do what we do better
• It helps to articulate the value of coaching
• It brings clarity and a scientific underpinning to what some have seen as a nebulous intervention

Let’s briefly take each one in turn:

Reinforcing what we already know

As coaches we have developed an effective methodology, both consciously and through experience.  What’s reassuring is that brain science supports the cornerstones of much coaching. It tells us that how we relate to one another is fundamental. That we have a system of “mirror neurons” that notices what’s going on in others (at great speed and not necessarily consciously) that influences what we do next. It tells us that our brains are “plastic”, that we (humans) can change with mindful attention over time and gives us some clues about how best to do this. Research has shown that effective goals are those that are transformed into concrete behaviours, that divided attention has implications and focussed attention will generate most effective change. Neuroscience talks about singularity; we’re all unique products of both genes and environment and therefore a primarily non-directive approach is immensely powerful.

In essence then, much recent research helps to explain why approaches that we know intuitively to be effective actually work. 

New Perspectives

And as you’d expect, modern neuroscience can help us to look at and understand things from a different angle, potentially adding a new dimension to our work with clients. The area of emotion is one that’s currently receiving much attention and as coaches we already know how important emotions are to peoples’ behaviour.  Research has looked at cognitive versus emotional systems in the brain, where each is located and which structures they are comprised of. You’ll probably be familiar with the “limbic system” which was held to be the seat of emotion in the human brain, though studies now tell us that it is too simplistic a conceptualisation and in fact there is not necessarily a clear boundary between cognitive and emotional systems. Neither should we look at emotions as needing to be controlled and contained or dealt with, rather we should understand them better and make better use of what they tell us, about our reactions for instance.

Brain science sheds light on our reactions to stress and uncertainty in a helpful way.  Uncertainty activates the limbic system in a big way, mainly because the brain likes to categorise things as being either a threat or a reward.  Knowing this is helpful, and knowing too that labelling a situation or feeling has proven to be helpful, as has changing the way one looks at it through reappraisal is of real practical use; to be able to discuss with a client why a particular reaction has been evoked can be immensely useful.  And as a coach, finding that right balance between support and challenge might now be informed by this knowledge.

Decision making has fallen under the neuro-spotlight too. Organisations like to think that they are run according to rational, economic principles.  Research has showed though that when it comes to making decisions the logical and economically advantageous choice isn’t necessarily the winner.  As coaches helping clients to wrestle with choices and options, this too reinforces the need for us to allow clients draw their own conclusions. 

Other new perspectives (and there are many more than space allows here) include the findings that we, as humans, respond to social pain neurally in the same way as we respond to actual physical pain.  If our clients are hurt socially (perhaps not being sufficiently acknowledge at work for instance) then the brain reactions are as if some physical pain had been inflicted.  With many of our clients working in large, complex organisations, the likelihood of social pain being part of their working lives is quite high.  Having this knowledge can begin to help them understand why it has such an impact.  

Articulating the value of coaching

In researching the value of a greater understanding of neuroscience to my role as a coach, it occurred to me that it brings benefit not only to the practice of coaching but also to my articulation of coaching itself as an effective intervention in any organisation.

For instance, research proposes that in order to make an effective change in oneself, one must go beyond our conscious systems – C systems (Lieberman) to our unconscious or “reflexive” systems (X system). Working alone we struggle to move beyond the C system, working with another – a coach for instance, which might bring specific tools to the table to help elicit the implicit – is vital. Studies also demonstrate the benefits of naming an emotion, of the value of action language in pursuit of goals, of having an individual outside the status hierarchy of one’s own organisation to work with, of how a relationship of trust and transparency can hasten change.

Scientific underpinning

By definition, neuroscientific research is scientific. And so a coaching approach that is informed by brain science may be more convincing to sceptics. Evidence that the brain functions or reacts in a certain way and that coaching methodologies account for this may make coaching itself a more compelling choice.

What I’ve included here is, in many ways just the tip of the neuroscience iceberg; there are many more examples of where our knowledge of the brain can and will begin to influence our work as coaches.  Before we get too carried about though, a word of caution – there is still a long way to go! What’s known (and not yet known) is in part a function of the research techniques and technologies available.  Whilst fMRI has opened a window to the brain hitherto impossible to see through, it does have its limitations – in particular that what it mainly shows us is simply the correlation between a task and brain activity. It can offer no explanation, no cause and effect.  Another limitation, albeit one that is beginning to be addressed, is that there has been a limited translation into practical applications with healthy individuals. So whilst ideas abound about how this might impact, for instance, organisational life, the reality is that no-one really knows.  And finally many bodies (RSA) and key thinkers caution against “neuromania” with the observation that many are simply adding “neuro” as a prefix to any word to create a new discipline.  Neurocoaching anyone?

That said there is much for coaches to take from neuroscience.  Talking about the brain can be immensely helpful with clients and it can give us the confidence and conviction that what we do is of immense value and efficacy.