When Engaging the Right Coach Matters Most

When Engaging the Right Coach Matters Most

Sometimes it takes a subspecialist to give advice you can trust.

While coaching can seem like a professional service without license, regulation, or credentialing criteria defining scope of practice, engaging the right coach can save a colleague’s career or launch another. But physicians and physician leaders are a very different client group to coach, teach, or tell much of anything. They deliver care to patients. They lead teams and manage a scope of services that are distinctly different from those of any other enterprise. Absent this critical understanding born of deep and relevant experience, credible counsel is most likely dead on delivery. We all recognize in our treatment of patients that seeking timely consultation from a highly qualified subspecialist will often improve outcomes and, sometime, save a life. Are we willing to set a lower standard in referring a physician/faculty/colleague for a coaching consultation, whatever the issues, concerns, or opportunities to manage and lead might be?

Engaging the right coach is far more likely if you focus on afive-question protocol for evaluating context and engaging coaching services for a faculty colleague or physician leader.

1. Why are you seeking a coaching consultation? (Have you exhausted internal options?)

It’s not reanimation for a career that has already crashed beyond repair. Coaching is no substitute for overdue psychiatric evaluation of a probable bipolar disorder; nor is it therapy by another name for the treatment of major depression following a nasty divorce and custody battle. Coaching will not cure terminal arrogance; nor will it teach empathy to an otherwise brilliant specialist with mild to moderate Asperger’s’. Those colleagues who are so habitually self-admiring of their own prowess and performance such that comparisons to mere mortals is taken as an insult – we all know a few of these bright stars – are not good candidates for coaching. True narcissists admit no fault and tend to reject any and all offers of professional assistance. Eliminating the false positives for seeking a coaching consultation greatly improves the potential efficacy and benefit of services delivered.

Adaptive Learning

The context of practice; the pace of innovation; and the expectations of patients and payers alike have all evolved at an unprecedented rate across the past couple of decades. The demand for accelerated learning by established, talented physicians has never been greater. Attitudes, behaviors and communications that were acceptable (or at least tolerated) by generations of physicians now have the potential of being career terminating events. Most of our colleagues demonstrate the resilience, intelligence and necessary flexibility to sustain professional success. But at least a few extraordinarily talented physicians fail to adapt; making mistakes in what they do (or fail to do) that a smart Chair or CEO simply cannot afford to ignore. The range of these mistakes is probably as diverse as the physicians making them. But there are a few patterns of physicians’ acting beyond acceptable limits of professional behavior that a coaching consultation can often significantly influence for the better.

A majority of such requests include reports of out-of-control affect/attitude (e.g., anger, defensiveness, arrogance, demeaning, frustration) and/or social myopia as reflected in repeated ‘incidents’ that violate interpersonal boundaries – cross the line - of acceptable professional behavior. Chiefs of service and CMOs are more likely to hear about (than observe) such infractions. They are known by the described effects of their actions on others (e.g. insulted, scared, dismayed, hurt, enraged, trapped). It’s clear that every doctor can (and does) have a bad day now and then. Most of us know when this happens and make an effort to soften the impact of spilling our impatience or misdirected aggravation. Physicians being referred for coaching consultation often fail to see (or accept responsibility for) the impact so clearly described by colleagues, nurses, staff and, sometimes, patients. Taken together (provocative attitude/affect and limited insight), these requests tend to reveal a disappointing gap in applied social intelligence despite often superb technical, analytic and clinical capabilities.

Presuming that the physician being referred for consultation is not a tenured, toxic mix of entitled insensitivity and decades of indifference to all feedback; the right coach can often support a substantial and sustainable shift toward more constructive (i.e. adaptive) attitudes, behaviors, communications, and professional interactions. Recent research has confirmed that many people exhibit neuroplasticity that allows for achieving peak performance in ‘relationship management’ into a person’s sixth decade; far later than has proven likely for breakthrough advances in growing technical talent or quantitative expertise in mid-career. Science seems to confirm our consulting and administrative experience. It really is possible to teach smart docs new tactics for profession (and self) management.

Growing Capability

The demand for physicians that are able to take on administrative responsibilities beyond direct patient care, teaching and research has never been greater. At a minimum, most physicians need to learn to become more effective clinical team leaders in ways that were not a part of medical school, residency or fellowship training. Some physicians in transition to management roles report practical benefit from pursuit of an MBA (or, perhaps, satisfaction in acquiring a complementary degree). But many do not, as the distance from business classes to proficiency as a physician leader is more than any curriculum or credential can fully cover. Many physicians who aspire to take on these new challenges are really good on-the-job students of what works and what does not. As with any specialty, achieving mastery comes only with a lot of experience. But sharp inquiry, common sense, and a collaborative approach can all reduce the long-term transition costs of this trial-and-mistake approach to leader development.

If your department or clinic can’t afford the time, risk and mistakes of a steep learning curve, however, engaging the right coach can accelerate a practice-focused, skills-based education that is immediately relevant to leading clinical teams; intensive care units; surgery centers; training programs; departments and divisions of academic medicine. This may lead to engaging the same sub-specialist (above) if they also have the expert knowledge and management consulting experience to deliver custom training in leadership core competencies need to sustain success of prospective (or incumbent) physician leader.  

2. When is the right time to propose a coaching consult?

Most requests for coaching consultation with a focus on adaptive learning are triggered by the latest example of troubling patterns of attitude/affect and social myopia that you simply can’t ignore (much as you might prefer to do so). Your occasional concern for a colleague has become a crisis requiring an urgent response. A crisis which often costs more; takes longer; and carries a greater risk of failure than might have been true a year ago. It is a familiar and often complicated balancing process. Is this a good investment to make now? Given what you know about this colleague today, is a coaching consultation likely to have a significant impact?

If you have already identified (or previously engaged) the right coach, you should be able to call them to ask for a second opinion without some clock ticking off billable time by the minute. It’s a professional courtesy we extend to each other. If it is not offered (and received), you probably have the wrong coach. Keep looking. You should also expect candid replies that include ‘no need now’ or ‘coaching isn’t likely to help’ as examples of advice you can trust. Sometimes you really do not need a subspecialist. It is good to work with one who tells you so.

3. What are the best practices of coaching for physicians and physician leaders?

There is little consensus on what constitutes accepted best practices for coaching in general or for coaching physicians and physician leaders in particular. There are, however, several features of effective consultation related to both ‘adaptive learning’ and ‘growing capability’ that can serve as baseline criteria for choosing the right coach. These include:

Analysis Will consultation create a professional development plan based on a rigorous analysis of performance and 360 feedback? (Show me the data!)

Strategies Will consultation inspire a physician colleague to try thinking differently – to consider a new point-of view – in response to current situations and in planning for future challenges and opportunities?

Skills Will consultation enable practice, observation, feedback and refinement of specific, targeted skills that reflect evolving capacity for doing differently?

Solutions Will consultation encourage physician clients to deploy new strategies and refined skills in resolving situations and solving problems differently?

Relationships Will consultation identify leaders, colleagues and staff that may need to see the client physician as capable of interacting differently?

While these criteria might feel awkward or too obvious for direct exploration, asking a potential coaching consultant to offer an informal case presentation (or two) of previous work with physicians and physician leaders will tell you most of what you need to know about their approach and how it compares to features aligned with successful interventions.

4. How will you structure expectations for an effective coaching consultation?

Be as clear as possible about how you will determine success. What specific attitudes, behaviors, and communications precipitated your request for consultation? By what metrics will you measure progress? These are rarely easy questions to answer. But failing to do so in early meetings that include you as sponsor; your physician colleague as client; and your coaching consultant is a prescription for confusion and post-hoc blaming if problematic patterns persist. In particular, be clear about possible (or likely) consequences of continued unacceptable behavior.

These meetings provide a means for agreeing to the rules of engagement that can enhance the probability that coaching will make a real difference. These agreements address the following (#1-3 in joint contracting for services; #4-5 in sponsor/consultant business contracting).

1.     Goals (What are you hoping to achieve?)

2.     Measures (How will you assess progress?)

3.     Communications (How will you stay current and respect confidentiality?)

          a. Content of consultant/client physician interactions are privileged.

           b. Consultant will communicate with sponsor on a monthly basis regarding the process of consultation (e.g. # of meetings; ops to observe; estimate of client effort; prognosis for positive change)

                c. Schedule a three-way review meeting for 2-3 months out to assess progress against and consider possible refinements to plan.

      4.   Duration (3 – 12 months) (How long before you see results?)

               a. Request an estimate of probable success at end of 2 months.

               b. Positive shifts in attitude, behavior, and communications will typically surface within 3-6 months. If improvement is evident…

               c. Consider continuing coaching consultation for 3-6 additional months at a reduced level of service intensity and compensation.

               d. Hire local whenever possible. Effective coaching consultation depends on in-person on=site observation, feedback, and teaching. Face-time is not enough.

               e. Show preference for consultants dedicated to becoming obsolete.

      5. Compensation (How much will consultation cost?)

              a. Since you are investing in outcomes, not effort; results, not process; negotiate fees as a value proposition independent of consultant’s billable hours or days. (Your colleague tell you if his/her coach shows deficient dedication).

              b. Subspecialists’ deserving of the title are rarely for hire on the cheap.

A request for coaching consultation to ‘grow capability’ is well served by a similar structure for ‘rules of engagement’ as long as the goals include specific management and leadership core competencies to be developed and practiced, including measures for assessing evidence of applied, relevant on-the-job learning.

5. Who are you going to hire?

As with any consultation, a referral from a trusted colleague who has engaged an effective coach for physicians’ professional development is the best means of identifying strong candidates. Whether pre-qualified or not, what factors should you consider in evaluating their potential?

Credibility We all make judgements about the face validity of other professionals within minutes of meeting. Are they the real deal? A peer worthy of respect? The baseline criteria for assessing the credibility of prospective coaches varies widely across industries and sectors of the economy. In working with senior partners in financial services, for example, fluency in the language of business is essential but industry knowledge may not matter. In collaborating with physicians in general and within academic medicine in particular, the quality of credentials and training is a prime driver of credibility. A terminal degree in a hard science or a clinical discipline (M.D., Ph.D., Psy.D., or D.Sci.) often enables doctor-to-doctor conversations between presumed peers that may not otherwise happen.

Experience Relevant, practical experience, of course, is the best source of credibility once the prospective coach has passed the ‘paper test’ of disciplined professional preparation. How many physicians have they coached, taught, or supervised? In what specialties and with what types of ‘adaptive learning’ and ‘growing capability’ challenges? Ask for a description of a client engagement that was a success and of one that fell short of goals.

References Ask for at least a couple of references of sponsors and client physicians or physician leaders who were recipients of coaching consultation. If you call they will be willing to be candid on the telephone in ways that letters and e-mails rarely are. A lot of consultants can talk a ‘great game’ but fall short of excellence in service delivery. Trust but verify. Make the call(s).

Chemistry Do you like him/her? While this is a professional consultation, it is also personal for the recipient and may not be exactly voluntary. Chemistry matters when you will be receiving constructive but challenging feedback. Would you trust her/him if your boss referred you for a coaching consult? If ‘no’ is the response to either of these questions, the search for the right coach continues because there is too much at stake to risk being wrong.

In our combined experience in consulting, teaching, supervising and consulting with physicians and physician leaders at more than a dozen academic medical centers and many more hospitals and health systems, focusing on these five questions (i.e. Why? What? When? How? Who?) will reduce the time, effort, money, and risk associated with engaging the right coach in service of sustainable learning for physicians and physician leaders encountering career crises, challenges and opportunities for professional transformation.