10-11-16
AGENTS FOR CHANGE
JUNIOR DOCTORS: TRAINING TO LEAD
COACHING AND MENTORING
LIVERPOOL, OCTOBER 31ST 2016
WOUTER A. KEIJSER MD
COACHING
Coaching is an effective method to help individuals and
teams to develop and enhance their leadership and
management ability.
FMLM website
A coach is someone who tells you what you don’t want
to hear, who has you see what you don’t want to see,
so that you can be who you have always known you
could be.
Tom Landry
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SOME BACKGROUND
§  Education: Radboud University, Nijmegen, Free University, Amsterdam;
Mayo Clinic, Rochester; U of Calgary, Alberta
§  Certified: NHS Leadership facilitator (2012); HumanSynergistics™ coach
(2011); TeamSTEPPS™ master trainer (2009)
§  Research: Associated researcher U of Twente:
§  National Medical Leadership Competency Framework (2015)
§  Dutch version TeamSTEPPS
§  International study on national development of ML
§  Pan-European study on (role physicians in) e-health enabled
integrated care à Physician e-Leadership (Keijser, 2015)
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SOME BACKGROUND
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COACH OR MENTOR?
I am a coach …
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COACHING VS MENTORING #1
JARVIS, 2004
Mentoring
On-going relationship that can last for a long period of time
More informal; meetings structured or ad hoc
More long-term and takes a broader view of the person
Mentor often senior person in organisation (knowledge, experience
and ‘open doors’) – ‘protégé-ship’
Focus is on career and personal development
Agenda is set by mentee, with mentor providing support
Mentoring revolves more around developing the mentee
professionally
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COACHING VS MENTORING #2
JARVIS, 2004
Coaching
Relationship generally has a set duration
Generally more structured; regular meetings
Short term (sometimes time-bounded) and focused on specific
development areas/issues
Coach not always direct experienced with coachees work
Focus is generally on development/issues at work
The agenda is focused on achieving specific and immediate
goals
Coaching revolves more around specific development areas/
issues
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WHAT DO WE KNOW ?
Medical
Leadership AND
Google
PubMed
Coaching
600.000
70
Mentoring
23.000.000
350
The Netherlands:
‘Coach voor medici’ (Dutch) >150 coaches provide services …
Medical leadership coaching = grey area
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COACHING TYPES (INDIVIDUALS)
§  Problem based (personal?)
§  Performance based
§  Competencies focussed (e.g. leadership; personal
effectiveness)
§  Disciplinary / punitive (e.g. disruptive behaviour)
(Team coaching)
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THE ESSENTIALS FOR COACHING
§  Perspectives:
§  the coachee
§  the organization
§  the coach
§  Motivations – Why?
§  Motivated - Why should I?
§  Role management / hierarchy
§  Coach-profile (development and search)
§  A ‘match’ / ‘click’
§  (Build) trusting relationship
§  Anticipate on resistance
§  Clear goal definition: SMART
SMART Goals
Specific
Measurable
Achievable
Relevant
Time-bound
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SELECTING A COACH
Selecting a coach
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Experience, and track record
Personal style and ‘fit’
Approach, methodologies, qualifications
Costs
Professional background and field specific knowledge of
organisation, industry and/or issues
Evidence of line management experience
Supervision of coach
Materials
Geographic considerations
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INTERNAL OR EXTERNAL ?
JARIS 2004
External
Internal
Political reasons; issues would be
difficult for internal coach
Internal knowledge is essential
Specific expertise
Easy available
Concerns relating CoI
Building high level of trust over
time
More broader, external expertise,
ideas etc.
No ‘consultant’ image
Less likely to judge; more
objective
Costs
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PITFALLS AND THREATS
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Ineffective goal setting, planning, follow up (home work)
Poor motivation; negative attitude
Low rapport / connection coachee-coach
Ineffective listening / dialogues
Relationship; distance – closeness
Ineffective / superficial coaching methods
Coach experiences alignment with work coachee
Interpersonal problems coachee
Ineffective endorsement / alignment (e.g. management)
Time pressure; Costs
Monitoring quality – self-awareness (coach; coachee)
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OUR ‘ML INSIDE’ TEAM WORK IMPROVEMENT PROGRAM
TITLE: Enhanced Dutch version or ‘Team Strategies and Tools to
Enhance Performance and Patients Safety’ (TeamSTEPPS, 2007)
AIM: Creating A Culture of Continuous Improvement
OUTCOMES:
§  Team climate (mono/multi)
§  Multi-disciplinary relational collaboration
§  Employee satisfaction
§  Clinical outcomes (e.g. safety; efficiency; cost-effect; …)
§  Medical leadership
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THE PROGRAM
1-1,5 year multidisciplinary program
Multi-faceted, evidence based curriculum
Train-the-trainer
Mono-disciplinary team coaching (‘priming’)
Multi-disciplinary
§  Team training
§  Improvement program
§  Leadership development for ALL physicians.
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PHASING TEAMSTEPPS
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MEDICAL LEADERSHIP DEVELOPMENT APPROACH
Characteristics:
§  Mono-disciplinary priming
§  Peer-to-peer coaching
§  ‘In situ’ coaching in working context (e.g. interpersonal relationships;
issues; atmosphere; challenges)
§  100% confidentiality and non-disclosure
§  Top-management included
Measurements:
§  Team Climate Inventory (TCI)
§  Individual 2x 360-degree assessments
1.  Life Style Inventory
2.  TEAM+ (American Board of Internal Medicine, 2014)
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LSI ASSESSMENT
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TEAM+ ASSESSMENT
360-degree: ‘TEAM’ = Team Work Effectiveness Measurement
+
3 additional SELF-assessments on:
1.  Emotional Intelligence
2.  Mindfulness
3.  Self-reflectivity
4.  Job satisfaction.
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SOME FIELD EXPERIENCE #1
SOME POINTERS FOR DAILY PRACTISE PHYSICIAN COACHING
Field experiences:
1.  Measuring is a MUST
2.  Management engagement and endorsement is CRUCIAL
3.  Resistance = emotion (like PASSION is …)
4.  Coaching with a medical background helps.
Coaching docs:
1.  Asking questions ‘with a bite’ (confrontational coaching)
2.  No teaching, no judging
3.  Helps to see/hear what you can’t see/hear easily by yourself (or
what others are afraid to tell you … !).
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SOME FIELD EXPERIENCE #2
Why are docs not quite so easy to coach … ???
1.  Often take an immediate (highly intelligent) stand (on anything)
2. 
3. 
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5. 
6. 
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Non-doc coach often does not know about their challenges
Docs can be sensitive being at the top of ‘accountability pyramid’
They are not used to it …
Are not (made) aware of benefits
Afraid for consequences
Not used to be subject to feed back.
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SOME FIELD EXPERIENCE #3
Top 5 Excuses not to be coached …
1. 
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5. 
Too busy
Patient care more important
How do you know this works for me?
It is not confidential
Why would I need it?
“But dear dr Keijser,
You are coach number 6 they send us …”
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THE YOUNGER GENERATION
(Keijser, 2016 – unpublished)
National ML Development Case Study – interviews:
1.  Engage in quality improvement (‘Can Do’-attitude)
2.  Growing up in a ‘connected’ information society
3.  (More) pro-actively interested in leadership
4.  Experience medicine shift towards population
based medicine
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THE COACHING AND MENTORING ‘GAP’
If ML is so new and is merely /just recently part of in
medical education:
Who of the senior colleagues should mentor or coach
you in developing it?
Is there a ‘Mentoring Gap’?
§  Socialisation process of becoming a physician
§  Copy-paste 'medical culture’
§  Tribes in healthcare.
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CONCLUSIONS
1.  ‘In situ’ coaching is feasible
2.  Use mono-disciplinary ‘priming’ and peer-topeer coaching
3.  Intertwine ML development in Quality
Improvement
4.  More research and regulations on high
quality ML coaching
5.  Coaching = dealing with resistance, and …
sometimes: kissing awake passion again!
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THANK YOU
[email protected]
10
novem
ber
2016
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