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The role of coaching in health care: Getting better at what we do

Dr. Eugene Tuyishime (left) of Masaka Hospital in Rwanda leads a clinical team through a role playing exercise on coaching techniques as part of an on-site Ariadne Labs training to implement the WHO Safe Childbirth Checklist. (Photo by Emily George)

Improving safety and quality within the health care setting can be challenging and isolating. Individuals driving these quality initiatives are in great need of a supportive network to share challenges, brainstorm solutions, and/or receive guidance on specific questions around implementation. Recognizing this need, Ariadne Labs created the role of “coaches” within our organization to provide a supportive

Dr. William Berry, Ariadne Labs Chief Medical Officer
Dr. William Berry, Ariadne Labs’ Chief Medical Officer

network to our quality improvement and implementation partners within all of our programs across the globe. Emily George, clinical implementation specialist/coach, recently sat down with Ariadne Labs’ Chief Medical Officer Dr. Bill Berry to discuss the purpose and value of coaching in the health care setting.  

Q: Coaching is a concept most of us are familiar with, especially when it comes to professional sports, but what does coaching mean in a health care setting?

A: The concept of coaching in the health care setting is the same as it is in professional sports — it’s the idea that someone wants to get better at something, so they have someone watch them and then discuss what they can do to improve their performance.

Q: We know from our work around the world that some health care professionals are uncomfortable with the idea of coaching. Why do you think that is?

The idea of coaching can seem foreign in industries like health care where you go through years of training and education, and then when you’re finished, you’re ready to be an independent practitioner. Asking for help from someone to sharpen your performance can sometimes make it seem like you don’t know what you’re doing. As a surgeon or any kind of doctor, that is the last thing you want. However, coaching is not telling someone how to do something. Coaching is helping someone get better at what they already know how to do. This can only happen if someone watches you and helps you see how you can improve. If we want to enhance the quality and safety of the care we are providing, everyone must be open to discussing how we can get better.

Q: How did you, as a surgeon, become comfortable with the idea of coaching?

It began when I was exposed to simulation as a teaching tool for healthcare professionals. The idea of simulation began in aviation and was used to help people improve their performance during stressful situations that could happen when flying. A few years ago, I began working closely with the Center for Medical Simulation to recreate stressful situations that could happen in the operating room. These simulations were recorded so teams had the opportunity to observe how they functioned when things didn’t go as planned. The magic happened during the debriefing, or the time when the teams had a chance to watch the recording and discuss what they could have done differently. Coaching hinges on observing and debriefing so individuals have “Aha!” moments for themselves.

Q: How would you describe Ariadne Labs’ coaching philosophy?

There is a spectrum of coaching. On one side is advocacy and on the other side is inquiry. Advocacy is telling. Inquiry is asking. A good coach sits somewhere in the middle, and maybe even more toward the inquiry side. This is especially true if you are coaching professionals. At Ariadne Labs, when we work with teams and individuals, we are not generally telling or teaching anyone anything new. We are working with people who already know how to do things, but who want to improve their practices or behaviors. We do this by observing and asking questions.

Take a professional tennis player, for example. Her coach is not teaching her how to play tennis. She already knows how to play. Her coach watches her play for hours and hours. When she needs help improving her backhand, the coach can reflect back to her exactly what he’s been observing. Then, together, they can figure out exactly how she needs to stand, how to slightly change her grip, or precisely when to swing. Your innate abilities can only take you so far. Then you need someone to help you improve. It’s the same in health care or any other industry.

Q: Coaching is a key strategy across all of the programs at Ariadne Labs. Can you describe the role coaching plays in quality improvement?

A: Implementing quality improvement programs can be very challenging. There are many things that need to be in place to ensure successful adoption of something new. In my experience to date, I have seen the value of having coaches walk people through each stage of the implementation journey. Changing processes or behavior is extremely difficult. The role of the coach is to observe, ask questions, give feedback and support the team as they go through the change. All of our programs at Ariadne Labs contain a coaching component with the hope that the changes our solutions are initiating will be sustained over time.

Q:What types of qualities or skills do you think a good coach has?

A: Coaches have to be coachable. What I mean by “coachable” is they have to be humble and open to receiving feedback. A good coach is entering the coaching experience with genuine curiosity about the way someone does something and wants to learn more about why and how. They know how to ask questions to help someone reflect on their own behavior. They must be able to find the right balance between advocacy and inquiry to achieve maximum impact with the people they are coaching. This takes practice. A good coach will take it upon themselves to have their own coaching skills honed through direct observation and feedback. We do this with all of our coaches at Ariadne Labs. We watch them coach and then we coach them on their coaching. We believe everyone can get better.