Partners for PatientsCoaching for Improvement

A Coaching Mentality

Stephanie Sobczak: WHA Quality Manager Thomas Kaster: WHA Quality Coordinator

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Overall Objective

The objectives of this series:1. Help you self identify your personal coaching style and

opportunities for growth 2. Help you analyze your personal work environment to

identify opportunities for effective improvement coaching

3. Provide you with the best known skills, resources and practice for leading effective improvement coaching interactions

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Series Webinar Plan

• A Coaching Mentality• Finding Time to Coach• Effective Coaching Interactions

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Today’s Objectives• Defining Strong Coaches• Leadership activity vs. Management activity– Balancing positive and constructive feedback– Judging vs. Coaching• Adaptive Coaching• Delegation Strategies• Developing Feedback Loops• Coaching for Improvement using Influence

Leadership

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Poll Questions: Characteristics of Coaches

Think back to a coach or leader you have had in the past that you felt really reached you and helped you grow. Which of the following characteristics did that person display?(Choose 2)

a. Really listened to meb. Communicated in a way that did not make me feel inferiorc. Helped guide me to the correct solutionsd. Valued me as an individual e. Always had all the answers and gave specific directions on the way things

should be donef. Was always firm and did not waver from their point of viewg. Would really chew me out when things did not go wellh. In their eyes they were always correct

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Characteristics of Good Coaches• Commonly identified characteristics of great coaches

include: – Great listeners– Very knowledgeable – Pulls rather than pushes– Creates an open environment and withholds judgment – Focuses on leadership and cooperation as opposed to top

down hierarchical position– Values individuals as crucial parts to each team – Seeks to create an effective team that works together to

produce positive outcomes

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Poll Questions: Characteristics of Coaches

Think back to a coach or leader you have had in the past that you felt really reached you and helped you grow. Which of the following characteristics did that person display?(Choose 2)

a. Really listened to meb. Communicated in a way that did not make me feel inferiorc. Helped guide me to the correct solutionsd. Valued me as an individual e. Always had all the answers and gave specific directions on the way things

should be donef. Was always firm and did not waver from their point of viewg. Would really chew me out when things did not go wellh. In their eyes they were always correct

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What is Coaching for Improvement?

• Steven Covey: 7 Habits of Highly Effective People

–Lead People, Manage Things “You lead (empower) people. You

manage and control things.”(The 8th Habit, p 101)

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Leadership/Coaching vs. ManagementLeadership Coaching

Activities• Empowering teams to make

improvement• Providing guidance and support• Asking questions to find solutions • Understanding the internal and

external environment • Finding the solutions from those

who do the work • Helping teams overcome obstacles • Coaching for improvement

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Managing Activities• Measuring outcome• Reporting / monitoring data • Scheduling meetings• Determining ROI• Identifying evidence based

practices• Identifying opportunities

for improvement

Leadership / Coaching vs. Management

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Have you ever had…

A manager or coach that was very organized, really knew their stuff, never missed a detail but did not have the heart of the team?

Or,

A manager or coach that was great with the team, really understood the personalities, but was disorganized, inconsistent and lost the team’s confidence?

Leadership vs. Management

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Have you ever had…

A manager or coach that was really good at pointing out deficiencies in data but was not able to help the team improve?

Or hopefully,

A manager or coach that understood that the data results were part of the system and worked with the team to find solutions for improving?

Leadership/ Coaching vs. Management

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Both hats are important, but need to be warn at the right time. There is a balance.

Leadership and Coaching for Improvement

Essential Key to Quality Improvement Coaching

Understanding that the system causes the outcomes, not just the individuals in the systems.

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Leadership vs. Management-Self Assessment

Your Leadership / Coaching Activities

• • • • • • •

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Your Management Activities

• • • • • •

Providing Feedback On Improvement

• It is commonly known that people respond more favorably to positive reinforcement than negative reinforcement.– It is very difficult to lead improvement by only

pointing out deficiencies– People are not going to make sustainable change

just because they are told their numbers are bad• Yet in most systems, the majority of feedback

only comes when there is an issue

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Keys to Providing Feedback

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• Provide positive feedback publically and constructive feedback privately

• Provide timely feedback• Understand that feedback is not a one directional

communication channel• Understand that most of our systems are designed to

analyze negative trends • Make a goal to provide more positive feedback than

constructive– Actively look for opportunities for positive feedback

Example of Positive Reinforcement ….

“I was noticing Sue, that whenever I see you come out of a patient room, I always see you cleaning your hands. I really appreciate you keeping patient safety in mind. Thank you.”

vs.

“Sam, caught you again. You need to wash your hands or you will spread infection. Why can’t you remember?”

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Assessing your Feedback • Take a few minutes to answer the following:

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Concept Yes or No

Thinking back on the my last several opportunities to give feedback, I feel like I have been able to balance between constructive and positive feedback.

If I were to ask those that I coach and support if I give enough positive feedback most would say yes.

I try hard to actively seek out opportunities to give positive feedback.

I feel like I am given a balanced amount of positive and constructive feedback from those that coach and lead me.

Most of my feedback pertains to data results.

The majority of my feedback is given when something is incorrect or not going well.

Constructive Feedback Judging vs. Coaching

• When coaching for improvement it is easy to get trapped into judging.

Example of Judging: “Sue, I do not think you completed hourly rounding fully any day last week.

You know it is essential for reducing falls and our new goal. Next week I want to see you do this.”

Do we know…• What legitimate obstacles Sue may have ?• If Sue fully understands the process?• Why Sue feels she is having difficulties?

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Constructive Feedback Judging vs. Coaching

Example of Coaching: “Sue, I have noticed that you may be having difficulties completing your hourly rounding. I

know you understand how important this is for our patients. If you are struggling others might be as well. What can we do to help you and others find more time to do this?”

Notice the technique:• First the opportunity is identified• Then it is openly acknowledged that Sue is doing the best she can• Direct blame is differed by explaining that others might be struggling• Then Sue is asked how she can improvement her environment so she can meet this

important goal

We will be practicing these strategies and more in session 3

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Judging vs. Coaching What can be judged What can be coached

Outcome Data How the team can improve the outcomes

Inventory Levels How the team can institute an inventory program

Efficiencies How the team can find way to make their work more streamlined

Prevalence of Processes How best known practices can work in the system

Adoption of Evidence Based Practices How the team can incorporate evidence based practices into their system

Management Activities Leadership activities

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Other Considerations when Giving Constructive Feedback

• Always realize that this is an opportunity for you to build trust with a valued employee

• Ask yourself: How would you want your staff to give you negative feedback?

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Other Considerations when Giving Constructive Feedback

• Make yourself a coaching example– Share stories about when you made a mistake– Talk about what you did to learn from it– This models for staff how to take accountability

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Take Away#1: Positive Feedback Brainstorm

• Take 5 minutes to list as many opportunities that you can think of to provide positive feedback to those that you coach.

• Do this in the next month• Consider teaming up with other coaches for ideas

Adaptive Coaching

• Is everybody coached the same way?• Does everybody take feedback the same way?

Individualize the coaching; no one size fits all

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The High Performers: Characteristics

Pros Considerations

Are usually self-driven Positive recognition refuels their tank

Can take a general idea and run with it May take on too much

Have lots of ideas for improvement Can get burnt out

Are driven to improve You may rely on them too much

Can get a lot done for you If they are over used, peers may start to resent them

Are often looked upon as leaders

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The Naysayers / Negative Nellys: Characteristics

Pros Considerations

They are often willing to comment when others are not

Sometimes they are not aware of how they are perceived

There are always elements of the truth in their comments

Coach them (privately) on how they are perceived by valuing their opinion but helping them communicate differently

Help them understand “it is not what you say, it is how you say it that counts.”

They may need periodic tune ups

Encourage them to come with solutions

Catch them doing things right and publically (or privately) acknowledge

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Those Along for the Ride: Characteristics

Pros Considerations

They may be an untapped resource Start to engage them slowly

They may have a unique point of view Learn what energizes them

Give them small challenges to see if they will take off

Remember that not everyone wants to go the extra mile and we need them to do their thing

If they do accomplish a goal you assigned, make sure to positively recognize

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Delegation Keys• You cannot single handedly drive

improvement • Sometimes is it challenging to hand off

elements of your pet project• Delegate for the right reasons

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Delegation Strategies

• Delegation for Development– Use delegation to challenge your high achievers– Make sure the hand off is a win-win for you and

the individual – Put them in a position to succeed– Make the project a learning opportunity

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Delegation Strategies• Delegation for Engagement– Use micro-delegation to engage the riders and fence-

sitters – Use delegation when you have a hunch that someone

has high potential that has not been tapped yet– Use delegation if someone has a particular strength – Early on keep the task easy and gradually grow

responsibility if performance is positive – Be prepared to scale back if needed

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Delegation vs. Dumping

– Delegate with purpose • There are always tasks that are not pleasant• If you delegate a project, make sure you are going to

follow-up in a timely manor • When delegating, communicate your purpose so that

the receiver does not feel “dumped” on

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Developing Feedback Loops• Feedback Types

– Formal Feedback – Informal Feedback

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Informal Feedback

• In quality improvement, informal feedback is essential– More impactful because it is just in time– More impactful because it is personally delivered– It supports rapid improvement through small tests

of change

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Informal Feedback Examples • Hallway or elevator quick conversation – How is xyz going? Are you experiencing obstacles?

What type of help do you need?• Quick e-mail / instant message from individuals

to coach– I am stuck here can you help me?

• E-mail chain distribution within improvement team– We are experiencing this… XYZ happened, how can

we learn from that?• Quick phone call etc…

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Formal Feedback• Useful for project development and planning • Useful when scheduled and consistently attended • Great to evaluate progress at specified

milestones • Is not intended to drive rapid improvement • Too often improvement is halted because teams

are waiting for a formal meeting to move forward

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Ideas for Formal Feedback Structure• Surveys or E-mailed survey links• Idea boxes• Meetings• Data from patients and families• Shared Governance Council• Quality Councils• Board or Medical Staff Presentations

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Poll Questions #2 Which of the following best describes your

current state as a improvement coach / leader.

a. I am good at the management functions but would like to improve as a improvement coach

b. My management and coaching skills are strong, but I need to delegate more

c. I am new to leadership and want to work on all aspects d. I am the Dalai Lama of Management and Leadership and need

not improve

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Influence Leadership• When those that you are coaching for improvement don’t

directly report to you

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Common Perceptions Common Realities

If I do not have any authority they will not respond for me

Sometimes by eliminating the hierarchical title, people open up and feel more comfortable and safe

Since I do not do what they do, they will not find me credible

Often, when driving improvement, not having all the answers is a benefit. You are better suited to drive engagement through facilitation, and asking questions not by giving orders

The managers want to do this work Often managers are so buried in the day-to-day operations that they gladly welcome improvement support

Influence Leadership Considerations• It is important to foster a relationship with the managers of the

teams you are helping, as well as the staff you are working with– Sometimes your manager can be a great help with this

• Work with the manager to clearly define the role of the improvement coach and manager in the project

• Be mindful of maintaining trust between all parties

• Inform the managers of your “informal feedback” strategies

• Work within the system of the operations and if you cannot, work with the managers to find a solution

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Poll Questions #2: Results Which of the following best describes your

current state as a improvement coach / leader.

a. I am good at the management functions but would like to improve as a improvement coach

b. My management and coaching skills are strong, but I need to delegate more

c. I am new to leadership and want to work on all aspects d. I am the Dahlia Lama of Management and Leadership and

need not improve

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Coaching for Improvement Series:

– Oct 11: Developing a coaching mentality – Nov 9: Finding time to coach – Dec 13: Effective coaching interactionsNext month action items:Complete webinar #1 workbook, which includes goal

setting. “If you write it, it will come.”

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Closing Comments • “Be a light, not a judge. Be a model, not a

critic” – Steven Covey: 7 Habits of Highly Effective People

Questions?

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