Supporting and retaining the workforce is a top priority for all NHS organisations, but it’s not clear how best to do this, or how such support should be funded. Junior doctors have clinical and educational supervision, and the quality of this support is monitored and regulated. However, for consultants there are no guidelines or standards, and very little in the way of evidence about what works.
With this in mind, Jo Mountfield, Director of Education and Workforce, and Liz Donovan, retired Director of Medical Education, set up the Doctors Development Unit (DDU) at University Hospital Southampton (UHS). The DDU offered up to six hours of 1-2-1 coaching to new consultants, consultants taking on a leadership role, or consultants identified as experiencing challenges. The coaching was provided by initially three (now increased to nine) doctors who were trained coaches. The theory was that senior medical staff might feel more comfortable working with other medics within the coaching interactions.
What is coaching?
Coaching is an empowering non-directive conversation that creates space for someone to think well about the challenges they face. The coach uses open questions to support and challenge the coachee on their goal. Coaching assumes the coachee is creative, resourceful, and whole, and can find their own answers, developing themselves in the process. The ‘agenda’ for the coaching is set by the coachee.
The International Coaching Federation (ICF) defines coaching as “partnering in a thought-provoking and creative process that inspires a person to maximize their personal and professional potential”[1].
What is the difference between a coach and a mentor?
Mentoring describes the relationship in which a more experienced colleague shares their greater knowledge to support the development of those who are more inexperienced in their role. The ‘agenda’ is set by the mentor.
Coaching differs from other forms of support such as counselling, and if you are interested in getting help with something consider what the purpose is and use the table below to guide you.
How do doctors feel about being coached?
It felt important to ask consultants their opinion about being offered coaching and being coached. We are a large trust with over 800 consultants. In the first three years of offering coaching, 202 staff members including 97 new consultants and 95 established consultants took up the offer. An external evaluation of the DDU found that the feedback was highly positive. Eightyfour consultants responded to a survey about the DDU. Ninety-seven percent of the responding coachees agreed that their coach provided a safe space, had a positive impact on their professional role, and that they gained confidence through coaching.
"If we introduce a coaching approach as another way of having development conversations [...] we can tap into and develop the thinking of our talented colleagues"
When interviewed for more detailed feedback, the coachees said the coaching had helped their wellbeing and their performance, for example one said it was “absolutely fundamental to my role and career as well as the outcome for my area of work.” Another said, “It helped to gather my thoughts and really unblock me.” Twenty-five percent of the questionnaire respondents were unaware that coaching was on offer at UHS, suggesting we could do more to advertise the DDU.
And what is the impact on the coaches?
All the coaches in the DDU were consultants at University Hospital Southampton. They were all qualified coaches, and they carried out the coaching in their job-planned time. The coaches felt really positive about their role, because they felt they were developing their own professional skills, connecting with colleagues from across the trust, and were perceived as role models. For example, during the evaluation interviews, one coach said, “There is satisfaction in seeing the people you coach develop into their role and become the leaders that you know the workplace really needs. Where they can take a step back, show perspective, care about their working environment and team and commit to what they do well.”
Could this coaching bring wider benefits to the hospital?
There is evidence that coaching has wider benefits within an organisation, for example, through role modelling, encouraging resourcefulness, and building a culture of high performance.
When doctors have a positive and enabling experience through their own coaching, they are more likely to adopt the approach themselves in how they lead and teach, role-modelling in an influential way. When coaching becomes habit, a coaching culture can be created, helping the hospital create support for colleagues from colleagues without using extra resources.
Team leaders who learn how to use coaching skills with their team members report using less energy when they use a coaching approach to conversations because they are enabling team members to do the thinking themselves – helping them solve the immediate challenge but also develop their own innate capability and grow in confidence at the same time.
Using coaching skills day-to-day increases the likelihood of staff answering their own questions where possible, so that team leaders do not become a ‘bottleneck’ for staff to make progress with tasks.
The culture in hospital is based on advice-seeking and giving. If we introduce a coaching approach as another way of having development conversations – another tool in the toolkit – we can tap into and develop the thinking of our talented colleagues. If colleagues can learn when to give advice in a directive conversation and when to coach in a non-directive way, we can create the conditions for high-performing culture.
And who pays for the coaching?
The funding for the DDU was identified as part of the training, development, and workforce budget by the Director of Education at UHS. The work of the DDU was carried out during NHS job planned time for all participants. The external evaluationincluded a financial examination of the Social Return On Investment of the DDU. It found that for every £1 invested, which effectively supported at least three doctors each year, the Unit generates, on average, between £1.47 (x3 doctors) and £44.03 (x90 doctors) in social value. This is based on a theoretical evaluation of the savings through doctors staying in their roles rather than leaving their jobs or taking early retirement.
How can I find out more about coaching?
- There is a wealth of resources available at The International Federation of Coaching: https://coachingfederation.org
- Many qualifications, apprenticeships and courses are run by ILM: https://www.i-l-m.com
- To support people to learn how to apply coaching skills in their work environment quickly and easily, visit: www.everydaycoachingskills.com
References
1. https://coachingfederation.org/about
2. Pullen B, Crane E. Creating a Coaching Culture in a Global Organization. The International Journal of Coaching in Organizations 2011;30(2):6-19.
Declaration of competing interests: None declared.
