11/5/15 Physician$Coaching:$A$Tool$for$$ Performance ......11/5/15 1...
Transcript of 11/5/15 Physician$Coaching:$A$Tool$for$$ Performance ......11/5/15 1...
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Physician Coaching: A Tool for Performance Improvement
by
Elizabeth R. Becker, LCSW Oct. 31, 201
Inner SoluLons for Success [email protected]
(619) 370-‐9679
www.innersoluLonsforsuccess.com
Today’s ObjecLves: • Why coaching? • Understanding the difference between coaching and other resources or intervenLons.
• BeZer understand the process of coaching and the coaching model
• Learn how coaching can improve performance reduce risk, and increase well-‐being.
• Case presentaLon
Q: Why Coaching? • It’s the most posiLve and effecLve method for addressing the
many ‘human factors’ that contribute to performance related issues, including well-‐being and professionalism.
• It is supporLve and prevenLve in nature and keeps potenLal problems out of the realm of disciplinary acLon.
• It helps good doctors become more effecLve doctors and leaders by developing the ‘so^ skills’ (EI)that are not adequately taught through medical educaLon.
• The Coaching Model is a PI process that addresses The Joint Commissions requirements designed to improve paLent safety by addressing the human factors.
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The Joint Commission set standards and made specific recommendaLons
• Standard MS 11.01.01 says hospitals must “idenLfy and manage maZers of individual health” for physicians that are separate from disciplinary acLon.
• Standard LD 03.01.01 mandates that leaders “create a culture of safety”
The commissions suggesLon: “Provide skill-‐based training and coaching for all leaders and managers in relaLonship building and collaboraLve pracLce, including skills for giving feedback on unprofessional behavior, and conflict resoluLon.”
The Coaching Model Emphasizes: • Professional growth and development through reflecLon, skill development, new behaviors, and increased mindfulness.
• Personal effecLveness, responsibility and accountability (less nurse blaming)
• Partnership based upon trust and personal moLvaLon
• Strength based • Future oriented • Goal directed (specific and measurable PIP)
• Value driven
Philosophy of Coaching: • Coaching seeks to meet the physician’s need for personal and/or
professional growth and development. • It assumes physicians are prefer a professional growth and development
model rather than correcLve acLon based on a series of failures.
• It assumes physicians will strive towards improved performance through personal effecLveness if given sufficient support and opportunity to learn relevant skills.
• It assumes problems and dysfuncLons are the result of ineffecLve skills,
lack of knowledge, lack of resources, lack of opportunity, or some combinaLon of these (not psychopathology).
• Future oriented and goal directed; past mistakes are for reflecLve learning. • The goal of coaching is to partner with physicians to support them in
learning to be a more effecLve physician. This can and does include behavioral changes that negaLvely impact performance.
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The Benefits of Using a Coaching Model:
• Aligns individual goals with organizaLonal mission • Increases personal responsibility by connecLng behavior with goals.
• Creates a sense of posiLve partnership between wellness commiZee and physician.
• Increases trust and aligns physician with moLvaLon/goals/outcomes.
• Improves team work through improved leadership skills (e.g. communicaLon)
Benefits of Coaching Model (cont.)
• Improves commitment and moLvaLon if physician feels that his needs and goals are being heard and addressed.
• Improved performance and producLvity. • Improved level of professionalism (and all related outcomes, such as pt. saLsfacLon)
• Improved relaLonships with other team members (colleagues, peers, family, etc.)
• Improved organizaLonal culture
Mentoring vs. Coaching A ‘mentor’ is based upon a relaLonship
• Uses the relaLonship to support the physician • It can be acLve or passive (lack of goals or accountability) • Usually a power differenLal • Mentee usually choses the mentor; based on connecLon
‘Coaching’ is an acLve process that is less focused on the relaLonship (although the relaLonship is important)
• Success or outcome focused • Goal driven and forward thinking • References the past for reflecLve learning based on paZerns.
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Coaching v. Supervision Coaching: Supervision: Shared agenda OrganizaLons agenda (e.g. MEC)
Growth oriented Mission focused Strength focused Problem focus Personal accountability Fault seeking Self moLvated CompeLLve Feed forward process Feedback process Thought partner Hierarchical SupporLng/encouraging DirecLng/telling Facilitator Manager CelebraLng Punishing/ correcLng
Coaching v. Psychotherapy Differences: • Not focused on providing treatment for psychopathology.
• Focuses on professional development and experiences. • Does not diagnosis based on DSM. • A PIP is developed rather than a treatment plan. • Professional boundaries differ in coaching relaLonship. • AcLvely gives opinion, shares experiences, and provides direct feedback or direcLon.
• Coach can ‘fire’ client.
Coaching v. Psychotherapy SimilariLes: • Uses an assessment process that includes bio-‐psycho-‐social
component; defense style, coping skills, insight, etc. • Based on trust and open disclosure. • Guidelines for confidenLality are similar. • DysfuncLonal thought and behavioral paZerns are idenLfied
and addressed. (cogniLve process, ethnic and gender bias) • MoLvaLon and readiness for change are assessed. • Goals always include increased self-‐awareness by aZending to
feeling states. • Coping and self-‐care strategies are always part of PIP • Process involves asking powerful quesLons!
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The Coaching Process Step 1: Assessment/EvaluaLon • Bio-‐psycho-‐social includes basic demographics,
developmental hx, and medical educaLon training. • Health and medical hx • Hx of substance use, abuse and paZern, treatment hx • Sx of depression (PHQ9), anxiety (GAD), thought disorders, • Recent or current stressors • Coping and defense style • Sources of support • On-‐set and percepLon of problems/issues • Level of insight and self-‐awareness • Level of moLvaLon and readiness for change
Coaching Process (cont.) Step 2: Stakeholder Input • MeeLng with key stakeholders in the organizaLon to get their perspecLve, learn concerns, and prior efforts at PI.
• Determine paZern or trends . • Discover impact on others and potenLal risks to organizaLon.
• OrganizaLonal assessment (level of dysfuncLon). • Clarify and agree upon coaching expectaLons. • Establish methods to measure improvement and success.
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Coaching Process (cont.) Step 3: Contract • Inform and process stakeholder perspecLve with MD • Discuss expectaLons • Review coaching contract, including confidenLality • Conduct PI SWOT (strengths, weaknesses, opportuniLes, threats) • Establish goals as part of the PIP (e.g. goal, acLon steps,
obstacles/challenges)
• Agree to Lme frames and process (e.g. phone calls 2x month for 1 hr per call for 6 mos.)
• Start immediately with skill development and ‘Stop Doing’ list.
Coaching Model to Improve Performance
Requires that we make a paradigm shift and understand that we cannot motivate the right behaviors from people who have significant EI deficits:
• Little or low self-awareness • Lack empathy for others • Ineffective communications skills • Poor impulse control • High levels of stress • Ineffective Coping Skills
Physician Communication (conflict) (skill)
Empathy (EI)
Impulse control (both)
Emotional regulation(both)
Insight (EI)
Problem-solving (skill)
Awareness of self and others (EI)
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What is Emotional Intelligence?
Definition: Emotional intelligence is the dimension of
intelligence responsible for our ability to manage ourselves and our relationships with others.
v Emotional Intelligence explains why, despite equal
intellectual capacity, training, competency, or experience, some people excel in life while others with comparable knowledge or skills (or even superior intellectual capacity) fail or flounder.
The Importance of EI • Relationship between EQ and professionalism –
“There are three recognized elements of professionalism: empathy, teamwork, and lifelong learning.” (D Stern, 2006)
• Relationship between EQ and conflict management – “Studies comparing superb leaders with mediocre ones have found that the competencies that distinguish the best from the worst in human services have little or nothing to do with medical knowledge or technical skill, and everything to do with social and emotional intelligence. What distinguishes leaders in medicine goes far beyond that knowledge, into interpersonal skills like empathy, conflict resolution and people development.” (D Goleman, 2006)
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“This process of critical self-reflection depends on the presence of mindfulness. A mindful practitioner attends, in a non-judgmental way, to his or her own physical and mental processes during ordinary everyday tasks to act with clarity and insight.” – R Epstein, 1999
ACGME Core Competencies • Professionalism, measured by the following
characteristics and behaviors: • Compassion • Integrity • Respect • Accountability • Sensitivity • Responsiveness
• Interpersonal skills and communication including: • Effective communication • Teamwork • Leadership role • Empathy
EI Personal Competency Self –awareness: • Emotional self-awareness • Accurate self-assessment • Self-confidence
Self-Management: • Emotional self-control • Transparency • Adaptability • Achievement • Initiative • Optimism
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EI Social Competence Social awareness: • Empathy • Organizational awareness • Service Relationship Management: • Ability to inspire others • Influence • Develop/mentor others • Change catalyst • Conflict management • Building Bonds • Teamwork and collaboration
Relationship between EI and ACGME Core Competencies
• Professionalism (EI = achievement, service, impulse control, initiative, integrity, transparency, confidence, clinical competency)
• Interpersonal skills (EI= self-awareness, empathy, mentoring)
• Communication skills (EI= conflict management, building bonds, influence, self-awareness, transparency, optimism)
• The ability to work as part of an interdisciplinary team (EI= adaptability, collaboration, organizational awareness, empathy, building bonds)
Support for EI Development
In fact, in the June 2010 edition of the Journal of Academic Medicine, Lucey and Souba address issues related to the core competency of professionalism by stating:
“Principles of emotional intelligence, reflective practice, and mindfulness can be applied to enhance professionalism and overall physician performance.”
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Performance Improvement Myth:
Physician behavior will change when they see the data that demonstrates their conduct impacts patient care and they are ‘outliers’ among their peers (this is more accurate related to clinical outcomes!)
Fact: Emotions, values and beliefs have a far greater influence over behavior than knowledge. Under stressful circumstances, human factors and conditioned responses usually trump knowledge and intellect.
Why Behavioral Change is Difficult • Behavior effects performance, but how we think
and feel effects our behavior! • Changing behavior is difficult because it often
involves a process of thinking about thinking. • Motivation for change is frequently the result of a ‘pain point’, rather than a reward.
• For this reason, addressing performance problems through policies, guidelines, etc. is usually ineffective at changing behavior or incentivizing behavioral change.
• The reward is often a change in how the person feels (this is why feedback is important!)
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The StarLng Gate and Cornerstone of Professionalism and EmoLonal Intelligence
PIP Goal and Focus of Coaching: • Awareness (self and others!) • Empathy • Impulse Control
Choosing an EffecLve Coach • Specific training as a coach!
• Experience and understanding of the unique aspects and dynamics of healthcare.
• Understands the world of physicians and the stress and demands of the healthcare team.
• Can conduct effecLve and thorough assessments of the individual, but also able to have a systems perspecLve.
• Able to ask powerful and relevant quesLons.
• Has credibility and authority among the organizaLons leadership.
Choosing an EffecLve Coach (cont.) • Able to respecsully, but firmly challenge and push back on
the physician and hold them accountable.
• Able to effecLvely uLlize a variety of assessment and feedback tools to measure progress, provide feedback, etc. (360’s, leadership inventories, etc.)
• Able to build rapport and establish high level of trust.
• Teach EI skills and understands how that translates to the healthcare setng.
• Can inspire and moLvate change, and assist with the integraLon of EI skills.
• Understands what a PIP is and how to hold MD accountable for implementaLon.
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Case PresentaLon
Ideal MD : Patrick from Kaiser Worse Case Scenario: Dan from Bay Area