November 2019, Volume XXXIII, No 8

Administration

Physician coaching

Enhancing performance and reducing burnout

iger Woods is one of the most dominant professional golfers of all time. Between endorsements and golfing, he has earned more than $1.5 billion. The pressure to remain at the top following his back surgery demanded that Tiger adapt to his new limitations. He engaged a swing coach, enabling him to return to the pro circuit and win his fifth Masters Tournament earlier this year.

Physicians are at the forefront of a rapidly changing medical care system. Their years of experience and professional success are challenged by technology, insurance-driven metrics, and managerial expectations. Just as Tiger engaged resources to enhance his swing, physicians likewise have access to professional coaching to improve their practice. Often underutilized, professional physician coaching is proven to boost a provider’s performance, patient satisfaction, and overall sense of well-being. In a medical care system that requires adaptive leadership, coaching is a value-added resource to help physicians thrive.

It takes a team

Traditionally, providers operated as skilled individual professionals, but now they are critical members of a larger care team. Outcomes depend on factors outside their individual control. As a result, many physicians are incredibly stressed and experiencing burnout. The speed of change and rapidly increasing expectations requires a level of flexibility and adaptability that can be difficult to sustain.

These challenges include:

  1. The need for substantial positive improvements to patient satisfaction scores, efficiency metrics, patient adherence, and quality indicators.
  2. Building more effective relationships with staff and colleagues.
  3. Working more effectively as part of a clinical team.
  4. Developing skills to serve as a valued and influential leader.
  5. Rekindling a sense of joy in their practice.

It is no wonder that many physicians wish they had help. Professional physician coaches specialize in human development and will guide physicians back to the top of their game. Professional coaching utilizes evidence-based techniques to create positive change and optimize performance. As a welcome side effect, coaching also increases a physician’s sense of well-being and happiness.

Moving beyond medical training

Human development research demonstrates that improving outcomes requires integrated social and emotional skills. Under today’s care team model, success increasingly hinges on the provider’s ability to work as an influential and respected member of a cohesive team. Emotional and social skills are the foundation for dealing with the inevitable challenges of working with different personalities and professional perspectives.

Coaching can help physicians perform at the top of their game.

A helpful analogy is to imagine a provider’s medical expertise as the rear wheel of a bicycle, and the front wheel as their social and emotional expertise. The power of their back-wheel technical skills requires good front-wheel people skills to make sure their medical expertise is directed in useful ways. Once a provider meets the minimal threshold for medical competency, social expertise becomes the most important predictor of performance, followed closely by emotional expertise.

Some talented practitioners have not developed their social and emotional skills in concert with their technical expertise. Low patient satisfaction scores, staff complaints, being considered “difficult” to work with, burnout, or ineffective leadership are often the result.

The good news is that these skills can be developed. While many believe that people are born with an innate ability to work well with others, the evidence is clear that people skills can be improved with deliberate effort. Improving people skills has been shown to improve professional outcomes by 30% to 40%.

Often it is difficult for an individual to figure out how to create intentional change on their own. People generally know that something isn’t working, but everything they try to do to improve has failed. Managers may provide feedback hoping to help, but unfortunately that often does not result in positive change either.

Engaging the support of a professional coach can make all the difference. Physicians may seek out a coach on their own, or they may have one recommended by their superiors. Whereas in the past employers often hired coaches to manage an employee with a challenge, today employers more often utilize coaches to help high-potential physicians develop leadership skills. Providing high-performing employees coaching benefits helps attract and retain high-quality physicians.

In problem situations, the cost of recruiting a replacement physician far exceeds the cost of providing a coach to turn the situation around. If a competent physician is put on a performance improvement plan because of a medical mistake, for example, a third-party coach can be particularly effective because it eliminates conflicts of interests and ensures confidentiality. But the most important value provided by this work is helping talented individuals create positive, intentional change to perform at their best and become influential leaders in their practice and organizations.

Unlike other approaches

Professional coaching is not mentoring. Giving advice, reading self-help books, and listening to motivational speeches rarely results in sustained change. Instead, the coaching approach engages clients in a personal journey to discover what will work for them in their unique situation. It helps doctors translate what they know they should do into their actual practice.

Professional coaching is also not therapy. Therapy treats a psychological diagnosis to bring a patient to a state of health. A coach guides a technically competent provider to develop their social and emotional skills to enhance their professional effectiveness and personal sense of well-being.

Coaching in practice

“Dr. Alex” had recently been promoted to lead physician for six clinics in a large health care system. It was not going well. His manager had ranked him at the bottom of her team, so the vice president of medical affairs suggested a third-party coach. Dr. Alex initially resisted, but when he learned that this was not “life coaching” or therapy, and that it would be conducted outside of the organization, he committed to the process for one year.

Improving people skills has been shown to improve professional effectiveness.

His initial intake interview revealed a high level of conflict avoidance, which framed one of the custom goals for future development: dealing with hard conversations and utilizing empathy to move past resistance and defensiveness.

Another goal was to improve his consistently low patient satisfaction scores. The vice president believed that he lacked credibility as a manager for other physicians when his own scores were considerably below the minimum threshold. Dr. Alex had twice completed the health care system’s internal training on improving patient satisfaction and had been shadowed and given personal feedback. A list of 10 steps to improve patient satisfaction was taped to the computer monitor in each of his exam rooms. His ratings still had not improved.

Dr. Alex’s coach worked with him to elicit more positive emotional responses during his patient encounters. Through role play, Dr. Alex revised his method of questioning to reduce negative emotional patient reactions and to increase the rate of positive emotional responses to be greater than three positive reactions for every negative reaction. Instead of focusing on what was wrong, he reframed his thought process to find something that was right, and then bridge the conversation to build on what was working to improve health.

In one videotaped mock office visit, a “patient” shared her real-life wish to finally stop smoking. When the patient offered feedback to the coach, her first words were, “Obviously Dr. Alex has never smoked.” In fact, Dr. Alex was a former smoker, but he could not empathically connect with the patient. As he reviewed the video, he saw how he had totally missed a moment when the patient came to tears as she shared her motivation to quit smoking because both her parents had died of smoking-related issues when they were her current age.

For Dr. Alex, this was an epiphany. His low patient satisfaction scores were no longer a mystery. Using tools provided by his coach, he made rapid improvements in his skills at connecting emotionally with his patients throughout their office visit, striving to achieve the goal we set for all of our physician clients: a ratio of positive emotional responses to negative responses greater than 3:1 during each patient encounter or interaction.

In a new round of patient satisfaction surveys, his scores had jumped to 100%. Two years later, his scores remained near 100%.

Resonant and empathetic physician leadership skills did more than boost patient satisfaction scores. They became integral to his interactions with physicians and staff across his clinics. Later he reported, on a personal note, that his new skills had even helped improve his relationships with his children and spouse.

One year later, Dr. Alex was ranked as a top physician leader in his system. His clinics had significantly improved in quality and productivity and were now ranked at the top or near the top across his entire organization.

The vice president of medical affairs who had hired Dr. Alex’s coach summarized the value of many years of working with an external coaching partner: “Not only have we retained every one of the physicians [who completed the program], 18 of them have taken on leadership roles and are contributing more to our organization’s success.”

Closing thoughts

Physician coaching is a powerful tool that supports physicians in making substantial improvements to their professional performance. It helps them deal with stress and burnout to improve their own well-being. It helps them build skills to help patients implement their care plans and feel positive about their experience. It builds adaptive leadership skills and the ability to serve as influential members with their care teams. Just as Tiger Woods hired a swing coach to overcome back surgery and win his fifth Masters this year, physicians can engage a coach to help them perform at the top of their game.

Timothy McClernon, PhD, CEO and Managing Partner of People Architects, is a former executive leader at two Fortune 100 health care organizations and has been coaching physicians for more 20 years. He is published in peer-reviewed medical and human development journals. Physician training, based on his research in maximizing performance, has benefited tens of thousands of providers around the world. 

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Timothy McClernon, PhD, CEO and Managing Partner of People Architects, is a former executive leader at two Fortune 100 health care organizations and has been coaching physicians for more 20 years. He is published in peer-reviewed medical and human development journals. Physician training, based on his research in maximizing performance, has benefited tens of thousands of providers around the world.