Dave Eccleston provides a synopsis of the work he undertook on coaching as part of a postgraduate degree course.
The NHS has entered its most radical reconfiguration since its introduction in 1948, with a realisation among managers that savings and reinvestment of £20bn is needed to deliver the government’s quality, innovation, productivity and prevention (QIPP) transformation programme.
In the context of pathology, various white papers and reports have resulted in a new dawn for the future delivery of services. They have brought recognition that to enable major changes resulting in a saving in England of £500m from pathology services alone would require innovation, improvement, workforce planning, implementation and the development of scientific staff fit for future purpose not only in scientific terms, but also in terms of management and leadership.
Concepts
The concept of coaching within the NHS is perhaps unfamiliar, but it is now envisaged that NHS leaders, not managers, will be instrumental in the delivery of QIPP. Leading change is about inspiring, designing and modelling a shared vision for the future, allowing and empowering others to take ownership of the vision by providing them with the infrastructure and identifying the development and knowledge needed. Coaching has been identified as the means by which this will take place.
A coach must develop a range of skills and competences. The “coaching model” provides the means by which a coach can bring the core skills of coaching to bear; skills that include active listening, asking questions, goal setting, clarity and feedback, building rapport, demonstrating empathy, intuition and the use of self, together with the establishment of the coach-coachee relationship and the formulation of a desired outcome.
Models
Coaching models are methodical by their very nature, permitting a systematic step-by-step, structured interaction, enabling the development of dialogue and rapport. At first this may appear multifactorial, but ultimately it focuses on specific issues and outcomes.
A range of coaching models is available including the Gestalt model, where the coach purposely raises awareness without the use of structured models. The GROW (Goal, Reality, Options and Way-forward) model has gained popularity because of its ease of use and application. Subsequently, the addition of T (Topic) saw this expanded to T-GROW, which allows the coachee to reflect on the wider environment. Staying with acronyms, the PRACTICE model involves Problem identification, Realistic goals, Alternative solutions, Consideration of consequences, Target most likely solutions, Implementation of Chosen solutions and Evaluation.
Analysis
Within the NHS a number of reviews and evaluations of the benefits and effectiveness of coaching have now been published. A CIPD survey in 2004 found that 99% of 500 respondents agreed that coaching could produce benefits both to individuals and organisations, and that the benefits could be identified for organisations in terms of increasing business, infrastructure redesign, staff development and motivation, as well as retention of staff, increasing creativity, and allaying fears and anxieties during reconfiguration and transformation.
A report presenting the results of the evaluation of coaching within the NHS advocated the need to increase formalised coach training within the service. The need to develop leaders as well as managers was identified, to bring about effective organisational transformation, not only to deliver the savings and reinvestment required for the provision of future services, but also to develop the new ways of working required for the delivery of a modern, efficient and responsive NHS.
Use of Self
Laboratory scientists are reasonably familiar with the concept of reflection, but what about “Use of Self”? It is said to be something that can be demonstrated, rather than described. Although skills and knowledge are brought into the coaching session, the most important element of the exchange is “self”.
Conscious Use of Self is a skill or ability developed over time and involves self-discovery, examination, engagement and connection to self and others, involving and being receptive to observation, feedback, exploration, action and reflection. This consciousness is perceived as non-automatic, requiring awareness of self intrinsically and extrinsically, and needing time to digest, absorb, formulate and reflect before initiating a response or reaction that is considered and non-judgemental. This increases awareness of the here and now and facilitates a decision about whether or not to reflect on observations, or mirror them back to the coachee.
Use of Self is also about how the coach behaves and what in terms of themselves they bring to the process. This suggests it is implicit that the coach be totally aware of their own moods, views, prejudices, attitudes and behaviours. Entering a session, the coach should be fully focused and tuned in to the coachee, and not distracted by their own extrinsic issues. This suggests that coaches, as unique individuals, should bring their individuality, personality, personal, professional and life experiences into the room.
Confidentiality is fundamental to the coach-coachee relationship, the only exception being where the potential for harm to self or others is shown to exist. The major issue here is one of implicit trust being broken, were the coachee has demonstrated emotions and behaviours that the coach has potentially played back (clarified and confirmed) to the coachee by employing Use of Self.
Dependence may occur in a good relationship, the drawback to this success being the coach’s desire to support the coachee past the period of usefulness. In such situations, the Use of Self has the potential to move from a coaching perspective to a psychotherapeutic one, for which the coach may not be qualified.
Owing to the nature of their working processes, organisations can be likened to an extended family. Changes in the coachee can impact not only on individuals but also on the organisation. Once again, through Use of Self, the coach has elicited from the coachee their inner thoughts, emotions and behaviours. I have seen this occur during a coaching session were a coachee was extremely vocal and negative about a senior manager in the organisation, and this had a negative impact on their team and performance. There was silence when the comments were played back to the coachee, as they reflected on their behaviour – this proved to be a spontaneous moment and had a real impact on the session.
Clearly, Use of Self is therefore fundamental in the delivery of coaching practice.
Dave Eccleston is Head of Modernising Scientific Careers for Liverpool Clinical Laboratories, Royal Liverpool University Hospital.