Partners for PatientsCoaching for Improvement Webinar III

Facilitating Effective Coaching Interactions

Thomas Kaster WHA Quality Coordinator Stephanie Sobczak WHA Quality Manager

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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 skills, resources and practice for leading effective improvement coaching interactions

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Today’s Objectives / Structure• The origins of coaching through asking questions• An essential framework for effective coaching

interactions• Learn strategies and observe scenario based role plays

for:– All performance level employees– Meeting disrupters– Getting engagement – Laggards

• Set future coaching goals

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Chat Question

What types of improvement coaching interactions make you the most nervous and why?

Examples:• Coaching the High Achiever• Coaching the Poor Performer• Coaching the negative Nelly's• Coaching other managers people• Group coaching

The System of Improvement Coaching

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Engaged Staff

The Socratic Method: Asking questions that lead to improvement

“Although leadership is about moving people, the truth is nobody moves unless they move themselves. The Socratic method is a way to help people see when they need to move and where they need to move to.”

The Socratic Method Leveraging Questions to Increase Performance M A J . N O R M A N H . P A T N O D E , U S A F

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Stephen Covey: 7 Habits of Highly Effective People

Use empathic listening to be genuinely influenced by a person, which compels them to reciprocate the listening and take an open mind to being influenced by you. This creates an atmosphere of caring, and positive problem solving.

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Habit #5:First seek to understand and then to be understood.

Setting the Stage for a Coaching Interaction: Considerations

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Suggested Avoid

Process relationship first and then task Jumping right into the constructive coaching conversation

Enter each conversation assuming that the person wants to do things right

Assuming that the person purposely is doing the wrong thing or does not care

Make the meeting place a safe place Only calling people in to your office or a meeting room when something bad happens

Understand the psychology behind meeting set up.

Having people sit in the corner of a room while giving them feedback

Talk about perceptions and observations Using trigger words like always, never and starting sentences with “You.”

Setting the Stage for a Coaching Interaction: Considerations

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Suggested Avoid

First seek to understand and then to be understood

Downloading what they did wrong and how they need to fix it

Getting them talking about positives in themselves

Allow them to only focus on their negative aspects

Provide timely feedback Waiting until several improvement needs are identified and then addressing them all in one sitting

Be comfortable when there is silence. Silence is golden

Not allowing the individual the time to think through the situation

Know when things have escalated and you need to regroup and reschedule

Digging in your heals determined to win the argument

Avoid the Garbage Sandwich Avoid this classic technique:

Top Bread: This is what you are doing wellMiddle: This is what you are doing wrongBottom Bread: This is what else you are doing well

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Why Avoid Using the Garbage Sandwich?• It becomes predictable • Staff starts to brace themselves whenever they

receive a compliment• It limits the recipient’s ability to self reflect and

analyze• There are better ways

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Chat Question

What are some common coaching mistakes you have done or that have been done to you?

Rules of Scenario Based Role Playing

#1 Scenario Based Role Play Rule: Role play to the 80% not the 20%– Role plays are intended to help people practice what usually happens– They are not intended to demonstrate the extremes of human behavior

• Be nice so we can learn

#2 Rule of Scenario Based Role Playing: You play like you practice– If you are the person practicing, take the practice to heart. Get into the role

and act exactly as you would if you were actually providing feedback.– By making the role play as real as possible, you are building mental and

muscle memory, so when the “game” starts, you are ready.

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A Framework for Effective Coaching Interactions (See workbook)

• Step 1: Frame the conversation-Why are we here• Step 2: Ask them to positively self-reflect on at least 2 topics

– Keep them positive

• Step 3: Ask them to constructively self-reflect • Step 4: Summarize your understanding of their statement• Step 5: Provide your positive observations• Step 6: Provide your constructive observations

– Most times will align with their observations

• Step 7: Help them set no more than 2 goals for improvement and document goals

• Step 8: Schedule a time to meet to assess progress on goals • Step 9: At next meeting repeat process

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Plan your Interactions

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When to Use Framework• When meeting with a high achieving employee

or staff member• When meeting with a moderate achieving

employee• When meeting with a struggling employee

– Make small adjustments when doing performance management

• It works great for almost all coaching interactions

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While Listening you Should…

• Observe one to two things that you felt worked well that you have used or can use in the future.

• If you hear something that could be improved, what could it be?

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Using the Framework Scenario #1

• Nancy is a valued night shift nurse. She has been at WHA Memorial for 9 years and is respected by her peers. WHA Memorial has recently started hourly rounding. Nancy has been struggling with consistently completing hourly rounding. Tom, Nancy’s manager and leader of the hourly rounding initiative, sit down to discuss her obstacles.

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What did you hear?

• Observe one to two things that you felt worked well that you have used or can use in the future.

• If you hear something that could be improved, what could it be?

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Engaging the High Potential Fence Sitter

• Someone who:– You sense or know has much to offer but is not

stepping up– You sense may be too shy or reserved to self

promote – You know would be great for a project but does

not volunteer

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Engaging the High Potential Fence Sitter Strategy Cont…

• Step 1: Remind them of the opportunity, briefly describe and ask them if they had any questions on the details

• Step 2: Ask them how they feel their knowledge skills and abilities could contribute

• Step 3: Reiterate to them how you feel they can contribute• Step 4: Ask them if they have any obstacles that would keep

them from participating in the project• Step 5: Help them work through the obstacles• Step 6: Tell them how to show interest / sign up for the

project• Step 7: Ask for their commitment to follow-up

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While Listening you Should…

• Observe one to two things that you felt worked well that you have used or can use in the future.

• If you hear something that could be improved, what could it be?

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Engaging the High Potential Fence Sitter Scenario

Scenario: Tom is a very solid contributing nurse to the ICU unit. His unit manager Stephanie, is starting a CLABSI project to help reduce the risk of a Central Line infections. In the staff meeting Stephanie asked for volunteers for the team and was hoping Tom would raise his hand. He didn’t. They are sitting down for Tom’s monthly one-on-one discussion

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What did you hear?

• Observe one to two things that you felt worked well that you have used or can use in the future.

• If you hear something that could be improved, what could it be?

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The Meeting Disrupter • Someone who:

– Generally has good intentions – There are always elements of truth to their

comments – Struggles with communicating positively in various

situations– Can be disruptive to meetings – Someone you do not want to loose – Can easily be interpreted as negative

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The Meeting Disrupter Guidance

• They may not realize how they are perceived • They may have very passionate stances on

topics • They may not have even taught how to

communicate more effectively • To insure you do not belittle, embarrass or

insult, talk in terms of how they are perceived or observed

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The Meeting Disrupter Strategy Step 1: Insure that they feel comfortable safe and that you

understand them.Step 2: Identify what you observed in the meeting and ask them

to explain why they felt that way.Step 3: Reiterate or paraphrase their explanation, letting them

know that you understand their concernsStep 4: Explain to them how they may / can / are perceived by

their peers and leaders when they communicate that wayStep 5: Work together to come up with an alternate solutions to

expressing feelings on topics in meetings when they disagree

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While Listening you Should…

• Observe one to two things that you felt worked well that you have used or can use in the future.

• If you hear something that could be improved, what could it be?

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The Meeting Disrupter ScenarioStephanie is a nurse on the med surge unit. In a

department meeting when discussing the new EMR daily falls and pressure ulcer risk check lists, Stephanie was very vocal about:

“All I do is spend my time on that computer. Can’t we just throw them all away and use paper again? I want to be a nurse not a software engineer.”

After Stephanie’s comment the meeting got derailed and people lost focus. Tom and Stephanie are sitting down to discuss her behavior.

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What did you hear?

• Observe one to two things that you felt worked well that you have used or can use in the future.

• If you hear something that could be improved, what could it be?

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The Very Late Adopters (almost laggards)

• Someone who:– Despite multiple communications and trainings, is

still not consistently performing the new process– Has the ability to complete the process correctly – You sense there are other underlying reasons why

they are not performing the requested process

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The Very Late Adopters (almost laggards) Strategy

The Five Whys• Ask Why Five Times

– You may get superficial answers in the first one or two attempts, but by the time you get to 4 and 5 you will most likely find a root cause.

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The Very Late Adopters (almost laggards) Scenario

The Five Whys

“Joanne is a night shift nurse and somewhat of a leader in her peer group. The first and second shifts are performing well on hourly rounding. For some reason the third shift is not. Tom, Joanne’s supervisor sit down to talk about the situation.”

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The Very Late Adopters (almost laggards) Example

• 5 Why’s approach example– I know that you have concerns with our new hourly rounding

initiative. By helping me understand your concerns we may be able to help the entire unit.

• Why 1: “If I could instantly eliminate the obstacles that are keeping you from embracing this change what would they be?”

– Answer: “We are just too busy and it is impossible.”

• Why 2: “When you say you are too busy, what do you mean? – Answer: “We just have too much to do”

• Why 3: “What are some tasks that you feel take up your time that keep you from completing hourly rounding.”

– Answer: “For instance it seems like during the night shift we never have the supplies we need. I spend a lot of time looking for clean linens and supplies.”

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Approaching a colleague who is resistant to participate (direct approach)

• 5 Why’s approach example continued…– Why 4: “Why do you think you do not have enough supplies.”

• Answer: “Well the CNA staff always restocks supplies in the morning and by the end of the day, supplies are usually low.”

– Why 5: “So what do you think we could do to insure your supplies are there for your when you need them?”

• Answer: “Maybe if supplies are checked prior to the staff change that could help.”– Paraphrase: “So if we developed a system that helped insure that you have the

supplies you need, do you think that will help you complete hourly rounding.• Answer: “It would certainly help.”

– Keep digging: “Are there any other obstacles that might be keeping you from completing hourly rounding?”

• Repeat

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Asking for Leadership / Physician Engagement

Keys: Start with reiterating your shared purpose Be clear about what you need, and what you are willing to

commit to doing. ______________________________________________“I want to talk about our goal of _______ . I am fully

committed to achieving that goal”.

“What I really need is _______, because it will____”.

“I want you to know that you can count on me to_____”. “

Does this make sense to you, or do you have other ideas?”

How Can you Learn?• According to Stephen Covey, the best way to

master a skill is to teach it.

Learn Do Teach Master

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Resources for You• Workbook

– Framework for techniques – Role plays

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WHA Quality Training and Consulting ServicesScience of Improvement Training for Hospital Managers

6 -7 hour workshop

Science of Improvement for Hospital Staff

3-4 hour workshop up to 2 sessions per day

Coaching for Improvement Workshop for Managers

6 -7 hour workshop

Culture of Safety Assessment 3 - 4 small group meetings with staff

Culture of Safety In-service for Managers

4 - 6 hour workshop

More details will be shared in January

Closing

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• Great Job in 2013!• Just like you make other goals, make coaching

and leadership goals as well• Look for a survey regarding the Coaching for

Improvement Series, in early January. • Have happy and safe holidays!