Lisa Gresty can be forgiven for grinning like the proverbial Cheshire cat. As head of OD and learning at Mid Cheshire Hospitals NHS Foundation Trust, she has helped the Trust’s multi-pronged coaching strategy go from strength to strength in both patient care and quality of experience.
One NHS Trust’s initiative to build a coaching culture across its organisation was hailed as ground-breaking when it launched. Ambitious and far-reaching, it foresaw the importance of developing a more empowering, less ‘heroic’ leader, says Lisa Gresty, head of OD and learning. Given the future changes for the NHS, it was “ahead of its time”, she says.
Using a combination of coaching interventions, it set out to penetrate multiple layers in Mid Cheshire Hospitals NHS Foundation Trust, to transform employees’ behaviour, language and thinking and, more importantly, to improve outcomes and quality of experience for patients.
The organisation brought in i-coach academy at the end of 2009 to help it design and implement its initiative, which kicked off in March 2010. The initiative includes an internal coach pool offering individual coaching; a series of short Coaching Essentials for Managers programmes and, more recently, team coaching. Coaching modules have also been included in leadership development programmes.
Three years on, the Trust is well on the way to building a sustainable coaching culture. Informal coaching conversations are taking place at many levels, including with patients.
“Not everybody has to be a coach, but leaders all have to be able to have coaching-style conversations. These could be five minutes around the kettle in the kitchen,” says former chief executive Phil Morley.
It wasn’t always like this. According to Morley, the Trust used to be “an organisation which was a poor performer, quite entrenched in its ways, not open to external experiences or scrutiny….It was clearly dysfunctional, an organisation in distress in many ways”.
Against the backdrop of upheaval in the NHS, it was clear it would be more important than ever for leaders to empower others and to be able to take calculated risks. Morley recognised that to bring this shift to a more transformational leadership style, an intervention was needed which was “positive, appreciative and collaborative, which got the best out of people, which was sustainable and not about giving people answers.
“When I described the turnaround I wanted to see, coaching was the obvious thing [to work with]….It was about evoking peer excellence, not dealing with poor performance.
It was about identifying skills and potential rather than fixing broken people,” says Morley, now chief executive at Hull and East Yorkshire Hospitals NHS Trust.
A tailored approach
The Cheshire Trust invited tenders from a number of organisations before choosing i-coach as its partner:
“i-coach really stood out in terms of their approach, as they asked questions and sought to understand our organisation and our objectives, offering an approach that not only tailored programmes to our specific needs, but which actively included and partnered our team,” says Gresty, who heads up the coaching strategy, as well as working with clients internally.
Apart from seeking to develop leaders who were more fit-for-purpose, enhancing their ability to be more flexible, think more strategically and empower others, the initiative sought to improve succession planning, and by helping individuals and teams to improve their effectiveness and their outcomes, to increase staff satisfaction and thus the quality of patients’ experience.
Caroline Horner, director of i-coach academy, says: “The role of all the interventions is to shift the types and level of conversation across the organisation, whether with patients, clinicians or managers, so that the workforce becomes more engaged, resilient and focused to innovate and deliver effective and compassionate patient care.”
i-coach helped the Trust design its coaching strategy and framework, and partnered with the organisation development team to educate and accredit the internal coaching pool and to design and facilitate learning programmes, enabling the adoption of a coaching mindset and core coaching skills.
Senior level buy-in
In addition to the multi-layered approach, other factors have contributed to the initiative’s success thus far. These include senior level buy-in, which Gresty describes as critical.
Being open about having a coach, highlighting the benefits of coaching, and demonstrating a coaching style of leadership have been key. Horner also stressed to the Trust the importance of engaging top leaders early on.
The first session was about getting senior leadership to understand their role in creating a coaching culture as well as giving them a taster for some of the skills development so they had some of the language.
Current chief executive Tracy Bullock, who worked alongside Morley as his deputy when the initiative kicked off, has engaged in leadership and management development programmes to highlight her support.
She says, “Senior leaders cast a shadow across the organisation and if [coaching] is not viewed as important to us, it will not be viewed as important to our staff. Therefore, I think senior level
buy-in is essential when creating and developing a culture that embraces a coaching ethos….I am very bought in to the initiative.”
She says that coaching “prepares staff to engage in a more transformational approach and to be less fearful of the future and what will be required of organisations.
“[Coached] staff are generally more motivated and confident and ready to embrace the challenges that lie ahead…[and] are generally more willing to take on new learning opportunities….[We’re seeing] greater commitment from staff, more positive survey results around staff development and engagement, we get fewer complaints and patient experience surveys are improving. Coaching is talked about positively. Even one of our most cynical consultants was wowed by the impact of one
of our coaches.”
Our thinking partner
The unwavering support of i-coach as, what Gresty describes, a “thinking partner”, has also been key, as has the dedication of the dozen or so internal coaches, and Gresty’s own constant passion and commitment. It has been crucial to have someone championing and leading the strategy, a role Gresty has taken on with vigour.
Horner says: “Lisa’s passion about coaching and learning stands out, and how she is actively leading the process. To build a coaching culture, you need someone who is a change agent, who is leading it on a daily basis. She knows the coaches, goes to the wards and gathers anecdotal evidence on how it has impacted and on whether it’s right for them. She encourages people and is looking for opportunities to bring people into the leadership development programme.”
Working within a relatively small organisation (3,500 staff) has made it easier in some ways as there is a strong sense of community. However, as she points out: “It also makes it trickier because you can’t afford to get it wrong.”
It’s particularly important to get the roll-out right, to build trust in the service. Educating people about what coaching is, and can offer, has been important, which has been done through a launch day and ‘brown bag’ lunches, for example.
Internal coaching
Thirty internal coach applicants were interviewed and assessed with the help of i-coach, which trained 11 internal coaches. Gresty highlights how dedicated the coaches are. “It’s not something that is written into their day job; they come in early and work at lunchtime.”
All coaches must attend regular supervision and undertake CPD.
Gresty, who has completed i-coach’s Certificate in Coaching Practice, has been supporting the coaches and is now studying to be a coaching supervisor through the NHS Leadership Academy and Bath Consultancy Group. The plan is to develop internal coaching supervisors, either through the Academy or internally.
Typically, four one-hour coaching sessions are offered to all senior leaders and those on development programmes.
The coaches have slightly different professional backgrounds and coaching underpinnings, including Cognitive Behavioural Coaching, Solution-Focused and Neuro-Linguistic Programming. Gresty underlines the importance of being able to offer clients a choice.
In the first half of last year (2012), i-coach helped the Trust to train around half of the internal coaches as team coaches, who work in pairs to ensure multiple perspectives on the teams’ dynamics and behaviours – they offer observational feedback on these. As Gresty says, “Some of our teams are working under huge pressure, but are not working as effectively as they could, so it’s about supporting them to look at those dynamics and look at their differences and use them.”
It’s still early days for team coaching. Staff are “naturally more suspicious about team coaching, thinking they’re for the chop”, says Gresty. However, this is changing. Team coaching is starting to deliver benefits and the Trust has high hopes for its future. Building trust is critical.
When the coaching initiative launched, it was against a much easier environment in the NHS. However, evidence suggests that coaching is proving to be supportive in these times.
Employees face change and cutbacks on an unprecedented scale, yet the requirement to provide world-class healthcare for patients remains high. Team coach Bobby Sharma, who is a service manager within the Trust’s occupational health service, says, “This pressure is being absorbed by staff on a daily basis in a cauldron of increasing levels
of stress and sickness absence. Coaching allows individuals an opportunity to take a pause, to reflect, to re-engage and to go back to their day jobs re-energised.”
Feedback from managers – 67 of them attended the Coaching Essentials for Managers programme in 2011 – has been positive. Benefits reported have included improved performance; improved delegation skills, and greater understanding of the impact of their behaviours.
By offering more feedback to staff, they are seeing higher engagement levels – an area targeted for improvement following results from the 2010 staff survey.
Only one out of 34 delegates on leadership programmes refused a coach, and feedback from individuals coached has been largely positive, with objectives met fully or partially. Some have reported that they are better able to manage themselves and feel more positively about working for the Trust.
Internal coaches are enjoying benefits too, including personal development, increased self-awareness, greater confidence, the satisfaction of making a difference and career progression.
“You see them blossom and they get a sense of doing something that makes a difference. It’s huge for those of us who don’t have face to face [work],” says Gresty.
Three have been promoted since becoming a team coach. One admitted that before doing the coach training, they would never have had the confidence to go for a promotion.
Clients report benefits from coaching too. Lisa, a ward sister who was coached by Gresty, has been inspired to become a coach herself.
She says, “The benefits to me have been immeasurable, personally and professionally…. I have once again begun to believe in myself and have more confidence….now I feel I can take ownership of my working life.”
The wider benefits
The Trust expects that coaching has impacted the bottom line in a number of ways, including improving patient outcomes, helping to increase staff retention and to reduce absenteeism caused by stress. Coaches, including Sharma, report it is also helping to improve working relationships, which suffer because of increased stress.
Conclusions
Gresty and her team have also taken away some lessons from the exercise. She says if she did it again she’d train more coaches to allow for people leaving, and offer an even wider range of personalities and style. It would have been helpful too, Gresty adds, to have worked harder on planning.
Coaching at work, volume 8, issue 1