How did a single coaching initiative at the NHS, with only modest support, lead to shifts in management thinking, enhanced leadership capability and a reassessment of customer-facing practices? Mark McKergow, Antoinette Oglethorpe and Justine Faulkner report
Avon and Wiltshire Mental Health Partnership NHS Trust (AWP) is one of the UK’s largest, most widely spread, mental health providers. With well over 4,000 staff, 16 inpatient and more than 100 community-based sites, AWP faces plenty of management challenges.In 2008, the Trust commissioned the Centre for Solutions Focus at Work (sfwork) to develop a coaching culture among senior and middle managers. The Trust liked the solution-focused (SF) approach – based in clinical practice – because of its positive and pragmatic features and because clinical managers were familiar with it.
Tools within a framework
The SF model of coaching begins with a startling assumption: the change you wish to see is starting to happen already – in some way, shape or form. The question is to establish what this change might look like and find elements of it in the organisation. These can be built on in small steps.
Probably the best-known SF coaching model is OSKAR, devised by Mark McKergow and Paul Z Jackson in their book, The Solutions Focus. OSKAR stands for:
Outcome What difference will success make to everyday experience?
Scale On a scale of 1-10, with 10 as the outcome, where are you now?
Know-how What’s already working? What do you know already about how to make progress here?
Affirm and Action What’s particularly impressive about progress so far? What are the next small steps?
Review What’s better? How to build on this.
Although coaching models like this are often taught as a process or a set of questions, we have found great power in helping managers think of each element as a separate tool. Our experience is that this is liberating and empowering for managers:
- They stop trying to do the ‘whole thing’ and focus on doing something useful in a short time – all the tools may not be needed.
- They are not focusing on the ‘right next question’, but instead on listening to the client and noticing useful elements emerging in the conversation.
- They are encouraged to use their coaching skills and these tools in short bursts, in meetings, in corridor conversations, and so on, rather than waiting for an illusory ‘serious coaching session’, which never arrives.
This translates into a huge range of practical ways to interact usefully with staff and colleagues.
Three levels of learning
The original initiative involved three levels of learning:
- Level 1 Training to be a coach (including supervision and review).
- Level 2 Coaching direct reports and others using the tools, and reflecting on the experience.
- Level 3 Being coached by an external coach.
The programme ran over a six-month period, with supervision and review days every two months and a monthly coaching session with an external coach from sfwork using the same tools and framework. Cohorts of around 12-15 participants share the process together.
This initial programme was seen simply as a coaching initiative, not a major intervention.
Programme impact
By the start of 2012, 11 cohorts of managers had taken the programme. Follow-up work published in Health Service journal (vol 119, issue 6174) showed that managers reported “spending less time on problems”, a decrease in anxiety and an increase in ability and action. They also noticed a ripple effect with colleagues. Difficult conversations were now progressed, and not left to fester.
Managers also found they started to use the skills to self-coach, so they too were able to find their own way past problems. All of these things helped increase their confidence and sense of control. The positive effects rippling through the organisation include:
- Less negativity
- More positive culture
- Team members are empowered and energised, and give everyone more of their time
- Staff are more self-reliant
- People feel more positive, enjoy work and are more proactive
- It helps things move forward
- It improves relationships.
Inside the organisation, these things translated into a positive ‘buzz’. SF thinking appeared in many aspects of people’s day-to-day working – meetings, management, staff communications and corridor conversations.
Expanding developments
As more people enjoyed the programme, opportunities arose for AWP to use the new developments in different ways.
It started with a coaching network for participants, with people supporting each other and meeting from time to time for mutual learning and encouragement. This has been particularly welcome during the tough financial constraints of recent times.
As this network grew, AWP connected the increasing levels of coaching and SF skills with different ‘difficult’ contexts. Workshops about negotiation, conflict management and personal effectiveness/time management have been popular, with each reinforcing the overall coaching message.
Managers also used their skills in setting up ‘target attainment’ workshops to focus attention on areas where progress was not yet good enough, bringing the SF approach to bear on particularly stubborn areas.
One division was losing £1m a year through under-performance and failure to hit pre-agreed targets. They set up an SF workshop and within eight weeks the key figures were 57 per cent on the way to where they needed to be.
Next steps
According to AWP’s Justine Faulkner, “The SF approach is becoming the way we do things round here.” With a community of SF-skilled leaders and managers, it was inevitable that this approach would begin to have an impact on the organisation’s relationships with service users. This connects with the growing movement towards a ‘recovery’ approach, where each user is seen as having their own experience of recovery at their own pace.
Rather than determining recovery routes, AWP is working towards a more collaborative approach, where users make their own decisions. This means using coaching ideas when working with users.
The project will be carefully researched and documented over the coming months.
Mark McKergow is director of the Centre for Solutions Focus at Work (sfwork) www.sfwork.com
Antoinette Oglethorpe is a solution-focused coach, facilitator and trainer, specialising in helping leaders develop their capability and manage their careers
Justine Faulkner is clinical director of the Acute Adult Community Services, at Avon and Wiltshire Mental Health Partnership NHS Trust www.awp.nhs.uk
What did we learn?
- A coaching initiative can ripple out to have an impact on many aspects of organisational work
- Start where the need and enthusiasm is greatest and build from there
- Take a ‘guerrilla’ approach – avoid a huge fanfare, statements from the board, etc
- Find ways to keep encouraging staff to use their skills and to work together
- The SF approach, combining a powerful way of thinking with practical tools, is
- well-suited to this kind of initiative
Podcast
Liz Hall interviewed Mark McKergow, director of sfwork, about the NHS coaching initiative at AWP. To hear the podcast, recorded during Coaching at Work’s conference on 23 November 2011, go to: http://bit.ly/CAWpodcasts