Freelance Medical Journalist
Living on the Wirral, Elizabeth Gates is a national freelance medical journalist specialising in public and occupational health. She is also an expert in managing change. "I have to be," she says, "I'm a wife, mother and Labrador owner"
In the brave new world of the UK National Health Service – where 1.3 million employees daily perform hundreds of functions across thousands of sites – coaching and mentoring (C&M) has been evaluated by independent researchers as the most useful form of managerial development.
Coordinated by the NHS Leadership Centre (NHSLC) and based on evidence from six primary care trusts (PCTs), the Leadership Research and Evaluation (LRE) programme sought to identify the best way of creating the new-style leaders required by a new-style NHS.
Since the programme ended in 2005, published LRE findings have flagged up benefits for best professional practice and optimum implementation. For organisations, C&M means improved goal setting, strategy implementation, prioritisation, management of board-level relationships and team-building.
As a result, in September 2006, former NHSLC director of development and evaluation Neil Offley could tell the Chartered Institute for Personnel and Development (CIPD) Coaching at Work Conference: "The LRE programme identified in a rigorous way a strong, direct and positive link between leadership and organisational performance. A good top team and first line leads to better organisational performance and fewer patient complaints! And coaching and mentoring have been shown to be effective forms of developing these leaders."
However, he issued a timely warning: "In 2007, restructured PCT organisations will need leadership development as people move into new roles with new responsibilities. But a lot will be expected from the outset. A wise and far-sighted organisation – large or small – will already be considering investing in leadership development, through coaching and mentoring, to enable it to deliver the required changes."
For individuals in human resources (HR) contexts, such as outplacement planning, training needs identification and stress management, C&M interventions could be crucial. As Mr Offley explains: "The NHS has chosen to restructure on such a scale there is a renewed interest in career management coaching to help affected people review skills and identify what they want to do in the future."
Leadership in practice
For NHS leaders at practice manager level, mentoring is already in full swing. The Institute of Healthcare Management (IHM), representing the interests of more than 7,000 practice managers, has recently project-managed vocational training schemes in England and Scotland for the NHS Working in Partnership Programme. These two parallel schemes brought 19 new manager trainees through a curriculum based on the IHM framework of competencies and professional ethics, by deploying existing IHM members as mentors.
IHM vocational training scheme (VTS) project lead Rosey Foster explains: "We have to ask ourselves 'Who are tomorrow's leaders?' The age range of the IHM is quite high, and so good succession planning is vital to bring on those who aspire to the role. It should already be on the agenda.
"The NHS must plan to ensure that the right people are in the right place at the right time – with no gaps between one person retiring and the next appointee. And there are already practice managers out there in the field with the right management skills to deliver this."
Funding, Neil Offley says confidently, will be provided by NHS employers. And – subject to the successful delivery of the national framework of NHS objectives – managers will be able to choose how they invest their development budgets. Even so, practice managers could demonstrate reluctance to invest in coaching and mentoring.
Rosey Foster points out: "Coaching and mentoring have until now had a negative baseline with practice managers – almost resisted as nonessential, add-on luxuries. Certain practical objections may be raised – such as the problems of covering for the staff involved or the usual anxieties over investing in staff who then leave."
Coaching, with its subtle and complex combination of skills, may be particularly difficult to sell. Coaching is not a quick fix. As Neil Offley says: "If managers choose to invest in coaching, they must protect 'time' for improvements to take place and be evident."
He continues: "Coaching may not suit everyone's style – it may be perceived as a touchy-feely means to an end. But good coaching – known as 'tough love' – can be performance-orientated and results- driven. This is the hard end of coaching."
Selecting a coach
In the NHS Institute for Innovation and Improvement Annual Report & Accounts, the government commits to providing one-to-one coaching support for newly appointed NHS executives via a national coaching register. The government also commits to assessing current and prospective coaches, offering NHS executives "the very highest standards of expertise".
But, says a Department of Health spokesperson, the current plan is that the NHS national coaching register is destined to serve only the most senior of NHS executives. And what if you – as the manager of a smallish general practice – feel that coaching could help you?
In future, a coaching and leadership development option is to be offered at "competitive prices" to IHM members by selected IHM-approved consultants. But as this service is embryonic, your only way forward at present could be finding your own coach.
This brings its own excitements. Dr Janet Price, executive development consultant from the University of Cranfield School of Management, comments: "The challenge for any coaching buyer is how to select a coach."
Criteria vary. IHM's Rosey Foster favours CIPD accreditation. Cranfield's Dr Price would add the proviso: "You could base choice on coaching qualifications, but there are so many qualifications out there that it's difficult to decide which would be the most valuable. Experience of working with senior managers and an ability to identify organisational culture is equally important."
A coach herself, Dr Price explains that when a coachee's principles, values and beliefs oppose those of the NHS employing organisation, the coach needs to be able to recognise it. A lack of congruence can cause serious stress.
The coach should also be familiar with NHS procedures and politics, she warns. For example, a practice manager may want to grow the practice by setting up new services and employing more staff. But other stakeholders – clinicians, staff, patients, even the local community – are involved in decisions regarding priorities and the allocation of time and resources. A coach who understands how the system works – as Dr Price explains – can help the practice manager handle conflicting interests and move a project forward.
But she warns: "The coaching buyer needs a safeguard of quality. You should ask a prospective coach about supervision."
Others agree. The CIPD Coaching at Work Conference learned that regular supervision provides continuing professional development for the coach, quality assures the coaching and generates organisational learning. But currently only 44% of coaches receive regular supervision and only 23% of organisations using coaching provide for supervision. Full research is to be published in November on this issue.
Considerations for success
To help managers guarantee the success of a coaching intervention, Neil Offley suggests a framework of questions. These, he says, are "pertinent to any size of organisation and should be asked". They include:
As an example, coaching programme delivery needs to be considered. IHM's Rosey Foster explains: "It is useful initially to have face-to-face contact, to establish rapport and make sure there won't be a personality clash – the coaching won't work if there is – and to ensure clarity about hoped-for coaching outcomes."
But, if you are a practice manager out in the wilds of Lincolnshire or hard by Hadrian's Wall, this may be difficult to arrange on an ongoing basis. You may have to continue by
telephone and/or email. The devil, as ever, is in the detail. Even so, explains Rosey Foster, coaching is nothing if not flexible, and "you don't have to have your coach on your doorstep".
Neil Offley Consulting
Cranfield University School of Management
Contributors to the LRE programme and other NHS coaching initiatives
Institute of Healthcare Management
Serving practice managers
UK International Coach Federation
For coaching ethics and to find a coach near you