It is widely agreed that to make clinical commissioning work and to deliver £20bn of efficiency savings by 2015, a new style of NHS leadership is required.

The new breed of leader must be able to engage staff, patients and partners to improve patient care and health outcomes. But just how is this new style of leadership to be achieved?

In the NHS, coaching is well established and could be at the heart of facilitating such a shift. But to step up and play this role fully, coaching too must evolve and adapt. I have been working with executive coach John Blakey to flesh out this vision, and we have written a book, ‘Challenging Coaching: going beyond traditional coaching to face the FACTS’, which sets out a new, more robust approach.

Historically, coaching has been supportive, helping an individual overcome personal issues through listening and empathising. Being non-directive, holding the individual’s agenda, and building rapport are the foundations of effective coaching. But this approach can also be risky. One risk is that the coach colludes with the coachee, only asking questions in a very supportive fashion. If a coach keeps strictly to the coachee’s agenda, irrelevance creeps in as the conversation is detached from the wider organisational context. There is also the risk of self-absorption - focusing only on the individual’s short term needs or rewards rather than organisational requirements.

Now is the time for coaching to move away from an exclusive focus on support, and balance this with challenge. It is here that the greatest growth takes place. The mirror is held up, people are held accountable, honest feedback is provided, and assumptions questioned.

The word ‘challenge’ has become synonymous with stress and pressure, in other words something to be avoided at all costs. But a high level of challenge is not inherently wrong. In fact the absence of challenge can lead to complacency, indulgence, apathy and disinterest. 

Coaching clients themselves are asking for more challenge. A 2012 study of coaching within the NHS conducted by the Institute of Leadership Studies found that 72 per cent of coaching clients thought coaching was most useful for transformative change. But in response to an open question on what could be better, respondents mentioned increasing the level of challenge and being more forceful.

The key is to provide challenge alongside equally high levels of support. John Blakey and I recommend that to ensure an optimum balance of support and challenge a coach needs to practice the five cornerstones of the FACTS coaching model. FACTS stands for Feedback, Accountability, Courageous goals, Tension and Systems thinking. One of the most significant of these for the NHS is courageous goal-setting built upon the belief that anything is possible.

As health select committee chair Stephen Dorrell put it in 2011: “No-one anywhere has ever delivered 4 per cent efficiency gains four years running. That means it’s an unprecedented challenge, but it isn’t the same thing as saying its impossible.”

Consider the unprecedented challenges facing the NHS and compare these to other historical goals which when first declared appeared absurd and outrageous. For example, in 1961, USA President John F Kennedy said: “I believe that this nation should commit itself to achieving the goal, before this decade is out, of landing a man on the moon and returning him safely to the earth.” Many perceived this as a crazy fantasy, but in July 1969 it was achieved - at which point it was rightly percieved as courageous and visionary.

Through these examples we see that the impossible is possible, that the NHS can overcome the challenges ahead, and that coaching has a central role to play in changing beliefs and creating this transformation.

Ian Day is an executive coach, leadership consultant, and co-author of “Challenging Coaching - Going beyond traditional coaching to face the FACTS

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