Paul Gander

As with so many management ideas favoured by the private sector, coaching has been given a warm reception in many parts of the NHS.

Coaching associate at the NHS Institute for Innovation and Improvement Sue Mortlock explains some of the changes that have taken place. “Many years ago, it was perceived as a remedial measure. But now, in the private sector, you haven’t really arrived as a company director until you have your own coach.”

In today’s health service, coaching is far more likely to be prized as a valuable resource than as a status symbol. A 2007 report for the NHS Institute by Sussex University’s Institute for Employment Studies suggests one reason for this. Its Evaluation of Coaching in the NHS stresses the support that coaching can provide in times of organisational change and shifting roles. Of the 14 coachees interviewed, most of them senior-level staff, the report says: “For many, coaching was an opportunity to get some clarity and guidance on how to cope with the changes.”

Within the NHS, a single board-level coaching session is still likely to have far greater impact within an SHA or trust than much larger amounts of coaching at other levels. Nonetheless, it is the latter, more democratic aspect of coaching which is now really coming into its own.

Certain trusts have taken a lead in this. At Cambridge University Hospitals Foundation NHS trust, which includes Addenbrookes Hospital, the past year has seen a dramatic increase in the provision of coaching. Jane Robinson is a leadership coach in the trust’s Organisational Development department. An outspoken champion of coaching, she says: “My dream is that anyone at Addenbrookes who wants coaching should have it.”

After she first saw the practical impact that coaching can have, Robinson helped to introduce a two-and-a-half-day coach mentoring programme at the hospital. When a new chief executive joined the trust in 2006, the idea of a fully-fledged Leadership Academy took off. What previously had depended on “lighting fires” became a “top-down” process. Now, she says, 40 senior managers are coaching 200 delegates in four cohorts, with each cohort divided into groups of five.

Robinson is relaxed about coaches adopting different styles that they are comfortable with. But the trend should be towards learner-centred learning, she says, where the coach is “asking the question so the coachees work out answers for themselves”. Coaching can happen in small groups or one-to-one, and in formal or informal settings, she says. She believes it works best where it is “opportunistic and iterative”.

Currently, says Robinson, the trust is providing coaching in Band 7 and above. “But there is all the informal coaching we don’t know anything about, individual department managers who use a coaching style,” she adds.

Although the will to change and develop has to come from the coachee, there is no reason why the coach cannot suggest the goals, Robinson argues. After all, coaching should be about organisational priorities, she says. For that reason, it can be a perfectly reasonable and effective style for any line manager to adopt.

At the Chartered Institute of Personnel and Development, coaching adviser John McGurk agrees that coaching has a place as a developmental tool throughout an organisation. “We think that coaching can no longer be reserved for board members,” he says. “It’s an intervention that can be used in any management relationship.”

That said, a coaching style will not be appropriate for – or effective in – every situation. He cites the example of an operating theatre manager urgently needing to improve the nursing team’s record on cleanliness. “That’s less likely to be a coaching conversation, it’s more of a performance issue,” says McGurk. “Coaching does not replace the performance and leadership aspects of management. It’s about deploying the most effective strategy in a given situation.”

Like Robinson at Addenbrookes, McGurk sees great potential for coaching as a group tool. Returning to the example of the theatre nursing team, he explains: “If there’s been a persistent problem, it might call for a group discussion. That can be done in a coaching context, just as it could be done in a performance context.” Whether for groups or individuals, he makes the point that coaching need not only be about long-term development.

For NHS trusts as for other organisations, one of the key distinctions is between the use of internal coaches and an external coaching resource. This becomes particularly important, McGurk notes, at executive level: “Power relationships can mean that the most senior managers will need specific external coaching. After all, who else in the organisation is going to give them that coaching?”

At the same time, as many have pointed out, life at the top of an organisation can be a lonely existence. Support and insights are likely to be appreciated even by the most capable board members.

The NHS Institute at the University of Warwick sees coaching as an important aspect of the leadership initiatives it offers within England. Coaching for newly-appointed chief executives, chairs and executive directors is a vital element within this provision. Mortlock explains: “We offer four sessions with accredited coaches within the first 12 months. It’s about supporting these key executives through that transition period. That’s the time to catch them and provide this support.”

Working with the SHAs, the NHS Institute has also created a cadre of internal coaches. “Each SHA puts forward a number of senior people to undertake the six-day Foundation Skills Programme,” says Mortlock. These national programmes have been running for nearly two years. “Those who complete it will coach people in addition to doing their ‘day jobs’. For the most part, people coach their peers or below, although there are some examples where a coach works with more senior colleagues.”

The NHS Institute has compiled a national coaching register, and Mortlock underlines the “rigorous selection procedure” that coaches undergo. Some of those registered have experience within the NHS, others do not.

At the same time, Mortlock acknowledges that individual SHAs have developed their own registers. “Each of the SHAs are at a different stage of doing this,” she says. “Some have had a coaching register for some time.”

Lindsey Masson, director of executive coaching at Ashridge Consulting underscores the importance of this “very thorough” registration process in the NHS. “Not all coaches go down an accreditation route, and there is no regulation of the sector,” she explains. “At Ashridge, we see accreditation as being at the very core of coaching ethics. After all, there are some very different perspectives on what coaching is.” So in theory, individuals may think they are signing up for coaching and in fact find themselves in a mentoring session.

There can be good reasons for using coaches both from inside and outside the NHS. Mortlock at the NHS Institute states: “An internal coach will have a working knowledge of the health service and an understanding of the drivers for change. An external coach won’t necessarily have that understanding. Nonetheless, some external coaches are highly valued.”

Looking in from the outside, Masson at Ashridge understandably has a different perspective. She argues: “As a coach, it can in fact be a benefit not to have experience of working in the NHS. You can stand back and question the coachee’s thinking.” She adds: “The limiting factor can be when the coach has only worked in the NHS.”

With 36 years in the NHS, 20 years in various chief executive roles and over three years as deputy chief executive of the NHS in England, coach and HSJ contributor Ken Jarrold might have his own view on this. He also has clear views on the centrality of the coachee to the process. “The coach is there to offer reflection and to listen,” he explains. He can offer different perspectives to the coachee. “But you only offer advice if you’re asked for it.”

He adds: “I have two rules: the person being coached sets the agenda, and I don’t chase people for further sessions – they decide.” The first of Jarrold’s rules indicates one key difference between executive coaching and the version currently trickling down through organisations such as Cambridge University Hospital trust. As well as the appropriateness of corporate goals alongside personal ones in coaching, the emphasis on the individual rather than the small group suggests a qualitatively different approach.

But however the executive variant may differ in practice, Jarrold is on the side of those who champion coaching throughout an organisation. “Of course, the reality is that it has tended to be focused among those senior people who have access to the training and development budgets,” he says. “But I would advocate it at every level.”

In fact, as evidence of the benefits becomes clearer, more trusts appear to be looking at more coaching at more levels. The IES report for the NHS Institute concludes: “It is clear that when coaching takes place it is delivering benefits to the NHS. But there is also an opportunity to improve the deployment of coaching, particularly through the internal coaches, so that even greater benefits can be achieved.”

BOX 1

Define ‘coaching’

While its reputation for results may have improved, a universally-acceptable definition of coaching remains as elusive as ever.

Jane Robinson, leadership coach at the Cambridge University Hospitals trust, says: “The definition given at a recent conference was ‘asking the right questions so the coachee can work out their own answers’.” But she adds: “Even in our team, some people would disagree with that definition.”

John McGurk, coaching adviser at the Chartered Institute of Personnel and Development offers this definition: “A structured conversation about performance with an outcome which includes goals and targets.”

In the initial findings of its Coaching in Organisations report for the CIPD, Ashridge Centre for Coaching points out that dedicated research could take a definition as a valid goal in its own right. But for the purposes of their report, the authors say: “We understand coaching to be an activity where an individual meets with a coach on a one-to-one basis to work on a range of work-related issues, some of which may also include personal factors.”

The report, which features at least one NHS trust, is due to be published in April 2008.

BOX 2

“People who are doing great can do even better”

“I’ve had coaching in the past, and I’m having it now,” says Karen Castille, director for organisational development at Cambridge University Hospitals Foundation NHS trust. “I also give coaching to others.”

“We need to see a paradigm shift in the NHS with regard to coaching. There’s still an assumption out there that if you’re having coaching you must be failing in some way. But people who are doing great can do even better if they’re talking to an independent, trained coach who’s not immersed in the same problems.”

“My coach isn’t from the NHS and doesn’t know an awful lot about it. His strength is that he enables me to see how I can deal with some of the complex issues I manage, and helps me structure my thoughts. Coaching is an exercise in listening and structured conversation which allows the coachee’s own thoughts and solutions to emerge.”

“A lot of people who haven’t had coaching seem to think it’s rather woolly, soft and fluffy. But when you get it right, coaching can really enhance performance.”