Published: 17/11/2005 Volume 115 No. 5982 Page 36

Who'd want to be a chief executive? It can be lonely and tough at the top. As David Nadler writes in his Harvard Business Review article 'Confessions of a trusted counsellor'.

The article explores some of the unique problems that come with being a chief executive:

Only chief executives needs to hear hard truths. Yet in their presence people are guarded and unwilling to raise difficult topics. Everyone who seeks their attention has an agenda.

Chief executives act as a lightning rod for criticism of the business.

They are the final arbiter in many vital business decisions, and consequently vulnerable to self-doubt.

They are the only person with no true peers in the organisation that they can unreservedly confide in.

Chief executives need close, longterm relationships with trusted professional advisers, including an executive coach, who they can work with to produce personal behavioural change and growth.

A fundamental question is whether these coaching relationships are effective at producing behavioural change and growth in the chief executive. A report for the NHS Leadership Centre by Manchester Business School reviews the impact on the person being coached and the wider organisation.

Finally, Stephen Berglas points out some of the very real dangers of executive coaching.

He draws a distinction between a 'problem executive', who can be coached to function effectively, and an 'executive with a problem', who can be best helped by psychotherapy.

Jay Bevington is associate director of board development at the NHS clinical governance support team.

For more on this article go to www. goodmanagement-hsj.

co. uk/bevington