Raising Physician Performance with Coaching

Healthcare Executive Magazine
On Physician Relations
May/June 2016 Issue


In healthcare today, physician excellence is crucial for peak-performing teams. Coaching is one way in which both high-performing and underperforming physicians can reach higher levels of performance.

All physicians have the potential to benefit from coaching. Successful performance outcomes are dependent on an innovative triad of communication:

  • A respectful relationship between the physician client and coach
  • An effective collaboration with ongoing communication between the coach and stakeholders
  • The setting of unified expectations for the physician by stakeholders and the coach based on assessment findings

Respect. Underperforming physicians are frequently referred to as disruptive—but research has shown such labeling is not only damaging, but also may have the unintended effect of fostering underperformance. Therefore, it is vital that healthcare leaders and the physician coach set a tone of respect in which the physician being coached does not feel shamed. When they feel respected, physicians who are coached more easily take ownership of both positive and negative assessment findings, resulting in improved outcomes and lasting positive changes.

Collaboration. Research also has shown that when innovative programming is linked to ongoing communication with stakeholders, the outcomes can be exponentially more successful. When the coach and stakeholders are in regular communication, they become a unified force whose aim is to elevate physician performance. This does not happen without open communication from the beginning of the coaching process.

Establishing Unified Expectations. Each component of the triad of communication is crucial to optimizing physician coaching outcomes. “Through open dialogue and effective collaboration with the physician coach, the organization can frame the engagement at the outset by contextualizing the situation and prioritizing goals and expected behavioral changes,” said Lisa M. Abbott, Senior Vice President of Human Resources at Lifespan Corporation and an ACHE member. “This approach allows us, as partners, to markedly potentiate positive outcomes.”

High and Underperforming Physicians

High-performing physicians already are meeting or exceeding the organization’s expectations with no apparent issues. These physicians have Olympic aspirations and many talents. They either seek coaching themselves or their supervisor wants them to achieve the highest level of performance possible. Supervisors within the organization may find that, at times, they are able to elevate the performance of high performers without outside assistance. However, when an outside coach is engaged, the physician client benefits from a coach who has a comprehensive set of skills in the core areas of leadership, professionalism, boundaries, life, wellness, habits, and addictions, as well as in the specialty areas of healthcare and patient experience. The physician also may benefit from additional modules for coaching such as onboarding, task and time management, minority empowerment, or advanced leadership development. With this practical knowledge, an effective coach can unlock a physician’s previously untapped capabilities.

Underperforming physicians either have a single behavior or a complex set of behaviors that require management. While the physician coach will explore underlying issues, most coaching goals for underperformers have a behavioral focus to optimize team relationships first.

Frequent signs of underlying issues contributing to underperformance include:

  • Irritability or temper outbursts
  • Fatigue, apathy, or other signs of burnout
  • Frequent or serious errors
  • Strained relationships with team members
  • Mental health issues, addictions, or medical symptoms
  • Boundary violations as victim or offender (e.g., bias, bullying, sexual harassment)
  • Absenteeism or tardiness
  • Legal problems
  • Problems in personal life
  • Complaints from staff or patients

In recent years, maladaptive behaviors have begun to be treated as seriously as addictions. “Now we can help physicians raise their performance by managing behaviors that may hinder adequate team functioning and patient care,” says Bonnie Kriescher, vice president of human resources for Advocate Health Care, in the Chicago area.

Three Levels of Performance Elevation through Coaching

When they are engaged in coaching, physicians tend to raise their performance.  Supervisors find they can foster development in some higher-performing physicians without outside coaching assistance. However, more challenging high and underperformers produce higher performance outcomes with the assistance of an experienced physician coach.

Level I: Entering coaching as a high performer. Level I physicians tend to be very disciplined and bright. These are physicians who are masters at mastery—they learn fast and implement strategies for achieving new goals proficiently. These clients usually succeed in raising their performance to even higher levels through collaborative work with their coach and stakeholders.

For example, Steven is a strong CMO at a medical center. He has been selected for a promotion and feels honored. He asks for a year-long onboarding coaching package to help him be successful in his new position, and his supervisor grants his request. Steven and his coach work together, collaborating with stakeholders, to foster Steven’s growth into an Olympic performer in his new position.

Level II: Entering coaching as a focal underperformer. A focal underperformer is a physician with a single behavior that negatively impacts his or her performance and the team. A physician coach will complete an initial evaluation of the focal underperformer to identify strengths as well as signs of underperformance and any underlying issues, and then will create performance goals to be monitored over time. The physician coach and stakeholders should be in regular communication regarding progress and goals. If a client relapses with an addiction or a maladaptive behavior, the physician may be referred to a physician health program or boundary program. If relapses persist, disciplinary action by organizational leaders may be taken.

For example, Susan, a surgeon, was in the operating room when she asked for scalpel “A” but was handed scalpel “B” by a nurse. Susan became hostile with the nurse, who filed a formal complaint against Susan. The organization decided to refer the physician to coaching. Here, Susan is learning that her threshold for becoming irritable—the underlying issue—is low and needs to be raised. Susan successfully works to utilize more adaptive coping methods for her triggers of irritability while in the operating room, thus avoiding further team conflict.

Level III: Entering coaching as a complicated underperformer. A complicated underperformer has multiple behaviors that negatively impact physician performance—and these behaviors, in turn, can affect the team and even patients. This physician usually requires the attention and expertise of a coach experienced in dealing with multiple issues and behaviors.

Physicians who fall under this category can require intensive evaluation with referral to a local multidisciplinary assessment, addiction or boundary program, physician health program, and/or a physician coach who can begin to raise the performance of the Level III physician by helping the client begin to manage maladaptive behaviors while simultaneously enrolled in treatment programs. Often, the referral to coaching happens after discharge from a treatment program as part of the continuing care plan.  Using the triad of respect, collaboration and unified expectations, the coach is able to communicate with both the stakeholders and the physician to develop an overall plan that all parties can embrace.  Disciplinary action may be averted if the physician is compliant with key goals and minimizes relapse.

For example, Barry, a dermatologist, was arrested for allegedly inappropriately touching a patient. He also had high levels of alcohol in his system upon testing. He was referred to a local multidisciplinary assessment, alcohol and boundary treatment programs, and a physician coach. Barry’s coaching targets compliance with recovery goals such as being free of substance and boundary violation relapses.  Barry will remain engaged in coaching to prevent future relapse.

Communication That Supports Performance Excellence

All physicians in coaching can benefit from the triad of respect, collaboration, and unified expectations.  The physician client implements key goals generated by the coach and stakeholders to catalyze higher performance.

High performers can rise to Olympic levels with proper supervisory and coaching support. Underperforming physicians can be elevated to higher performance levels with effective coaching. Physician clients are able to own their persistent challenges while developing into more effective team members and sustaining positive progress. Optimized physician performance benefits organizations, stakeholders, teams and, most important, patients.

Joe Siegler, MD, is a board-certified physician, president of Full Life, and creator of Spheres® Leadership Coaching (joesieglermd@spherescoaching.com).


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