Clinical Coaching:
An Approach to Motivating Clinical
Practice Change in Home Care
Adele W. Pike RN, EdD
Background:
New Trends, New Ideas and Better Practices in Geriatric Home Care
Motivating clinical practice change among home care clinicians has many
challenges given the autonomy of their roles and the multiple (and often
competing)demands for their time and attention.
In 2007, Adele Pike was selected as a Geriatric Practice Change Fellow
(www.practicechangefellows.org) Her change project was to create a model for
motivating evidence-based practice change among home care clinicians and then
to use that model to improve core geriatric competency.
The critical objective of this project was to increase the knowledge, skill and
confidence of front line managers in motivating clinical practice change.
Clinical Coaching was identified as the tool front line managers identified as
holding the greatest promise for motivating practice change among clinicians.
Consensus on What is
“Clinical Practice”
Clinical Practice is the hands on care that
clinicians provide at the bedside, the chairside, or the home-side. It includes patient
and family assessment, critical thinking
about the assessment and ensuing creation
of a plan of care. Additionally, clinical
practice is the actual “hands on” application
of interventions, and evaluation of the
patient’s family’s response to interventions.
Clinical Coaching
Clinical coaching is a purposeful, planned, regularly
occurring meeting between clinician(s) and manager for
the purpose of envisioning, planning and improving
patient care in accordance with evidence based practice.
One to one coaching meetings are goal driven with a clear
articulation of the purpose, the expected outcomes, and
the agenda for each encounter. Coaching in this context
can be conceived of as a “thinking partnership” between
manager and clinician, and must be grounded in mutual
trust and respect. Managers use skills such as active
listening, asking thought provoking questions, providing
feedback, reinforcement of practice strengths, reframing
of clinical situations, and transforming ideas into action
steps to help clinicians integrate changes into their clinical
practices. Managers use a formalized process to follow up
on these action steps.
What’s the Goal?
To facilitate ongoing development of the
clinician in the context of practice and to
enhance the delivery of care.
-Hines-Martin, V. and Robinson, K. (2006).
Supervision as Professional Development for Psychiatric Mental Health Nurses.
Clinical Nurse Specialist. 20(6), 293-297
Styles of Clinical Supervision
≈ Prescriptive
≈ Informative
≈ Confronting
≈ Supportive
≈ Catalytic
Clinical Coaching Skill Set
•Managing Meetings
•Prepping for coaching sessions
•Differentiating when a clinician will benefit
from coaching and when a clinician
needs a corrective action plan
•Formulating Socratic Questions
•Active Listening
•Giving Feedback
•Timely and consistent follow up
Steps in Clinical Coaching
1.
The Invitation to Clinical Coaching
2.
Selecting the Location
3.
Planning the Logistics
4.
Plan for the Session
5.
Running the session
6.
Plan for follow up
7.
The Follow Up
The Invitation to Clinical Coaching
Inviting clinicians into a coaching relationship
takes thought and planning. Clinicians’
defenses and suspicions can go up quickly and
coaching can readily be perceived as a
disciplinary tool.
Selecting the Location
In the office?
Out of the office?
At the curbside?
Planning the Logistics
Time to Meet
Prevent Interruptions
Avoid Distractions
Seating Arrangement
Planning for the Session
When preparing for a coaching session,
ask yourself, “What do I really want to be
the outcome?” and use that as your
compass.
Running the session
The two riskiest times in a coaching
session tend to be at the beginning and at
the end.
-Patterson,
K., Grenny, J., McMillan, \R., and Switzler, A. (2002)
Crucial Conversations.
McGraw-Hill
Center for Creative Leadership’s
Framework for Coaching:
A- Assess
C- Challenge
S- Support
www.ccl.org
Center for Creative Leadership’s Coaching Framework Applied to Clinical Coaching in Home Care
Coaching Element
What’s Involved?


ASSESS
(allow 10 minutes)




CHALLENGE
(allow 20 minutes)




SUPPORT
(allow 10 minutes)




Identifying what you see as an area for practice
improvement
Discovering the clinician’s perspective about
what you have identified
Assessing clinician’s motivation to improve this
area of practice; to grow and/or change his or
her practice
What are the clinician’s strengths and interests
and areas for growth
What would the clinician consider improvement
or success in this area of practice
Engage the clinician in dialogue, problem solving
about a particular patient situation, and/or
envisioning about how care could be even better
than it is now
You want to create a bit of a disequilibrium for
the clinician between current practice and what
practice could be
You want to challenge the clinician – or better
yet- get him or her to challenge him/herself to
growth his or her practice around this issue
Support a plan for practice growth, but not a
plan to “do for “ the clinician
End the session by getting the clinician to
identify learning needs and then help in finding
resources to meet those needs
Help by managing or problem solving barriers to
the clinician addressing learning needs
Recognize wins and set backs
Acknowledge small gains and improvements
Celebrate success
Skills that can help
Socratic Questioning
Active Listening
Socratic Questioning
Active Listening
Written action or follow up
plans
Regularly planned follow up
meetings
Regular and spontaneous
feedback
Socratic Questioning
Thinking is driven by questions, not by
answers
What’s a “Good Question”?
•One
•
that causes clinicians to reflect on their practice
•
One that probes the decisions clinicians have made in a
particular patient situation
•
One that encourages clinicians to think about how care
could be different
One that causes clinicians to question the assumptions on
which they base clinical judgments
•
One that engages clinicians in discovering their own
answers to clinical problems
Sample Socratic Questions

What is your experience with this clinical problem?

How do you manage this problem when it occurs with a patient in
your care?


Describe how patients have responded when you have managed
the problem this way?
What other ways are there of managing this problem?

What is another perspective you could consider?

What is another approach to care you could try?

What would superb care of this patient look like? What would be
the outcomes of this care?

What do you think about the outcomes your patients achieve?
Planning for Follow Up
The two riskiest times in a coaching session
tend to be at the beginning and at the end.
-Patterson,
K., Grenny, J., McMillan, \R., and Switzler, A. (2002)
Crucial Conversations.
McGraw-Hill
The Follow Up
Leaving following up to chance
reduces clinical coaching to a nice
chat!
Practice and Reflection
“It takes a lot of practice to adopt a coaching
approach to practice improvement and to stop
wrestling with clinicians and start partnering with
them”
-Diane Garrow
Patient Service Manager
Visiting Nurse Association of Boston
Opportunities for
Practice and Reflection
•Every other week “Coaching for the Coaches” Rounds
•Role Plays and Video Case studies
•Small, rapid cycles of change: try something new and out of
the box and see what happens
•Using clinical coaching with joint visit: Discovering
of the power of Curbside Coaching