Coaching in healthcare

The Impact of Coaching on Healthcare Employee Engagement

Leadership coaching in healthcare has become an increasingly effective method for sustaining employee engagement and mitigating the symptoms associated with burn-out. This paper will explore how coaching has supported healthcare workers to survive and, in many cases thrive during a period of intense stress and ambiguity.

Specifically, this paper will focus on the attributes of employee and team engagement that were positively impacted by a direct supervisor’s “leader as coach” mindset. These attributes were gathered through a series of individual interviews with a wide range of healthcare professionals, to include registered nurses, physician’s assistants, doctors and healthcare administrative personnel. They were employed in hospitals, office practices and non-profit clinics. This research was started and completed during the spring of 2022.

The interviews were structured to engage the healthcare provider “in the moment”, which allowed for a spontaneous response and subsequent ad-hoc exploration of themes brought up during interviews vs. completion of a rigorous questioning protocol. 

Note- this paper is intended to be exploratory in nature and should serve as a starting point for further research on this topic.

Why now?

The rise in symptoms of “burnout” (see definition below) across the health care community, and specifically nurse burnout, is becoming an increasingly challenging issue for healthcare providers. In a recent article (2022) published by the Journal of Continuing Education in the Health Professions it was shared that, among other findings, “…(1) compared to physicians, nurses experienced a higher level of distress and burnout, and used more maladaptive coping strategies. (2) Both nurses and physicians experienced more distress and burnout during COVID-19 than before. ” Another 2021 article on burnout in healthcare stated

“Healthcare professionals are generally considered to be in one of the highest-risk groups for experience of burnout, given the emotional strain and stressful work environment of providing care to sick or dying patients. Previous studies demonstrate that 35% to 54% of clinicians in the US experience burnout symptoms.”

A March 2022 article published online through incrediblehealth.com (a nurse staffing provider) shared that over a third (34%) of the nurses recently surveyed reported that it is very likely that they will quit their job by the end of 2022. 44% cited burnout and a high stress environment as the reason for their desire to leave.

Burnout was also cited in a recent as yet unpublished academic article as having negative consequences for physician well-being. Per the authors:

 “Burnout has serious negative consequences for physicians, the healthcare system and for patient outcomes. Burnout in physicians has been linked with lower work satisfaction, disrupted personal relationships, substance misuse, depression, and suicide. Within healthcare organizations, burnout is related to reduced productivity, high job turnover and early retirement. Importantly, burnout can result in an increase in medical errors, reduced quality of patient care and lower patient satisfaction” (p. 6)

Note on burnout in early career healthcare professionals: A significant number of academic studies explicitly pointed out the belief that burnout affected early career nurses and physicians to a greater degree than more tenured professionals. For example, in the aforementioned unpublished study, the authors believe that:

“The evidence indicates that young physicians are at higher risk for burnout compared to experienced physicians, so future research should focus on prevention among less experienced physicians. Interventions focused on enhancing teamwork, mentoring and leadership skills might be particularly suitable for young physicians and for physicians dealing with intense work and complex patients.” (p. 20).

And another article shared the belief that

nurses aged 20 to 29 years reported higher burnout and intention to leave than more senior nurses”

What is burnout?

For the purposes of this paper, I have used the definition provided in an article published by the National Institutes of Health on pubmed.com. Their definition states

Burnout is a work-related stress syndrome characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment”.  In terms of nurse burnout “Nurse burnout is related to nurses’ deteriorating mental health and poorer patient care quality and thus, is a significant concern in healthcare”.

What are examples of current workplace stressors in health care that may contribute to burnout?

From the above literature and through additional insights gained from attending a recent focus group with healthcare providers in the winter of 2021, I began to frame a “workplace stressor” model. This model is similar to operational risk models used in other industries. Sorting the sub-stressors into the “people, process and technology” domains helped me gain further clarity regarding the sources of the stressors. While not complete, it does provide a visual for further exploration.

Healthcare workplace stressors:

Note-when asked to comment on this suggested model, healthcare practitioners found it directionally accurate, and in addition generally felt that the ‘people’ related stressors should be weighted more heavily than stressors relating to processes or technology.

What does literature suggest as a way to reduce burnout?

The aforementioned articles (along with a wide range of similar academic and current literature) also shared there were several ways healthcare employers could help mitigate the risk of burnout, to include providing:

  • Resources to “…improve nurses’ psychological…health”
  • “…medical education, such as resilience training, focusing on adaptive coping approaches”
  • Training leaders to recognize and address burnout
  • Provide training on “…mindfulness techniques or cognitive behavioral techniques to enhance job competence, improve communication skills and personal coping strategies.”

Most of these suggested solutions were found to be fairly general, poorly defined, and tactical in nature. They also did not fully address how these interventions would specifically address burnout, to include no evidence suggesting they had been proven useful in a healthcare setting or in other domains.

Summary of initial findings

So far in this brief article I have affirmed that burnout among healthcare employees is a real issue, specifically with nurses. And due to the current environment, it is getting worse and having a greater impact on turnover and intent to remain in the healthcare field. I have also built a simple model to see where the stressors fall (e.g., people, processes, technology).  Feedback on this model suggests exploring people-centered mitigation strategies may have the greatest effect on burnout reduction.

From these initial insights I took several progressive steps to further explore what was being done to mitigate this issue.

Step 1- sharing my insights and receiving initial feedback from healthcare leaders

In subsequent interviews with healthcare executives, I received feedback that the above suggested training (along with similar training related to cognitive hardiness, mindfulness and adaptive coping methods) needed to be integrated into a more proactive and holistic “leader as coach mindset” versus being delivered as separate interventions.

This approach was further framed by a key executive leader when she shared her belief that:

 “We needed to move from a reactive to a creative state when dealing with our employees. This required us to not only train our leaders to recognize (and react compassionately) to the symptoms, but also how to get ahead of the curve and create a psychologically safe space through a more compassionate, coaching-centered approach to leadership”.

Step 2- further refining my approach through additional targeted interviews

These insights then led me to explore what healthcare organizations have done to create and sustain a more holistic framework to reducing burnout, with a specific focus on how coach-like leaders were able to reinforce this approach. Through connections with best-in-class healthcare providers, clinicians and ACT’s alumni community I was able to reach out to healthcare professionals who had been successful in applying a coaching approach to their profession. Through their insights I have attempted to more fully understand the impact of these skills on sustaining employee engagement and mitigating burnout.

Step 3- asking the question “Can coaching help reduce the impact of burnout on healthcare employees?”

Feedback from my initial connections within the healthcare community led me to frame my subsequent inquiries along two lines of thought. The first line of thought was to further explore how healthcare professionals who self-identified as being part of a coaching-centered workplace (e.g., as a member of a clinical practice, or a high-cadence hospital department such as the emergency room, post-anesthesia care team, etc.) felt this approach reduced the symptoms of burnout.

The second line of inquiry was to explore and understand how being coach-like in healthcare affected the coach. I took the initiative to seek out healthcare professionals who had completed a coaching certification program and who were actively applying coaching skills in their jobs. My desire was to seek out their perspective as to what attributes of coaching supported their ability to be more effective at helping mitigate burnout for themselves, their peers and members of their team.

To support these expanded lines of inquiry I framed out the following definitions of 1) what a coaching-centered workplace would feel like and 2) how a coach-like leadership style supports employee engagement. These elements are based on feedback from the ICF, ACT leadership and current academic literature.

Coaching-centered workplaces are defined “as creating and sustaining an environment that celebrates a human-centric, growth mindset that couples relationships and results”. These attributes reinforce the beliefs that:

  • Everyone has the capacity to be creative and resourceful and whole
  • The organization and its leaders focus on the “whole” person
  • The employee and co-workers bring curiosity, agility and presence to their work
  • Within the workplace, all participate in co-creating the agenda around engagement mutually agreed-to values and inclusion.

A coach approach integrates these beliefs into practices that easily blend with existing individual leadership styles. These relationship-focused practices humanize work and help to unlock potential and reinforce self-efficacy. Some of the concepts and skills demonstrated by leaders with this approach include:

  • Co-creating a safe and trusting environment
  • Listening actively what someone is saying and how they are saying it
  • Asking open-ended questions that engage critical thinking, feelings and connection
  • Applying a number of practical coaching skills that improve the quality and effectiveness of conversations.
  • Connecting with and leading from a deeper understanding of their own values and purpose, taking actions and making conscious decisions that are mutually aligned with their organization and their own internal compass.

Top three impacts of a coaching-centered workplace on reducing burnout

From the employee’s perspective, they believe that the following three attributes of working in a coaching-centered organization helped reduce the impact of burnout. I have synthesized participant responses in their “voices of the employees” to retain the spirit and intent of the feedback.

Meeting me where I am at

Participant’s Definition: My leadership and co-workers accept me “where I am at” and have actively engaged in learning what helps me feel included and supported within the workplace.

Example of behaviors:

  • “…during orientation, my leadership asked me how I liked to receive feedback…I shared that I prefer to receive feedback immediately ‘in the moment’, versus waiting for a periodic review…they now make sure they connect with me after a major event to walk through and co-evaluate how my work supported the team.”
  • “Right after I accepted my offer my new coworkers set up a zoom call to welcome me. They asked if there was anything they could do to support my transition to their team.”
  • “When I am on call, I prefer to receive a text message vs. a phone call because I have a newborn that still has problems falling asleep (so I often turn off my ringer). They supported this request and let everyone on the team know of my preference…everyone supports this minor exception to the rules and has made my life easier”.
  • “I prefer to receive praise in private…I am uncomfortable getting in front of a large group to be recognized for an achievement. Now my team and direct supervisor take the time to celebrate my achievements one-on-one.”
  • “…I struggle with my weight…in the past HR would regularly place piles of packaged doughnuts and salted snacks in the break rooms as a way to “recognize our contribution”.  I felt safe enough during a shift change ‘check-in’ meeting to suggest that instead of this type of junk food recognition we would have more input into what foods were available for take out in the cafeteria, like smaller, healthier snack-sized balanced meals. The team and my leadership supported my idea and now we are seeing a pilot program for the second shift employees.”

Impact on burnout:

  • “Being asked how I like to receive feedback has really reduced my anxiety and I feel the feedback I do receive resonates more deeply because I know it took them time to adapt their style to my needs.”
  • “I felt I didn’t have to prove myself; I was accepted for who I was when I joined the new team.”
  • “The fact that the team was supportive of making small changes to policy made me feel they had my back when it came to me managing my work-life balance needs. It helped reduce my stress at home and I appreciated their understanding of my unique needs.”
  • “Having the safe space to share how the unintended consequences of an ‘unprovoked good’ affects my self control helped me feel back in control of my work space, especially when it came to managing a deeply personal issue.”

Trust within the team

Participant’s Definition: I trust my team and my team trusts me with each other’s emotions, well-being and expertise/professionalism. We have co-created our relationships to help each other better understand how to deal with the strong emotions that go along with working in a healthcare environment. They provide me a safe space to share my thoughts, emotions and work-life balance needs.

Example of behaviors:

  • “I work in public health and have seen an increase in the frequency of patients who are actively challenging their course of treatment…in the past I used to bottle up my emotions around this behavior and ‘take it out’ on co-workers. My team has partnered to give me ‘permission’ to vent my emotions in a safe space. They actively help me honor how I feel and work through getting to a better place…”
  • “We are constantly having to deal with the impact of changes to technology…it has not made our life easier. In the past each of us would work on our own to resolve these issues, with varying degrees of success. This was a very frustrating and often overwhelming process. After sharing within the group, we realized we had all the same issues. Now, we set aside ten minutes during our shift changes to work through as a team what we need help on. Our leadership then takes on the responsibility to get answers and communicates updates through a white board for all of us to share.”
  • “We work in a critical care ward that has had high turnover. Half our staff has been here less than two years, the other half over ten. In order to reduce turnover, we are now actively engaging our new team members in recognizing how they prefer to deal with stress. For those that need ‘just a moment alone’ we have a quiet room. For those who need to walk it out we have suggested safe space to walk within the grounds. And for those that need time to process we have a ‘on-demand’ text messaging protocol that offers peer support off-shift. These options were agreed to as a team and we worked together to learn more from each other as to additional resources or other self-care options we can provide…”

Impact on burnout

  • “Having a safe space to work through my feelings and emotions has really helped reduce my frustration and overall sense of fatigue.”
  • “Knowing my team has had the same issues and is working to reduce the stress of dealing with new technology has helped me feel my voice is being heard and someone has my back.”
  • “I know now that I can give myself permission to feel sad, angry and sometimes overwhelmed, and that others understand what I need to do to cope with these feelings.”
  • “I appreciate the resources that are available to help cope with my emotions in the workplace.”

Leadership supports personal and professional growth

Participant’s Definition: My leadership actively listens and engages me in ongoing personal and professional development. In addition to supporting the team’s trust relationships, my leadership actively engages me in supporting my personal growth, growth within the team and ongoing professional development opportunities.

Example of behaviors:

  • My team works with our direct supervisor to forecast work schedules that include ‘time to learn.’ During these meetings we all talk through what we would like to work on…both skills as well as more effective patient care techniques. Sometimes during these meetings I learn as much from my co-workers as I do from some of the formal training”
  • “Our periodic performance reviews are now less about what I’ve done and more about what I am curious about…my leadership actively supports my learning, often asking what they can do to help remove barriers to taking time to learn.”
  • “Going off to take training outside the hospital used to be seen as a perk. Now we are all actively encouraged by our leadership to discuss learning programs…we set aside time during nurse grand rounds to share learning opportunities and co-create learning plans as a team.”
  • “I remember our Chief Nursing Officer sharing during a recent shift change huddle that she would personally advocate for our professional development. She came through… and I saw how that had a positive impact on our team”.

Impact on burnout:

  • “When I talk about my personal development with my leadership I hear more ‘yes, and here are some additional opportunities’ instead of ‘we can’t because…’ This gives me a sense of hope and the belief that there are others out there who are interested in my development.”
  • “I had a ‘stay interview’ instead of a traditional mid-year performance review where my first line supervisor asked me what it would take to keep me here. In my ten years of nursing I never had anyone ask this question, except after I submitted my resignation.  It ended up being a very powerful discussion and helped build trust…”
  • “Knowing that my entire chain of command supports a learning culture helped reduce my anxiety over asking for training. I felt a stronger sense of inclusion and community knowing I was a part of a team that was provided the opportunity to learn and grow…”

Overall, employees working in coaching-centered healthcare organizations felt a stronger sense of inclusiveness, trust and acceptance compared to their employment experiences with non-coachlike work environments. From their perspective this helped reduce their:

  • Levels of anxiety
  • frequency of experiencing a feeling depersonalization, and
  • Concern that they not were making a positive difference for their patients.

Current practice, reinforced by academic research strongly suggests that creating a coaching-centered workplace requires a strong “leader as coach” mindset. From interviews with healthcare employees (spanning first line supervision through executive leadership) I derived a “top three” list of those behaviors that were most effective in creating and sustaining this mindset. Note that all of my interviews were with healthcare leaders who had completed some form of professional coaching certification program.

Top three impacts of being a coach-like leader on reducing burnout

Leaders in healthcare believed completing coaching certification training made a significant difference in their approach to leading both their teams as well as “leading themselves”.  For most, the major challenge has been to evolve from trying to be a 24/7 heroic “I can do it all” leader to a leadership style that is more balanced and inclusive.

This evolution to a more balanced coach-like leader led interview participants to believe the following three attributes have made the most impact on reducing burnout for both themselves and their teams.

Deeper understanding of self, to include greater awareness of:

  • The energy they bring to the team and how it supports positive engagement
  • Personal and team core values and how they support a sense of purpose (why they love what they do)
  • Individual and co-worker capacity for dealing with emotions in a compassionate and supportive manner
  • How they sustain themself and their teams during intense periods of ambiguity
  • Belief that everyone on their team needs to be provided coaching and training in coaching skills.

Examples of behaviors that support these insights include:

  • “I learned through my coaching certification program to recognize and focus my emotional energy in a positive way…helping reducing my level of emotional fatigue”
  • “Through coaching I re-established my core values, and in turn have learned to engage and honor the core values of my coworkers. This has helped us get through some challenging times together…”
  • “I used to be very uncomfortable when I saw others sharing their emotions at work. Through coaching I have gained a greater capacity for honoring and supporting others as well as dealing with my own emotions in a safe and nurturing way…”
  • “I was always taught that showing emotions at work was a weakness, and would try to disconnect myself. Now I realize that the more I disconnected the less effective I was at supporting others through their emotional journey. I now deliberately focus on recognizing and stating my emotions… it has helped me become more resilient.”
  • “An ACT facilitator shared during my coaching certification program the belief that ‘expressing and releasing authentic emotion is healthy’… I have never forgotten that insight and share it whenever I work with a new team.”

Impact on burnout:

  • “Feedback from my team supports the belief that being more coach-like has helped them feel their voices are being heard. I now advocate for coaching skills to be included as part of orientation, professional development and first-line supervisor development… I have also suggested we include some form of coaching orientation for our traveling nurses…”
  • “Opening up to my team and sharing my core values and then asking them to share their values has deepened our working relationships.”
  • “Now when I am experiencing painful emotions I don’t walk away and try to hide, I am comfortable being with my emotions around my team. That has helped me feel less stressed and wiped out at the end of my shift”.

Greater capacity for sustaining a more inclusive workspace.

This is believed by those surveyed as being key to creating a safe space for coworkers to “be who they are” without judgment or criticism.  This includes being present with teams and asking questions that recognize and value:

  • The diversity of insights and experience that coworkers bring to the workplace.
  • The belief that “I can no longer be a hero” and need the support of others to make the best decisions for our patients.
  • The emotions that others are experiencing. This includes ensuring coworkers feel comfortable sharing and honoring each other’s emotional journey.

Examples of behaviors that support these insights include:

  • “As a coach I now take the time to provide everyone on my team time to ‘clear’ their emotions and co-create a readiness to support our patient’s needs.  This extra ten minutes during our shift change huddle has made a difference- my co-workers feel this has helped reinforce trust and understanding with their peers.”
  • “When confronted with a procedural issue I used to jump in and give the correct response. As a leader I felt it was my role to ‘take charge’. Now I take the time (in non-emergency situations) to ask the staff for their thoughts, intentionally going beyond routine yes/no questions to actively listen and really connect with their point of view.”
  • “When we were required to dress in multi-layered PPE (personal protective equipment) it would be difficult to know who was standing next to you – even with your name on masking tape in different places on your clothing. So during our team huddle I asked how we could better communicate with each other in the critical care unit, especially during times where we needed to react quickly as a team. A new team member suggested we take time to spend a few minutes before the start of the shift looking into each other’s eyes while wearing our full PPE…you know, I can say that there were several times that there were tears in my eyes as I looked into the eyes of my co-workers…that simple exercise had a profound impact on our connection to each other…”

Impact on burnout:

  • “We recently lost a team member to a spouse’s reassignment to another city. She shared during her last shift with us that she had never felt so close to  her co-workers, and that she planned to take several of our engagement practices with her to her new job.”
  • (From a Chief Nursing Officer) “Now before I walk through a ward, I ask the shift lead what I can do to support her team (before I would do “no-notice’ visits). And during my visits I would encourage nurses to ask me any questions that they have on their mind, from the food in the cafeteria to recent policy changes. My first line supervisors have shared that in the past they felt my walk-throughs were ‘gotcha” inspections- they now feel much more appreciative of the time I take to support their leadership.”

Continuous growth and co-development.

The awareness of the need to celebrate and sustain a continuous growth mindset for the individual, the team and the community of healthcare practitioners.

Examples of behaviors that support these insights include:

  • “During the selection process I spend time with the candidate asking about what additional learning they would like to pursue. I then work with my team to integrate this into their onboarding and first year development plan…”
  • “I do several ‘stay interviews’ with my employees throughout the year. This helps me understand what challenges they are facing and what I can do to help provided a better workplace”
  • “At least once a quarter we sit down as a team and co-create what learning we want to explore both individually and as a team. We also walk through how to accommodate off-site on-shift learning to make sure everyone has time to learn…”

Impact on burnout:

  • “A new nurse shared that she really appreciated having the time to talk through what additional learning she needed to feel successful. For her it was more about having caring co-workers that could help her do a better job with basic tasks and understand how to be more efficient in a new ward and less about attending seminars.”
  • “I’ve learned that high performers prefer to have a leader that helps them remove barriers to their success, so I make sure I follow-up after each stay interview to let employees know what I have done (and sometimes, what I could not do) to make their jobs less stressful. They appreciate the feedback, even when I admit I wasn’t fully successful…”

Summary thoughts

From the above feedback it does appear that employees who work in organizations that reinforce a coach-like approach to leadership have a reduced perception of burnout due to:

  • leaders accepting them where they are at in life,
  • greater trust within the team and
  • support for their growth and development.

These attributes complemented the beliefs that healthcare leaders who completed coaching training and applied their skills to the workplace felt being more coach-like had a positive impact on reducing burnout and increasing employee engagement. Coach-like leaders felt their:

  • Deeper understanding of self
  • Greater capacity for sustaining a more inclusive workspace, and
  • Approach to continuous growth and co-development

Strongly contributed to reducing co-worker burnout, and helped to foster teams who were more compassionate, engaged and supportive of each other’s development.

How do we create and sustain a more coach-like workplace for healthcare practitioners?

I would often ask the above question at the end of my interviews. Feedback from healthcare executive leadership continued to suggest organizational leadership focus on developing a more holistic approach to reducing burnout. One executive suggested:

“Evolve employee engagement and inclusiveness initiatives from an inconsistent series of tactical interventions into a scalable, dynamic and creative recognition of a coworker’s value to self and the field.”

Others shared:

“Coaching provides us with a set of practices that we can use to help others…move beyond resiliency, (which is a reactive state) to embracing a creative mindset… contributing to a readiness to thrive during ongoing periods of change”. 

         and…

“Using a coach-like approach helps us engage our team at a deeper level and… proactively constructs a level of ‘cognitive hardiness’ that is reinforced through actively supporting the ‘whole person’ within an inclusive community of practice.

When asked “why coaching” as a preferred approach, participants shared that coaching provided them a:

  • Foundation for establishing and maintaining deeper, trust-based connections with co-workers
  • Evidence-based method for increasing cognitive hardiness as well as psychological safety, self-efficacy and inclusive growth & development
  • An approach to employee engagement that is based in neuroscience
  • A skill that adapts to the participant’s current environment
  • Scalable mindset that is relevant to individual, team, and community inclusion.

Final thought

Leaders in the healthcare community are constantly striving for solutions to reducing burnout (especially nurse burnout) that also contribute to creating and sustaining a more engaged, inclusive and purpose-driven community of caregivers. Adapting a holistic, coach-like approach appears to be making a difference.

Taking the first step

ACT Leadership and Performance Coaching, LLC has a great deal of experience partnering with the healthcare community to develop and deliver coach training and coach training certification programs. If you would like to learn more about an initial coaching certification program or coaching in healthcare, please take a look at ACT’s Leader as Coach and Leader as Coach for Healthcare offerings.

In addition, if you are curious about how other organizations have benefited from organization-wide coaching programs, ACT has the expertise to guide you through a review of best-in-class case studies and the option to speak to Erin Hutchins or Mike Hutchins (ACT’s co-founders) regarding your specific needs.

The author

Mike Beckmann is an experienced workforce development strategist with human capital executive leadership experience in both the public and private sectors. He has a Ph.D. in Human Development from Virginia Tech and is an active executive and career coach.

LinkedIn profile: www.linkedin.com/in/michael-beckmann-phd-95759133

ACT is an internationally recognized coaching, leadership development and consulting company known for its commitment to leadership and performance coaching, valuing its long term partnerships with Brown University, the intelligence communities and its loyal and devoted diverse community.