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Coaching & healthcare

If burnout and emotional exhaustion are affecting you – and you think you might leave clinical medicine – you are not alone.

Burnout and emotional distress were some of the factors that underpinned my decision to leave clinical medicine for the non-clinical world.

And I’m not the only one. There are a range of reasons why doctors leave clinical work – but for many it’s to preserve their mental health or even just to stay alive. Sadly, tragically, we’ve been hearing more and more about suicides in medical professionals. And we urgently need to do what we can to stop this.

If you are in distress – contact Lifeline 13 11 44
Or contact the Doctors Health Advisory Service in your State or Territory

Had there been better supports for doctors who find themselves exhausted and in some sort of emotional distress, I might have found a way forward to build a clinical career. Then again – had the system not been so horrific to work in then these types of problems might never have arisen in the first place.

When I think back from this perspective about the decision I have mixed feelings. On the one hand – it was undoubtedly the right decision for my health and my family at that time. However, I’m also acutely aware that this has meant one less clinician working at the coal face. I’m aware that in the greater scheme of things this may have made things harder for everyone else.

It’s hard to rewrite history – much more productive to work towards the future. So, despite my personal decision to not do clinical work – I made the decision to find ways work to support the provision of health care and in the long term try and improve the healthcare experience and outcomes for doctors and patients.

This commitment has lead me to work in a range of non-clinical worlds including:

  • Public health and clinical governance – particularly in the world of quality use of medicines – helping to make systems safer and healthier
  • Medical writing and communications supporting clinicians and patients with accurate and easy to use information and training
  • Advocating for suicide prevention activities in national advisory groups
  • Coaching – supporting individual clinicians to develop skills needed to manage burnout and promote wellbeing

Coaching (my favourite adventure in supporting the health profession so far) has the potential to not only help individuals – but to help systems become healthier places to work through leadership training and system wide interventions. Let’s have a closer look.

The problem in health care today

That the health care system is in a crisis is not news – at least to those working in health care.

A recent US report highlights the of burnout in health care professionals and the serious consequences of that. Here are just some of key facts from that report [1]:

  • Burnout is an independent predictor of reporting major medical error and being involved in a malpractice suit
  • As emotional exhaustion in doctors and nurses rises, so too does patient mortality and perceived quality of teamwork
  • Burnout is linked to job dissatisfaction and intention to leave – which may help the individuals who decide to leave but puts further strain on the system (just like I suspect my leaving did to my colleagues)
  • Burnout is likely to result in higher costs across the health system – directly through higher rates of investigations and referrals, and indirectly through absenteeism and reduced job performance
  • Female doctors have a suicide rate that is 130% higher than the general population – while for male doctors the suicide rate is 40% higher. Please seek help if you have had thoughts of suicide or harming yourself

The report outlines a variety of factors that potentially contribute to burnout including:

  • Excessive workloads
  • Conflict between work and family pressures
  • Cultural issues such as tension between disciplines
  • Little opportunities for autonomy and perceived powerlessness
  • Loss of meaning in work
  • Leadership behaviour – the following quote is telling:

“How well leaders seek input from, inform, mentor, and recognize individuals for their contributions relates to burnout and the career satisfaction of the clinicians they lead”. 

Unfortunately there is little evidence regarding preventing and enhancing recovery from burnout – but what data is available show that both individual and system interventions are effective. And there is emerging evidence that coaching is one such methodology that can help both individuals and systems change – and may have much usefulness in helping individual clinicians and ultimately improve patient care. It’s early days – but let’s have a look at what coaching may have to offer.

The potential contribution of coaching

In the business and professional services world, evidence-based coaching has a track record for helping staff deal with change, develop leaders and improve wellbeing [2]. Despite this, coaching has had a much slower uptake amongst health professionals. Nevertheless there is mounting evidence that it could prove an effective intervention. Anecdotally, from my own practice in coaching doctors, coaching is having an impact on helping them improve self-confidence in managing high stress situations, tolerate uncertainty better, and reconnect with their purpose and meaning in practice medicine. But that is not yet evidence.

Here are some ways coaching has been used in healthcare and at least made it to a peer-reviewed journal:

Leadership coaching for senior health staff in Australian hospitals [3]

A recent study by NSW Health and The University of Sydney showed solution-focused cognitive behavioural coaching had a number of positive effects among executives, senior managers and senior clinicians. The six-month leadership coaching program helped participants develop:

  • Improved levels of resilience and ability to manage stress –  this included improved self-insight and awareness of communication styles when under stress
  • Improved confidence in their leadership abilities – this is an important predictor of behaviour change and can have important flow on effects such as more positive appraisals from co-workers
  • Improved work/life balance and home relationships
  • Improved ability to manage complexity, ambiguity and uncertainty

Case reports of successful coaching

  • Coaching to improve teamwork in the NHS: A six-session coaching of a multidisciplinary team improved teamwork in a radiology department in the UK [4]
  • A US physician leadership program in a Michigan healthcare system resulted helped physicians increase self-awareness, build relationships across the organisation, undertake behaviour change in areas such as communication style, improve self-confidence [5]

Theoretical use of coaching to prevent physician burnout

  • A US paper describes a theoretical approach to prevent physician burnout in individuals using approaches derived from positive psychology, mindfulness, and self-determination theory [6].

Given coaching has been shown in an at least one paper to have a ripple effect and positive impact on people close to those coached [7], it is plausible that implement a coaching program in health care organisations that focuses on targeted leaders as well as appropriate applied to individuals at high risk may have important impacts for individuals and across the system as a whole.

So yes, it’s early days. There’s not much research – and much of it is limited by small sample sizes or other methodological issues. Or is simply anecdote and not systematically collected information (the positive stories I can tell about my own clients falls into this category).

Nevertheless, coaching shows much promise in helping work towards a healthier health care system.

And for me – each doctor I help helps me use my experience to help doctors move towards not only doing their best at work – but being their best as well.

References:

[1] Dyrbye, L. N., Shanafelt, T. D., Sinsky, C. A., Cipriano, P. F., Bhatt, J., Ommaya, A., . . . Meyers, D. (2017). Burnout among health care professionals a call to explore and address this underrecognized threat to safe, high-quality care.
[2] Theeboom, T., Beersma, B., & van Vianen, A. (2014). Does coaching work? A meta-analysis on the effects of coaching on individual level outcomes in an organizational context. The Journal of Positive Psychology, 9(1), 1-18.
[3] Grant, A. M., Studholme, I., Verma, R., Kirkwood, L., Paton, B., & O’Connor, S. (2017). The impact of leadership coaching in an Australian healthcare setting. Journal of Health Organization and Management, 31(2), 237.
[4] Woodhead, V. (2011). How does coaching help to support team working? A case study in the NHS. International Journal of Evidence Based Coaching and Mentoring, 5, 102-119.
[5] Throgmorton, C., Mitchell, T., Morley, T., & Snyder, M. (2016). Evaluating a physician leadership development program–a mixed methods approach. Journal of Health Organization and Management, 30(3), 390-407.
[6] Gazelle, G., Liebschutz, J., & Riess, H. (2015). Physician burnout: coaching a way out. J Gen Intern Med, 30.
[7] O’Connor, S., & Cavanagh, M. (2013). The coaching ripple effect: The effects of developmental coaching on wellbeing across organisational networks. Psychology of Well-Being, 3(1), 1-23.

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One Response to Coaching & healthcare

  1. Rob Burnside July 24, 2017 at 8:22 pm #

    I think it all began when “Personnel” became “Human Resources.” That was about the time the non-academic sabbatical concept was ever so briefly popular in American business and industry. Reviving this practice, especially for those in critical care, would do much to blunt the growing threat of burnout in our medical community. Rest is vital to healing, and makes other remedies like coaching much more effective.

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