The emerging profession of coaching has three primary applications in the health care industry: (1) leadership coaching, (2) health care provider coaching, and (3) patient coaching. As explained by Wolever et al. in chapter 29 of the Sage Handbook of Coaching, the goals of all three applications are to promote health and wellness, to improve outcomes, and to decrease the individual and societal burdens of chronic disease. While all three applications are important, this article will focus on the use of health care provider coaching as a way to address the increasing problem of physician burnout.
The Burnout Epidemic
Health care provider coaching focuses on provider well-being and performance challenges in the current pressurized environment, in which mounting rates of physician burnout represent what medical ethicist Arthur Caplan has characterized as a public health crisis. Burnout has taken center stage in the world of physician health, with an April 2017 joint session of the Federation of State Physician Health Programs (FSPHP) and the Federation of State Medical Boards (FSMB) focusing on burnout prevention.
To understand how coaching may play a role in alleviating burnout, we need to understand the change process involving the corporatization and commodification of the medical profession. Roughly 30 years ago (circa 1985), the physician was a knowledgeable, highly-revered healer who alleviated human suffering and cured disease on his or her terms, one patient at a time. The doctor-patient relationship was central to the art and craft of medical practice. Record-keeping, regulatory compliance, medical billing, and adherence to standardized practice guidelines remained in the background, rarely overshadowing the healing relationship with the patient or the autonomy of the physician. In today’s corporate health care environment, screen time and the ever-mounting stream of bureaucratic tasks have crowded out the main event: quality face time with patients. Frustration and pressure have supplanted the pride and satisfaction derived from alleviating the pain and suffering of a fellow human being.
Coaching Individual Health Care Professionals: Theory and Practice
How might coaching play a role in helping physicians and other health care professionals recapture meaning, joy, and satisfaction in their work and enable them to increase their internal locus of control? From a theoretical perspective, coaching enhances self-awareness, draws on an individual’s strengths, fosters creative problem-solving, questions self-defeating thoughts and beliefs, examines new perspectives, aligns personal values with professional duties, and helps clients maximize their inner knowledge and skills to enable them to handle the challenges before them.
From a more practical standpoint, coaching sessions can be held either in person or remotely. Although face-to-face coaching is preferable, coaching sessions are often conducted by telephone or Skype for 30 to 60 minutes to accommodate busy physician schedules. During the initial coaching sessions, coaches collaborate with their clients to identify and implement (1) actionable short-term and long-term goals that are consistent with clients’ strengths and values and (2) small and large actions that the clients themselves can take to achieve those goals. During subsequent sessions, coaches and their clients maintain focus on the goals, make necessary modifications, and may establish new goals in what can be thought of as an accountability partnership.
Coaches also may employ mindfulness training, resilience training, and stress management to assist their physician clients. These techniques are known to have efficacy in counteracting burnout, and they have been cited in a handful of studies suggesting that coaching helps practicing physicians. A February 2017 presentation on Physician Well-Being at the Society of Consulting Psychology focused on coaching as a strategy for enhancing the performance of teams and for promoting “healthcare industry culture change.” Figure 1 illustrates how different coaching interventions fit into the health care ecosystem and facilitate interactions between individual patients, professionals, and health care leaders.
Controlled Study of Physician Coaching: Encouraging Preliminary Results
In a current study funded by a grant administered through the Institute of Coaching at McLean Hospital (an affiliate of Harvard Medical School), a team of coaches and researchers is evaluating a group of 60 primary care physicians at four large Boston-area health care organizations (Atrius Health, Beth Israel Deaconess Medical Center, Mt. Auburn Hospital, and Boston Medical Center). The investigators are examining the extent to which a six-session, 3.5-hour positive psychology coaching intervention improves well-being, reduces burnout, and attenuates the intention to leave medical practice. To our knowledge, this investigation represents the first controlled study of a physician coaching intervention at this scale and is the first to focus on the development of client-centered goals.
Preliminary data have suggested that this type of intervention, in which coaches partner with distressed primary care physicians to identify and address their goals, can result in measurable improvements in job satisfaction, engagement, compassion, and other related variables. In addition, several study subjects have reported that working with a coach helped them initiate concrete changes that enabled them to improve their self-care and become more satisfied and engaged in their current position.
Deployment of Coaches to Different Settings
Increasingly, experienced coaches are being deployed to assist physicians in a variety of settings. At Physician Health Services in Massachusetts, an organization that assists physicians and physicians-in-training with health challenges that may impede their professional abilities, the number of physician self-referrals has nearly tripled in 4 years. Many of these self-referred physicians identify themselves as “burning out” and welcome referrals to coaches who can assist them with goals related to self-care and work-life balance. Many of our Massachusetts-based coaches are themselves physicians who have received training and certification in coaching. Some coaching engagements are completed in two to four sessions, whereas others may involve 20 or more meetings over a year or more, depending on the agreed-upon coaching goals.
We have observed that some physicians who are reluctant to receive services from mental health professionals are amenable to coaching interventions. The Brigham and Women’s Hospital Professionalism Program utilizes coaches to assist physicians with challenges in a wide variety of domains, such as professionalism, anger management, stress management, social and emotional intelligence, communication skills, and organizational skills. From our vantage point in Massachusetts, it appears that coaching physicians and other health professionals in how to deal with burnout and a variety of other problematic workplace behaviors is just beginning to enter the mainstream. Word of mouth, experience with health professional coaching, and the International Coach Federation’s FAQs all may guide the selection of an appropriate coach.
Toward a Culture of Coaching: Individuals, Teams, Organizations, and the Health Care System
Meta-analyses of the literature on remediating physician burnout that have been published in The Lancet and JAMA Internal Medicine have indicated that system-level interventions are more important than individual-level interventions. However, individual physicians, health care professionals, medical leaders, managers, and executives are the effector arms of the practice teams, groups, organizations, and corporate entities that together comprise the entirety of the health care delivery system. In order to optimize the performance of a system, individuals who direct the entities that comprise the system should interact and interface with one another harmoniously and with minimal friction.
Coaching’s emphasis on self-management and self-awareness is fundamental to the improved functioning of individuals such as practice and health system leaders as well as frontline clinicians. In addition, the focus on strengths-based solutions can enhance both individual and group performance. We would like to see coaching skills become a core competency of team leaders and medical managers at the practice level and are encouraged by initiatives such as the Resident Coaching Program at Massachusetts General Hospital.
This program pairs faculty members who are trained in positive psychology and coaching with residents and fellows. The purpose of these dyads is to help trainees overcome challenges and achieve goals early in training, thereby improving the self-management and teamwork skills that will become the foundation for a successful long-term career. We remain hopeful that a “culture of coaching in health care” is just now beginning to take root and that it will ultimately spread across the teams, organizations, and institutions that comprise the larger system. This culture may help stakeholders at every level embrace the dizzying change process that is one of the root causes of the burnout crisis.
In the past decade, the business world has become increasingly aware of the value of coaching. As the largest and one of the most important sectors of the entire U.S. economy, the health care industry is now discovering this important resource. Sadly, the overwhelming majority of physicians have not been adequately prepared to manage the personal and interpersonal stresses and strains of the rapid and choppy change process of health care in the 21st century. In addition to investing in technology and technical advances, health care innovators should invest in the development of scalable, evidence-based coaching programs with the potential to alleviate burnout by improving the functioning of the system’s human assets at every level.
Note: This article is an outgrowth of an interview with Dr. Adelman that took place in February 2017.