The Role of Coaching in the Restructuring of a Healthcare Organization

Introduction

Introduction and Background of the Problem

Currently in Washington, the health care debates continue. President Obama is hoping to eventually sign into law a new plan that is geared to overhaul the current health care system. As the bill passed through the Senate, several Republicans were geared to “slam the bill as a government takeover that would increase taxes and lead to rationing of healthcare.” (Werner, 2009, p.1). As the plan has continued to go through the political venues, the plan is making headway to be put into law soon. This plan says that it will overhaul the current health care system.

As the plan has maintained momentum, the general public has created opinions about the bill and many people are frightened. Many fear that government intervention in healthcare will happen and the quality of services will diminish. The media continues to exacerbate fears which are also substantiated by the Internet. As this researcher has read various comments about this overhaul, one issue is clear: The American people are more afraid of change than anything else. However, change is inevitable in life and in also in the health care sector.

Prior to this particular overhaul, many changes have already occurred in health care facilities. Hospitals and clinics have had to change their way of doing business and private insurance companies have also had to change the way they operated their business.

Statement of the Problem

In each change, a restructuring, or re-engineering had to take place in order to facilitate these organizations to continue moving forward. In order to create these changes, executive coaches have been consulted in order to make sure that leaders understood how to help their employees surmount these changes. Many leaders have found that they were more effective in their positions when they worked on a one-to-one basis with an executive coach.

Health care organizations are some of the few segments used for executive coaching because they have had to deal with many factors within their organizations. Hadikin (2004) suggests that one of the reasons that coaching has not been used is because of the adverse culture it has created over the last several years. Many health care professionals work in environments that are detrimental to their mental, physical and emotional health. Many professionals have to submit to bullying, some are intimidated by health care professionals and others have found that they need to learn how to work more effectively with their employees. “As you will see, coaching offers a way to convert this psychtoxic emotion into a nurturing healthy environment.” (Hadikin, 2004, p.xiv-xv). Because of these actions, health care organizations today are realizing the importance of coaching executives in the restructuring of their organizations in order to overcome the negative aspects of the work environment and embrace its positive aspects, thus performing better in functional areas.

Purpose of Study

This research will focus on the idea of change management and how it can be implemented within health care organizations with the help of exemplary leadership coaching. Coaching executives are needed by large and small organizations to evaluate the behavior patterns of their employees, their attitudes at work, their level of enthusiasm and motivation and the factors that help them have a positive outlook towards their job.

It is also the capacity of organizations to hire the services of coaching executives in accordance to their affordability. According to Giglio, Diamanate & Urban (1998) organizations are willing to provide a coach for senior level managers when it is perceived that the executive is in some form of transitional changes that involves anxieties. The challenge is that they need to work with their managers to solve these anxieties so that they can be more effective in their work during, and after the transition has taken place.

Significance of the Study

The purpose of this research is to identify of the role of coaching executives in the restructuring of a health care organization. This dissertation will identify the key areas that the coaching process will involve, including employee motivation, change management, employee empowerment, employee involvement and psychological issues related to the employees with regard to their behavior.

Research Questions

1. What is the role of a coaching executive during the restructuring of a health care organization?
2. Is it more efficient to hire executive coaches to enter the healthcare environment and work on a one-to-one basis with leaders, or is it better to create in-house coaches to coach other non-leader employees?

Basic Assumptions

This research assumes that the organizations being researched have a basic understanding of coaching executives and will be open to using coaching within their organizations. Further, it is also assumed that they may have had a few individual leaders who may already be coaching others inside the organization or have used such kind of executive coaching in the past.

Limitations

The results of this study are limited because only one such health care organization is being observed. A questionnaire will be the initial contact. There may be a margin of error in the questionnaire. In order to resolve this, focus groups and interviews will be used to create a case study in order to reinforce this study.

Definitions

Coaching is defined in many ways. For the purpose of this project, coaching is referred to a one-to-one relationship where one individual (the coach) guides another to the realization of specific goals. Executive coaching involves upper level management in this one-to-one relationship with a coach. An executive coach is an individual who has several years’ experience in a specific field who has obtained coaching credentials; to say the least they are certified as an executive coach. Health care professionals include doctors, nurses, technicians and any other leaders/employees who work within a health care organization.

Methodology

The research will use questionnaires, focus group interviews and observations to collect data for this project. Questionnaires will be comprised of both open-ended and closed ended questions. The goals is to talk to (number) of upper level managers within the organization. The main aspect that needs to be considered is the role of executive coaching in leadership development. In this study, 150 Executives and 40 coaches of an uptown large service organization in the medical field were surveyed as part of the research, using pre-determined data. The main areas that need to be tested and measured in this survey would be as follows:

1. How executive coaching improves people management skills (2). How it fosters better managerial relationships (3). How this improves goal achievement and managerial priority setting (4). Using executive coaching for increasing productivity (5). Enhancing effective managerial communication skills and communication networking.
2. The main focus of this research study would be on ways and means to ascertain how executive coaching could help in effective improvements in the functioning of executives, and thus, in the overall conduct of business.
3. It is also necessary to understand whether a one-to-one relationship between executive coaches and leaders is more worthwhile, or would a direct interaction between coaches and non-leader employees be more effective from point-of view of managerial effectiveness and performance ?

Summary

Coaching is an effective way to assist leaders in many areas. Within the health care arena, many leaders are faced with stress and constant change. Hiring the executive coach can help them negotiate these periods of transition with a greater degree of ease and comfort.

Chapter 2 of this study would be concentrating on the review of literature and would concern itself with the current trends of coaching and how this would empower industry leaders to exercise better control and supervision in the exercise of their executive functions.

Chapter 3 would be considering survey of literature and the role of executive coaching as a specialized and distinct entity intending to improve managerial and executive performance along pre-determined lines. It would also be considering the critical role played by coaching in management performance, especially during major transitions, stress, diverse clients. It also considers the successful leadership traits required for implementing executive coaching schemes, especially relating to coaching that focuses on managerial performance and enhancing skills and abilities.

Chapter 4 focuses on research method and analysis that considers selection, research method and analysis and also selection procedures.

As far as Chapter 5 is concerned, this considers the actual outcomes and analysis of data as against the different possibilities that ensure due to distinct possibilities. This chapter would consider the fact that, more than the theory attached to executive coaching, the practical implementation of this would be more appropriate.

In Chapter 6, the summary, recommendations, and conclusions would be considered.

Literature Review

Within the last several years, executive coaching has been a part of the mainstream media because of its use in business organizations. Generally coaches have been used to increase the effectiveness of corporate leaders. Kilburg (2007) states that coaching began in 1987 but was not known until 1996 when the Consulting Psychology Journal: Practice and Research (CPPI), focused a special issue on executive coaching (p. 7). There were several volumes of information about coaching that CPPI created but this information was only available to subscribers of the journal. These articles were later published in the book:

The Wisdom of Coaching: Essential Papers in Consulting Psychology for a World of Change. This book allows the readers to know about “the tactics and methods coaches use to help clients improve their performance in a variety of difficult situations.” (Kilburg & Diedrich, 2007, para.4). This action was significant because it brought coaching into a more mainstream arena and allowed non-subscribers the ability to take advantage of the new information.

Smith (n.d.) explains that the field that is now known as coaching grew rapidly between the years 1980 and 1994 and it evolved into a variety of specialties, including executive coaching. Since 1995, the need for business coaches arouse out of the need to improve the performance of leadership. Today, executive coaching has often been used synonymously with successful executives.

Health care organizations have found that coaching is a very important way to effectively assist leaders in becoming more effective. Since September 11, 2001, many health care organizations found that they would need to restructure their businesses in order to meet the needs of the community. Rowitz (2009) suggests that public health organizations went through an identity crisis because of this terrorist attack. Another reason why health care organizations had to change was that the public at large was not aware of what public health organizations did or their various accomplishments. Many organizations realized that they would need to change the way they practiced health care because of this lack of awareness.

As the new healthcare plan comes to fruition in the United States, health care organizations will again need to change and developing leadership purposefully becomes more important. Rowitz suggest that as healthcare continues to evolve, health care provides will need to not only advocate at the opinionated and strategy improvement stage but they will also need to create their own visions of how health care should look. In order to answer Rowitz’s charge, leaders will have to be able to understand how to coach their employees towards these changes.

The Role of Coaching in Business Leadership

Coaching has been a very important aspect of business because it has allowed companies to improve their bottom lines. In times of change and restructuring, coaching has played a vital part to help executives not only prepare employees for change but also to assist them in the transition. Hamel (2007) suggests that management must continue to change if companies will become more innovative and open to change. Since many companies have a global component today, coaching has also helped executives pay more attention to the needs of diverse groups they employ. Leaders have learned techniques and skills that have helped them work more effectively with their employees.

Organizations have found that leaders must be more people-oriented if they want to keep their best talent and organize them to be more effective. As an example, Dotlich, Cairo and Rhinesmith (2006) explain that heart is something that all leaders need because they must combine the needs of the company with the needs of the people inside the organization and also show “the ability to set strategy, empathize with others, and take risks—all at the same time.” (Dotlich, Cairo & Rhinesmith, n.d., para.1).

When they are able to do this they are able to move their employees forward. When they only focus on the business, they find that their employee’s morale diminishes and they lose their best talent. Some of the characteristics they must have include empathy, to ability to foster inclusiveness, and demonstrating a real concern for their employees will help employees develop trust with the leaders

Shelton (2007) suggests that in order for leaders to create strong employees they must understand the blind spots they may be working under. She defines blind spots as obstacles that prevent leaders from using their strengths and they hide the significant talents that leaders may need to use. When leaders work from these blind spots they can make employees have negative view points of the leader which can cause mistrust.

White (2006) adds to this discussion by stating that motivation is necessary for change. Within change a leader must understand that change is going to bring discomfort, employees will feel awkward and stress will definitely have a part of any change. This researcher agrees that a leader must have certain people skills in order for them to create effective change within any organization. Without a knowledge of people and how they will react to change, a leader cannot be as effective as they can be within the organization.

Perspectives in Coaching

There are several perspectives that are taken into consideration when defining caching. The major goal for coaching, according to White (2006), is behavior change. White suggests that the following perspectives are important to understand as leaders begin to understand coaching:

Behavior perspective: This theory promotes the idea of observable behavioral change. To enact this type of change, the coach helps the leader to focus on specific behaviors to in order to make change happen.

Cognitive perspective: In this perspective, the thought processes that drive behavior are the focus and it defines how people make decisions. Within this perspective, there are three types that are important to cognitive thinking:

1. Mental models identify the thoughts that create a leader’s behavior. This perspective also holds the motives and intentions that create behavior.
2. Beliefs determine how a leader perceives the world and describe how people act in the way they do. Beliefs also determine how their industry works.
3. Self-concept is about how leader sees themselves, how others view them as leaders and how they would like to view themselves in the future.

The goal for this cognitive perspective is for the leader to examine their thinking patterns that are a part of the client’s behavior that is most significant

Values perspective: The values perspective helps to define “the things that are important to a person … things they cherish and want in their lives.” (White, 2005, p. 190). Work-related values like high earning potential, influence with people, independence, challenge and risk taking are all a part of the workplace. The role of values in coaching is that values make a leader put a lot of energy into the areas that they most value. Values are another way that behavior is shaped.

The emotional perspective: The emotional perspective explains the drives an demotions that drive an individual. These emotions are more involved with certain behaviors. When leaders are aware of their emotions, they are also aware of how their emotions, they are also aware of how their emotions interact in the workplace. Emotions are another factor that will give the individual a “Greater choice and flexibility” in the workplace. (White, 2005, p. 194).

The neuro-scientific perspective: The neuroscientific perspective brings together all of the other perspectives and suggests that there is a neural foundation for each of the other perspectives. According to White, this perspective allows a coach to work on several levels at once.

The Benefits of Using a Coach

Coaching has many benefits for the leader. According to Wilson (2007) there are seven principles that coaching adheres to that are central to the benefits that it brings. According to Wilson, coaches assist leaders in finding the awareness of what they need to do to become better leaders. The coach can bring self-knowledge to the leader and help them better move toward their goals.

Coaching makes more responsible leaders and helps them gain confidence in their skills and abilities especially in the area of working more effectively with their employees.Coaches provide leaders an opportunity to become more solution focused and challenges the coach to look for new ideas and perspectives that allow them to take action Wilson demonstrates that coaching can help a weak leader become stronger once they understand their own strengths.

Organizations benefit from using coaches as much as the individuals within the organizations. Fitzgerald and Berger (2002) discuss the ways that the executive coach can assist the organization. They stated that “executive coaches bridge.. the worlds of the executive coach and the executive’s organization. A good coach knows that it is vital to have a sense of the key corporate issues that surround the executive an, also, that he or she must understand those issues both from the executive’s perspective and from the perspectives of others in the organization.” (Fitzgerald & Berger, 2002, p.28).

In summary, coaches help the organization by enhancing leadership. They provide the executive with the environment to develop the skills they need to work with employees more effectively. In doing so, the coach also helps the executive find the most innovative and creative ideas to bring to the organization; this action will also stop the best talent from leaving the organization in many cases.

The Importance of Coaching Leaders

Although many people may think that coaching leaders would not be necessary, there are different reasons why leaders would need coaching. As an example, a leader who has been an entry-level manager, may need coaching when they receive a promotion. A leader who leaves one organization for another may find coaching important to understand the new environment. These are opportunities for executives to be coached from within an organization where coaches have become a strong part of the organization. Hargrove (2003) suggests five steps to coaching executives that illustrate the point that coaching leaders is important:

• Step 1: Enroll leaders in an “extraordinary coaching relationship.” (Hargrove, 2007, slide.5). This is in order to build rapport and understand the needs of the leader and their organization.
• Step 2: Coach leaders to design an “impossible future” (Hargrove, 2007, slide.5) for themselves and their business. So they will automatically align their goals with the goals of the company. This step helps the executive see a bigger picture for themselves and helps them find out what they are most passionate about in their career.
• Step 3: Gather “360 degree feedback” (Hargrove, 2007, slide.5) and create a leadership remuneration plan. In the coaching relationship, a leader can receive feedback from colleagues, customers, their boss and even their families so that they can address their total leadership acuity. This valuable information can help them re-invent part of what they are doing in their lives and this in turn helps them in re-inventing the organization (Hargrove, 2003).
• Step 4: Strategic planning in action wit the leader and his or her group so that everyone can understand what things are going well, where the company is headed and what may be missing from their experience here and now.
• Step 5: Coach leader effectiveness through rigorous, active, monthly follow-up so that the leader can become highly effective in what they do.

These steps show one example of how coaching can be effective on many levels. This is not to say that the only way to work with leaders is coaching, but of many techniques, coaching is one of the most effective.

Although some people may think that all leaders are the same and should be coached the same, Grubb & Ting (2007) point out that senior leaders are very different than other types of leaders. Their definition of senior leaders is those who have at least “Fifteen years of management experience and leadership responsibility for five hundred or more people.” (Yip, Ernst & Campbell, 2009, p.8).

These are leaders who are seasoned and who have gone through many transitions during their many years in one or many organizations. Senior managers will also have different concerns than lower level managers. Grubb and Ting state that senior leaders have specific traits/themes that should be taken into consideration when coaching them. These traits/themes can be important at several management levels. These traits include:

1. Experience – they have many more years of experience than other leaders and they are usually older.
2. Ambition and mastery – they have strong ambition and a strong drive to succeed. They are in a position to take on new challenges and they have the character traits of Ego strength, self-confidence, resilience, determination, and drive.
3. Power and control – they understand they have their own ideas that should take precedence over all other ideas. They seem to have a strong need for power and control in their careers.
4. Leadership stature – they are more confident in their careers so they appear very assertive and comfortable in their careers.
5. Resistance to change – these are the managers who will be most resistant to change because they have been more successful than others. Because what they have done to the point where they are know has worked, they question why they would need to change.
6. M.O.O. or the Myth of Omniscience and Omnipotence – Grubb and Ting refer to this as a psychological blind spot because these leaders are highly successful and are the top talent in the organization. They always feel that they should be the ones who fix everything in the organization, often single handedly.

These characteristics are important because when coaching these executives, coaches must have a high level of skill and experience to help these individuals.

Survey of Literature

Coaching Leaders through Transition

Transition is a common experience that leaders and organizations go through and how they move through the transition is determined by the leadership in the organization. Bunker suggests that change is always quick and constant.” Executives can learn to be more effective in dealing with the emotional elements of transition.” (Ting & Scisco, 2006, p.205).

This means that a leader must be at top performance all the time. The challenge for leaders in a fast paced and changing environment is that emotions are always high. Leaders may need to let go of skills they have already established and they may find that the way they have always done some procedures will have to change in the process of moving the organization forward.

Coaching Leaders through Stress

In transition, leaders and employees will be under stress which will also mean that emotions will be high. This means that leaders will need to be in touch with their own stress, so they can understand what their employees are experiencing. By being in touch with their own feelings, they will also be alert to the various conflicts that may happen. A good point that Bunker makes is that during times of transition, organizations often go in search of the best practices for avoiding or doing away with thorny emotional issues. “Furthermore, the coaching process can help them develop the skills that underlie the process of becoming more authentic and empathic leaders.” (Ting & Scisco, 2006, p.205).

In other words, Bunker is saying that organizations want to ignore the emotional issues that are a natural part of any transition.

Selby and Netanel (2008) agree that understanding the emotions of employees is important for leaders. They also suggest that leaders can set the reactions to emotions for the day. These authors also agree that a leader must understand their own emotions so that they can create the emotional environment for each day. In other words, the leader must understand that they can set the mood they want by modeling to their employees what they would like. This will often involve a shift in focus for the leader so that they can focus on what is going on in the present moment instead of putting focus on the past or too far into the future. This action will help everyone leave negative emotions out of the workplace as much as possible. As leaders guide their employees through transition, they must understand that emotions are a very integral part of change in any type of change situation.

Selby and Netanel describe executive genius and Menkes (2005) describes a similar concept called executive intelligence. They explain that leaders must have certain traits that guide individuals through transition. Menkes defines executive intelligence as “a distinct set of aptitudes that an individual must be able to demonstrate in three central contexts of work: the accomplishments of tasks, working with and through other people and judging oneself and adapting one’s behavior accordingly.” (Menkes, 2005, para.14).

Both of these concepts encourage leaders to consciously work with their employees through transition and help them move forward.

Bridges (2004) agrees with Selby and Netanel as well as with Bunker that emotions are important when going through a “transition.”

Bridges refers to this as the individual side of the organization. He emphasizes the fact as did Selby and Natanel that leaders usually do not have challenges, implementing physical or tactical issues because they generally have the skill to do these aspects of change. However, they must be ready to embrace change so that they de-emphasize the old ways of doing things so they can undergo a mental transformation to adjust to new ways. “Transitions coaching helps people recognize the phases of transition and act in the best ways to make the changeover successful.” (Bridges, 2004, p.2).

Bridges says that transition coaching should focus on helping a leader through their own transition so that they will have the skills to help their employees do the same (p. 94). This researcher agrees that leaders must understand the emotional, psychological, and tactical aspects of change in order to align the organization for these changes.

Coaching Diverse Clients

Leaders are also in charge of a diversity of employees and they should take into consideration that there may be different reactions to change that are based within cultures. Thomas (2005) suggests that leaders must look further into diversity and understand that a variety of “mixtures” are part of diversity; the mixture goes beyond race and culture. He continues to define diversity as having many differences that included different processes that come together and have to be sorted out. This broader idea of diversity allows leaders to identify the “critical diversity mixtures.” (Thomas, 2006, p.22).

This could also infer what their specific circumstances needs. Hunt and Weintraub (2007) take a more traditional approach to diversity and state that diversity brings more opportunity for on-the-job learning. “This work explores the developmental transitions required of managers if they are to effectively promote learning rather than compliance.” (Hunt, 2004, para.1). Ruderman and Ohlott (2006) reported on counseling high level leaders who are “women.” (Sheppard, 2009, p.9).

In the majority of organizations, women are in a structure that was created around a traditional male environment. In this type of environment, women are often left out of formal networks and must find their own way. Often wages and salary structures are different as well as understanding of how they must create their own way within the organization. These researchers also found there were psychological differences that were also important. In this area, coaches must understand that women are more internally motivated and they respond differently to feedback, and they communicate differently (Ruderman and Ohlott, 2006). Rudderman and Ohlott demonstrate also that coaching is a specific action that each individual coachee defines for themselves. The coach is involved on the level of understanding the differences in executives they coach and being mindful of the aspects they must take into consideration when they are creating the opportunity for coaching. “It is based on a US study into the developmental issues that high-achieving women face in defining and shaping their careers.” (Sheppard, 2009, p.9).

Coaching Successful Leaders

Goldsmith (2002) suggests that to coach successful people that it is important to understand how they think. He states that successful people usually have four beliefs that underlie everything they do: “1) I chose to succeed, 2) I can succeed, 3) I will succeed and 4) I have succeeded.” (Goldsmith, 2003, p.2).

Because they have these beliefs, they do not respond to a coach’s manipulation, therefore the motivation for their change must come from within. Goldsmith also discusses the concept of “cognitive dissonance” which states that the more an individual is committed to believing that something is true, the less likely they will be to be willing to change their beliefs. (Goldsmith, 2003, p.3). For leaders, this means that coaching must be ready to address their specific needs that are defined by the leader. As an example, feedback should be geared towards the self-directed behaviors that the leader has identified for themselves.

Fulmer and Goldsmith (2001) suggest that the best way to coach in any organization is to adapt a program like Six Sigma so that everyone will be trained at different levels so that everyone is being helped. They also caution that in order to make sure leadership development is accepted, it “leadership development is closely tied to and used to support the business strategy of the organization.” (Fulmer & Goldsmith, 2001, p.306). Flaherty (2005) adds to this discussion by stating that ” in enrollment, both the client and the coach make explicit what they are committed to authorizing in the coaching program, potential outcomes and possible hindrances.” (Flaherty, 1998).

In other words, successful coaching happens when the CEO is engaged in the process and the coachee is also engaged and interested in being coached.

In summary, Goldsmith suggests that successful leaders are not going to change behavior because they enroll in a course but because of their individual hard work and the labors of their “respected colleagues.” (Goldsmith, 2003, p.2).

In other words, successful leaders can be a complicated group to coach if the coach does not understand how to effectively work well with them.

Coaching Health Care Professionals

Coaching has been used in a varsity of ways with health care professionals in a variety of settings. Powell (2001) begins the discussing on coaching in health care because she acknowledges that health care organizations need positive leadership through the use of “useful strategies for team-building, delivering criticism, resolving conflict, and increasing staff cohesion.” (Powell, 2009, para.1).

Leaders are responsible for understanding the vision of their organization and then communicating this vision. Because of the recent changes in health care, Powell suggest that physicians and other medical personnel must use active leadership in order to coach other personnel.

Pelote and Route (2007) provided case studies that provide information into best practices for health care leaders to explain how coaching worked for their organizations. The hospitals they spotlighted had several traits in common: strong leadership, making patients first, team work and rewarding and recognizing employees. These traits are important to any organization and leaders who are able to use these traits are able to coach more effectively.”Leaders selected the competencies and styles that they felt were most reflective of their leadership practices.” (Pelote & Route, 2007, p.15-16).O’Grady and Mallock (2007) suggest that in order for leaders to be effective they must learn to coach instead of using the older, traditional methods. They suggest that in order to use coaching, leaders must “gain an understanding of the emotions and attitudes of all members of the organization and communicate this understanding to everyone else.” (O’Grady & Malloach, 2007, p.260).O’Grady and Mallock also state that leaders should coach upwards in their organizations. Their suggestion means that employees with less authority should coach those with more authority. This is an interesting idea but I am not sure it would be easy for those upper mangers to accept. However, this could be part of a 360 degree assessment.

Health care organizations have their own unique environments. Most Americans would agree that when they go to a health care faculty, they can tell by the attitude of the staff whether they want to go back to that facility again. In light of the current changes in health care brought on by President Obama’s Administration, health care organizations will see a change in their environments again. Common sense seems to dictate that the staff in these organizations must be flexible and ready for change. Seren and Baykal (2007) researched the attitudes of health care workers in hospitals in order to evaluate and assess the management’s efforts “To define organizational culture in hospitals that have received quality certificates and to identify attitudes of healthcare personnel toward change.” (Seren & Baykal, 2007, para.2).

Their purpose was two fold: 1) They wanted to define “organizational culture” in hospitals that had received top recognitions and 2) they wanted to “identify attitude towards change.” (Westaby, 2010, para.1).

Several significant issues came from this study:

1. For effective restructuring, all staff must be coordinated for common purposes and for setting up open communication.
2. Transitions through change in health care can be difficult because of many factors that include differences of opinions between departments, members who have different requirements or interests and the strictness of organizational cultures.
3. In order to have positive change, leaders must concentrate not only on the organization’s culture but also on the values, outlook, and customs of the culture.
4. In identifying the culture they must identify the one that is most dominant in the culture.

Basically, these researchers are saying that health care organizations must understand that as they are moving through change, all staff must be involved in the change and there must be opportunities for open communication.

Customer care is a very important of health care operations and the personality of the staff that customers (patients) first come in contact with, will let the customer know whether they want to return. Alleyne and Jumaa (2007) studied the role that executive co-coaching and clinical group supervision had on nursing leadership

The researchers found three significant results from the study:

1. Coaching and group supervision provided leadership interventions that helped improve the quality of service done by he participants in the study.
2. The participants gained confidence in their performance because leaders used the techniques, tools, methods and frameworks used in the coaching sessions.
3. Using a structured approach model allows more flexibility with change and it makes change more practical and manageable when the organization is going through the turbulence of change.

This was also in order “to link management and leadership theories with clinical practice and to improve the quality of the service provided to their patients.” (Manag, 2007, para.1).These researchers demonstrate that solid coaching and interventions can create a positive movement through change. In other words, employees need strong leadership and structure when they are moving through change zones.

Caldwell, Butler and Poston (2009) agree with Alleyne and Jumahh in that a formal structure works best in change in health care environments. The structure that they suggest is Lean Six Sigma. Their research shows that the role of Senior managers is to 1) raise the bar on performance, 2) cost recover, 3) organizing to drive change, 4) being accountable for managing change, 5) experimenting with what works and does not work, 6) making organization change sustainable, and 7) engaging physicians in the process (p. 4). To do this they suggest that Lean Six Sigma will assist with the organization.

Lean Six Sigma is described as having four characteristics — It is a “strategy deployment approach, a belief system, a statistical calculation [and] a suite of project improvement methods” (p. 5) (Caldwell, Butler & Poston, 2009, p.5). In other words, the system provides a structure that encompasses all the aspects o leader needs to do their job. Hadikin (2004) also attests for the need for structure in health care coaching. In her view, the coaching is always fluid so that it can be changed when necessary. Also, the actual coaching session should be structured according to Hadikin, so that time is set aside, within the regular work day, for coaching to occur “that empower, motivate and facilitate our growth and development.” (Hadikin, 2004, P.169).In the health care field the traditional way of leading has been through giving directives to subordinates. Leebov and Scott (2002) suggest that in today’s health care environment, coaching should be used instead of this traditional way. They suggest that different forces that are acting upon health care providers constrains them and managers need to “act from it in how we manage our area of responsibility and how we focus and coach our teams.” (Leeboy & Scott, 2010).

I agree with these authors because it seems that people respond better to leaders who help them in their jobs instead of those who only tell them what to do. I also agree that there have been many changes in health care and there will be more changes. Leaders will need to respond to these changes in positive ways. Leebov and Scott also encourage leaders in health care to get to know their employees better, to find out how they perceive the environment and to develop better relationships.

Rowitz (2009) adds to this discussion but suggests that coaching should be done by hiring a coach to come into the organization to coach executives. Rowitz stated that “coaching involves the learning of new information and finding its fit with pre-existing information.” (Rowitz, 2008, p.455). An observation that I have made through this research is that health care seems to be one of the last areas of business to adopt coaching on a large scale. Perhaps this is because health care has always been a traditional profession where employees were used to being told what to do. Coaching takes a very different approach and as health care changes, coaching may be the answer to keeping employees and patients happier.

Clark (2009) suggests that coaching and mentoring go hand in hand. There is a distinction between coaching and mentoring in that coaching is a short term process that focuses on enhancing immediate professional development and anchor “leadership information.” (Clark, 2009, p.4).

Mentoring on the other hand, is a longer-term relationship that allows potential leaders who want to move forward in their careers to do so. Mentoring is more focused on learning new ways to do things over time while coaching is more immediate. I agree that mentoring is important because my experience with mentors in my own life confirms that what she is saying is true.

Conclusion

The research suggests that coaching is a very important process in health care organizations. The majority of the studies either said or implied that coaching should be an internal process. The literature describes the coaching process and how it can help leaders move their organizations forward. The literature also supports building leaders inside the organization would allow the coaching to continue throughout the life of the organization. The literature also supports mentoring as an on-going and long term process that compliments coaching. “These articles tend to be anecdotal rather than empirical however, and despite the wealth of apparent experience in the practice, no clear definition of the outcomes or the process of coaching is defined.” (Natale & Diaminate, 2005, para.3).

The question still remains, as to which method works best in health care? Because of this, the research that I will conduct will give answer to this question.

In the next Chapter, the focus would be on research method and analysis that considers selection, research method and analysis and also selection procedures. Perhaps at the next stage, it would be possible to gain better insight and understanding on the subject of executive coaches and coaching process. It is often and truly believed that, despite the plethora of theories on executive coaching, empirical studies that are available for this kind of coaching are limited, since most have been internal exercises that are held back for competitive and confidentiality reasons. Thus what is available under the current genre of literature need to be supplemented with further research, “the construct of executive coaching and examine how coaches’ professional training, client characteristics, and types of coaching impact the effectiveness of this intervention.” (Fledman, 2005, para.3).

References

Alleyne, J., & Jumaa, M.O. (2007). Building the capacity for evidence-based clinical nursing leadership: The role of executive co-coaching and group clinical supervision for quality patient services. Journal of Nursing Management 15(2), pp.230-243.

Altman, W. (2007). Executive coaching comes of age. Engineering Management 17(5″), pp.26-29.

Atwater, L., Wang, M., & Smither, J.W. (2009). Are cultural characteristics associated with the relationship between self and others’ ratings of leadership? Journal of Applied Psychology 94(4), pp.876-886.

Battley, S. (2006). Coached to lead: How to achieve extraordinary results with an executive coach. CA: Jossey-Bass.

Belf, T.E. (2002). Coaching with spirit: allowing success to emerge. CA: Jossey- Bass/Pfeiffer.

Benton, D.A. (1999). Secrets of a CEO coach: Your personal training guide to thinking like a leader and acting like a CEO. NY: McGraw-Hill.

Bridges, W. (2004). Profiles in coaching: Transitions coaching. Link&Learn. Web.

Bridges, W. (2005). Transition coaching in Morgan, H., Harkins, P. & Goldsmith, M. (Eds.) The art and practice of leadership coaching: 50 top executive coaches reveal their secrets, pp.93-96. NJ: John Wiley & Sons, Inc.

Buckingham, M., & Coffman, C. (1999). First break all the rules: What the world’s greatest managers do differently. NY: Simon & Schuster, Inc.

Butler, K.A. (2007). Coaching leaders through change and transition. In Ting, S., Scisco, (Eds). The CCL handbook of coaching: A guide for the leader coach, pp.203-229. CA: Jossey-Bass.

Caldwell, C., Butler, G., & Poston, N. (2009). Lean-Six Sigma for healthcare: A senior leader guide to improving cost and throughput. 2^nd Ed. WI: Quality Press. Web.

Clark, C.C. (2009). Creative nursing leadership & management. Amazon.com. Web.

Clark, C.C. (2009). Creative nursing leadership and management. MA: Jones and Bartlett.

Claridge, M.T., & Lewis, T. (2005). Coaching for effective learning: A practical guide for teachers in health and social care. WA: Radcliffe Publishing.

Conger, J.A., Spreitzer, G.M., & Lawer, E.E. (1999). The leader’s change handbook: An essential guide to setting direction and taking action. CA: Jossey-Bass Publishers.

Crippen, C. (2005). Servant-Leadership as an effective model for educational leadership and management: First to serve, then to lead. Management in Education 18(5), pp.11-16.

Dierdorff, E.C., Rubin, R.S., & Morgeson, F.P. (2009). The milieu of managerial work: An integrative framework linking work context to role requirements. Journal of Applied Psychology 94(4), pp.972-988.

Dotlich, D.L., Cairo, P.C., & Rhinesmith. (2006). Head, heart and guts: How the world’s best companies develop complete leaders. NY: Jossey-Bass.

Dotlich, D.L., Cairo, P.C., & Rhinesmith, S. (2006). Head, heart and guts: How the world’s best companies develop complete leaders. J-B US non-Fanchisee Leadership. Web.

Ennis, S., Goodman, R., Hodgetts, W., Hunt, J., Mansfield, R., Otto, J., & Stern, L. (2005). Core competencies of the executive coach. Web.

Erwin, D. (2009). Changing organizational performance: Examining the change process. Hospital Topics 87(3), pp.28-40. Retrieved October 2, 2009 from Academic Search Premier. AN: 39887942.

Fitzgerald, C., & Berger, J.G. (2002). Executive coaching. Nicholas Brealey. Web.

Fitzgerald, C., & Berger, J.G. (2002). Executive coaching: Practices and perspectives. CA: Davis-Black Publishing.

Flaherty, J. (2005). Coaching: Evoking excellence in others. MA: Elsevier Butterworth- Heinemann.

Flaherty, J. (1998). Coaching: Evoking excellent in others. Butterworth-Heinemann. Google docs. Web.

Fledman, C.D. (2005). A review and a gender for future research. Journal of management executive coaching. Southern management association (Sage journals online). Web.

Flora, C. (2009). How to become indispensible in scary times. Psychology Today 42(4), p.59.

Fulmer, R.M., & Goldsmith, M. (2001). The leadership investment: How the world’s best organizations gain strategic advantage through leadership development. AMACOM div American management association. NY: AMACOM. Web.

Gagne, M. (2009). A model of knowledge sharing motivation. Human Resource Management 48 (4), pp.571-589.

Giglio, Diamanate & Urban. (1998).

Goldsmith, M. (2002). Changing the behavior of successful people. In Hesselbein, F., Goldsmith, M., & Somerville, I. (Eds.). Leading for innovation and organizing for results, pp.39-56. NY: Jossey-Bass.

Goldsmith, M. (2003). Helping successful people get even better. London: Business Strategy Review, p.2. Web.

Goldsmith. (2003).Helping successful people get even better. London business school, Spring. Web.

Grubb, T., & Ting, S. (2006). Coaching senior leaders. In Ting, S., Scisco, P. (Eds.). The CCL handbook of coaching: A guide for the leader coach, pp.145-175. CA: Jossey-Bass.

Hadikin, R. (2004). Effective coaching in healthcare. CANADA: Elsevier Science Limited. Web.

Hamel, B., & Breen, B. (2007). The future of management. MA: Harvard Business School Press.

Hamric, A.B., Spross, J.A., & Hanson, C.M. (2009). Advance practice nursing: An integrative approach. 4^th Edition. Missouri: Saunders/Elsevier.

Hargrove, R. (2003). Masterful coaching. CA: Jossey-Bass/Pfeiffer.

Hargrove, R. (2007). 12 catalytic coaching conversations. Masterful Coaching Certification Program, slide 5. Web.

Heifetz, R., & Mery, L. (2002). A survival guide for leaders. Harvard Business Review 80(6), pp.65-72.

Hesselbein, F., Goldsmith, M., & Somerville, I. (2002). Leading for innovation and organizing for results. NY: Jossey-Bass.

Hunt, J.M. (2004). Learning developmental coaching. Journal of Management Education, Sage Journals Online. Web.

Hunt, J.M., & Weintraub, J.R. (2007). The coaching organization: A strategy for developing leaders. CA: Sage Publications.

Kilburg, R.R., & Diedrich, R.C. (2007). The wisdom of coaching: Essential papers in consulting psychology for a world of change. American psychological association. Web.

Landry, G., & Vandenberghe, C. (2009) Role of commitment to the supervisor, leader-Member exchange, and supervisor-Based self-esteem in employee-supervisor conflicts. The Journal of Social Psychology 149(1), pp.5-27.

Leeboy, W., & Scott, G. (2002). The indispensable health care manager: Success strategies for a changing environment. CA: Jossey-Bass.

Leeboy, W., & Scott, G. (2010). The indispensable health care manager: Success strategies for a changing environment. Amazon.com. Web.

Levenson, A. (2009). Measuring and maximizing the business impact of executive coaching. Consulting Psychology Journal: Practice and Research 1(2), pp.103-121.

Lippitt, L.L. (1998). Preferred futuring: Envision the future you want and unleash the energy to get there. CA: Berrett-Koehler Publishers, Inc.

Luecke, R. (2004). Coaching and mentoring: How to develop top talent and achieve stronger performance. Harvard Business Essentials. MA: Harvard Business School Press.

Mackie, D. (2007). Evaluating the effectiveness of executive coaching: Where are we now and where do we need to be? Australian Psychologist 42(4), pp.310-318. Academic Search Premier 27240620.

Mang, N.J. (2007).Building the capacity for evidence based clinical nursing leader ship: the rule of executive co- coaching and group clinical super vision for quality patient services. Ncbi.

McAdam, S. (2005). Executive coaching: How to choose, use and maximize value for yourself and our team. London: Thorogood Publishing Limited.

McRae, H. (1994). The world in 2020: Power, culture, and prosperity. MA: The Harvard Business School Press.

Menkes, J. (n.d). Executive intelligence: What all great leaders have. ACT Public Library. Web.

Menkes, J. (2005). Executive intelligence: What all great leaders have. NY: Harper- Collins.

Morgan, H., Harkins, P., & Goldsmith, M. (2005). The art and practice of leadership coaching: 50 top executive coaches reveal their secrets. NJ: John Wile & Sons, Inc.

Morris, J. (2007). The five insights of enduring leaders. CO: Bristlecone.

Natale, M.D., & Diaminate, T. (2005).The five stages of executive coaching: Better process making better practice: journal of business ethics 59. pp. 361-374. Web.

O’Grady, P.T., & Malloach. (2007). Quantum leadership: a reason for health care innovation. 2^nd Ed. Jones and Bartlett Publishers. Web.

O’Neill, M.B. (2007). Executive coaching with backbone and heart: A systems approach to engaging leaders with their challenges. 2^nd Ed. CA: John Wiley & Sons.

Orem, S.L., Binkert, J., & Clancy, A.L. (2007). Appreciative coaching: A positive process for change. CA: Jossey-Bass.

Pelote, V., & Route, L. (2007). Masterpieces in health care leadership: Cases and analysis for best practice. Jones and Bartlett. Web.

Pelotte, V., & Route, L. (Eds.) (2007). Masterpieces in health care leadership: Cases and analysis for best practice. MA: Jones and Bartlett.

Powell, K. (2001). Communicating with your staff. U.S.: American Medical Association.

Powell, K. (2009). Communicating with your staff: Skills for increasing cohesion and teamwork. American Medical Association. Flipkart.com. Web.

Rouse, W.B. (1993). Catalysts for change: Concepts and principles for enabling innovation. NY: John Wiley & Sons.

Rowitz, L. (2009). Public health leadership: Putting principles into practice. 2^nd Ed. MA: Jones and Bartlett Publishers. Web.

Ruderman, M.N., & Ohlott, P.J. (2006). Coaching women leaders. In Ting, S., Scisco, Eds). The CCL handbook of coaching: A guide for the leader coach. CA: Jossey-Bass, pp.65-91.

Salopek, J.J. (2006). Leadership for a new age. T&D 60(6), pp.23-24.

Savage, C.M. (2001). Executive Coaching: Professional Self-Care for Nursing Leaders. Nursing Economic$ 19(4). pp.178- 182.

Seren, S., & Bauykal, U. (2007). Relationships between change and organizational culture in hospitals. Journal of Nursing Scholarship 39(2), pp.191-197.

Selby, J., & Netanel, A. (2008). Executive genius: How to build a high-awareness company. NJ: The Career Press.

Shelton, C.M. (2007). Blindspots. NJ: John Wiley & Sons.

Sheppard, L. (2009). Coaching senior professional women in the UK: What is the focus and what has been learnt in the process? i-coach Academy, p.19. Web.

Silsbee, D. (2008). Presence-based coaching: Cultivating self-generative leaders through mind, body, and heart. CA: Jossey-Bass.

Smeltzer, C.H. (2000). Executive coaching: A tool for success. Journal of Nursing Administration 30(12), pp.565-617.

Smeltzer, C.H. (2002). The benefits of executive coaching. JONA: The Journal of Nursing Administration 32(10), pp.501-502.

Smith, E.R. (n.d.). A brief history of executive coaching. Web.

.Ting, S., & Scisco, P. (Eds.). (2006). The CCL handbook of coaching: A guide for the leader coach. John Wiley and Sons, p.205.

Thomas, R.R. (2006). Building on the promise diversity: How we can move to the next level in our workplaces, our communities, and our society. AMACOM Div America Mgmt Assn, p.122. Web.

Thomas, Jr., R.R. (2005). Coaching for strategic diversity management. In Morgan, H., Harkins, P. and Goldsmith, M. The art and practice of leadership coaching: 50 op executive coaches reveal their secrets, pp.165-172. NJ: John Wile & Sons, Inc.

Werner, E. (2009). Initial senate vote looms on health legislation. Yahoo! News. Web.

Westaby, J.D. (2010). Identifying specific factors underlying attitude towards change: Using multiple methods to compare expectancy-value theory to reasons theory. Journal of applied social psychology 32(5). Web.

White, D. (2006). Coaching leaders: Guiding people who guide others. CA: Jossey- Bass.

White, D. (2005). Coaching leaders: Guiding people who guide others. John Wiley and Sons, p. 190. Web.

Wicks, A.M. (2007). Competing values in healthcare: Balancing the (Un) balanced scorecard. Journal of Healthcare Management 52(5), pp.309-324. Web.

Wilson, C. (2007). Best practices in performance coaching: A handbook for leader, coaches, HR professionals and organizations. PA: Kogan Page.

Yip, J., Ernst, C., & Campbell, M. (2009). Boundary spanning leadership: Mission critical perspectives from the executive suite. Center for Creative Leadership, p.8. Web.