Historically, the responsibility of a patient’s well-being resided with the physician. To move part of that responsibility back to the patient involves a change in thinking on both the part of the physician and the patient. The PSC’s role is largely that of ‘change agent’ for those on the clinic team. With change there are accompanying feelings of unease and resistance due to the unknown. The expectation of the coach in this environment is to facilitate the changes in the practice; therefore, it was important to understand each person’s unease with the changes being proposed.
From the physician’s perspective, they felt they were being asked to let go of the control in which they have been accustomed to in the doctor-patient relationship. It was important, therefore, to explore with the physician and team the benefits this transfer of control could result in (‘what’s in it for me’ concept). Sessions with the clinic team resulted in a list of many benefits including reduced levels of frustration on the part of the physician as patients began to take ownership for their own health. The ownership was the result of physicians giving the patients a voice in what and how they implemented health care goals. As a consequence patients began demonstrating increased compliance in taking medication, exercising more, monitoring and managing blood sugars regularly etc. Interestingly, this type of partnership between the physician – patient paralleled the partnership occurring between the PSC and the physician.
Self-management planning training was introduced to the physicians and their staff by the PSC. The process is achieved through motivational interviewing techniques and results in increased patient confidence as they develop a plan that is important to them, and that they are held accountable for in follow-up checks. The important point of this technique is that the ideas and plan originate from the client and there is no expert ‘direction’ given by the interviewer (may be the physician, MOA or any other person trained in this technique). Self-management plans are developed around what is important to the client, not what the health care practitioner believes to be important for the client. In this way, the health care professional guides the patient on his/her journey to increased confidence. Once the patient begins to feel more confidence in his/her ability to succeed in one area of life, it is anticipated that further plans will be undertaken to improve their health. The responsibility for maintaining and improving one’s health is being given back to the patient by helping them to gain confidence in parts of their lives that are important to them.
The above illustrates the benefits of having a coach ‘in-house’ in that not only does the clinic benefit from coaching, but that the coaching is also passed on through the clinic physicians and staff through to the patients.
What Made the Difference?
Interestingly, in the role of PHC Developer, I did very similar things as I do now as a PSC: I held formal meetings, attempted to empower the team through listening and engaging them in their ideas, spent time building good rapport and trust with them, but it was always based on an agenda I was holding for the organization. Although there is still a list of provincially-led projects and initiatives for physicians to engage in within their practices, it is the approach in delivering this material that determines whether or not the physicians choose to participate.
Progress comes very slowly but when it does happen, it is owned by the team and it is sustainable. The group I work with is a very conscientious one and is very patient-centric. The members all take time to process change and by doing so often come up with brilliant alternatives and variances on the same idea which has always resulted in better health care delivery to the patient. I asked them to trust me and must, in turn, allow myself to trust them.
Learnings Through the Coaching Transition
- That coaching has been one of the tools chosen to address the health care challenges in our province attests to the credibility coaching has achieved in our mainstream culture.
- Facilitating team discussion through use of effective meeting skills, consistent and frequent scheduled meetings, learning from the team, intentionally listening and questioning and empowering them to make the decisions which are important to them is all essential
- Smaller meeting rooms are more conducive to participant engagement (recognizing physical elements that contribute to a ‘coachable’ environment)
- Accepting that before we could focus on clinic improvement measures and move forward, relationship building had to take place to gain their trust. Through listening and learning from each other over two years, we were finally able to really focus on significant clinic improvement in a way that could be measured. The main challenge throughout the initial stages of the relationship was to educate the team as to the reasons for my entering ‘their’ domain. Historically, there had been a high level of mistrust between physicians and the health authority; that I worked for the health authority with an aim to effect change in the health care system was an immediate barrier in the beginning.
- Meeting the physicians and patients’ where they are at’ – working to their agenda and priorities, not mine
o Life throws curve balls, and many of them which slows down progress – physicians leave practices, families of staff and physicians have emergencies resulting in staff being away from work for long periods of time, physicians wind down in anticipation of an imminent retirement date, staff turn-over etc.
- Practice a large degree of patience, even when you do not feel it
- Trust in your team and yourself
As anticipated, being a relatively new member to this small rural community (village population of <700), being accepted turned out to be the most challenging of my tasks which in itself evolved over next two years until a tangible ‘breakthrough’ was made. The most significant breakthrough occurred after a series of workshops completed over six months in which I participated with one of the practice team members. At the end of the workshop series, the team member voiced her belief that I had demonstrated I had the best interests in mind for the clinic practice team and that she would go to the others and confirm her trust in me. This may seem like a small milestone, however, it set the stage for increased communication between myself and the rest of the team; it simply required two years for this team to build a level of confidence in an ‘outsider’. As a coach, I was able to work closely with the team, take time to understand their concerns, needs and passions – and ultimately know them in a more meaningful way other than just as ‘colleagues’ – knowing them as whole persons.
This paper is a very brief look at the benefits of introducing coaching into a traditionally directive environment. There has been a marked response from both physicians and patients to the new approach the health authority is taking in implementing change in the health care environment. A key coaching requirement is in acknowledging the barriers in a physician’s day and working with them with that knowledge in mind in order to integrate new practices and ideas into the clinic. Coaching skills open up the potential of unlimited solutions available to a health care team by tapping into the knowledge of a highly skilled, educated and caring group of people. Combine the potential of such a group with the self-knowledge a community of patients holds for itself, and there is much with which to work and move forward.
Centre for Comprehensive Motivational Interventions (CCMI). (2013). Brief Action Planning and Motivational Interviewing. Retrieved on October 11th, 2013 from:
The College of Family Physicians of Canada (Discussion Paper, 2009). Patient-Centred Primary Care in Canada: Bring It On Home. The College of Family Physicians of Canada.
Modified from material from Heartland Health Region, Saskatchewan. What is primary health care? Retrieved from on December 18th, 2013: