The pivotal role of mentoring and coaching in health services
The health sector has a long history of involvement with mentoring. The first supported mentoring programmes in Europe took place in the UK’s National Health Service (NHS), aimed at supporting the integration and retention of young graduate recruits. The NHS and the Health sector continue to pioneer good practice. For example:
- Mentoring for newly appointed executive and non-executive directors of Trust Boards
- Mentoring to support the career progression for people from black and minority ethnic groups (BAME)
- Maternity (parental) mentoring – aimed at supporting people returning to work after maternity, paternity or other long-term leave as they re-enter the workforce. Maternity mentoring increases the proportion of new mothers, who return to their old jobs, and speeds up the process of re-integration
- The creation of local coaching and mentoring consortia, bringing together coaches and mentors from other public-sector employers, such as police, fire service, local authorities and schools
- Ethical mentoring. Ethical mentors assist staff in recognising and thinking through what to do about ethical dilemmas – and hence prevent much of the damage caused by whistleblowing. The NHS has the largest cadre globally of ethical mentors in a single organisation.
- The use of coach assessment centres to select a pool of coaches competent and suitable to work with health service managers
- Supporting newly appointed medical researchers in their fellowships
- Mentoring for general practitioners starting work in the field of addiction treatment
- Supervision of internal coaches and mentors
- Creation of an internal cadre of team coaches – a substantial upskilling for experienced one-to-one coaches
The international medical charity Medicins sans Frontieres is the first health sector organisation to achieve gold standard in the International Standards for Mentoring and Coaching Programmes. However, many other organizations in the health sector have used the standards to design and benchmark their mentoring programmes.
Some confusion still exists in the world of nursing, with the traditional practice of preceptorship, which is actually a form of clinical supervision – and hence incompatible with the “power-free” nature of mentoring. Nursing has also been the field with the strongest literature base on the dark side of mentoring – the term “toxic mentoring” originates from a series of studies of nursing in the United States! Nonetheless, nursing remains a fertile ground for good coaching and mentoring practice.
Challenges for coaching and mentoring in the health sector
In conversations with Human Resources and practising coaches and mentors in multiple countries, a number of common challenges occur time and again. These include:
- Pressure on time and resources. Every health service is experienced rapid growth in demand, stimulated by a combination of factors, including greater life expectancy, wider ranges of treatments and an explosion of life-style related diseases, such as obesity-derived diabetes. When people feel over-worked, they struggle to find time and energy for their own development, let alone for helping others to grow and learn.
- Skills deficiencies. Managers and senior professionals often think they don’t need to be trained as coaches or mentors. These beliefs often go hand-in-hand with a relatively directive style of management. An outcome of this combination of beliefs and behaviours is that coaching and mentoring relationships can have a low level of psychological safety and trust, which reduces their positive impact.
- Silo mentality. Most mentoring and most internally resourced coaching takes place within the silos of the major disciplines. Yet health strategy increasingly focuses on cross-disciplinary patient care – often including not just medical support but social care in the community. Coaching and mentoring could be valuable reinforcements here; but this opportunity is fairly uniformly neglected.
- Lack of psychological safety. Numerous studies link clinical excellence with psychological safe working environments. Yet bureaucratised health organisations typically harbour enclaves of wariness and sometimes fear, where open and honest conversations are overtly or covertly discouraged. In such environments, coaching and mentoring can only work in relationships with people outside the immediate system.
- Coach fatigue. Compassion fatigue is typically associated with health professionals’ relationships with patients. Yet, it applies equally to supporting colleagues. Internal coach pools frequently report that they struggle to maintain numbers, because members get tired of having the same conversations with clients bringing the same old issues. It doesn’t help, if the coach feels that their own career aspirations are not getting the attention they deserve.
Opportunities for coaching and mentoring in the health sector
On the brighter side, the long history of successful coaching and mentoring means that there is typically a strong reserve of goodwill to draw upon. And once again, the health sector has the opportunity to be at the forefront of developments. For example:
Making use of artificial intelligence. AI has the potential to make coaching and mentoring both less expensive and more effective. A current project with Saberr, the coachbot designer, involves comparisons between six teams of mental health nurses. Two teams are controls, with no intervention; two will receive support from a coachbot; and two will have support from both a coachbot and a human coach. The outcome will hopefully be a deeper understanding of how coaches and AI can form effective partnerships.
Building genuine coaching and mentoring cultures. In many health sector organisations, there exist numerous small pockets of coaching and mentoring experience – some of them centres of excellence. A coherent organisational coaching and mentoring strategy, which weaves these pockets together, has the potential to leverage them to achieve significant shifts towards a learning culture. One thing that would help this is the development of trained and qualified coaching and mentoring managers, with the authority and budget to implement mentoring and coaching wherever a business case can be made. The European Mentoring and Coaching Council will shortly produce an accreditation process, based on a competency framework, to professionalise the programme manager role.
Establishing a development route for coaches and mentors. A partial antidote to colleague-related compassion fatigue is to ensure that coaches and mentors feel they are continuing to grow in their relevant skills and practice. There are at least two ways to make this happen – vertical solutions and horizontal solutions. A vertical solution is to offer a ladder of higher level qualifications, based on reflection on practice and an accumulated evidence base, as offered by the European Mentoring and Coaching Council. Another practical approach is the coach development centre, in which internal coaches receive expert feedback on coaching “real plays”, and are helped to create a personal development plan as a coach. They are then supported with an action learning set for a year; after which a repeat development centre assesses how they have improved. Horizontal solutions add whole new subdisciplines to their portfolios. Ethical mentoring and team coaching provide sufficient challenge to maintain their interest, while learning skills they can apply within their own daytime roles and teams.
The bigger picture
The argument can increasingly be made that the health sector needs coaching and mentoring to cope with its increasing challenges. The increasing complexity of the healthcare environment demands transparency and an integration of co-learning at the individual, team and organisational levels. To achieve this, it must develop the habit of continuous learning dialogue.
© David Clutterbuck, 2018
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