The Evidence for Coaching in Leadership

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The Evidence for Coaching in Leadership
HealthcareMargaret Moore/Coach MegFounder
CEO, Wellcoaches Corporationwww.wellcoaches.com
www.coachmeg.com coachmeg_at_wellcoaches.com
Co-Director, Institute of CoachingMcLean
Hospital, Harvard Medical School
www.instituteofcoaching.org
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Coaching journals
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Agenda

• What does evidence-based mean?
• Theoretical foundation How does coaching work?
• Coaching outcomes measurement - How do we know
  coaching works?
• Does coaching work?
• Coaching evidence in life and executive coaching
• Coaching evidence in healthcare

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What does evidence-based mean?

• Evidence-based practice was first explored in
  Journal of American Medical Association in 1990
• Best available research evidence combined with
  clinical expertise.

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What does evidence-based mean?

• International Journal of Evidence Based Coaching
  and Mentoring Evidence is a verb David Drake,
  PhD (Feb 2009)
• Approach to evidence in coaching
• Valid research
• Personal reflexivity
• Professional experience
• Contextual awareness

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Best evidence (from dictionary)

• Evidence that is the most reliable and most
  direct in relationship to what it is offered to
  prove.
• Most reliable well-designed research studies,
  preferably randomized
• Most direct in relationship similar
• - Coaching model theoretical foundation
  skills/processes
• - Coaching specialty
• - Coaching population
• - Coaching outcomes metrics

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What is coaching aiming to accomplish?

• Coaches facilitate a process of change or
  development which enables individuals and
  organizations to realize their potential.
• Potential is unrealized latent ability,
  capacity, or possibility.

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What are we trying to prove?

• Theoretical foundation of coaching skills and
  processes
• How does coaching work?
• Coaching outcomes
• How do we know that coaching works?
• How well does coaching work?
• Optimization of coaching outcomes
• What in coaching works?
• When and with whom does coaching work?
• What might work better?

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Theoretical foundation of coaching skills and
processes
Dianne Stober Anthony Grant
Stephen Palmer Alison Whybrow
Margaret MooreBob Tschannen-Moran
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How does coaching work?

• Evidence-based coaching mechanisms of action
• Build growth-promoting relationship
• Elicit motivation jet fuel for change
• Improve capacity to change by increasing
  positivity, resilience, and self-efficacy
• Facilitate process of change (constructive
  development)
• View How Coaching Works at YouTube

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A. Build growth-promoting relationship

• Relational flow
• Autonomy
• Self-awareness
• Coaching presence
• Theories
• Relational Cultural Theory
• Motivational Interviewing
• Nonviolent Communication
• Mindfulness
• Emotional Intelligence
• Relational Flow

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B. Elicit motivation

• Uncover, ignite, and sustain motivation the jet
  fuel for the journey of change
• Theories
• Self-Determination Theory
• Motivational Interviewing
• Positive Psychology
• Mindfulness

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Self-determination theory Innate and universal
needs

• Autonomy - Im in charge
• Competence - I did it!
• Relatedness - I have strong connections and
  collaborations

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C. Improve capacity to change by increasing
positivity, resilience, and self-efficacy

• Hope optimism
• Self-efficacy
• Resilience
• Theories
• Positive Psychology
• Hope Psychology
• Social Cognitive Theory
• Appreciative Inquiry

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D. Facilitate process of change (constructive
development)

• Vision, goals, planAccountabilityJust-in-time
  learningRising above challenges
• Theories
• Transtheoretical Model
• Appreciative Inquiry
• Hope Psychology
• Immunity to Change (Kegan)
• Goal-Setting Theory
• Adult Learning Theory

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Coaching developmental cycles

• Coaches help clients move from Point A to Point B.

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What are we trying to prove?

• Theoretical foundation
• How does coaching work?
• What in coaching works?
• Coaching outcomes
• How do we know that coaching works?
• How well does coaching work?
• Optimization of coaching outcomes
• When and with whom does coaching work?
• What might work better?

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Categories of coaching outcomes

• Performance reaching a destination (sales
  target, new job, run a marathon, weight loss)
• 2. Skills developing new skills or abilities
• (managing stress, handling adversity,
  leadership, learning how to cook, ability to
  focus)
• 3. Behavioral establishing new behaviors or
  habits (interpersonal relations, management,
  health and wellness)
• 4. Development increasing consciousness,
  through new perceptions, beliefs, meaning,
  values (confidence, hope, optimism,
  self-awareness, insight)

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Coaching outcomes metrics How do we know that
coaching works?

• Executive Life
• Performance workplace well-being, stress scores
• Goal attainment scaling (GAS) skills goals with
  behavioral markers
• Development self-reflection, insight
• Healthcare
• Performance - biometrics for physical and mental
  health
• Behaviors - health and wellness
• Development self-efficacy, positivity,
  readiness to change

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Tony Grant, PhD (first coaching
psychologist)Director of Coaching Psychology
Unit University of Sydney

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University of Sydney Coaching Research Program

• Eight outcome studies 6 randomised, 2
  between-subject
• Range of theoretical papers
• Coaching Models Mental Health and Goal
  Attainment Commentary papers
• Additional coaching-related empirical work
• Self-reflection and Insight Stages of Change
  Solution-focused vs. Problem Focused Coaching
• Mindfulness and Perspective-taking in Leaders
• Over 100 articles and book chapters, reports and
  gt 100 conference presentations

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The Solution-focused Cognitive-Behavioural Model
PositiveAttentionalFocus
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Measuring Coaching Outcomes

• Goal Attainment Scaling (GAS)
• Simple scaling Levels of attainment
• Presence/Absence of Mental Distress
• DASS Depression, Anxiety, and Stress Scale
• Presence/Absence of Well-being
• QOLI PWB SWB PANAS Hope Cognitive Hardiness
  Workplace Well-being Index
• Metacognitive Processes
• Self-reflection and Insight Scale

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Coaching as Applied Positive Psychology

• First Study Solution-focused, coaching group
  program
• Q Does Coaching work, and how does it impact
  on self-reflection and insight?
• Within subjects N 20 (Adults 35.6yrs)
• 13 wks, 50 min weekly, group-based GROW
  sessions
• Self-Reflection Insight Scale Quality of Life
  Mental Health Goal Attainment
• (Grant, 2003)

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Goals and Quality of Life
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Depression, Anxiety Stress
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Self-Reflection Insight
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First randomized study of external executive
coaching

• Q Is executive coaching effective at enhancing
  workplace well-being?
• During organisational change
• Solution-focused, cognitive-behavioural executive
  coaching with 360 feedback
• 45 executive and senior managers from large
  public health service
• Quantitative and qualitative measures used
• (Grant, Curtayne, Burton, 2009)

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Executive Coaching, Goal Attainment Well-being

• Half-day leadership development w/shop
• Organisation in major change process
• 360 feedback (HS-LSI)
• Goal Attainment Scaling (GAS)
• Cognitive Hardiness Scale
• Depression, Anxiety and Stress Scale
• Workplace Well-being Index
• Four coaching sessions over 8 to 10 wks

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Goal Attainment
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Resilience
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Depression
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Workplace Well-being
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Conclusions

• The quantitative results of the (second)
  randomized study
• provide support for the notion that executive
  coaching can
• increase goal attainment, enhance resilience,
  ameliorate
• depression and stress, and increase workplace
  well-being.
• The participants qualitative responses suggest
  that
• executive coaching may well be a valuable tool in
  helping
• Individuals deal with the uncertainty and
  challenges
• inherent in organisational change.
• Overall there is emerging evidence that coaching
  can be
• an effective positive individual change
  methodology.

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Coaching Research in Healthcare

• Randomized Controlled Studies (12)
• Non Randomized Study (1)
• Qualitative Reports (4)
• Case Study (1)
• Project Demonstration (1)
• Descriptive Articles (7)
• Medical Education (2)

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Coaching ResearchManage, Treat, and Prevent
Disease

• ADHD
• Asthma
• Cancer pain
• Cardiovascular disease
• Compromised urinary bladder syndrome
• Diabetes

• Depression
• Male caregivers of dementia patients
• Osteoporosis
• Physical activity
• Spinocerebellar degeneration
• Weight loss

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Conclusions Coaching Research Studies

• There is evidence in the medical literature that
  coaching alone is effective at improving health
  outcomes
• Cardiovascular disease
• Diabetes
• Asthma
• Cancer pain
• Weight loss

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Conclusions Common strategies of coaching
research in healthcare studies

• 11 relationship
• Goal setting and commitment
• Accountability over time
• Live sessions

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Paper in preparationHealth Integrated
telephonic health coaching

• 30 behavioral health therapists who are trained
  and certified health coaches
• Coaching clients have depression co-morbid
  medical conditions 1,000 for each population
• High ROI (reduced ER visits, admissions, hospital
  stays, and other urgent care)
• Significant improvement in depression and
  productivity scores

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Mental Health Functionality - PHQ-9 Scores in
Diabetes
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In press cancer survivors pilot

• Three cohorts (n30)
• Delaware
• Vermont
• Illinois
• Breast, prostate, colorectal cancer survivors
• 90 minute initial coaching session and five
  30-40 minute sessions over three months.
• Data collected at baseline, 3, 6, 12 after
  completion of coaching

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HADS-Depression 1 Surveys completed at
baseline 2 Completion of the wellness coaching
intervention (at 3 months) 3 Six months after
intervention ended 4 Twelve months after
intervention ended
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Coaching outcomes studies underway

• 1. Midwest Hospital 2 year randomized study of
  144 employees with metabolic syndrome, complete
  late 2009
• 2. Oakwood Hospital 5 year randomized study of
  400 women with cardiovascular risks complete in
  2012
• 3. Emory University pilot post bariatric
  surgery
• 5. Methodist Hospital 2 year employee health
  risks and weight loss
• 6. Mayo Clinic ongoing study of wellness
  coaching for employee health risks and weight
  loss
• 7. MGH Back Bay Harvard Vanguard clinics
  pilot of wellness coaching for chronic disease
  management

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Future Goals for Coaching Research in Healthcare

• Standard definition of health and wellness
  coaching
• Consistency of coaching protocols
• Standardized coach training
• Larger studies in multiple clinical indications
• Long term follow up
• Distinction between light and intensive
  coaching
• New developmental outcomes metrics which predict
  sustainability

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What can we conclude?

• Coaching is an effective mode of facilitating
  change performance, skills, behavior, and
  development
• Coaching increases goal attainment engagement
  in new behaviors related to skills development
• Coaching improves the capacity to change by
  increasing positivity, resilience, and
  self-efficacy

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What are we trying to prove?

• Theoretical foundation of coaching skills and
  processes
• How does coaching work?
• Coaching outcomes
• How do we know that coaching works?
• How well does coaching work?
• Optimization of coaching outcomes
• What in coaching works?
• When and with whom does coaching work?
• What might work better?

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The ICF values your feedback. Please take a
moment to complete an evaluation form and return
it to the room host located at the back of the
room.
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The Evidence for Coaching in Leadership
HealthcareMargaret Moore/Coach MegFounder
CEO, Wellcoaches Corporationwww.wellcoaches.com
www.coachmeg.com coachmeg_at_wellcoaches.com
Co-Director, Institute of CoachingMcLean
Hospital, Harvard Medical School
www.instituteofcoaching.org