Teaching Implementation Coaching for Culture Change
Coaching Objectives and Overview
Display Slide 42, “Coaching for Culture Change,” as you transition to the culture section.
Present Slide 43, “Objectives,” after you complete the implementation planning section. Note that executing a plan requires substantial effort at both the individual and organizational or unit levels. Introduce coaching as an essential method for enabling staff to use TeamSTEPPS effectively and to reinforce their efforts to do so. Briefly review the objectives for the discussion of coaching:
- Define coaching and its outcomes.
- Describe the role of a TeamSTEPPS coach.
- List competencies of an effective coach.
- Describe how to implement coaching in TeamSTEPPS.
Implementation Process Overview
Use Slide 44, “TeamSTEPPS Implementation Process,” to help reinforce the overall picture of implementation and its phases and note the key role coaching can play in fostering implementation and culture change.
What Is Coaching?
In discussing Slide 45, “Coaching,” explain that coaching is defined as instructing, directing, or prompting as a coach. The term describes specific actions that include demonstrating, reinforcing, motivating, and providing feedback. These actions share the purpose of improving performance or achieving a specified goal for the individuals or team being coached.
Coaching is an active and typically ongoing process that can be used in structured and unstructured activities. It requires routine monitoring and ongoing assessment of performance.
Coaching is different from traditional instruction. With traditional instruction, teaching typically ends when the new content or skill is mastered. Coaching, however, continues even after content or skill mastery.
Importance of Coaching
In discussing Slide 46, “Why Is Coaching Important?,” explain that coaching is an effective way to influence and improve performance and that it can achieve each outcome noted on the slide. Rather than reading each outcome, focus on two or three that seem particularly important for the class you are teaching.
In discussing Slide 47, “Why Is Coaching Important in TeamSTEPPS?,” note that in the context of TeamSTEPPS, the key to integrating teamwork behaviors into daily practice is through frontline coaching. Coaches will help ensure that team members understand teamwork concepts and that the teamwork tools and strategies you implement are used correctly and appropriately. If you help staff become proficient in and comfortable with the new behaviors, they will integrate them into daily practice.
Over the longer term of your implementation, coaches will continue to monitor teamwork behaviors to ensure continued use of implemented tools and strategies, as well as to identify new areas for improvement. TeamSTEPPS coaches play a critical role both in TeamSTEPPS implementation and in efforts toward sustainability.
The Coach's Role
In discussing Slide 48, “The Role of a TeamSTEPPS Coach,” explain that coaching requires performing each of the four roles noted on the slide. You may want to ask a class member to provide an example of a coach they’ve observed (in healthcare or another setting) who performed one or more of these roles extremely well.
The Coach as a Role Model
In discussing Slide 49, “The Coach as a Role Model,” point out that effective coaches must model the behavior they intend to reinforce. Modeling the teamwork behaviors being trained and reinforced will not only demonstrate the behavior to the team members, but also highlight the acceptance of the behavior in the environment. This modeling may include general teamwork skills or use of a specific TeamSTEPPS tool or strategy, depending on your implementation plans.
Coaches should be well respected and supported in their work area. They will send an important message by demonstrating the behaviors they are working to improve and then reinforce in your organization. The most effective skills coaches are members of the team in which TeamSTEPPS is being implemented.
Stress the first bullet point on the slide by noting that sometimes people may be very skilled communicators but not be good coaches if they are not likable and their peers don’t respect them. It’s better to have coaches who are respected but slightly less skilled than to make coaches of people who do not model being an effective team member.
Coaching and Feedback
As you review Slide 50, “Coaches Provide Feedback That Is…,” note the discussions of feedback in the Communication Module as well as the discussion of performance feedback in the Mutual Support Module. Also remind the class that the advice for team leaders on how to provide performance feedback is the same as this advice on feedback for coaches.
You may want to provide coaches with a specific structure or model for providing feedback. For example, the SMART model stands for “specific, measurable, attainable, realistic, and timely.” If your organization already has a feedback model in place for use in performance management, teach coaches to use the same model.
The Coach as a Motivator
In discussing Slide 51, “The Coach as a Motivator,” note that the characteristics of coaches on this slide are aligned with the traits of effective leaders discussed in Module 2. Emphasize that coaches and leaders should spend as much time identifying and praising good behaviors as they do addressing substandard performance.
Opportunities for Practice
In discussing Slide 52, “Providing Opportunities To Practice,” observe that TeamSTEPPS coaches must also provide opportunities for staff to practice the teamwork behaviors. These opportunities for practice might be formal and structured in nature, such as a sports team’s practice or a simulated exercise, or they might be informal.
In some environments, opportunities to practice TeamSTEPPS may be inherently frequent. In other environments, they may not occur frequently or may apply only to some team members. Ensuring that everyone has opportunities to perform the behaviors and to receive feedback will be critical in sustaining the behaviors in daily practice.
Note that coaches may provide opportunities to practice TeamSTEPPS using any of the ways noted on the slide.
Coaching Exercise
Present Slide 53, “Exercise: Effective Coaches.” Once you’ve discussed what coaches do, ask the trainees to think about the characteristics of effective coaches. Ask them to think about coaches they have known or observed in their lives. Then ask:
- What characteristics did those coaches have that made them effective?
- Are coaching characteristics innate or can they be learned?
After you review the coaching competencies on the next slide, you may want to compare what is discussed with what the participants originally shared in the brainstorming session.
Coaching Competencies
In discussing Slide 54, “Coaching Competencies,” explain that knowing the role of a coach is not sufficient to understanding what it takes to be an effective coach. Effective coaches exhibit specific competencies. The Association for Talent Development (formerly the American Society for Training and Development) identified 13 competencies coaches should exhibit.1 These can be organized into the four clusters shown on the slide:
- Communication
- Performance improvement
- Relationship building
- Execution
Then provide an overview of the competencies falling in each cluster.
Communication
- Communicating Instructions – Demonstrating to the person you are coaching how to accomplish the task and clarifying when, where, how much, and to what standard it should be done. The role of coach often involves teaching a skill or procedure to another person. The ability to break down a task into easy-to-understand steps you can articulate to one another is vital to being an effective coach.
- Providing Feedback – As we have discussed, feedback involves carefully observing performance and sharing these observations in a nonthreatening manner.
- Listening for Understanding – Demonstrating attention to and conveying understanding of others. Listening is an indicator of respect. It requires being open-minded to what others say and focusing on both the content of what is said and the feelings others may be expressing.
Performance Improvement
- Setting Performance Goals – Collaborating with others to establish short- and long-term goals for performance on particular tasks. Effective coaching sometimes starts with pointing someone in the right direction. First, you work with the person to set broad goals; then you become very specific in agreeing on desired outcomes and how they will be measured.
- Rewarding Improvement – Using a variety of ways to provide positive reinforcement to others for making progress on important tasks. Timing of rewards is important. Don’t wait until you see either perfection or failure on the task. Look for growth in task accomplishment, and reward that soon after you observe it. Although coaches don’t always control formal rewards, such as pay, perks, or promotions, they can make frequent and effective use of informal rewards.
- Dealing With Failure – Working with others to encourage them when they do not meet expectations. When an individual displays an inability or unwillingness to perform a task according to expectations and standards, you need to be able to deal with the result. This effort can mean encouraging, redirecting, retraining, or otherwise affecting their ability to willingly change. Patience can be a virtue or an enabler of more failure, so use it wisely.
- Assessing Strengths and Weaknesses – Identifying root causes of good or bad performance through keen observation and effective definition and articulation of performance issues.
Properly identifying the skills, abilities, and interests of the person you are coaching directs your coaching efforts to the most critical areas. This task involves distinguishing between symptoms and root causes of problems. Without accurate assessment, coaching efforts might be spent addressing the wrong problem or a nonexistent one.
Relationships
- Building Rapport and Trust – Showing respect for others. Acting with integrity and honesty. Easily forming bonds with others.
Rapport and trust are the cornerstones of an effective coaching relationship. The person you are coaching needs to trust that you have their best interests at heart, so they can be honest with you regarding shortcomings. There also needs to be a bond of mutual respect so the advice, teaching, and counseling of the coach will be more readily accepted. - Motivating Others – As we have discussed, coaches must encourage others to achieve desired results. The right button to push to help motivate another person differs widely across people, so there are no hard and fast rules for motivating others. It is best to ask each person what is important to them and how the task at hand relates.
- Working With Personal Issues – Listening empathically and without judgment and offering emotional support for personal difficulties. In general, coaches are not expected to function as counselors. Few are qualified to carry out such responsibilities, and the context of the organizational relationship might preclude this type of interaction. Faced with an individual whose personal situation is interfering with their performance, however, you need to be able to intervene.
A good rule of thumb is that whenever you feel “in over your head,” you are. Be prepared to refer the person to appropriate sources of professional assistance and adjust the coaching process to support getting through the personal situation. - Confronting Difficult Situations – Raising uncomfortable topics that are affecting task accomplishment. Coaching often involves situations in which performance has not met expectations. Unmet expectations often lead to finger pointing, denial of personal responsibility, and other dysfunctional behaviors. Talking about these issues can make people uncomfortable.
Good coaching requires the ability and willingness to confront difficult and uncomfortable situations head on, but with tact and diplomacy. When the best interests of all concerned are at heart, the honesty and courage to confront difficult situations are welcomed.
Execution
- Responding to Requests – Consulting with others as needed. Responding to requests in a timely manner. Timely response to requests is a tangible indicator of respect. To build and maintain a healthy coaching relationship, make sure your responsiveness reflects a high priority level.
- Following Through – Keeping your commitments. Monitoring outcomes of the coaching process and providing additional assistance when needed. Trust is a critical component of any coaching relationship. Keeping your commitments helps build and maintain trust. Showing an ongoing commitment to the long-term success of the person you are coaching also builds a strong relationship.
Coaching Self-Assessment Exercise
In discussing Slide 55, "Exercise: Coaching Self-Assessment," once you have reviewed the four competencies required of an effective coach, encourage students to perform a self-assessment of their own coaching performance. This is an individual exercise. If the exercise falls before a break, introduce the exercise and hand out the self-assessment forms before the break. Ask the participants to fill out the self-assessment when they return from the break.
If the exercise does not fall around a break, introduce the exercise, hand out the self-assessment forms (PDF, 161 KB), and give participants time to complete the forms. No debrief is required.
Depending on how much time is available, give the class 5–15 minutes to complete the Coaching Self-Assessment (PDF, 161 KB).
You can introduce the exercise by noting that it gives them an opportunity to map their own coaching potential to the competencies we’ve discussed. Explain that each will use the coaching self-assessment form (PDF, 161 KB) to map the competencies to their individual coaching strengths and weaknesses. The self-assessment form is for themselves and won't be shared with anyone else unless they choose to.
Implementing Coaching
In discussing Slide 56, “Implementing Coaching in TeamSTEPPS,” explain that the focus is now shifting from what coaches should do to how to implement coaching to support TeamSTEPPS. Note that the five strategies on the slide are general guidance on how to implement coaching that will be discussed further in the slides that follow.
Developing a Coaching Plan
In discussing Slide 57, “Develop a Coaching Plan,” remind your class that plans for coaching were introduced as part of step 6 in the overall implementation planning process. As with all aspects of your TeamSTEPPS implementation, you should present the coaching concept and plans to your organization’s leadership. It is essential to gain the buy-in of your leaders to implement a coaching strategy in your facility. A coaching brief may help achieve buy-in; its contents were discussed in the implementation planning section.
Identifying Coaches
Present Slide 58, “Identifying and Preparing TeamSTEPPS Coaches.” As part of your TeamSTEPPS implementation plan, you will need to identify TeamSTEPPS coaches. Coaches may be those with extensive experience as TeamSTEPPS trainers, other members of your Change Team, or additional individuals whom you identify, train, and otherwise prepare to serve as coaches.
Describe the recommended considerations for identifying TeamSTEPPS coaches, including:
- Where TeamSTEPPS is being implemented. What type of individual has access to observe, provide feedback, and direct staff in the targeted work area? Align the coaches to the professions represented in the work area. For example, if physicians and nurses staff the targeted area, your identified coaches should include a physician and a nurse.
- Individual characteristics. Identify coaches who are qualified to develop the skills of others in their practice of teamwork skills. Usually, the coach must have advanced knowledge and expertise in teamwork concepts and training. Effective coaches have integrated team behaviors into their own practice and coach by example. Some individuals may require training in the coaching competencies reviewed earlier.
It is also important to ensure that identified coaches have the support of leadership and are highly respected among staff. These characteristics will facilitate the ability of coaches to effect changes in work patterns and behaviors.
Interpersonal style can also have a great bearing on the coaching outcome. Effective coaches typically demonstrate a supportive attitude and the ability to build self-confidence in others. - The number of coaches needed for your implementation. In general, TeamSTEPPS recommends one coach for every 10 staff. However, you must also consider the availability of coaches across shifts and schedules.
Note that after you have identified the coaches and they have agreed to participate, they must be prepared for their role by conducting a coaching session. This session can be conducted informally or formally, based on the resources and number of coaches you select. You can use the coaching material in this training, along with adaptations that reflect relevant feedback tools and performance improvement processes already in place in your organization.
Finally, your implementation plan may involve matching coaches with team members. Your organization’s culture may drive how this matching is done. You can match coaches with team members without feedback from the team member. You can have the coaches identify whom they would like to coach based on existing relationships. You have many options. Make matches based on what fits best in your organization’s culture.
Preparing Staff
Display Slide 59, "Prepare Staff for TeamSTEPPS Coaching." Another important aspect of ensuring the success of your TeamSTEPPS coaches is to ensure that staff are also prepared to be coached. Staff will need education about the role of coaches to allow them to engage the coaches in a meaningful way, have a shared understanding of the role and responsibilities of coaches, and view coaches as resources.
The change agents for your TeamSTEPPS implementation should:
- Identify who the coaches are to the staff.
- Describe the goals and positive outcomes of coaching.
- Explain the role and responsibilities of the coaches to staff.
- Describe expectations for staff’s interactions with coaches. For example, staff should expect to receive feedback from coaches about their teamwork performance. Staff should ask the coaches questions about teamwork and view coaches as a source of guidance and support on the changes taking place. Finally, staff should be encouraged to provide the coaches with feedback about the TeamSTEPPS implementation based on their own observations and experiences.
Organizational Support for Coaches
Present Slide 60, “Organizational Support for Coaches.” If participants think formal coaching sessions are unlikely and coaching will be done more informally, you may want to adjust your overview of this slide to focus on equipping team members to play a role as a coach. In your TeamSTEPPS training, you may want to introduce coaches to the trainees and have them help facilitate formal or informal group activities to help them make connections and enhance their credibility.
Coaching Tips
In discussing Slide 61, "Coaching Tips," if many trainees are parts of virtual teams, you may want to lead a discussion of how coaching will differ in relationships that involve little or no in-person contact. Note the added importance of virtual coaches developing a relationship outside of group online meetings to make their coaching more effective.
Coaching Practice Exercise
In discussing Slide 62, "Exercise: Coaching Practice," introduce the next exercise as an opportunity to practice providing and receiving coaching. Participants will also receive feedback on the coaching skills they practice.
Divide the participants into groups of three.
Hand out the Coaching Feedback Form (PDF, 181 KB) and Coaching Scenarios for each group to select from. The scenarios need to be developed by the trainer and selected based on the participants’ background. Alternatively, the session participants can also create the scenarios.
Tell the groups that to practice their coaching skills, they will each take turns playing the role of the coach, the team member being coached, and the observer. The coach works through the designated issue with the team member; the team member acts out the particular scenario; and the observer watches the interaction and notes on the Coaching Feedback Form (PDF, 181 KB) which competencies the coach exhibits and does not exhibit.
Within your group, participants should read the first scenario and assume designated roles of coach and team member. They’ll have about 2 minutes to act out the scenario while the third person observes and completes the Coaching Feedback Form (PDF, 181 KB). At the end of the scenario, the observer provides feedback based on comments noted on the Coaching Feedback Form (PDF, 181 KB). They'll then rotate roles and use a new scenario.
You may encourage group members to compare the results of their self-assessment with the feedback they received during this exercise to see whether these match. At the end of the exercise, remind participants that effective coaching skills in specific interactions are not a substitute for modeling effective teamwork and using TeamSTEPPS skills regularly. Their reputations as TeamSTEPPS users will have a huge impact on their effectiveness as coaches.
Note