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HUMAN RESOURCES

L et’s begin by stating the obvious: a medical practice manager, by definition, is an individual who man- ages a medical practice. Does it make sense, then, that a practice manager’s first thought is to manage?

Of course. That is as it should be. When it comes to appoint- ment scheduling, inventory control, equipment, facilities, finances, contracts, patient records, and so forth, managing is exactly what practice managers need to do.

However, the more human aspects of medical practice management sometimes call for a different approach. Managing will not always foster, nurture, and draw out the very best from the medical practice team. Sometimes, employees will benefit much more if the practice manager functions less as a manager and more as a coach. As Green1 succinctly puts it, “We have to be both coaches and man- agers. To lead effectively, we need to know when to wear which hat.”

MANAGING VERSUS COACHING

When we manage others, we generally tell them what to do to get a job done. Usually, managers act from greater

experience, knowledge, or training than those they man- age. In some cases, the manager has done the very job of those he or she manages, and manages from the strength of that experience. Nonetheless, the manager’s position is from above, and his or her primary tools are command and control. Managers get things done by directing and monitoring staff performance. They set the bar for their employees. They share their expectations and require- ments through tasking, directives, and initiatives, and by measuring outcomes.

Coaching is a most effective approach whenever we are trying to develop the best in others.

Certainly, it makes sense to manage in situations where immediate needs are paramount and when we need to achieve specific outcomes efficiently and quickly. As Stack2 suggests, “Your team members look to you for answers, and rightly so in critical circumstances.” Managing can also be

Staff Coaching: Using Active Listening and Powerful Questions to Unleash Your Staff’s Potential Laura Hills*

Although the terms coach and manage sometimes are used interchangeably, they are, in fact, very different from one another. This article explores that differ- ence and argues that coaching is the best approach to take when medical prac- tice managers wish to develop the best in their employees. This article explores active listening as an essential skill in coaching. It describes 8 characteristics of active listening and offers 10 tips practice managers can use to listen actively when they are coaching their employees. This article also suggests that practice managers ask their employees powerful questions. It describes the characteris- tics of powerful questions and offers 50 powerful questions practice managers can use. Finally, this article provides five tools to keep coaching conversations going, practical strategies practice managers can use to take their coaching skills to the next level, and a quick-reference chart describing when to manage and when to coach medical practice employees.

KEY WORDS: Coach; manage; active listening; powerful questions; employee development; retention; loyalty; employee engagement.

*Practice leadership coach, consultant, author, seminar speaker, and President of Blue Pencil Institute, an organization that provides educational programs, learning products, and professionalism coaching to help professionals acceler- ate their careers, become more effec- tive and productive, and find greater fulfillment and reward in their work, 10618 Regent Park Court, Fairfax, VA 22030; phone: 703-691-8468; e-mail: [email protected]; website: www.bluepencilinstitute.com; Twitter: @DrLauraHills. Copyright © 2018 by Greenbranch Publishing LLC.

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Hills | Staff Coaching 303

a useful approach when employees have never undertaken a task before and whenever they need a leader to tell them what to do and how to do it. Adds Stack, “Sometimes a team just needs someone to coordinate, while everyone else does their piece of the project.”

Coaches get things done by guiding staff performance, by anticipating and clearing obstacles from their paths, and by supporting their employees’ immediate and long-term career goals.

Coaching, on the other hand, is a most effective ap- proach whenever we are trying to develop the best in oth- ers. The coach does not direct others. In fact, the coach doesn’t set an agenda for the coaching; the person being coached does. As Green1 explains, “Coaching involves ex- ploring, facilitating, partnership, long-term improvement, and many possible outcomes.” The coach’s position is be- side the employee, and his or her primary tools are active listening and powerful questions. Coaches get things done by guiding staff performance, by anticipating and clearing obstacles from their paths, and by supporting their employ- ees’ immediate and long-term career goals. Stack explains that when you coach, “You teach your people the ropes as necessary, acting as a mentor rather than autocrat, and otherwise make suggestions in real time concerning what they can do to tweak their behavior toward an optimum.” When employees don’t quite reach a standard or goal, coaches may praise what they did well, but they will also shine a light on where employees showed weakness. They focus attention on what employees can improve, but they won’t tell them how to do it. Whenever possible, they will pull next steps from the employees themselves, rather than tell them what to do.

Coaching can help practice managers to engage their employees, to foster employee loyalty, and to improve employee retention.

Medical practice managers who use a coaching ap- proach with their employees will develop more effective teams in the long run. That’s because they will develop better people. Coaches change people’s lives, often in profound ways. As Harski3 explains, “Good coaches show team members their potential, help them find confidence

in their work, point out the value of what they do, and inspire them to be the best versions of themselves.” They help employees feel that someone is in their corner and that with that needed support, they can improve and grow. Adds Harski, “Every time we coach an individual, we as leaders have that opportunity to have an impact on him or her.”

There’s another slightly less obvious benefit of coaching medical practice employees; coaching can help practice managers to engage their employees, to foster employee loyalty, and to improve employee retention. Most employ- ees want to continue to work in a place where they feel that they are able to achieve their own career goals and where they feel supported in their own development. A practice manager who coaches employees can help them feel that way about the medical practice. As Stack succinctly puts it, “Coaches create the kind of engaged, empowered employ- ees needed for survival today.” In the end, employees are more likely to stay with an employer who they feel brings out the best in them.

ACTIVE LISTENING IN COACHING

Active listening is an essential skill in coaching. Yet, lis- tening is probably the most overlooked, misunderstood, and undervalued communication skill. As Hills4 suggests, “Most of us take listening for granted and don’t think much about our listening skills.” Unfortunately, we can fall into passive, uncritical, distracted listening all too easily. When that happens, our listening becomes short and shallow, Hills warns.

When we listen actively, we must concentrate fully to absorb all of what it is the speaker is saying, even when we want to do otherwise, even if the speaker is dull or illogical or all over the place.

On the surface, active listening appears to be a simple skill. We listen all the time, so we reason: how hard can it be to listen actively? However, we listen actively only when we’re paying really close attention. That means that our minds can’t wander, even for a little while. We can’t drift into our own memories. We can’t start generating solutions for the issue at hand. And we can’t mentally argue with the speaker. When we listen actively, we must concentrate fully to absorb all of what it is the speaker is saying, even when we want to do otherwise, even if the speaker is dull or illogical or all over the place. We must

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pay careful attention to the speaker’s body language and how the speaker uses the space he or she occupies. We must also consider what the speaker is not saying.

For most of us, listening actively will require new habits, care, and consistent effort.

Active listening is challenging for a couple of reasons. For one thing, many of us assume that we listen well enough and don’t try to improve our listening skills. For another, most of us have had little or no training in active listening. As Hills suggests, “Listening is rarely taught or intentionally practiced and it is almost always assumed.” Another reason that active listening can be difficult is that listening is the easiest communication skill for us to fake. Says Hills, “Some of us have become masterful at pretending that we’re listening when we aren’t.” For these reasons, many people find it difficult to stay engaged in active listening even when they want to. Old habits do

indeed die hard. For most of us, listening actively will require new habits, care, and consistent effort.

Although active listening is challenging, it is absolutely essential whenever a practice manager steps into the role of coach. In fact, as Aguilar5 argues, “Active listening is the highest priority skill for a coach to master and it must be mastered prior to success using any other strategy.” This is so, Aguilar says, because the core of active listening is empathy. Says Aguilar, “It’s not so much about the exact words that you use as the listener, it’s about the feeling behind them. It’s about who you are being when you use them—are you being a caring, compassionate coach? Or are you being someone who is trying to be right . . . ?” Active listening is a needed foundation for building trust and con- nection between you and your employee. Coaches who use active listening effectively can guide their employees into personally challenging coaching explorations, even into “the scary realm,” Aguilar says. From there, employees may be able to experience deep insights and make big changes that ultimately will lead to their personal growth, she says.

THE EIGHT CHARACTERISTICS OF ACTIVE LISTENING IN COACHING

The International Coaching Federation (ICF)6 defines ac- tive listening in coaching as the ability to focus completely on what the client is saying and is not saying, to understand the meaning of what is said in the context of the client’s desires, and to support client self-expression. Of course, as a medical practice manager, your coaching “client” will be your employee. Nonetheless, the ICF offers good advice that medical practice managers can use when they coach their employees. Specifically, the ICF says that any coach who listens actively does the following: 1. Attends to the client and the client’s agenda and not to

the coach’s agenda for the client; 2. Hears the client’s concerns, goals, values, and beliefs

about what is and is not possible; 3. Distinguishes between the client’s words, tone of voice,

and body language; 4. Summarizes, paraphrases, reiterates, and mirrors

back what the client has said to ensure clarity and understanding;

5. Encourages, accepts, explores, and reinforces the cli- ent’s expression of feelings, perceptions, concerns, beliefs, suggestions, etc.;

6. Integrates and builds on the client’s ideas and sugges- tions;

7. ”Bottom-lines” or understands the essence of the cli- ent’s communication and helps the client get there rather than engaging in long, descriptive stories; and

8. Allows the client to vent or “clear” the situation without judgment or attachment in order to move on to the next steps.

When to Manage, When to Coach

Knowing when to manage and when to coach your employees will be critical to your effectiveness as a practice manager. Stack1 offers the following suggestions:

Management is needed when:

77 A crisis requires quick, positive results. 77 You are handling new, inexperienced personnel, espe- cially those tackling a task for the first time.

77 The team needs to complete (and may be resisting) low-level or unpopular tasks.

77 You are meeting difficult deadlines when every min- ute counts.

Coaching is needed when you wish to:

77 Support your team while guiding them in their career goals.

77 Work together with your team to define and facilitate the best strategies for your team and your organ- ization.

77 Share your mission, vision, and goals in a transparent way with your team members and invite them to join you in your quest for success.

77 Facilitate everyone’s progress toward the goals you’ve mutually set, as well as toward organizational goals. 

REFERENCE

1. Stack L. Managing vs. coaching: in today’s workplace, you really need both. TLNT. July 7, 2014. www.tlnt.com/ managing-vs-coaching-in-todays-workplace-you-really- need-both/. Accessed November 21, 2017.

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Hills | Staff Coaching 305

According to Lee,7 two conditions must be present for a coach to listen actively, as the ICF has described above. The first is calmness. Lee suggests, “A calm mind will free you from the anxiety and need to try to be helpful.” When your mind is calm and at rest, all thoughts are silenced, to help you focus on the one thing that matters: listening. The second condition that Lee suggests will help you listen ac- tively is curiosity. Says Lee, “A healthy level of curiosity will heighten your interest in the person you’re speaking to.” If you are curious, you will naturally pay close attention and ask the right questions to make the coaching conversation productive, Lee says.

TEN TIPS FOR LISTENING ACTIVELY

When it comes to active listening, as with most skills, there is no substitute for practice. You’ve got to close your mouth, focus your mind, and listen purely for comprehen- sion, and you’ve got to do this repeatedly to hone your active listening skills. To help, Hills4 suggests the following 10 strategies:

1. Eat well and get plenty of rest. It’s challenging to lis- ten actively when your stomach is grumbling or you’re exhausted.

2. Commit to being fully present. Consciously decide to put aside the task you’re working on or whatever is on your mind. Don’t attempt to multitask. Give the speaker your full attention.

3. Put aside biases. You may have a history with some employees or topics that bias you for or against them. Let go of prejudgments and keep an open mind.

4. Choose a venue with good ventilation and a comfort- able temperature. When you can control the listening venue, make sure that the room is neither too warm nor cool and that the air circulates. Poor air quality can impede your ability to pay attention.

5. Turn off electronic distractions. Make sure you won’t see or hear anything to derail your active listening.

6. Don’t interrupt. Let the speaker complete the thought. Allow time for silence when the speaker stops. Pause and reflect before you respond. This is difficult for many of us, but essential for processing the messages we’re receiving.

7. Focus on meaning, not words. Don’t let a speaker’s occasional malapropism, mispronunciation, or gram- matical error derail you from the message. Don’t be distracted by words with an emotional charge. Recog- nize your hot buttons and defuse them.

8. Stay with it. Listening in spurts and then taking breaks may cause you to miss important information or cues. Recognize when your mind is wandering and inten- tionally pull it back to the listening task.

9. Listen between the lines. Search for meaning that isn’t necessarily put into the speaker’s spoken words. Pay attention to nonverbal communication (e.g., facial

expressions, gestures, and speed, volume, and tone of voice) to see if you can tease out meaning.

10. Paraphrase to check for comprehension. Ask the speaker to elaborate on any point that isn’t clear to you.

ASKING POWERFUL QUESTIONS IN COACHING

As the title of this article suggests, there are two tools medical practice managers can use to unleash their staff’s potential through coaching: (1) active listening and (2) powerful questions. At first glance, it may seem that powerful questions are simply questions that have the potential to make a profound impact. While this is true, it is helpful for us to explore more specifically what power- ful questions are and what they can do. Let’s look at this in three ways.

First, Vogt8 suggests that powerful questions are distin- guished from ordinary questions by nine characteristics. According to Vogt, powerful questions are those that: 1. Stimulate reflective thinking; 2. Challenge assumptions; 3. Are thought-provoking; 4. Generate energy to explore; 5. Channel inquiry; 6. Promise insight; 7. Are broad and enduring; 8. Touch a deeper meaning; and 9. Evoke more questions.

Following Vogt, a coach would focus on the depth and quality of response the questions elicit. Powerful questions would be those you ask to dig deeper and to expand your employee’s thinking. They are also questions that are likely to propel the coaching conversation forward.

Second, the ICF suggests that coaches who have the ability to ask powerful questions do so to reveal the in- formation needed for maximum benefit to the coaching relationship and the client. According to the ICF, a coach using powerful questions asks questions that: 1. Reflect active listening and an understanding of the cli-

ent’s perspective; 2. Evoke discovery, insight, commitment, or action (e.g.,

those that challenge the client’s assumptions); 3. Are open-ended and create greater clarity, possibility, or

new learning; and 4. Move clients toward what they (the clients) desire.

The ICF suggests that powerful questions are not those that ask clients to justify or to look backward. What is sig- nificant here is that powerful questions are designed first and foremost to be beneficial to the client, not to serve some other purpose.

Finally, Miglino9 suggests three characteristics of power- ful questions. These questions are:

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1. Open-ended: They’re not yes or no questions and they often begin with the word what. Example: What oppor- tunity is here?

2. Challenging: Powerful questions may cause a little discomfort.

3. Free of judgment: They are curious questions with no agenda behind them.

Miglino’s focus on discomfort is important. Personal and professional growth sometimes requires us to go places that we’d rather not go. Be mindful, however, that a coach is not a therapist. If you uncover concerning is- sues through your use of powerful questions, discontinue the coaching session and refer the employee to a qualified mental health professional for appropriate help. Do not overreach your capabilities.

As we consider the use of powerful questions in coach- ing, it becomes clear that powerful questions are not those that can be answered easily or quickly. Powerful questions require a thoughtful response, one that has the potential to lead the employee to new and better insights. Clearly, the medical practice manager who asks power- ful questions must have the employee’s trust. Otherwise, the employee is unlikely to open up to the coaching experience. The coach also must be very careful in tone, demeanor, and words not to come across as accusatory. There are many ways to ask an employee, “Why did you hesitate just now?” or “What do you think was behind your behavior?” Asking powerful questions well is a skill that can be learned and honed. Practice asking powerful questions with someone you trust and who can provide you with high-quality feedback. For examples of power- ful questions, see the sidebar “50 Powerful Questions You Can Use to Coach Your Employees.”

FIVE TOOLS TO KEEP THE COACHING CONVERSATION GOING

When you coach an employee, there may be lulls, stalls, and even dead ends in your conversations. The Coach- ing Tools Company10 recommends having a plan in place for those challenging moments. When coaches get stuck, the trick is to take a deep breath and ask a question to get the employee to show you the next step. The Coaching Tools Company recommends that you trust the coaching process and trust your employee to know what is best for him or her. Specifically, develop a bag of coaching tricks that includes the following five tools. They can help you to propel the coaching conversation forward. 1. Catch-all questions for when you don’t know what to

ask: Examples: What would be the best question I could ask you now? If you were coaching yourself, what would you ask yourself now? I don’t know where to go with this; where would you go?

2. Softeners for tough questions: Examples: I’m curious… Just for a moment…Let’s suppose…I was wondering… Would it be OK for us to play with this?

3. Phrases for dealing with talkative employees: Ex- amples: I’m going to interrupt you here. So, tell me what finally happened. In a nutshell, what is the issue? If we were to take a helicopter view, what would you need me to know? If you could sum up the situation in one word or phrase, what would it be?

4. Responses to “I don’t know”: Examples: Just feel into the question for a moment. Just let me know when you’ve thought of something. What’s it like for you not to know right now?

5. Wrap-up phrases to end a coaching session: Examples: What do you feel was the most beneficial part of today’s session? What was your biggest win of today’s session? What specifically that you’ve learned here today can you use/will help you most as you move forward?

TAKING YOUR COACHING SKILLS TO THE NEXT LEVEL

Coaching will be attractive to medical practice managers who are looking for new ways to develop their employees but also to those who wish to grow professionally and per- sonally. In fact, coaching can add an exciting new dimen- sion to your career. At this time, coaching is not regulated by any country or state. You do not need to be credentialed to coach, and you may begin coaching your employees, or for that matter anyone, any time that you feel that you are ready to do so. However, you may find that you would like to learn more about coaching and improve your coaching skills. If so, there are many ways to do this.

For example, many books, articles, and videos are available that will help you broaden your understanding of coaching. If coaching is new to you, this may be a good place for you to begin. You may find it particularly help- ful to watch videos of actual or mock coaching sessions so you can get a feel for how coaching typically looks and sounds. Another good strategy is to engage a coach personally so you can experience the power of coaching first-hand. You also may find it helpful to practice coach- ing one or more people you know and who you can trust to give you useful feedback. That will give you some valu- able experience before you take your coaching live with your employees.

If coaching becomes important to you, you may want to pursue coach-specific training, either face-to-face or online. Look for an excellent, reputable program. You also may want to work one-on-one with a coach-mentor who can help you improve your coaching. Ultimately, you may choose to pursue membership in a professional coaching organization such as the International Coaching Federa- tion, and even to pursue coach credentialing. Truly, with

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Hills | Staff Coaching 307

coaching, there is no limit to what you can learn and how much you can help others. Y

REFERENCES 1. Green H. Know when to manage and when to coach. Forbes . May 1,

2012. www.forbes.com/sites/work-in-progress/2012/05/01/know- when-to-manage-and-when-to-coach/#5806995223be. Accessed November 21, 2017.

2. Stack L. Managing vs. coaching: in today’s workplace, you really need both. TLNT. July 7, 2014. www.tlnt.com/managing-vs-coaching-in- todays-workplace-you-really-need-both/. Accessed November 21, 2017.

3. Harski C. Why the coach approach beats the manager mentality. Entre­ preneur . February 18, 2014. www.entrepreneur.com/article/231568. Accessed November 21, 2017.

4. Hills L. They’ll eat out of your hand if you know what to feed them: the 30 essential communication skills that give highly successful career

The best and most powerful questions will grow organi-cally from the coaching conversations you have with your employees. However, the list below of 50 powerful coaching questions can help you learn what powerful questions sound and feel like. Identify those that you feel will be most useful with your employees. Practice them aloud so you can ask them comfortably during your coach- ing sessions. 1. What’s missing from this picture so far? What is it we’re

not seeing? 2. What do we need more clarity about? 3. What’s most important to you about it and why do

you care? 4. What assumptions do we need to test or challenge

here in thinking about it? 5. What opportunities can you see in this? 6. What would it take to create change on this issue? 7. What would be the biggest impact if you achieve

your goal? 8. What’s emerging for you? What new connections are

you making? 9. What’s been your major learning, insight or discovery

so far? 10. If there was one thing that hasn’t yet been said in order

to reach a deeper level of understanding/clarity, what would that be?

11. If our success was completely guaranteed, what bold steps might we choose?

12. On a scale of 1 to 10, how excited do you feel about taking these actions? What would make it a 10?

13. What’s your favorite way of sabotaging yourself and your goals? If you were going to sabotage yourself on this project, how would you do it?

14. What are you trying to prove to yourself? 15. What small steps can you take to get you closer to

your vision? 16. What do you think the moral of that story is? 17. What are you waiting for? 18. What part of what you’ve just said could be an

assumption? 19. If I were in your shoes and asked for advice, what

would be the

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