REACHING OUT - Mentoring - London Deanery

mentoring.londondeanery.ac.uk

REACHING OUT - Mentoring - London Deanery

Coaching and Mentoring

REACHING OUT

A Report on London Deanery’s Coaching

and Mentoring Service 2010-2012

Dr Rebecca Viney

Prof Elisabeth Paice

www.mentoring.londondeanery.ac.uk


contents

4. Reaching out – Rebecca Viney

8. Who wants a mentor – and why?

Rebecca Viney, Tom Sensky,

Elisabeth Paice

16. Embedding a coaching and

mentoring culture in trusts

Coaching at Kings’ – Tj Lasoye

Coaching for new consultants – Quen Mok

24. Coaching for Health

London Deanery’s GP Registrar Health

Coaching Project – Doug Hing

Coaching in clinic – Gillian Robertson

32. Where Next?

London Deanery International Mentoring

Project – Arti Maini

The future for coaching – Jenny Rogers

12. Reaching out through tasters

and workshops

Getting a taste for coaching and mentoring –

Sue Morgan

A taster for the School of Pathology – Shirley

D’Sa

A One-Day Introductory Workshop – Sue

Morrison, Jane Hawdon

Coaching and team dynamics – Elisa Bertoja

Developing a local coaching faculty - Jane

Hawdon

20. Reaching out to special groups

Doctors in difficulty – Paquita de Zulueta

Overseas graduates and SAS doctors – Meng

Aw-Yong

Empowering patients – Helen Massil

28. Learning and growing

CPD for London Deanery coach/mentors – Sue

Morrison

Deliberate practice – Elisabeth Paice

Reaching out in new directions – Rebecca

Viney

35. Contributors

London Deanery Coaching and Mentoring Service 3


eaching out –

rebecca viney

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London Deanery Coaching and Mentoring Service 5


Reaching out – Rebecca Viney

Welcome to the second report from the London Deanery Coaching

and Mentoring team. Following the warm reception given to The

First Five Hundred, I decided to ask some of our 84 strong core

team of coach/mentors to write about how they are developing the

service and spreading the word to others.

Something to celebrate

• Over 1000 doctors and dentists in London

have applied to be mentored since the

service started.

• 20 Deanery mentors have achieved the

Certificate or Diploma (Level 7) of the Institute

of Leadership and Management in Executive

Coaching and Leadership Mentoring,

postgraduate qualifications endorsed by the

European Mentoring and Coaching Council.

• 48 Deanery mentors are either working

towards or have completed these

qualifications.

• 264 new mentors have been trained in the

last 12 months, bringing the total trained so

far to 508.

• 15 supervision group meetings have been

held in the past year

• 19 master classes have been held, on topics

ranging from mindfulness to setting up a local

mentoring scheme.

London Deanery Coaching and Mentoring

won the National Leadership and Innovation

Agency for Healthcare award for best

learning and development strategy in the

2011 HPMA Awards. The award recognised

outstanding contributions to human resource

management, and the tangible difference to

patient care.

A trip to Boston

I learned of many exciting developments at the Harvard and

McLean Hospital annual ‘Coaching in Medicine and Leadership’

two day event. Three new areas were being transformed by

the coaching approach - medical education, physician health

and patient change. But I and others saw that we were doing

something extraordinary and unique in London, both in providing

a professional standard of coaching and mentoring and in

embedding the coaching approach in issues of leadership,

innovation, appraisal, teams, management, teaching, supervision,

self, family and - of paramount importance - in patient care.

Coaching for health

On getting back home I found small fires already burning in the

area of coaching for health. Not surprisingly many of our mentors

had already used their new coaching mindset and skills to facilitate

better patient engagement. I commissioned master classes to

develop and spread this philosophy further. With the GP School a

small project was run to see how training GP registrars in coaching

for health changed the physician mindset and the consultation for

patients. Not surprisingly, it demonstrated that the mindset change

of the doctors changed patient outcomes. You can read more

about how coaching for health worked out in practice in this report.

Reaching out nationally and

internationally

Over the last year, we have expanded our scope, reaching out into

new areas, extending the influence beyond deanery boundaries.

I have visited South Devon Healthcare at Torbay Hospital, and

the Wessex Deanery. I have been to national SASG events, to

Belfast to speak to CEOs of Trusts and organisational development

leads. I have given talks on coaching and mentoring for health, for

leadership, for doctors in difficulty, about the supervision coaches

need. The reputation of the London Deanery Service has spread.

Deanery mentors are now working with Trusts, Royal Colleges,

the Medical Women’s Federation, the British Medical Association

and others.

From a Consultant psychiatrist in

northern Ireland

I was terribly enthused by what you were


doing for doctors as it seems to me there

is a great need for it. I had gone along

somewhat sceptically expecting it to be

more about how doctors could be coached

to become what organisations have

decided they should be rather than the

healthiest and most productive versions

of themselves. So I was very pleasantly

surprised and very taken with the model

of coaching which is very much about an

awakening or reminding of innate skills and

knowing in the individual. That can be such

powerful stuff in the realms of personal and

subsequently professional development.


Finally, with difficult financial times globally, it seemed right to

offer our skills and services to countries less fortunate. We were

invited to join the ranks of coaches helping women in fragile

parts of the world to develop themselves for their families and

communities through the Cherie Blair Foundation. It dawned on us

as we engaged with this organisation that the world is struggling

to keep doctors in countries with sparse resources and that we

should develop links to sustain healthcare workers in countries

with adverse conditions. There was a great response to my call for

interest in this area, and it is being led by one of our mentors.

Please read about this and many other developments, in the

accounts of those who were involved first-hand. I am sure you will

be as inspired as I have been.

Rebecca

A rose by any other name...

Are we mentors or coaches? Should we talk

of mentees or coachees? Or clients?

The European Mentoring and Coaching

Council recognises the myriad of conflicting

attempts to distinguish between coaching

and mentoring and recommends using both

terms together. But coach/mentor does not

trip off the tongue and coachee/mentee is

simply ridiculous.

Mentoring is the word used by DH and

GMC reports, reason enough to hold on to

the term. But in the medical and academic

world, mentoring implies a longterm

relationship which is not part of the Deanery

service. Coaching fits better with the

interventions we offer.

There is an argument that the word ‘mentor’

is a relationship-describer like ‘friend’ or

‘partner’. Whereas ‘coach’ implies a set

of skills and activities, like ‘practitioner’ or

‘negotiator’. We talk about mentors needing

coaching skills, but it would seem odd to

say coaches need mentoring skills. If we

adopt this approach we would continue

to talk about the people as mentors and

mentees (or clients), but the skills and

activity as coaching (as in coaching for

health).

We have been relaxed about which

terminology contributors use in this

publication, and hope the reader will forgive

the inconsistencies.

Rebecca Viney and Elisabeth Paice

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London Deanery Coaching and Mentoring Service 7


who wants a mentor –

and why?

8 London Deanery Coaching and Mentoring Service

London Deanery Coaching and Mentoring Service 9


Who wants a mentor – and why?

An analysis of applications to the

London Deanery service - Rebecca

Viney, Tom Sensky, Elisabeth Paice

What we did

By March 2011, three years after its launch, the London Deanery

Coaching and Mentoring service had received 850 applications.

This seemed a good point at which to take a closer look at who

had applied and what they were looking for. From the start, all

applicants had been asked to complete a confidential form with

demographic details, their experience of mentoring, the reasons

why they wanted a mentor, and their expectations of the mentor.

The anonymised free text responses were reviewed by two of us.

We worked independently to identify themes which were then

discussed and agreed. We then independently assigned codes,

discussed the cases where there was disagreement and agreed

the final codes.

Who applied?

The applicants came from a wide range of specialties and career

levels. 50% were trainees, 64% were female, 52% were white,

62% had no previous experience of mentoring. The reasons they

gave for applying fell into six main categories: career development;

change and transition; self-doubt; work/life balance; career in

difficulty; and leadership. These could be summarised further into

choice, change and challenge.

What did they want?

Applicants mainly expected their mentor to offer help and

guidance, although a few expected advice or practical assistance.

They wanted their mentor to have experience - ideally to have

lived through the issues that the mentee was dealing with.

Confidentiality was important as was objectivity – and being from

outside the workplace was seen as ensuring both of these. Noone

suggested that they would prefer a mentor from their own

workplace, although some did say they would prefer one from their

own specialty.

CHART 1 – Grade of applicants

OTHER GP/

CONSULTANT

NEW GP/ 121

CONSULTANT

121

OTHER

35

OTHER

35

NEW GP/

CONSULTANT

NEW GP/ 199

CONSULTANT

SAS GRADE

199

96

SAS GRADE

96

CHART 2 – SPECIALTY OF post

foundation applicants

OBSTETRICS AND

GYNAECOLOGY

29

DENTAL

33

ANAESTHETICS

47

SURGICAL SPECIALTY

50

PAEDIATRICS

54

PSYCHIATRY

95

FOUNDATION

82

FOUNDATION

CORE SPECIALTY

82

115

CORE SPECIALTY

115

HIGHER SPECIALTY

202

HIGHER SPECIALTY

202

EMERGENCY

MEDICINE

10

OTHER

10

GP

226

MEDICAL

SPECIALTY

171

I am at the point in my training where I


have to decide what path I want my career

to take. I am finding this decision very

challenging and I’ve been struggling with

it for some time. I’d like a mentor as an

objective sounding board so I can work

through my options. Conversations with

consultants in my field always end up with

advice rather than what I actually need.


As a new consultant my role has


completely changed and I feel this being

a constant challenge... senior advice and

experience would contribute a lot to me

adjusting more quickly and also with less

difficulties to this new role.


My new job involves a level of leadership


and project working that I am not

accustomed to; the fact that the entire

service is new means that there is a lack

of structures, formal or informal, that I can

call on for support in my role... I worry that

this combination of new responsibilities,

and a lack of support structures, carries

with it the risk of early burn-out...


I would like to be able to speak to


someone who maybe has experienced

wanting to leave medicine...


Formal or informal?

Much of the literature on coaching and mentoring has stressed

the advantages of informal spontaneous mentoring relationships.

These have always existed and will continue to do so. But not

everyone meets an effective mentor through serendipity. A

sustainable system should provide equitable access to mentors

who are themselves supported with training, an ethical framework,

time, and reasonable reward and recognition. The London Deanery

service does just that.

External or workplace?

Most studies of mentoring focus on workplace-based relationships

and many effective workplace schemes have been described.

However, doctors and dentists set much store by self-confidence

and commitment. Admissions of self-doubt or a desire for a

better work/life balance can be risky. Aspirations to develop an

atypical career or take on a leadership role may fuel surprise or

even resentment among senior colleagues. Confidentiality and

externality were important features of the scheme for those who

applied.

Evaluation underway

Most applicants wanted help in realising their potential and

enhancing their careers. Many wanted help with maintaining their

self-confidence and motivation, achieving a good work/life balance,

avoiding burn-out and building their resilience. A formal evaluation

of the success of the scheme in helping applicants achieve these

aims is currently underway.

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eaching out

through tasters

and workshops

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Getting a taste for coaching and

mentoring – Sue Morgan

I have been helping the London Deanery deliver taster sessions for

the last couple of years. The sessions are based around interactive

exercises which are great fun to deliver and participate in. They

enable attendees to experience the problems around advicegiving

and illustrate how coaching techniques such as reflective

questioning immediately enable engagement and reflection.

My problem was so complex that I couldn’t


explain it to the person giving the advice,

so most of the advice given didn’t feel

relevant to me.


The questioning brings new insights and enables mentees to

plan how to tackle the problem themselves. This illustrates how

mentoring can be a powerful tool in enabling people to initiate

change in their lives where they have been stuck for some time.

The questioning allowed me to focus on my


issue and work out solutions for myself that

had actions that I felt comfortable with.


There is usually a flurry of new applications for mentoring from the

participants following these sessions, evidence that the message

has been received.

The sessions can be tailored for different audiences but in general

run between two to three hours in order that an understanding

of the process is gained. If you are interested in having a taster

session delivered to your department please contact me via

mentoring@londondeanery.ac.uk.

A coaching taster for the School of

Pathology – Shirley D’Sa

My journey from doctor to coach

I first encountered coaching seven years ago, when I found myself

at a personal crossroads. I made contact with a coach who was

writing in the BMJ Careers section at the time. Our discussions led

to a series of coaching sessions which showed me how coaching

could lead to change. When the coaching and mentoring initiative

was introduced in London Deanery, I jumped at the opportunity

to take up the training. It has been a journey of exploration into

the world of interpersonal communication with valuable lessons in

the art of listening, providing space, holding back from ‘planting’ a

solution on another individual. This was a major learning exercise

for a doctor trained in problem-solving, reaching a diagnosis and

making a management plan!

Coaching for educators

The ever-changing specialty training landscape has at times

promoted feelings of insecurity, uncertainty and a sense of

disempowerment in trainers. Consequently, a coaching initiative

was trialed at a School of Pathology evening for Training

Programme Directors and Educational Supervisors. It was felt

that an introduction to coaching would provide an opportunity for

those in leadership positions within the School to gain insights

into how coaching might fit into their personal and professional

armamentaria. How can senior doctors fulfil the competing

demands that are placed on them? How might they rise above

their own concerns to support and nurture themselves and their

trainees?

A convivial and enlightening evening

An evening programme at BMA House started with an opportunity

to network as for many this would be the first time they met. I

then opened with my personal perspective on coaching, followed

by Rebecca Viney who conducted a round of exercises with the

participants. Discovering the power of coaching as opposed to

advice-giving was the major focus. None of the participants had

prior experiences of coaching and some were sceptical. Following

the exercises, there was universal agreement that it was a powerful

tool. Some participants expressed interest in training as coach/

mentors and most felt that such techniques would be applicable in

many aspects of their lives and work.

A One-Day Introductory Workshop –

Sue Morrison, Jane Hawdon

In response to requests from NHS organisations over the last six

months, we have developed and delivered one-day introductory

workshops on coaching and mentoring. As London Deanery

coach/mentors with a background in education, we were keen to

spread the ethos and learning that has developed in the London

Deanery scheme.

Aims and objectives

Our aim was to raise awareness of concepts and approaches in

coaching and mentoring and to disseminate basic coaching skills

that might be used in a variety of clinical, team and educational

settings. We envisaged that participants might later go on to

explore further training to become mentors themselves

The objectives for the workshop were that each participant:

• Explored some coaching paradigms that may

be useful in the workplace

• Practised coaching and mentoring skills

• Completed an action-learning development

plan.

Tailored training

We tailored each workshop to the participants’ levels of experience

and knowledge. Participants included paediatric consultants,

paediatric trainees, educationalists (medical and non-medical),

staff grade and specialty doctors, leaders in human resources and

organisational development, GP vocational trainees.

A structured day

We used the IGROW model in structuring the day. The aim and

objectives of the workshop were taken to be the Issue. A group

learning needs assessment, using a pre-course questionnaire and

workshop opening exercise provided the Goals. We then did a

Reality check of what was possible to achieve in the time and the

Options for learning. The emphasis was on demonstration of skills

and practical, facilitated and interactive small group work. We took

some time to define coaching and mentoring and contrast advicegiving

with encouraging clients to find their own answers. We

explained that existing skills, such as developing rapport, active

listening and giving feedback would be enhanced and practised

new skills such as contracting, motivational questioning and brainstorming.

Will - the day closed with participants committing to an

individual action-learning plan.

The way forward

The use of coaching techniques can help clinicians and leaders

reflect on their professional experience and stimulate deeper

learning and development in themselves and others. There

is enormous opportunity for the application of coaching and

mentoring approaches in settings such as consultations,

educational and clinical supervision, and appraisal.

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EMBEDDING a culture

of coaching and

mentoring in trusts

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Coaching at King’s – Tj Lasoye

The way it was

King’s used to have a list of older consultants who felt they

could offer support and advice to those in the early years of their

consultant career. This arrangement was advertised to newly

appointed consultants but no more than half a dozen took up the

offer at any one time. I remember hearing about it during my own

induction and immediately dismissing it as ‘not for me’. I thought it

would be a sign of weakness to take up such an offer!

Discovering coaching and mentoring

It was not until I attended a leadership development programme

that I became aware of what coaching and mentoring was really

about. My interest in the subject drove me to undertake a Trustbased

coaching development programme and the Deanery training

which led to my enrolment as a Deanery coach/mentor. I quickly

realised how useful coaching and mentoring could be in helping

people improve their performance and enhance their self-belief. I

became convinced that everyone could benefit from it. The case

for developing a local scheme to which all our colleagues would

have access wasn’t difficult to make. The Trust Executive did not

need any persuasion to give their approval and support for the

proposed scheme.

What we did

In the spring of 2010, we announced our intention to develop a

quality assured mentoring scheme for the Trust. We modelled

our programme on the well-established London Deanery service.

Everyone who expressed interest in becoming a mentor undertook

a three-day training programme delivered by a professional

firm. Once we received confirmation of successful completion,

individuals were added to our database of trained mentors. We

set up a matching process, each mentor being asked to produce

a brief resume to aid mentees in their choice of mentors. Our

postgraduate education centre staff manage that process.

Where we are now

Feedback from mentees has been extremely positive. They say

they find coaching and mentoring most useful in helping them

develop their leadership and management skills. Mentors report

that these skills have helped them to be more effective in their

educational supervision roles. Both mentors and mentees are

reporting enhanced morale and performance in general. The

potential benefit to the Trust with regards to improved productivity

of a highly motivated workforce in the current financial climate is

clear.

Sustainability

Our initial investment of less than £10,000 to cover training fees

and other start-off costs has already started yielding dividends

as described above. This investment also covers quarterly halfday

workshops for mentors and advanced training for our ‘super

mentors’ who will be training their colleagues in the future. We

are encouraging trainees to become mentors; we believe this will

further embed coaching and mentoring, and its potential benefits

within the culture of the organisation.

Coaching for new consultants –

Quen Mok

Stressful start

I found starting as a new consultant in a new hospital very

challenging. Having to find my way around the maze of corridors,

and trying to get to know the key people was a stressful and

daunting prospect. Hence after a few years of being a consultant,

I was keen to join the Trust mentoring scheme for new consultants

which was being started up and supported by the Medical

Director. This seemed a superb idea. Senior staff from the different

health professions and senior managers were encouraged to

attend the one-day training programme. We were then paired

with new consultants joining the Trust. However there were no

guidelines for the mentors, and there was no assessment, ongoing

supervision or training updates for the mentors. We were mainly

acting as “buddies” to help someone find their feet and settle in

more quickly.

A different approach

I attended the London Deanery three day basic coaching skills

course soon after it was launched. I soon realised that the ethos

being taught here was entirely different. It was much more about

aiding personal development by supporting and challenging,

focusing on change and action, and using reflective questioning

and problem-solving techniques to help mentees find their

own solutions and to realise their potential. The training was

structured and intensive. We were assessed and accredited before

being entrusted with mentees. We were required to develop

by attending regular update courses and supervision sessions

where difficult issues could be shared. This provided support

and encouragement, refreshment and reassurance, as well as

networking among colleagues. I encouraged our Trust mentor

lead to attend the Deanery training. Subsequently the London

Deanery was asked to provide a taster day for the mentors in the

Trust. I hope this will lead to better coaching and mentoring being

embedded in our Trust, and to new consultants being given the

support they need to meet those initial challenges.

Coaching and team dynamics – Elisa

Bertoja

I joined the London Deanery mentoring training a few years ago

because I wanted to support my trainees in making the best

decisions for their careers. While I was training to become a

mentor, I also became a mentee in order to fully appreciate what

I was getting myself into. It was a ground breaking experience! I

felt I was given the opportunity to learn how to help people to help

themselves. After I finished my first two Deanery courses everything

started to happen as a gentle but neat cascade: first few mentees,

immediate satisfaction after the sessions, followed by positive

feedback and new challenges. It was a quite natural step to try to

apply the mentoring skills outside the mentoring sessions.

As an anaesthetist I work in acute settings and the environment

can be extraordinarily stressful. In these situations communication

between team members is paramount to maintain safety and

efficacy. In studies on untoward incidents it is frequently mentioned

how junior or less educated members of teams do not feel

empowered to speak their opinion and yet are often aware of the

mistake that is about to happen. I realised there was room to use

mentoring skills in order to improve the team dynamics. It is still

early days, but I have already detected an improvement in the

morale of the team members and communication is more fluid.

I am receiving positive feedback from medical colleagues and

ancillary staff. Training and working as a mentor has changed my

approach to peoples’ achievement and failure.

Developing a local coaching faculty

– Jane Hawdon

Having identified at my Trust that there were six trained and active

Deanery coach/mentors and a number of other staff trained in

coaching, I convened an internal coaching faculty. The principles

and process for applications and matching follow the Deanery

model. The Trust is sufficiently large for coach/mentors and

mentees to be from different specialty areas and different staff

groups. This maintains objectivity and a degree of confidentiality.

The faculty meet regularly for CPD sessions and supervision.

The scheme has been popular and has received good feedback.

Next steps are to encourage more staff members to train and

join the faculty and by “osmosis” engender a coaching culture

in the organisation. This is entirely consistent with other Trust

programmes such as After Action review, a form of debrief

whereby questions are asked to elicit learning and change rather

than apportion blame.

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eaching out to

special groups

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Coaching and mentoring for

doctors in difficulty – Paquita de

Zulueta

A catalyst for personal and professional

flourishing.

Doctors are unused to having time allocated just for their own

personal development or to attending to their own emotional

needs. This can sometimes lead to a neglect of self-nourishment,

which, when coupled with rigid maladaptive perfectionism, can

lead to exhaustion and burn-out. I have recently been working

with some doctors who have been struggling in this way. One had

suffered a catastrophic illness, but it was relentless self-criticism

that was the main impediment to recovery. I have mentored

doctors struggling with illness or disability who have had to face an

inflexible regime of competency box-ticking as well as stigma and

prejudice.

Coaching and therapy

I am qualified in cognitive behavioural therapy - this adds to the

repertoire of tools that I can utilise in helping individuals to reframe

challenging situations and to release themselves from self-limiting

beliefs and self-prejudice. I am very much of the positive school of

psychology and prefer to work with strengths and build resilience.

I have also learnt a lot about myself in the process and have

gained new insights and perspectives about what makes me

and others tick. I use self-disclosure when it seems appropriate

and this seems to build trust and rapport. One mentee told me

that my narrative of recovery from a difficult chapter in my life

inspired her confidence more than anything else. I have found that

the boundary between therapy and mentoring is not clear. The

difference is that mentees generally, but not always, score higher

on the spectrum of resourcefulness than do therapy clients. But

both enterprises have enablement as their core aim and utilise

a collaborative approach underpinned by curiosity, respect and

mutual trust.

Anything can happen

Mentoring involves working in that liminal space between what

is and what can be. Dreams and aspirations are crystallised into

concrete goals and action plans. Surprises occur. One doctor

decides that perhaps full time medicine is not for her. Another

changes his career orientation. The key is change in a direction

that is consonant with authentic values. By learning more about

themselves and making changes, mentees lay down the seeds to

become mentors themselves. So let the garden grow.

Coaching and Mentoring for

Overseas Graduates – Meng Aw-Yong

New cultures and systems

The GMC report State of Medical Education 2011 http://www.

gmc-uk.org/publications/10586.asp highlights that doctors who

trained abroad can face difficulties when they start to practise in

the UK, due to language problems, unfamiliarity with UK systems

and difficulties with communication and cultural differences. Role

play, a feature of many interview and assessment processes,

may be unfamiliar to them. A study on the perceptions of staff

grade and associate specialists (SAS) doctors, many of whom

are overseas graduates, of being educational supervisors showed

a lack of understanding of what was required. Possibly as a

consequence of these difficulties, overseas graduates feature

in a higher proportion in referrals to NCAS and GMC Fitness to

Practise. Some innovative steps are being undertaken to address

these issues.

Leveling the playing field

London Deanery offered SAS doctors free access to its Coaching

and Mentoring service from the start and SAS grades were wellrepresented

among the first 500 applicants. Wessex and Oxford

Deaneries and the College of Emergency Medicine are following

this lead and also offering training as coach/mentors for suitable

SAS grades.

Safer starts

The Forum for Associate Specialist and Staff Grade Doctors in

Emergency Medicine is joining forces with an education training

provider and several locum agencies to develop an induction

training programme to the NHS for overseas doctors. This will

include a life support course, an introduction to the NHS and its

systems, and an insight into regional social differences. Coaching

and mentoring are seen to be key to unlocking these issues and

also promoting leadership such as in the roles of clinical and

educational supervisors.

Spreading the word

I am committed to embedding mentoring in

my royal college. Without the support of the

Deanery, freely sharing their expertise, this

would not be possible.

Geoff Norris

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London Deanery Coaching and Mentoring Service 23


coaching for health

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It is amazing how many of the mentors are

coming back and telling me that the training

has revolutionised the way they themselves

work with their patients!

Matt Driver, Management Futures trainer

London Deanery’s GP Registrar

Health Coaching Project – Doug Hing

Who is the expert?

Although times have changed and there has been an enormous

emphasis on patient-centred consultation models in medical

schools and GP vocational training, it is still extremely easy to

adopt a doctor-centred approach and try to solve patients’

problems for them. In contrast, the health coaching approach puts

patients as the experts of their own lives and permits them to find

solutions to their own problems through collaboration and support

from the doctor.

Crucial concepts

Through the Health Coaching Project, I learned some crucial

concepts relating to behavioural and motivational interviewing,

recognising barriers to behaviour change and raising my own selfawareness

about how I consult and self manage. For example,

how often do I only listen out for answers I want to hear? How

often and how significant are interferences such as personal

feelings on the day, running late or trying to achieve practice

targets like monitoring blood pressure?

Coaching consultations

Coaching questions and techniques can be simple, but the skill

comes from knowing which question or technique to use and

when for the consultation to be most effective. Coaching can

be used as a formal process, a brief intervention tool or even as

an approach to having a conversation. Using it in consultations

can allow the doctor to quickly determine the appropriate level

of patient engagement, the type and amount of information to

provide, the extent of responsibility for problems, potentially reduce

unnecessary specialist referrals and to facilitate an improved

doctor-patient relationship.

Brainstorming

I attended the Coaching for Health half

day this summer. This has given me a

brand new tool in the consultation and has

enabled me to reach a newer depth in the

way I deal with patients in the consulting

room. Brainstorming has been extremely

enlightening and given me insights about

a patient that I would never have gained

with any amount of active listening. There is

nothing more satisfying to me as a doctor

than seeing a patient leave my room with

hope and optimism and I think that coaching

for health empowers people to find this hope

for themselves.

Farzan Hussain

Coaching in clinic – Gillian

Robertson

Widening applications of coaching

I started coaching and mentoring two years ago. As part of the

London Deanery’s basic skills course we had to coach someone,

so I chose a colleague at work. This made me think about the role

of coaching in my work place, with staff and patients. Before I had

heard about the Coaching for Health Masterclass I had started to

incorporate the “magic questions” into certain consultations. I also

changed from being the doctor asking questions to being a coach

within a consultation.

The stages of change

Health coaching aims to increase patient awareness and

knowledge of their condition, assume greater responsibility for it

and make the necessary changes to improve their own health.

The patient is encouraged to clarify their own reasons for change

and then to plan how to best effect the change. The coach assists

the patient with making the changes and also with identifying and

utilising strategies to prevent relapse. The patient will progress

through knowledge change, attitude change and then proceed

to action. Many patients require several attempts. However, the

technique can be very successful and patients are most likely to

be successful when working in partnership with their health care

provider.

Coaching in practice

I have incorporated aspects of coaching for health into my

everyday practice. For example I occasionally see clients with

difficulties with contraceptive choices. Telling a client all about

the methods often leads to glazed eyes. Asking them question

about what they are looking for in a contraceptive method and

transferring the responsibility to them can be very helpful and

provide some illuminating insights.

Coaching and chronic disease

By 2020 it is predicted that three-quarters of all deaths will be from

chronic disease; currently adherence to prescribed medication is

estimated at 50%, and where life style change is required only 10%

achieve their goals. Perhaps if those with chronic disease such

as diabetes, obesity or asthma were treated using the coaching

model these figures might be improved.

Coaching for doctors’ health

Coaching for health should be expanded to the health providers.

It is well documented that stress levels in doctors is high; the

personality traits which make a good doctor also are responsible

for high rates of stress and depressive illness. Doctors need to

know how to look after themselves, so coaching for personal

health should become part of both the undergraduate and

postgraduate curriculum.

Empowering patients – Helen Massil

My clinical work includes psychosexual therapy. Over the past year

I have started introducing the skills I have developed through the

London Deanery Coaching and Mentoring service. The essence

of this approach has been for me to move from being the expert

to enabling my clients to make decisions for themselves. I use

open questions, summarising, reflecting, giving feedback, and

techniques from the Egan Skilled Helper and Transactional

Analysis models.

Building trust

The majority of people of who come to see me are feeling nervous

and anxious since this is a very sensitive and intimate area and

they have to deal with an unknown doctor. In the first session

I work on building rapport and trust. I emphasize that they are

resourceful people and that they are experts in their own lives. I

also explain that the clinic encourages positive change and they

will need to work on making the changes. My role is to act as a

facilitator to guide them through the process. I offer the option that

they can call me by my first name (although that can be a step too

far for some clients!). It is interestingly to see how a client reacts

to these introductory statements – most people show enthusiasm

for this approach while a few are wary. From the first session I

introduce the idea of goal setting so that the clients start to think

about the problem and what changes they want to make. This

inevitably changes the dynamics from me being the expert to a

partnership between myself and the client.

Unexplained medical problems

Coaching and mentoring techniques have been particularly

successful for clients referred with ‘unexplained medical problems’.

These are clients who may have seen many clinicians without any

explanation for their physical symptoms. By the time I see them

they are feeling disempowered and confused. Coaching and

mentoring can enable them to feel more in control of their lives,

and allow them to identify the real area of concern which can be

very different from their presenting symptoms.

Coaching for change

Over the past year I have seen some major and rapid changes

in some of my clients. A simple exercise using the Transactional

Analysis model enabled a client to see how she always “tried to

please others”. Once she recognised this pattern of behaviour

by documenting how often she was doing it on a daily basis, she

made a decision to act more assertively and consequently made

changes in her sexual relationship. Another client identified the

thought patterns that had impeded her making choices for herself

over many years. She consequently made significant changes in

her life and in her relationship with her husband and felt that she

could manage her sexual problems by herself.

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learning and growing

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Transforming impact

Training as a mentor was life changing.

It changed the way I relate to patients,

colleagues, friends, and family, and gave

me a powerful set of skills, to help others

reach their full potential and develop

their own effective ways of managing

problems. Having a skilled mentor was

also transforming, enabling me to see my

previously unchallenged assumptions and

remove barriers, which mean I can now strive

for heights I had not previously considered

possible. These benefits have transferred

into different areas of my life. Two years later,

I cannot imagine working as a clinician, or

educator without these skills, which have

increasingly become embedded into my

everyday work and life.

Connie Smith

Masterclasses in Myers Briggs personality

type, coaching for health, mindfulness,

transactional analysis, and neurolinguistics all

in different ways emphasised the importance

of asking open questions and listening to

the answers.

Geoff Norris

CPD for London Deanery coach/

mentors – Sue Morrison

Commitment to quality

The London Deanery has required CPD for its coach/mentors from

the beginning. Regular professional development opportunities

have been provided with ample opportunity for interactive learning

and feedback. Coach/mentors have been encouraged to direct

their own learning, starting by identifying key development needs

within broad coaching and mentoring categories such as models,

tools, context, aspects of process and attitudes to practice.

Feedback

Client feedback can be a rich source of learning and coach/

mentors are encouraged to ask for this at the end of each session.

The Deanery also encourages clients to submit detailed written

feedback with complete confidentiality and a no-blame approach.

Fortunately, most clients are only too happy to share their

(invariably positive) feedback with their coach/mentor.

Educational events

The Deanery has held events, ranging from half-day to four-day,

on topics like Emotional Intelligence, The Egan Skilled Helper, and

Coaching for Health. Coach/mentors have been sponsored to

work for the Institute for Leadership and Management certificate

and diploma in Executive Coaching and Leadership Mentoring.

Those who have been preparing for these qualifications have kept

detailed portfolios of their work, comprising a log of CPD activities

(conferences, workshops, reading, peer discussion for example)

and of individual client sessions, reflecting on the learning and

noting how this has become incorporated into their practice. This

is a useful framework, even for those not involved in study for a

qualification and has increasingly been promoted during CPD

workshops and supervision.

Supervision

Supervision of practice is another requirement. Deanery

coach/mentors must attend a minimum of two out of four

group supervision evenings a year. Deanery supervisors have

incorporated coaching principles into their supervisory practice,

focusing on the coach/mentor rather than the mentee. The

supervisor steers the coach to reflect on patterns in their practice

and different models and styles, but the coach remains in control

of their own learning. The supervisor may spot vulnerable areas in

the coach’s attitudes and professional behaviours and help them

avoid responding to mentee’s issues out of their own needs.

Quality standards

Given the importance of this supervisory relationship, and in line

with its aim to be a learning organisation, the London Deanery has

invested in higher professional training for its supervisors. Our next

task is to develop quality standards for coach/mentors, trainers

and supervisors and use these as the basis for appraisal and

quality assurance.

A liberating philosophy

I went on a London Deanery coaching and

mentoring course a year ago as I thought it

would enhance my skills as a GP appraiser. I

did not think that attending this course would

change my practice as a GP, assist me as a

new trainer with a difficult trainee and help

me in my personal life. I found the philosophy

liberating as an appraiser, letting individuals

choose their own goals without being told

what to do. It has added a much more

optimistic feel to my appraisals.

Farzan Hussain

Deliberate practice – Elisabeth Paice

Most professionals reach a stable, average

level of performance within a relatively short

time frame and maintain this mediocre status

for the rest of their careers.

Ericsson, Academic Medicine, 2004

We know it takes at least 10,000 hours to make an expert, but

plenty of people with decades of experience never reach expert

level. Ericsson’s studies on expert chess players, musicians,

tennis players and doctors show that outstanding performers all

adopt the same approach which he calls deliberate practice. They

seek to discover their weaknesses and take steps to address

them. They self-monitor and are hard on themselves. They seek

out external feedback. They construct ways of working on their

weaknesses through repetitive practice. They look for training

opportunities that stretch them. They compare their performance

with that of other experts in their field, and use that comparison to

drive further efforts.

As coach/mentors, how can we make sure our practice is keeping

true to the principles we were taught and that we keep on growing

and improving? What are our own individual weaknesses? Do we

get lazy? Do we always remember the clients’ resourcefulness? Do

we make sure we stick to the client’s agenda? Are we occasionally

tempted into advice-in-disguise?

Here are my own plans for deliberate practice as a coach/mentor

in the year ahead:

1. Spotting weaknesses – seek client feedback

at the end of every session; record every

session (if clients agree) and write reflective

notes, sharing some of these with

a supervisor.

2. Practising skills – at the start of each session,

plan what skills I will work on, and afterwards

reflect on how it went, for me and for the

client.

3. Going on courses – plan regular CPD

activities and make a note of what I am going

to do differently after each one.

4. Reading – engage in action-oriented reading

– how will what I read influence how I coach?

5. Motivation – benchmark my performance

with peers; work with an inspiring and

rigorous supervisor.

30 London Deanery Coaching and Mentoring Service

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Where Next?

32 London Deanery Coaching and Mentoring Service

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Contributors

London Deanery International

Mentoring Project – Arti Maini

Never doubt that a small group of thoughtful,

committed citizens can change the world.

Indeed, it is the only thing that ever has.

Margaret Mead, Social Anthropologist.

These famous words are relevant to our London Deanery-trained

mentors, many of whom have experience of living and/or working

in developing countries and are keen to use their mentoring skills

to support healthcare colleagues in developing countries. Speaking

to these mentors about their experiences and ideas has been

hugely inspiring, and has helped shape an exciting vision for a

unique project.

The London Deanery Coaching and Mentoring Service has

been working closely with partner organisations to develop a

project where volunteer London Deanery trained mentors will

have the opportunity to be matched with and support healthcare

professionals in developing countries through distance mentoring.

These professionals may face a range of challenges including

a lack of information resources, professional isolation, and little

opportunity for continuing professional development, personal

guidance and development of leadership skills. Understandably,

many decide to emigrate in search of better conditions overseas.

There has been growing recognition of this problem over the past

decade and its impact on the delivery of health programmes,

particularly for those in poor and fragile areas.

The goal of our project is to utilise the skills and expertise of

volunteer London Deanery trained mentors to support key

healthcare professionals in developing countries. Through the

fulfilment of professional and personal learning goals, this project

will aim to improve retention of health professionals in their

countries of training and to develop senior leadership capacity.

The future for coaching – Jenny

Rogers

Knowledge and insight about the amazing power of the coaching

approach is spreading. The first of the London Deanery coaches

quickly discovered the value of using it with patients, reporting

back joyfully that it had frequently transformed the quality of the

work they were able to do, especially with patients with chronic

conditions. Now, ‘coaching for health’ has become a catchphrase

whose time has come, potentially saving the health service millions

of pounds and making a positive step-change in doctor-patient

relationships. Coaching as the foundation of a manager’s approach

to staff can create the golden grail of ‘employee engagement’,

a phenomenon which has been shown to correlate highly with

bottom line performance when it is also linked with creating a

‘coaching culture’. So coaching will survive. The need for tough

qualifications will increase. Some kind of regulation may be on the

way.

Reaching out in new directions –

Rebecca Viney

Our joint vision for the future is to continue to embed a coaching

approach across the NHS. Ultimately we aim to reach out beyond

the UK and beyond medicine. Doctors and patients must use the

mindset and skills to transform healthcare provision over the next

decade into one that is sustainable, valuable and effective.

Now that coaching and mentoring are on the map of medicine and

dentistry our next steps will be to develop a set of nationally agreed

coaching and mentoring standards for the medical and dental

profession to use to drive up quality.

And finally, the General Medical Council have introduced

“mentoring” into the draft new duties of a doctor. This gives us the

opportunity to embed quality coaching and mentoring behaviours

and mindset change right from the start of medical education.

Please work with us to take this forward in medical schools around

the world.

Dr Meng Aw-Yong, Associate Specialist

Emergency Medicine, Hillingdon Hospital,

London Deanery coach/mentor

Dr Elisa Bertoja, Consultant Anaesthetist UCLH

and The Heart Hospital, Educational Supervisor

and London Deanery coach/mentor

Dr Paquita de Zulueta, GP, CBT therapist,

Honorary Senior Clinical Lecturer Imperial

College London, London Deanery coach/mentor

Dr Shirley D’Sa, Consultant Haematologist, TPD

in School of Pathology and London Deanery

coach/mentor

Dr Jane Hawdon, Consultant neonatologist at

UCLH and London Deanery coach/mentor and

trainer

Dr Doug Hing, GP ST4 and Darzi Fellow and

new coach

Dr Farzana Hussain, GP in Newham and new

London Deanery coach/mentor

Mr Tj Lasoye, Director of Medical Education

and Consultant in Emergency Medicine. King’s

College Hospital NHS FT and London Deanery

coach/mentor

Dr Arti Maini, GP and London Deanery coach/

mentor and trainer

Dr Sue Morrison, GP and London Deanery

coach/ mentor and trainer

Dr Sue Morgan, Associate Specialist Elderly

Care Medicine, Croydon University Hospital.

London Deanery coach/mentor and facilitator

Dr Geoff Norris, Locum GP, London Deanery

coach/mentor

Prof Elisabeth Paice, Chair NWL Integrated Care

Pilot, London Deanery coach/mentor

Dr Gillian Robinson, Associate Specialist

Reproductive and Sexual Health, South London.

London Deanery coach/mentor

Jenny Rogers, Executive Director of

Management Futures, author of Coaching Skills:

A Handbook and Adults Learning and series

editor of the OU series, Coaching in Practice

Prof Tom Sensky, Consultant Psychiatrist in

Occupational Health, and London Deanery

Coach/Mentor

Dr Connie Smith GP Tutor and London Deanery

coach/mentor

Dr Rebecca Viney, GP and London Deanery

Coaching and Mentoring Lead, Associate

Dean Workforce Development and Professional

Support Unit

Our volunteer mentors will benefit through ongoing support

(supervision, action learning sets), CPD and skills development

opportunities (e.g. e-mentoring, transcultural mentoring) and

through becoming part of a like-minded community of healthcare

mentors. We envisage a key benefit for volunteer mentors will be

the development and emergence of new perspectives which will

impact on their own work and lives.

We aim to launch this exciting project in the next few months.

Please contact me through mentoring@londondeanery.ac.uk

if you would like to know more or to become involved.

Thank you for being part of the coaching and mentoring

community of practice in London, the NHS and beyond.

Dr Helen Massil, Consultant in Sexual and

Reproductive Health, London Deanery coach/

mentor

Dr Quen Mok Consultant paediatric intensivist

in Great Ormond Street and London Deanery

coach/mentor

34

London Deanery Coaching and Mentoring Service

London Deanery Coaching and Mentoring Service 35


London Deanery, Stewart House, 32 Russell Square, London WC1B 5DN

www.londondeanery.ac.uk

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