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Coaching for Quality of Care

To achieve results in the practice, connect with the beliefs that ultimately drive the actions of associates and staff.

GULROOP SINGH HANSRA, O.D., DOWNERS GROVE, ILL.

Imagine this: You just spent $25,000 on new instrumentation that you have dreamed about owning for months. As the proud owner of the Visual Enhancer 3000 (fictitious name), you congratulate yourself on the change the instrument will make in your practice.

The honeymoon ends

Fast-forward a month or two, and the honeymoon is over. You can’t figure out why patients no longer want to spend the additional money for the test. When you probe, technicians tell you, “Patients are particularly ‘price-conscious,’” or, “The test is not covered by insurance.”

You struggle to pinpoint the reasons for these poor results, and the only thing certain is that you are losing money. Your spouse reminds you of your last emotional purchase — the timeshare condo in Orlando, Fla., that you never visit.

An easy sell?

Have you ever experienced such a situation or heard of a practice that has? Sales presentations often simplify potential revenue streams — just “install and bill for it.” Few of the discussions include how the new instrument enhances the patient experience that is unique to your practice and what to do to get repeatable and measurable results that impact patient outcomes. The easy part is financing. The difficulty comes from everything that happens thereafter.

The root of failure

Through hundreds of office visits, it has been my experience that the root cause of poor performance is a non-alignment in the beliefs of the optometrist, associate optometrist(s) and/or the staff. If you have recently introduced new instrumentation or systems that did not meet your expectations, ask these questions of associate O.D.s and staff: Do you believe in the technology? Do you feel the benefits of the instrument outweigh the cost for the patient? Do you believe it is a necessary expense?

These beliefs drive the behaviors, or lack thereof, which leads to the results, or lack of results.

A matter of leadership

Unfortunately, most leaders don’t coach to the level of creating new experiences for their employees to establish the beliefs they want them to hold. They simply do not connect that it is the beliefs that ultimately drive the behaviors that achieve the results. Craig Hickman, Tom Smith and Roger Connors have written extensively about this model, which they call the “Results Pyramid” (see Figure 1) in their best-selling book, The Oz Principle: Getting Results Through Individual and Organizational Accountability (Portfolio Trade, 2010).

Figure 1. While most leaders focus on results, authors Crig Hickman, Tom Smith and Roger Connors have found that addressing the bottom half of the Results Pyramid — that is, people’s beliefs and experiences — helps leaders create meaningful change in the practice culture.

Training vs. development

Most of us diverge on this path of executing the Results Pyramid by failing to differentiate between training and development. We think of training as results, or understanding which buttons do what on the Visual Enhancer 3000.

Development, or coaching at the level of experiences and beliefs — the bottom two layers of the Results Pyramid — is much different. Leadership that creates experiences and changes beliefs, which ultimately change results, is intensive and requires a lot of coaching. It explains not how to use the Visual Enhancer 3000, but how instrumentation, systems and procedures fit into the beliefs or mission of the practice.

Development creates alignment in the office, and if done well, it seeds a culture of shared values consistent with what the practice stands for. The answer to the question “Why do we do what we do?” becomes intuitive in every patient touch point. So, how do we coach this?

Coaching for development

The American Society for Training and Development defines coaching as “an interactive process to help individuals and organizations develop more rapidly and produce more satisfying results; improving others’ ability to set goals, take actions, make better decisions and make full use of their natural strengths.”

I find it effective to break down coaching in terms of instruction, development and confrontation.

Instructional coaching

Use instructional coaching when you roll out a new initiative or provide new information. Here, it is imperative you present structured content to facilitate learning; therefore, preparation is key.

With instructional coaching, you might find you are doing much of the talking as you teach the recipient what the instrument is, why you choose to use it and how it works. You also must uncover current staff beliefs, identify obstacles and begin the process to shift the team toward the beliefs you want them to hold.

Sharing relevant stories and asking prepared probing questions shapes thought. Using the Visual Enhancer 3000 as an example, questions could include:

▸ What have you heard about the device?

▸ How does using the device compare with what you are used to doing?

▸ What obstacles will get in the way of utilizing the device?

When you encounter obstacles, dig deep by simply asking “Why?” five times. Be prepared to model the actions you desire, and leave ample time to practice or role-play.

For example, you might role-play an obstacle a technician faces: The patient who does not agree to pay for the testing with the Visual Enhancer 3000. Asking “why” five times, you find the technician is reluctant to recommend patients pay for additional testing. To overcome this reluctance, you and your tech agree to an action plan in which the tech uses a scripted presentation to educate patients about the device.

During your practice sessions, remember staff are learning something new, so encourage them.

At the end of the session, communicate clear objectives, performance standards, goals, next steps, owners (who ultimately is responsible) and deadlines.

Developmental coaching

Developmental coaching is used after the initial role-playing. Follow-up, follow-up, follow-up is the essential mantra for this type of coaching. Set aside planned time to maximize the potential. Prepare yourself with an observation guide, action plans from past sessions and performance metrics that you can lay out in a series, and look for measurable improvement.

If you find yourself doing much of the talking during these sessions, you probably are not effective. Observe your staff members modeling the ideal behaviors in real life, and role-play it when customers are not present. A non-threatening and effective debrief model answers the questions:

▸ What did you do well? (Celebrate their success.)

▸ Here is what I thought you did well…

▸ Where did you struggle?

▸ Here are the one or two items that can make you even more effective…

▸ What do you plan on doing differently?

Mapping out your next developmental session is where many leaders fail. Once again, follow-up, follow-up, follow- up. A well-known action plan that can help you with the next steps is SMART, an acronym that stands for objectives that are specific, measurable, attainable, realistic, and timely. One or two sessions might not be enough to get your entire team aligned, so patience is key. When objectives are met, provide recognition, establish collaborative stretch goals, and leverage your winners to elevate the performance of non-performers.

Confrontational coaching

If after multiple developmental sessions, performance standards are not met, consider using the confrontational coaching model. A lack of performance could be due to will, skill or blamelessness. In these situations, be prepared with documentation that includes observational notes, action plans, performance evaluations, numeric results and a plan for the follow-through process.

Point out agreed-upon goals, and state clearly where the staff member is not meeting expectations. That could sound like, “I wanted to meet with you today to talk about. . . Do you recall where you agreed your performance would be?” “We agreed you would achieve _____ at a minimum. Do you know where you currently stand? What feedback do you have for me related to your performance?” Indicate where performance is missed, support with documentation, and allow the staff member to confirm or offer new information.

This can be very uncomfortable for many people, but at the end of the day, it is the patient who suffers if quality of care is subpar due to a non-performing staffer. Decrease the timelines, gain staffer agreement to the plan, measure, and execute the plan. Once again, your follow up must be relentless. During subsequent coaching sessions, if performance is met, reinforce the positive behaviors, and move back to developmental coaching. If immediate steps are not achieved, move to further counseling up to and including termination. By not acting on poor performers, others will believe that quality of care and being excellence minded is an option, not a requirement. Don’t let “inactions” reinforce powerful negative beliefs and cause a culture of misalignment.

Culture of excellence

When all staffers share common beliefs and goals, results feel automatic, as a culture of excellence is being created. A sustained plan is needed as new staffers are brought on board or beliefs begin to shift slowly out of alignment.

One way to accomplish this is to develop your best people into effective coaches.

The benefit of creating a developmental hierarchy is your responsibility changes from coaching many to simply coaching the coach. Now, you are free to work on other aspects of your office, such as searching for that next cutting-edge instrument. OM

Dr. Hansra is the senior director Eye Care Strategy, LensCrafters N.A. Contact him at ghansra@luxotticaretail.com. Send comments on this article to optometricmanagement@gmail.com