CPD: A coaching mindset within occupational health – release your inner ‘enabler’

Occupational health practitioners are trained to be “the expert in the room” when it comes to workplace health and often act as problem solvers. But, argues Mandy Murphy, this can sometimes mean we don’t see, hear or embrace the whole picture – and developing a coaching mindset can help.

Within occupational health, the breadth of skills we acquire across our careers is wide and it is not long before our toolbox is full of great techniques and tools that we can use in a variety of situations to help our clients.

But what about our mindset? How we think, our sense of curiosity, adaptability, enthusiasm, viewpoint, attitude is how we can move from being just “good” to being great. How we “be”? Having a coaching mindset might be the new “skill” we need to help our clients achieve their goals.

I fell into coaching, like many I suppose, and have been heavily influenced by two books, one by David Rock called Quiet Leadership, and then Nancy Kline’s book Time to Think.

Looking back now, they were a life-saver for me at a pivotal time in my OH career. I was managing a large OH service in the NHS at a time when everything was growing – the team, the contracts, the demands on the service, performance targets (and a decreasing budget) and our own aspirations to excel at what we did.

Working for a highly ambitious organisation (and a good dose of my own competitiveness) made the pressure feel immense at times.

We had a strong team, but did I need something to strengthen my leadership or strengthen the team? All the “lean” process mapping tools and the many study days on project management or “how to think strategically” and such like were not, I felt, quite hitting the mark either. I still I felt like I needed more of “something else”. And that “something else” became a coaching mindset.

Why do I share this with you now? My story above is not meant to sound like a fairy-tale and the journey was very challenging at times. Initially, I entered into coach training thinking it would top-up the resources in my backpack of tools and techniques, but it influenced much more transformation in my OH practice than I expected.

It must be said coaching is not the answer to all our problems in occupational health. Nor is it the magic pill that makes everyone compliant and follow the expert advice we repeatedly give out. However, I strongly feel that the insights developed through coaching can be invaluable in our interactions and how we can create a level of empowerment in others to create sustainable change.

My hope in sharing this experience of how I developed a coaching mindset will help to reflect its value and place within the repertoire of occupational health we all use.

What is coaching?

Bear with me, the answer to this question isn’t as obvious as you might assume. On the face of it, coaching seems to overlap across many other disciplines: consultancy, mentoring, therapy, counselling and motivational interviewing to name a few.

Indeed, the term coaching is often misrepresented and the fact it is not a protected title means there is a never-ending list of interpretations of it within job titles. In that respect, it is perhaps no wonder that it is easy to lose sight of what coaching really is.

I often meet people at a networking events and they introduce themselves as a “coach”, perhaps a finance, business or marketing coach or, I kid you not, a dating coach.

Often when the conversation evolves as to how they do this and what coach training they have undertaken, what transpires is they are more akin to being a mentor; they are sharing their expertise and helping an individual to develop their confidence or skill in a particular area where they have expertise.

In many of these roles the professional is leading the agenda, setting the objectives or outcomes and often the client thinks you have the secret ingredient that will somehow lead them to greatness.

The true essence of coaching is not this, however. Coaching is where the client sets the agenda; they define the goals for what they need, they have the resources within to solve their own issues.

In this scenario, the coaching process helps them work out how to use their own resources to achieve their goals and ultimately live or fulfil their potential. Coaching is solutions-focused rather than about resolving the past; it is goal-orientated rather than problem-orientated; it is a way of enabling rather than directing a person’s progress rather than bolting on your opinion of the best way forward.

Coaching can be defined as: “the art of creating an environment, through conversation and a way of being, that facilitates the process by which a person can move towards the desired goal in a fulfilling manner”. (Timothy Gallwey, The Inner Game of Work).

What coaching has taught me

Gallwey’s definition on coaching, how it is “a way of being”, has had the biggest impact on my practice. What he highlights is that coaching is much more than just a set of technical skills that enable you to have a coaching conversation.

Having said that, those technical skills do come instinctively when you position your mindset as “an enabler” rather than “an expert”. And I appreciate this can be a transition that occupational health professionals in particular sometimes find difficult.

To pull back in this way can be hard to do after the years of training and experience we have built up in providing advice, direction and guidance – of leadership – of being the OH “expert in the room”. Developing this sort of mindset can also have a profound impact on your listening skills, on the instinctive thoughts you often have as an OH practitioner of “I know how to help that” or “I’ve seen this before, this is what you need to do”.

For me, there are four key facets – skills or, perhaps more accurately, ways of thinking – that make for an effective coaching approach and mindset. Let’s look at each in turn.

1) Self-reflection

Coaching has improved my skills in self-reflection and I learned to understand what it means to truly reflect on my practice, my presence in sessions and my mindset.

Self-reflection in clinical practice has always been an essential of course to help us improve, to learn and evolve.

What I have discovered is our trusted clinical “self-reflection” often just skims the surface of our practice. Do we really dig deep enough? Are we ok to feel vulnerable when we discover our mistakes? Are we honest about the key strengths that helped us get a good outcome? Are they celebrated? Are we brave enough to pull the curtains back on our Johari window?

Having stronger questions to deepen your self-reflection is crucial if you want to transform insights into practical strategies for growth in your practice.

Everyone will have different questions to support their reflection; the important part is to ensure you do it, often. Give your brain the opportunity to pause amidst the chaos, to examine your thinking, even if you don’t like or agree with your thoughts.

2) Listening actively

Communication skills are the foundation of being a good clinician and, naturally, becomes such an integral part of our practice. But how often have we noticed the bad habits we create along the way, or what we do just because we are human?

Coach training has enabled me to understand what level of listening I was at in my interactions and notice the interferences in my listening.

Raising my own awareness of what is stopping me from being fully present in a conversation and the triggers for shifting from active listening mode to preparing my advice mode have made a big difference to creating the right environment for my clients to make progress.

There are many reasons why we don’t always listen fully, as listed below. It’s important not to make any judgements of these. They are all part of our human nature or created in our environments we find ourselves in.

Have you noticed any interferences in your listening skills? What thought/words move you away from active listening? The important bit is to raise your own awareness of what’s happening and then you can learn to manage it and reframe.

Reasons we don’t listen

• Selective listening. We just hear what we want to hear.
• Responses and opinions. I am so busy working out what I am going to say back to you that I stop listening to what you are saying.
• Lack of interests/judgements. I am finding this/you boring.
• Beliefs and attitudes. Values, preconceived ideas and attitudes get in the way. We can switch off or begin to challenge what is being said, often before the speaker has even finished!
• Reaction to the speaker. Like or dislike/repelled or attracted.
• Distractions. Sounds, sights and smells! Once distracted, it can then appear embarrassing to have to tell the speaker you have been.

3) “I don’t need to fix it”

An innate human condition is our need to fix things. And it’s really difficult to resist the urge to help with problem-solving when we can see someone is struggling and needs help.

How many times are we giving out good advice on what works to adopt a healthy lifestyle, flexing the choices to suit personal preferences and yet change still does not happen? Maybe it is confidence, maybe it is not the right solution, or maybe it is the lack of connection to the client and their motivations.

We tell ourselves it is about “patient-centred care”, but is it really? The client might want help to resolve a problem, but me providing them with my answers to their problem rarely creates awareness, builds confidence or creates ownership and responsibility for taking action. In fact, it often becomes limiting in how the patient can achieve their potential in their goals.

The other side to this is the personal validation you get from providing solutions. We like to be useful, and we like others to think of us as being useful, too. Providing solutions shows our experience and capabilities and makes us feel good about ourselves. There’s also something tangible, real and measurable about offering our solutions and expertise. But this is not about me, it’s about the client and their successes, not mine.

A good coaching conversation starts with “what is important?”, why it matters and the end-goal. The mindset shift is that I am not an expert in them, or their values.

I might understand the issue they are facing but I cannot make them change. They can do this, often with their own resources. Using a coaching approach, combined with the expert resources we can bring to bear as a coach, can raise their awareness of the choices available to them. The “tug” against the need to fix things is still strong within me at times, but I hang on to the fact that the impact of taming “the advice monster” will allow me to go beyond the quick fix and often leads to sustainable change.

4) Asking effective questions

How a question is placed or phrased can be a game changer in a coaching conversation. What is the intention of my question? For whose benefit was I asking it? How can my questions create more impact?

In coach training I became acutely aware of questions that didn’t lead to impact; they were fact-finding in the first instance (good OH training of course) and sometimes went down a dusty road full of weeds and endless bits of information. But ultimately they were irrelevant to solving the issue, namely what it was the client wanted to express, dates in the past, who said what to whom, what they ate for lunch and so on! Give people enough space to get distracted like this and it risks becoming all-consuming.

The questions we choose can radically change the dynamic of the outcome of a session or even the attainment of the end-goal. We can instinctively ask powerful questions when we are present; we can bring our genuine curiosity and deep listening and leave judgement at the door. Here are some key points I have found helpful about how to take questioning techniques beyond the “open/closed” techniques:

• Ask questions in context, relevance and raise awareness in the client. Help them be curious about their issue in the way questions are proposed.
• Do not issue commands and hope they somehow land as questions. “Tell me”, “show me”, “help me understand”, for example. These often lead to closed responses if the client doesn’t want to share in this way.
• Watch out for “advice-in-disguise” questions. These can often appear as suggestions, for example “have you thought of…..,” “would it be a good idea if ….”, “should you do …..”. But these come from your own agenda not that of the client and therefore can often be readily deflected.
• For whose benefit is the question being asked? Is it for you and your interest or the client and their benefit to raise their awareness?
• Open questions start with “what”, “where”, “when” and “how”. They almost never use “why” and it is important to be aware of the impact when using it. “Why” can create a defensiveness in the client, implying they need to justify their own actions. In fact, as research by Petter Johannsen has suggested, “why” can even create a fictional state that didn’t exist before.
• Be aware of your energy and tone when asking a question. Does your tone imply an underlying judgement you are making? This can lead to a defensive response or lead the client to telling you what they think you want to hear.

Conclusion – moving from “expert” to “enabler”

Coaching starts from the basic premise that the individual is resourceful; they have the resources already to resolve their own issue.

Whilst, as OH professionals, we have the expertise and extensive knowledge of occupational health to call upon, and all that falls under this vast umbrella, at the end of the day we are not an expert on the individual, their core values or what makes them tick.

So think, “I am not the expert in you; you are the expert in you.” As soon as you make this mindset jump, the coaching relationship becomes one of equals. However, it is of course still our training and experience and finite expertise that help us understand the context and environment the client is operating within.

Developing a coaching mindset is not a technique we can turn on and off when a defined situation presents itself. It becomes a way of being and the journey to this state is not linear.

I have found that understanding and holding to the six principles of coaching that Jenny Rogers describes (and see below) can enable more coaching-based approaches in our clinical settings. To Jenny’s list I would add the following:

• Don’t assume you know the answer and recognise it’s ok to not have the answer.
• Consider when to push; direct with your expertise and learn when to just listen.
• Our personal situations/values affect how we can coach.
• It’s about their success, not ours.
• Stay out of the weeds!
• To be better, a person needs to be committed to self-improvement – and that goes for ourselves, so embrace good self-reflection and drawing back the curtains to our own Johari window.

Finally, coaching is not the panacea to all interactions and certainly does not replace the skills and expertise essential to an occupational health consultation, particularly when direction is needed.

However, there will be clients or occasions when a coaching approach will give you different results, cases that you feel need that “something else”. It’s not about therapy, treatment or “fixing” them, it is simply about taking, and learning, a different approach.

Coaching, and a coaching mindset, can help you change the lenses on a client’s perspective of an issue and, in turn, release their potential to greatness.

Jenny Rogers’ six principles (from Coaching for Health)

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I have personally found these immensely useful and, importantly, relatively easy to adopt for an occupational health setting.

1. The client is resourceful.
2. The practitioner’s role is to move from expert to enabler.
3. Coaching addresses the whole person, and all that’s going on in their life.
4. The client sets the agenda.
5. The practitioner and client are equals.
6. Coaching is about change and action.

References
Quiet Leadership: Six Steps to Transforming Performance at Work (2006), David Rock, Harper Collins
Time to Think: Listening to Ignite the Human Mind (1999), Nancy Kline, Cassell Illustrated
The Inner Game of Work (1997), Timothy Gallwey, Random House
Coaching for Health: Why It Works and How to Do It (2016), Jenny Rogers and Arti Maini, Open University Press
Petter Johansson, 2016. TED Talk:  Do you really know why you do what you do?, https://www.ted.com/talks/petter_johansson_do_you_really_know_why_you_do_what_you_do
Understanding the Johari Window model, https://www.selfawareness.org.uk/news/understanding-the-johari-window-model