Developing leaders from the ground up

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There is a buzz around the room as small groups engage in animated discussions. As you watch a bit more, you realize that only two people are talking while the other person watches. As you wander through the room you catch snippets of conversation.

“What does success look like to you for this project?”

“Who can you draw on to help you finish this project?”

“I’d like to touch base with you next week on your progress. When is a good time for you?”

You’ve just witnessed people practicing “coaching conversations”, a fundamental part of Leaders Supporting Learning: Foundational Healthcare Leadership Development Program, a program designed by BC Children’s Hospital and Sunny Hill Health Centre for Children and BC Women’s Hospital & Health Centre, and now offered across the agencies that make up the Provincial Health Services Authority (PHSA).

Coaching involves asking questions of others to help them define their goals and focus on what they need to do to achieve those goals. It shifts the role of a leader from one who provides answers and solutions for others to someone who helps colleagues find their own solutions.

PHSA manages specialized provincial agencies including BC Children’s Hospital, BC Transplant, and BC Cancer Agency. Its primary role is to ensure that BC residents have access to a coordinated network of high-quality specialized health-care services. As such, it’s critical that PHSA recruit and retain highly-skilled and specialized health-care providers. With retirements looming among a large number of staff, effective succession planning is also a priority.

“Traditionally, there has been a lack of support for clinical staff when they move from front-line to leadership roles. We wanted to help formal or informal leaders gain the skills they need to support more open dialogue and shift our culture to that of an organization that learns from its mistakes,” said Dori van Stolk, senior leader, clinical education, BC Children’s Hospital and one of the team members who developed the program.

The program began at BC Children’s Hospital and BC Women’s Hospital in 2005, and was subsequently adapted by another PHSA agency. By 2008, it expanded to clinical and non-clinical staff across all PHSA agencies and services.

The six-month program focuses on using a coach approach to enhance conversations and build relationships and networks that are crucial to creating a culture of learning to improve patient care and safety. Working with certified coaches, participants learn together and attend a series of workshops and coaching sessions on enhancing leadership skills. Participants attend seven full-day sessions over the course of six months on topics such as coaching skills, developing a culture of safety, improving performance and team building. In between, they get together in groups of three to work with a certified coach. They can use these sessions to practice coaching skills or to be coached through a particular challenge they are facing.

“When I moved from front line nursing to management, I felt like I was in a foreign country and I didn’t know the language. To be successful, I knew I needed some new skills,” said Janice Penner, program manager, surgical suites at BC Children’s Hospital.

“I learned how to approach challenging situations in an open way. The program taught me to stay curious and explore the situation rather than feeling that I have to have all the answers.”

The goal of the program is to foster change in both ways of thinking (attitudes, assumptions, mental models) and ways of being (behaviour and actions) so staff find ways to have conversations that are less judgmental, more supportive, and build a healthier workplace by encouraging dialogue about what can be done differently, rather than assign blame.

To date, feedback and evaluation of the program have been positive. Over 400 of staff have completed the program. Self-assessments, pre- and post-surveys, focus groups and anecdotal qualitative data show that the staff who have completed the program feel more confidence and competence in their leadership role and have improved working relationships with colleagues. With respect to patient safety, there have been improvements related to the use of non-blaming language and exploration of adverse events and an increase in the number of near miss or hazard events reported.

PHSA has rolled Leaders Supporting Learning into its overall succession planning strategy and is exploring the possibility of implementing a similar coaching-based program for mid- and senior-level leaders. As well, PHSA is working with other health authorities in BC on a leadership collaborative and there has been some interest in adopting elements of the program in other regions.

Leaders Supporting Learning was developed by a team representing nursing, clinical education and human resources. Project team members currently include Dori Van Stolk, Debbie McDougall, Tracie Northway, Denise Hudson, Sandra Harris, and Charlene Mellors.