What takes Lean Healthcare from a tools-centric approach to a transformational change?  Management systems, strategy deployment, change leadership and coaching at the front line, management and executive levels.  Executive coaching can be challenging for internal Lean staff.  It is difficult to adjust from process improvement tools and group facilitation experts to becoming – and being accepted as – management and executive coaches.  While I recommend applying a coaching framework that is complimentary to Coaching Kata, the following tips are intended to begin the conversation of how to support executives in transformational work.

Most executive coaches utilize a coaching model that guides them through the coaching process.  Is this standard work? For a coach, yes.  The successful coaches have incorporated this into their coaching activities, guiding them through some of the most challenging change an organization can go through – the personal change a leader will experience. The following is my own framework for illustration:


The most important phase is the first – the Coaching Alliance. This initial activity is designed to establish the clarity of coach-coachee roles.  It is within this phase that both parties establish how they are going to work together and the expectations of each other.  Some refer to this as the “contracting” phase and others, the “dance”.   A respectful, authentic presence with a measure of curiosity and humility by the coach is essential.  This is the coaching stance.  This first phase may be handled in one session in terms of setting role boundaries and goals, but the actual alliance is a longer term process wherein the coach, by his or her actions, earns the trust and respect of the executive.

The initial sessions explore the current situation, appreciating the positive aspects of the work the executive is doing within the transformation while sensitively exploring the gaps in his or her efforts.  In this relationship-building stage, it is important to explain the role of the coach: to provide technical guidance on tools and methods while being present to listen and offer guidance using the Socratic Method on the challenges the executive is experiencing as they shift their normal approach to the Coaching Kata.  The latter can be more challenging for internal change agents than that of an external consultant because of the existing hierarchical role relationships of internal staff and executives.

Advice for the internal change agent: show up with a confident curiosity and respect for the executive’s current state and challenges.  Meet the executive where they are – without judgement – and listen!

KirkwoodBillRSToday’s blog was written by Bill Kirkwood, Ph.D., director at HPP.

Bill has 30 years of healthcare leadership experience in both system and individual hospital settings across the United States.  His experience includes change management activities, Lean transformation engagements and serving in an executive capacity in quality, operations and human resources. He holds a Master’s Degree in Health Administration from Xavier University and a Doctorate of Philosophy in Organizational Behavior from the Union Institute and University.

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