1. Introduction to effective coaching skills Adapted from HAIVN and ITECH training on clinical mentoring (www.go2itech.org))

2. Learning Objectives By the end of this session, participants will be able to: – Describe effective approaches to building relationships, active listening and giving feedback – Explain the importance of these activities in coaching – Gain skills in active listening and giving feedback

3. The continuous cycle of QI coaching Diagnose and plan Let the team implement Monitor progress Give constructive feedback Coach

4. The continuous cycle of QI coaching Diagnose and plan Let the team implement Monitor progress Give constructive feedback Coach

5. Coaching steps 1 and 2 1.Diagnose and plan: Identify areas where coaching is needed and your approach Active Listening Diagnose the challenge(s) the team is facing Determine approach(es) to help team move forward 2.Initiate coaching – Initial feedback Share observations Celebrate success Empathize where having difficulties – Listen, observe, question – Implement other coaching intervention(s)

6. Coaching steps 1 and 2 1.Diagnose and plan: Identify areas where coaching is needed and your approach Active Listening Diagnose the challenge(s) Determine approach(es) to help team move forward 2.Initiate coaching – Initial feedback Share observations Celebrate success Empathize where having difficulties – Listen, observe question – Implement other coaching intervention(s)

7. Coaching principle There is not one way to coach or “best” way to coach It is a process adapted to and guided by each situation Coaching and Training your work team, 5 th edition, Institute of Leadership and Management

8. Demonstration Role play ______ is the quality improvement expert coming to work with a clinic team (you). The chart review shows the following. 8 Quarter 1Quarter 2Quarter 3 Timely start on ART 49%33%51% Weights23%65%99% Adherence screen91%65%42% People seen120251504

9. Comments What did the coach do well? What did he/she do poorly? – How could he have done better? Overall would you say he/she was a good or a bad coach? Why? 9

10. Building relationships

11. Building a relationship Effective coaches : – Build relationships based on mutual trust and respect – Developing a good rapport with the team – Tailor their approach to reflect the realities in which the team is working – Actively communicate

12. Building a good relationship Make sure the team knows you are there to help them – not judge, supervise or punish Communicate that you – care about their challenges – understand that QI is not always easy – will work with them to help them solve their own problems. Ref. The Coaching Manual

13. Techniques for building rapport Introduce yourself and shake hands Show patience and do not interrupt Make eye contact Give the team your full attention Use affirming statements Ref. ITECH

14. Affirming statements Affirm: To acknowledge the positive in someone else, to support and encourage that person to build upon his/her successes Goal is to increase the QI team’s belief in themselves and their abilities. Adapted in part from ITECH

15. Examples: Affirming statements “This is a very difficult issue, but I see that you are really trying to work together to solve this.” “That was a great meeting and you have some very clear next steps for this QI project” “You’ve made excellent progress on improving the problem of CD4 testing”

16. Active listening Essential component of good communication Goal: gain shared understanding of the issues being discussed Increases likelihood that coach understands the issues in the clinic and the team knows that you understand Helps you to diagnose specific needs for coaching. Adapted in part from the Coaching Manual

17. Active listening Make eye contact (or face) each speaker on the team. Concentrate on what the person is saying. Observe team interactions look for non-verbal cues Avoid other side conversations and distractions (phone calls) Reflect back and ask additional questions Adapted in part from the Coaching Manual

18. A listening mistake Formulating your response or next statement before a person is done talking. When this happens it may contribute to misunderstanding between two individuals. Adapted in part from the Coaching Manual

19. Reflect back and Question Helps the coach clarify issues and ensure that he/she understands the specific situation and need for coaching. – “So you are concerned there are not enough resources to solve this problem, correct?” – “So, as I understand, in June there was a national stock out of reagents so tests couldn’t be done, is that correct?”

20. Active listening to diagnose Use information from active listening to help understand reasons why change is not happening – Systems – knowledge – Individual resistance From there, you will develop interventions to coach a team to move forward with QI

21. Feedback: Your first coaching intervention

22. Large group discussion: Feedback Identify a time in the last few months when: someone gave you helpful feedback s omeone gave you feedback that was not helpful or actually hurt 2 minutes Write down and be ready to share

23. Feedback What: Comments, opinions or reactions given to a person or team about an issue in the clinic Why: To initiate and improve communication To evaluate or modify a process To encourage improvements to be made To provide useful information to help the team make decisions and take next steps Adapted from ITECH

24. Feedback: Basic Principles (1) Ask permission or identify that you are giving feedback. Examples: – “Can I give you some feedback on your progress on this QI project so far?” – “I’d like to provide some feedback on what I observed during the discussion on finding a root cause to the gap in TB screening.” Ref. ITECH

25. Feedback: Basic Principles (2) Give feedback in a “feedback sandwich” 1) Start with a positive observation 2) Provide a suggestion for improvement 3) Finish with a second positive observation Ref. ITECH

26. Feedback: Basic Principles (3) Use first person: “I think,” “I saw,” “I noticed.” Describe what you observed and be specific State facts, not opinions or judgments Address what a person/team did... – “You skipped several steps of the root cause analysis.” …not your interpretation of his or her motivation or reason for it. – “I know you want to finish quickly because it’s almost lunchtime, but you skipped several sections …” Adapted from ITECH

27. Feedback: Basic Principles (4) Don’t be judgmental or use labels: – Avoid words like “lazy,” “careless,” or “forgetful” Don’t exaggerate or generalize: – Avoid terms such as, “you always,” or “you never” When making suggestions for improvement, use statements like: – “You may want to consider…” – “Another option is to…” Ref. ITECH

28. Feedback principles (5) You can provide feedback any time: – during a coaching visit, quality meeting, immediately afterwards, or after you leave the clinic. Don’t wait too long to give feedback. – The closer the feedback is to the actual event or discussion, the more likely the HCW(s) will remember the teaching point. Adapted in part from ITECH training on clinical mentoring

29. Providing feedback to teams You can give feedback to both the team and to individuals. – Be sensitive not to give feedback that may embarrass individuals in front of their co-workers. Focus on improving the system Make general teaching points without drawing attention to one person’s behavior or knowledge gap.

30. Everyone vote: Good (right hand) or bad (left hand) Tell me what you’ve thought about doing? How did something this bad happen? There are other clinics with some of the same challenges, would it be helpful to hear what they have done to start to improve? So whose fault was this? What might be some first steps to solve this challenge? You need to fix this by using this tool You did WHAT??

31. Key Points Good rapport is the foundation of a productive coaching relationship The use of listening, observation and questioning will assist coaches both to build rapport as well as diagnose what issues need coaching Feedback should: – include both positive and “how to improve” commentary – be descriptive, objective, and nonjudgmental – focus on the teams’ actions, not your interpretation

32. References ITECH training on clinical mentoring NQC JSI The Coaching Manual

33. Exercise Feedback Scenarios