Hospice Staff Retention: Part 2. Coaching

“If you want to go fast, go alone. If you want to go far, go together.” – African proverb

Retaining your team members is especially critical for hospice providers. The ability to keep team members long term and provide consistent care affects patients, referrals, CHAPS reporting, business operations, and much more.

7 Elements of Staff Retention

Alignment: Company’s purpose or mission, the company values & direction. Click here to read Part 1. Alignment
Coaching: Company leadership care about employee concerns, provide assistance as needed, and encourage development.
Connection: Employees feel appreciated, their work is meaningful maximizing their potential and information is transparent.
Engagement: Team members feel the work is challenging & productive and that they want and are wanted to be retained.
Leadership: Team members feel confidence in their company’s leadership & management.
Performance: Well developed processes that are flexible, achieving goals, innovation, leadership that is involved in operations.
The Basics: Pay, benefits, training, expectations. “People work for money but go the extra mile for recognition, praise and rewards.” – Dale Carnegie

Coaching: A Growth Mindset

“To win in the marketplace you must first win in the workplace.” – Doug Conant, Former President and CEO of the Campbell Soup Company

Start with “why.” Just like with Alignment, people need to understand why you do what you do, not just what you do. The why of coaching is to connect your your agency’s mission, tasks, and goals. As coaching directly impacts and flows from your mission, it’s important to consider whether your agency has a clear mission and if coaching is appropriate and aligned with your mission. If your organization’s culture is a strong top-down hierarchy where team members are not empowered to solve problems and take ownership, you may want to consider a mentorship program or simply ongoing training of rules, process, and procedures rather than developing a culture of coaching.

If your mission is to ‘provide premier end-of-life care’, it implies a drive to say ‘yes,’ to empower team members to find solutions rather than going back to their ‘boss’ for every question and then following the given answer. This mission implies that when a knowledgeable, trusted, and experienced teammate runs into an issue, they have the freedom and recognition to make decisions. Whereas if your mission is to “provide end-of-life care that adheres to Medicare guidelines,” your agency’s philosophy may be more rigid, where staff must request permission for every change, follow schedules tightly and wait in a holding pattern while higher-ups make adjustments and decisions when an issue arises.

The WHY of coaching is built for the agency that actually wants to empower their team members and isn’t just using that as a slogan or social media post. The WHY of coaching for an agency with an aligned mission is to grow individuals into becoming knowledgeable, trusted, and experienced teammates while also enhancing the leadership skills of the coach. Hospice is busy time-consuming work. Leadership within a hospice is often a binary option of ignoring team members and micro-managing them. A coaching mindset that flows from an aligned mission develops team members and leaders into a synchronized team of people working towards the same goals, who feel recognized, educated, and supported.

Coaching: What it is

“In the past a leader was a boss. Today’s leaders must be partners with their people… they no longer can lead solely based on positional power.”– Ken Blanchard, Author on leadership

Coaching takes different forms – and is often confused with cheerleading or passive managers with no structured rules, guidelines, and processes. What coaching is in the context of growing empowered and knowledgeable staff is about personal interactions between you and your team members in order to develop an agency of constant learners and a drive for improvement. Coaching is not a one-off or monthly or quarterly meeting. The coaching we’re discussing, the type that flows in alignment from a clear mission to having real impact on your agency, is the effort that all team leaders and administrators should practice in their internal interactions. An effective team leader or admin with a coaching mindset focuses on asking questions to enable your team members to develop answers and solutions. Your goal as a coach is to empower your team and to learn from new ideas.

Obviously a new novice team member will need more guidance than an experienced and knowledgeable team member. But how you deliver that guidance, and how and if you allow that less experienced team member to learn from the guidance and springboard into new solutions – or old solutions they reach on their own, will be the difference between an empowered and coached team, or powerless employees following directives.

Coaching as a business strategy is an evolution from the traditional organizational hierarchy and from other forms of learning such as mentoring or process training. Coaching is much more than just transmitting information to someone less knowledgeable and experienced. Coaching at it’s core is about interpersonal relationships and asking questions that trigger insights and understanding.

Coaching: The Model

“Coaching is unlocking people’s potential to maximize their own performance.” – John Whitmore

The GROW model of coaching was developed by John Whitmore in his book Coaching for Performance: GROWing Human Potential and Purpose.

GROW stands for:

Goals.
Reality.
Options.
Way forward.

Goals

There’s an old line – How do you eat an elephant? In small bites. When we talk about Goals in coaching we’re talking about the goal of this moment, this conversation, this situation, or meeting.

It can be difficult to hone in on the immediate and totally ignore the wider, longer term goals. But in order to achieve the long term expansive goals, we have to address, what do you want to accomplish right now. Early in the discussion, ask the team member, ‘what do you hope to have at the end of this conversation?’ This frames the interaction much like a work-back technique. Start with the end result and then work back each stage in succeeding order as to what steps must be take to achieve that goal. That framing of the conversation allows your team member to clearly articulate, what do they need to accomplish right now, what information or action plan will they have when they walk out the door.

Once the immediate goal is stated, you, as the experienced and knowledgeable leader can start posing the questions to elicit and spark insights and understanding. – as opposed to the traditional route of laying out a roadmap for your team member to mindlessly follow.

Reality

Reality refers to having a project manager mindset. Project managers look at their goal and start asking wh-questions – what, when, where, and who. These questions are grounded in the reality of the situation or issue and demand that you explore process and outcomes. The only wh-question we don’t ask is why. We don’t want to fall down the rabbit-hole of motivation and further, our why is our mission. A reality based discussion is like an operating surgeon, clear, concise, and precisely focused on what is the situation, what options do you have, who is involved or should be, or do you need to be, what was done, when was it done. And every time you come to an impasse, ask more wh-questions.

Your focus as being a leader & coach is to keep asking the right focused questions in order to spark insight, understanding, ideas, and a plan.

Options

Coaching is a tool that is most needed with those team members with the least confidence and experience. When in a discussion with a team member who is stuck and doesn’t know what to do, your goal as a leader coach isn’t to provide one answer, or even have the team member develop one answer. Your goal is to have them develop options. Developing options means they are engaged in the conversation and are bringing their perspective to the problem at hand and actually exploring possibilities.

If you see the conversation has led to a place where the team member feels stuck and only develops one possible path, or not even that, your job in the conversation is to broaden their perspective. One way to do that is to ask, ‘if you were totally in charge, with all the resources at your disposal, what would you do?’

Remove the gates around their thinking and allow them to develop possibilities and weigh the options based on potential outcomes, risks, rewards, resources, and how it aligns with your agency’s culture and mission.

Will

“What will you do?”

You’ve had the conversation with your team member, you’ve heard the goal and helped them cycle through a series of wh-questions and have found a few options for the next steps. How will you achieve your goal? The conversation needs to lead to a concrete next step or set of actions. It’s not enough to trigger perspective and insights, this is where conversation becomes action – otherwise the conversation ends and the less experienced team member is left with a new problem, what to actually do next.

If the discussion developed real understanding, then the next steps are already laid out and your goal as leader/coach is to get them to understand and commit to the next action or plan. If a plan hasn’t developed through your discussion, then the discussion isn’t ready for Will and you need to step back and start asking more wh-questions.

Coaching isn’t as formal as you might imagine. Coaching team members isn’t about setting regular meetings with an agenda of coaching. Coaching is about day to day short interactions that come from a place of empathy. A team member has a question, an idea, a problem that needs addressing and asks their question when you see them in the office and you genuinely stopped and asked, ‘How are you?’.

These brief interpersonal moments are the most effective moments in developing a culture of learning and growth.

Tips To Build Empathy in Coaching Conversations

Tip #1. One Of These Things Is Not Like The Other

To build empathy skills it’s important to first know what empathy is and what it is not. Though often used interchangeably, empathy is not the same as sympathy or pity.

Empathy is: the ability to understand and share the feelings of another.

Sympathy is: feelings of pity and sorrow for someone else’s misfortune.

Pity is: the feeling of sorrow and compassion caused by the suffering and misfortunes of others.

Given how similar these definitions are, it’s easy to understand why they are used as synonyms for each other. However, they are different.

Empathy is feeling what somebody else feels through their own feelings. Sympathy is feeling what somebody else feels through your feelings. Pity is expressing sadness for someone else’s misfortune though not necessarily relating to their or your feelings.

With pity there is no indication that the patient has been heard. Pity can be expressed without deriving from any emotional impact. When you are being sympathetic, while acknowledging the other’s feelings, you’re making the situation about you and your feelings, your understanding of them through feeling the same way. Empathy, expressing that you understand their feelings as their feelings, allows the team member to feel heard and creates a path to deeper communication with the focus remaining on their situation, goals, and growth.

Here are three different real-life statements to clarify the difference between reactions when a patient or their loved one expresses a bad situation:

You’ve asked a nurse how are you and they say, “not great, the DON at facility x complained that my patient isn’t getting enough help with their pain.”

Pity statement: That’s awful.

Sympathy statement: I know how you feel, that’s awful.

Empathy statement: That sounds awful, tell me more.

Tip #2. Listen

Cultivate the art of active listening

While hospice leaders are super busy and often overloaded by business needs, patient needs, regulatory & compliance issues, and a host of other time drains, taking the time to listen to your team members is a lot like driving safely.

If you’ve ever take a driver’s ed. program you may have seen the film clip where two drivers make their way across town. One driving recklessly, speeding through yellow lights, frequently changing lanes, zipper merging after a red light on a one lane road, and worse. The other driver makes their way across town following all the rules of the road. At the end, the reckless driver made it to their destination about 2 minutes ahead of the safer driver.

While you may feel rushed, in truth, taking the time to listen to your team member is rarely the cause or contributor to your overworked schedule; it’s simply the easiest thing to drop and makes you feel like you’ll get somewhere faster.

Don’t minimize their feelings through well-intentioned pity or sympathy. Use empathy to provide the space for them to express themselves. Being heard is an important element of the coaching process and giving them the space to develop options and understanding with the feeling that they’ve been treated with empathy and respect. And in the long run, hearing and coaching your team members will delivers far greater benefits than the few minutes these brief interaction take

Tip #3. Learn from Cats

Cats, once they are no longer kittens, meow to communicate with people but don’t meow at each other.

Most communication is non-verbal. Be aware of yours’s and their physical cues.

Make eye contact.
Don’t look at your phone or other devices while coaching.
Act professionally, don’t lounge or talk with a full mouth or crack jokes – your team member in this brief interaction needs to feel like they are being heard and respected by a professional.
Keep it personal and level – don’t take the team member into your office and sit behind a desk as ‘the boss.’ talk where they are – standing the the hall, pull up a chair in an office, come around the desk and sit with them to discuss – think how you would engage with a partner, not an employee.

Tip #4. Cultural Identity

Culture is a word that is often used synonymously with traits like religion or ethnicity. However, that view of culture limits our view of the patient’s identity and the distinct culture of each identity.

Every team member you has multiple overlapping identities, which means understanding each person’s cultures may be more than just a general idea of their religion or ethnicity.

It may mean recognizing the culture of young nurse who is now in the new position of making important decisions for others. Or the new salesperson who is used to showcasing products but is lost when it comes to listening and describing services and getting consents signed. Navigating the tapestry of identities and cultures within an individual is no easy feat. However, with patience, active listening, professionalism, and empathy, you’ll find that picking up your team members cues is less complicated than you imagine, but it requires a pro-active determined mindset that long-term, the benefits of coaching will deliver returns far greater than micro managing.

Empathy is a crucial element in effective coaching. Practicing these skills and developing a mindset of empathetic coaching and empowering team members to grow will create a culture of learning and empowerment that is attractive and important to retaining your staff long-term. A stable solid and experienced team leads to better outcomes for patients, co-workers, business goals and more.

Coaching isn’t for every leader or every company. But if you think it fits for you and your agency, you should examine how the traditional command & control hierarchy of business has seeped into your operations. Are you using tools that are powerful, flexible, and empower team members to do their best work? Or are you using rigid cumbersome tools that force team members to stop and get approval, or have the next piece unlocked or where everything is put on hold until x is met or an admin overrides the system?

Some hospice agencies are rigid and inflexible and need tools to match that cultural mindset. But if you’re a an independent agency that has an aligned mission and is the type of agency that wants flexibility and an empowering culture for your team, you need to find out more about the Hospice EMR built for teams like yours!

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