Implementation Coaching

If training and other implementation activities are methods for helping your organization effectively use TeamSTEPPS and its tools, coaching is a strategy for assisting individuals and teams through this process. This discussion of coaching provides information to:

Define coaching and its outcomes.
Describe the role of a TeamSTEPPS coach.
List competencies of an effective coach.
Describe how to implement coaching in TeamSTEPPS.

After TeamSTEPPS training is conducted, the changes your implementation plan targets will be driven primarily through on-the-job reinforcement and coaching. Coaches can play a critical role in the success of your implementation and sustainability efforts by:

Modeling the trained behaviors;
Observing, and providing feedback to, staff using the new behaviors;
Providing opportunities to practice what has been trained; and
Facilitating sustained motivation for the implemented changes.

As coaches work directly with staff in day-to-day situations, they can help identify and remove barriers to adoption of new team behaviors.

What Is Coaching?

“Coaching” is defined as instructing, directing, or prompting specific individuals in their workplace setting to meet your TeamSTEPPS goals. The term “coaching” describes specific actions that include demonstrating, reinforcing, motivating, and providing feedback. These actions share the purpose of improving performance or achieving a specified goal for the individuals or team being coached.

Coaching is an active and typically ongoing process that can be used in structured and unstructured activities. It requires routine monitoring and ongoing assessment of performance. Formally defined coaches may perform it, although it is rare in hospitals and virtually never the case in other care settings. More frequently, coaching is an action performed by peers who have learned and become active users of TeamSTEPPS as part of informal mentoring relationships.

Coaching is different from traditional instruction. With traditional instruction, teaching typically ends when the new content or skill is mastered. Coaching, however, continues even after content or skill mastery to ensure sustainability. Coaching should be viewed as an important activity for all trained leaders and staff. While your organization may designate some people as official coaches, it also must enable people trained in TeamSTEPPS to reinforce what they have learned in their ongoing interactions with their peers and teams.

Why Is Coaching Important?

Coaching is an effective way to influence and improve performance to achieve several positive outcomes.

In general, the results of effective coaching include:

Goals that are defined and understood.
Alignment of expectations between the team leader and team members.
Transfer of knowledge on a “just-in-time” basis (training at the point of need, rather than “just in case”).
Increased individual motivation and morale.
A more adaptive and reactive team.
Early identification of unforeseen barriers to performance.
Commitment to continual learning and improvement.
Movement to superior team performance.

More specifically in the context of TeamSTEPPS, frontline coaching can serve as a key strategy to integrate teamwork behaviors into daily practice. Coaches will help ensure that team members understand teamwork concepts and that they are appropriately using the teamwork tools and strategies you implement. If you help staff become proficient at and comfortable with the new behaviors, they are much more likely to integrate them into daily practice.

Over the longer term of your implementation, coaches should continue to monitor teamwork behaviors to ensure continued use of implemented tools and strategies and to identify new areas for improvement. TeamSTEPPS coaches play a critical role in both TeamSTEPPS implementation and sustainability efforts.

The Role of a TeamSTEPPS Coach

To achieve the important outcomes of coaching, a TeamSTEPPS coach’s role includes:

Modeling desired behavior.
Observing performance and providing feedback.
Motivating team members and reinforcing positive behaviors.
Providing opportunities to practice and refine performance.

These roles and their relevance to the implementation of TeamSTEPPS are discussed below.

Modeling Desired Behavior

Effective coaches must model the behavior they intend to reinforce. Modeling the teamwork behaviors being trained and reinforced will not only demonstrate the behaviors to team members, but also highlight acceptance of the behaviors in the environment. Behaviors may include general teamwork skills or use of a specific TeamSTEPPS tool or strategy, depending on your implementation plans.

Designated coaches should be individuals who are well respected and supported in their work area. As such, coaches will send an important message by demonstrating the behaviors they are working to improve and then reinforce in your organization. The most effective skills coaches are members of the team in which TeamSTEPPS is being implemented.

Observing Performance and Providing Feedback

Effective coaches also observe team member’s performance and provide feedback. To do so, coaches must conduct ongoing observations of performance and identify what is being done well and what can be improved. TeamSTEPPS coaches focus their observations and feedback on the use of TeamSTEPPS tools and strategies that align with the implementation plan.

Strengths and weaknesses in performance must be conveyed to team members through effective feedback, which is:

Timely. Coaches should provide feedback when the behavior is still fresh in the team member’s mind.
Respectful. Feedback from coaches should be about behavior, not about an individual. Coaches should not attribute a team member’s performance to internal factors. If negative feedback is specific to an individual team member, the feedback should not be delivered in front of others.
Specific. Coaches should describe behavior in a specific, objective way and not be judgmental. Feedback should clearly describe what was good about the performance or what was incorrect or demonstrated need for improvement.
Directed toward improvement. Coaches should provide information aimed at improving skills. When a behavior is performed correctly, it is critical for coaches to identify what was good about the performance and reinforce it for continued use. When behavior is not performed correctly or shows room for improvement, coaches must point out not only what should be improved, but also how it should be improved. Feedback should include goals related to improvement.
Two way. As part of providing feedback, coaches should give team members an opportunity to ask questions. Thus, the coach needs to use active listening skills. Similarly, coaches should ask questions to try to understand team members’ point of view and to ensure they understand the feedback provided.
Considerate. Coaches should provide feedback with the goal of correcting or improving behavior while leaving self-esteem intact.

You may want to provide coaches with a specific structure or model for providing feedback. For example, the SMART model stands for “specific, measurable, attainable, realistic, and timely.” If your organization already has a feedback model in place for use in performance management, teach coaches to use the same model.

Motivating Team Members

In addition to modeling desired behaviors and providing feedback, an effective TeamSTEPPS coach motivates team members. In this role, a coach:

Helps team members see the bridge between new behaviors and patient safety and outcomes.
Encourages belief in team members’ ability to succeed, by asking powerful questions to identify the source of team members’ perceived expertise, knowledge, or experience and aligning their level of confidence with their abilities.
Expresses enthusiasm with and commitment to team members.
Validates current levels of accomplishment while advocating greater achievement.
Recognizes and reassures team members when they succeed, such as when they use a TeamSTEPPS tool or strategy effectively.
Identifies potential challenges, pitfalls, barriers, and unforeseen consequences.
Offers support and assistance and displays empathy toward team members facing challenges.
Communicates positive results and outcomes to the team, such as highlighting for the team a potential error that was avoided with the effective use of teamwork behaviors.

Providing Opportunities To Practice

TeamSTEPPS coaches must also provide opportunities for staff to practice the teamwork behaviors. Opportunities for practice might be formal and structured, such as a sports team’s practice or a simulated exercise, or they may be informal.

In some environments, opportunities to practice TeamSTEPPS might be inherently frequent. In other environments, they may not occur frequently or may apply only to some team members. Ensuring that everyone has opportunities to perform the behaviors and to receive feedback will be critical in sustaining the behaviors in daily practice.

Seeking coaching opportunities within virtual teams is even more important because virtual team members interact less frequently outside of group meetings. Establishing regular individual interactions with other virtual team members can create opportunities to provide informal coaching without appearing to be criticizing another team member’s performance.

Coaches may provide opportunities to practice TeamSTEPPS in several ways, such as:

Asking team members how they might have approached a situation differently by using a TeamSTEPPS tool or strategy.
Using regularly scheduled meetings, such as staff meetings, to have a few staff role-play or discuss a scenario in which use of a TeamSTEPPS tool or strategy would be effective. This exercise can be done as easily in virtual meetings as in those occurring in person.
Developing tools that facilitate use of a desired tool or strategy, such as preprinted notepads that outline the SBAR components for the easy organization of information that needs to be shared.
Providing staff with a TeamSTEPPS “tip of the week” that facilitates use of a tool or strategy.

In conjunction with ensuring that skills are practiced, coaches may also want to reward the effective use of TeamSTEPPS. For example, coaches may design contests that allow staff to submit descriptions of how they used a tool or strategy on the job.

Coaching Competencies

Knowing the role of a coach is not sufficient to understand what it takes to be an effective coach. Effective coaches exhibit specific competencies. The Association for Talent Development (formerly the American Society for Training and Development) identified 13 competencies coaches should exhibit.¹ These can be organized into the four clusters shown below.

Communication

Skill in communicating is clearly critical for coaching effectively. Three specific areas of coaching competency relate to communication:

Communicating Instructions – Demonstrating to the person you are coaching how to complete the task and clarifying when, where, how much, and to what standard it should be done.
The role of coach often involves teaching a skill or procedure to another person. The ability to break down a task into easy-to-understand steps you can articulate to another person is vital to being an effective coach.
Providing Feedback – As we have discussed, feedback involves carefully observing performance and sharing these observations in a nonthreatening manner.
Listening for Understanding – Demonstrating attention to and conveying understanding of others.

Listening is an indicator of respect. It requires being open to what others say, focusing on both the content of what is said and the feelings others may be expressing.

Performance Improvement

A coach cannot be successful without skill in improving the performance of others. Four areas of coaching competency relate to performance improvement:

Setting Performance Goals – Collaborating with others to establish short- and long-term goals for performance on particular tasks:
- Effective coaching sometimes starts with pointing someone in the right direction. First, you work with the person to set broad goals; then you become very specific in agreeing on desired outcomes and how they will be measured.
Rewarding Improvement – Using a variety of means to provide positive reinforcement to others for making progress on the accomplishment of important tasks:
- Timing of rewards is important. Don’t wait until you see either perfection or failure on the task. Look for growth in task accomplishment, and reward that soon after you observe it. Although coaches don’t always control formal rewards, such as pay, perks, or promotions, they can make frequent and effective use of informal rewards.
Dealing With Failure – Working with others to encourage them when they do not meet expectations:
- When an individual demonstrates an inability or unwillingness to perform a task according to expectations and standards, you need to be able to deal with the result. You may encourage, redirect, retrain, or otherwise affect their ability to willingly change. Patience can be a virtue or an enabler of more failure, so use it wisely.
Assessing Strengths and Weaknesses – Identifying root causes of the quality of performance through keen observation and effective definition and articulation of performance issues:
- Properly identifying the skills, abilities, and interests of the person you are coaching directs your coaching efforts to the most critical areas. This task involves distinguishing between symptoms and root causes of problems. Without accurate assessment, coaching efforts might be spent addressing the wrong problem or a nonexistent one.

Relationships

Effective coaches must be able to build relationships with those they coach. Four areas of coaching competencies relate to relationship building:

Building Rapport and Trust – Showing respect for others; acting with integrity and honesty; easily forming bonds with others:
- Rapport and trust are the cornerstones of an effective coaching relationship. The people you coach need to trust that you have their best interests at heart so they can be honest with you regarding shortcomings. The coach also needs to form a bond of mutual respect so the coach’s advice, teaching, and counseling will be more readily accepted.
Motivating Others – Encouraging others to achieve desired results:
- The right button to push to help motivate another person differs widely across people, so there are no hard and fast rules for motivating others. It is best to ask each person what is important to them and how the task at hand relates.
Working With Personal Issues – Listening empathically and without judgment and offering emotional support for personal difficulties:
- In general, coaches are not expected to function as counselors. Few are qualified to carry out such responsibilities, and the context of the organizational relationship might preclude this type of interaction. Faced with an individual whose personal situation is interfering with their performance, however, you need to be able to intervene. A good rule of thumb is that whenever you feel “in over your head,” you are. Be prepared to refer the person to appropriate sources of professional assistance and adjust the coaching process to support getting through the personal situation.
Confronting Difficult Situations – Raising uncomfortable topics that are affecting task accomplishment:
- Coaching often involves situations in which performance has not met expectations. Unmet expectations often lead to finger pointing, denial of personal responsibility, and other dysfunctional behaviors. Talking about these issues can make people uncomfortable. Good coaching requires the ability and willingness to confront difficult and uncomfortable situations head on, but with tact and diplomacy. When coaches consider the best interests of all concerned, the honesty and courage to confront difficult situations are welcomed.

Execution

The final cluster relates to coaches’ skill in executing their role as a coach. Two areas of coaching competency relate to execution.

Responding to Requests – Consulting with others on an as-needed basis; responding to requests in a timely manner:
- Timely response to requests is a tangible indicator of respect. To build and maintain a healthy coaching relationship, make sure your responsiveness reflects a high level of priority.
Following Through – Keeping your commitments; monitoring outcomes of the coaching process and providing additional assistance when needed:
- Trust is a critical component of any coaching relationship. Keeping your commitments helps build and maintain trust. Showing an ongoing commitment to the long-term success of the person you are coaching also builds a strong relationship.

Across all four of these coaching domains, some approaches should be encouraged, while others should be avoided.

Approaches for coaches to use:

Actively monitor and assess team performance.
Establish performance goals and expectations.
Acknowledge desired teamwork behaviors and skills through feedback.
Coach by example – be a good mentor.

Approaches to avoid include:

Coach from a distance. However, in virtual teams, coaching from a distance may be the only option. Doing so effectively requires communicating regularly about a variety of topics to create a positive relationship. That will create natural opportunities to coach within the context of a trusting relationship.
Coach only to solve problems.
Lecture instead of coach.

The curriculum includes a coaching assessment form people can use to assess their own coaching competencies or to assess strengths and weakness of other coaches.

Implementing Coaching in TeamSTEPPS

In general, actions for implementing coaching as part of your TeamSTEPPS initiative include:

Developing a plan for whether and how coaches will be used.
Obtaining buy-in to the plan.
Identifying coaches.
Training coaches.
Preparing staff to receive coaching.
Ensuring that the organization supports coaches.

Developing a Coaching Plan

When developing the TeamSTEPPS implementation plan, you’ll need to decide whether and how your organization’s TeamSTEPPS initiative will include coaching. As with all TeamSTEPPS implementation planning decisions, the coaching concept and plans should be discussed with organizational leadership. It is essential to gain the buy-in of these leaders to implement a coaching strategy. These discussions may be facilitated by creating a coaching brief that discusses the following:

The importance of coaching in TeamSTEPPS
Your plan or ideas for how coaching may be implemented, including number of people involved, the time it might take, and any associated costs
The anticipated results of coaching in terms of improving teamwork performance among staff

Identifying and Preparing TeamSTEPPS Coaches

As part of your organization’s TeamSTEPPS implementation plan, the Change Team will need to identify TeamSTEPPS coaches. Coaches may be those who have been trained as Master Trainers, other members of your Change Team, or additional individuals whom you identify, train, and otherwise prepare to serve as coaches.

Recommended considerations for identifying TeamSTEPPS coaches include:

Where TeamSTEPPS is being implemented.
- What type of individual has access to observe, provide feedback, and direct staff in the targeted work area? Align the coaches to the professions represented in the work area. For example, if physicians and nurses staff the targeted area, your identified coaches should include a physician and a nurse.
Individual characteristics.
- Identify coaches who are qualified to develop the skills of others in their practice of teamwork. Usually, the coach must have advanced knowledge and expertise in teamwork concepts and training. Effective coaches have integrated team behaviors into their own practice and coach by example. Some individuals may require training in the coaching competencies we reviewed earlier in the module.
- Ensure that identified coaches have the support of leadership and are highly respected among staff. These characteristics will facilitate the ability of coaches to effect changes in work patterns and behaviors.
- Account for interpersonal style. It can also have great bearing on the coaching outcome. Effective coaches typically demonstrate a supportive attitude and the ability to build confidence in others.
he number of coaches needed for your organization’s implementation.
- In general, TeamSTEPPS recommends one coach for every 10 staff receiving TeamSTEPPS training. However, consider the availability of coaches across shifts and schedules.

After the Change Team has identified the coaches and they have agreed to participate, prepare them for their role by conducting a coaching session. This session can be conducted informally or formally, based on the resources and number of coaches you select. The coaching material in this training can be used, along with adaptations that reflect relevant feedback tools and performance improvement processes already in place in your organization.

Finally, the implementation plan may involve matching coaches with team members. Your organization’s culture may drive how this matching is done. Coaches can be matched with team members without feedback from the team member. You can have the coaches identify whom they would like to coach based on existing relationships. You have many options. Make matches based on what fits best in your organization’s culture.

Preparing Staff for TeamSTEPPS Coaching

Another important aspect of ensuring the success of TeamSTEPPS coaches is to ensure that staff are prepared for being coached. Staff will require education about the role of coaches to allow them to engage the coaches in a meaningful way, have a shared understanding of the role and responsibilities of the coaches, and view the coaches as resources.

The change agents for your TeamSTEPPS implementation should:

Identify who the formal or informal coaches are to the staff.
Describe the goals and positive outcomes of coaching.
Explain the role and responsibilities of the coaches to staff.
Describe expectations with regard to staff’s interactions with coaches. For example, staff should expect to receive feedback from coaches about their teamwork performance. Staff should ask questions about teamwork to the coaches and view coaches as a source of guidance and support on the changes taking place. Finally, staff should be encouraged to provide the coaches with feedback about the TeamSTEPPS implementation based on their own observations and experiences.

Ensuring Organizational Support for Coaches

Frontline coaching is critical to implementing and sustaining teamwork behaviors in daily practice. However, the coaches’ role in the success of TeamSTEPPS also requires organizational support and reinforcement.

Organizational leadership can provide support for and reinforce TeamSTEPPS coaches by:

Including coaches in efforts to integrate TeamSTEPPS into the organization, such as efforts to include TeamSTEPPS in processes to integrate staff into the unit or work area or including TeamSTEPPS tool use in staff performance evaluations. Coaches not only play a critical role in ensuring staff’s use of teamwork skills, but also have knowledge of frontline staff and perceived and actual barriers to performance. Organizational leaders should leverage coaches’ expertise in these areas as they work to further integrate TeamSTEPPS into the organization’s processes and procedures.
Integrating TeamSTEPPS tools and strategies into policies and processes. In addition to including coaches in these organizational efforts, implementing such efforts supports coaches and increases the likelihood of success. For example, an organization may implement use of the Two-Challenge Rule language as the first step in the organization’s escalation policy.
Formally recognizing or rewarding coaches for their contributions to the unit’s or work area’s success.
Providing opportunities for coaches to work together, which could include planning, solving problems, and sharing feedback as a group. Having coaches work together will also promote accountability for their role.

Note

Chen CW. Coaching Training (ASTD Trainer's Workshop Series). Alexandria, VA: ASTD Press; 2003.

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