The Evidence for Coaching The Evidence for Coaching in by alicejenny

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									The Evidence for Coaching
in Leadership & Healthcare

Margaret Moore/Coach Meg
Founder & CEO,
Wellcoaches Corporation
www.wellcoaches.com www.coachmeg.com
coachmeg@wellcoaches.com

Co-Director, Institute of Coaching
www.instituteofcoaching.org
McLean Hospital, Harvard Medical School
.
Coaching journals
 g
Agenda

1. What does evidence-based mean?
2. Theoretical foundation: How does coaching work?
3. Coaching outcomes measurement - How do we know
   coaching works?
4. Does coaching work?
   – Coaching evidence in life and executive coaching
   – Coaching evidence in healthcare
5. Conclusions
What does evidence-based mean?


Evidence-based
Evidence based practice was first explored in
Journal of American Medical Association in 1990:

B t available research evidence combined with
Best      il bl       h id         bi d ith
“clinical expertise.”
What does evidence-based mean?

Evidence is a verb… David Drake, PhD (Feb 2009)

No: universal, static, objective, neutral and codified data
Yes: contextual, dynamic, subjective, political, socially
constructed

Approach to evidence in coaching
–   Foundational knowledge
–   Professional knowledge
–   Self knowledge
–   Contextual knowledge

    International Journal of Evidence Based Coaching and Mentoring
  p       (              y)
Empirical (from dictionary)

Capable of being confirmed, verified, or disproved by
observation.
              (              y)
Best evidence (from dictionary)

Evidence that is the most reliable and most direct
in relationship to what it is offered to prove.

Most reliable – multiple well-designed research studies,
randomized with control groups

Most direct in relationship – similar:
- Coaching model – theoretical foundation & skills/processes
- Coaching specialty
- Coaching p p
         g population
- Coaching outcomes metrics
Ignoring the Evidence:
Why do psychologists reject science?
By Sharon Begley | NEWSWEEK, Oct 2, 2009

  “…many clinicians fail to "use the interventions for which
  there is the strongest evidence of efficacy" and "give more
     i ht to their        l     i        than to i
  weight t th i personal experiences th t science."      "

  As a result, patients have no assurance that their "treatment
   ill be informed b science."
  will b i f     d by i       "

  “The disconnect between what clinicians do and what science
                                         embarrassment,
  has discovered is an unconscionable embarrassment “ and
  there is a "widening gulf between clinical practice and
  science” which will discredit psychology.”
Cope and Allison, University of Birmingham:
International Journal of Obesity

   “…we scientists have our own code of conduct. Central
   is         it     t t f ithf l    ti   t    k     l d i
   i a commitment to faithful reporting, to acknowledging
   our study limitations, to evaluating bodies of evidence
   without selectively excluding information on the basis of
       desirability. short,                   truthfulness
   its desirability In short a commitment to truthfulness.”

   “The demonization of some aspects of evidence and
        tifi ti    f th       lth   h    h    helpful in
   sanctification of others, although perhaps h l f l i
   spurring social action, may be more harmful to us in the
   long run by giving unconscious permission to breach
        code,
   that code thereby eroding the foundation of scientific
   discipline.”
               g      g         p
What is coaching aiming to accomplish?


    Coaches facilitate a process of change
    or development which enables
    individuals and organizations to realize
    their potential.

                  nreali ed        abilit
    Potential is unrealized latent ability,
    capacity, or possibility.
              y g prove?
What are we trying to p
Theoretical foundation of coaching skills and processes
1. How does coaching work?

Coaching outcomes
1 How do we know that coaching works?
1.
2. Does coaching work?
3. What is the return on the investment in coaching?

Optimization of coaching outcomes
1. What in coaching works?
2. When and with whom does coaching work?
3. What might work better?
   y    y g         g
Demystifying coaching research
Kauffman, 2004


 I believe that coaching works.

 The basic empirical evidence each of us already has is that
      li t       f           i      i      th f db k th t
 our clients pay for our services, give us the feedback that
 what we’ve done is helpful and show us the validity of their
 claims through changes in success, life satisfaction, and
      attainment
 goal attainment.
Demystifying coaching research
Kauffman,     (Director Harvard Institute
Ka ffman 2004 (Director, Har ard Instit te of Coaching)
 But we need to broaden our personal experience to include
 more rigorous study and analysis of what works with whom,
 when, where, and how. Whether we are explicitly aware of it
 or not, there is, in fact, a deep theory and science of
 coaching.

 For many of us it lurks beneath the waterline of our
 conscious awareness. Although we may sense it, it may feel
                                             uninformed.
 ephemeral when we try to describe it to the uninformed

 Learning the basic skills of research empowers us to reach
                                               day,
 down and pull the knowledge into the light of day where
 everyone can see it. Our theory and practice can be
 articulated, defined, researched, and replicated.
              y g prove?
What are we trying to p
Theoretical foundation of coaching skills and processes
1. How does coaching work?

Coaching outcomes
1 How do we know that coaching works?
1.
2. Does coaching work?
3. What is the return on the investment in coaching?

Optimization of coaching outcomes
1. What in coaching works?
2. When and with whom does coaching work?
3. What might work better?
Theoretical foundation of coaching skills
and processes




 Dianne Stober   Stephen Palmer   Margaret Moore
 Anthony Grant   Alison Whybrow   Bob Tschannen-Moran
How does coaching work?


Evidence-based coaching mechanisms of action
E id     b   d     hi      h i      f ti

A. Build growth-promoting relationship
B. Elicit motivation – jet fuel for change
C. Improve capacity to change by increasing positivity,
   resilience, and self-efficacy
D. Facilitate process of change (constructive development)


   View How Coaching Works at YouTube
A. Build growth-promoting relationship
                          Autonomy
                          Self-awareness
                          Coaching presence
                          Relational flow

                          Theories:

                      •   Relational Cultural Theory
                      •   Motivational Interviewing
                      •   Nonviolent Communication
                      •   Mindfulness
                      •   E ti     l Intelligence
                          Emotional I t lli
                      •   Relational Flow
B. Elicit motivation
                       Uncover, ignite, and
                       sustain motivation:
                       the jet fuel for the journey
                       of change


                       Theories:
                       Self-Determination Theory
                       Motivational Interviewing
                       Positive Psychology
                       Adult development
                       Mindfulness
Self-determination theory:
Innate and universal needs



   • Autonomy - I’m in charge
     Competence - I did it!
   • C
   • Relatedness - I have strong connections
     and collaborations
Self-determination theory:
Innate and universal needs



   • Autonomy - I’m in charge
     Competence - I did it!
   • C
   • Relatedness - I have strong connections
     and collaborations
       Intrinsic motivation

•   External regulation - low investment
•   Introjected regulation - self-imposed related
    to self-esteem – motivation unstable
• Identification - a valued outcome that can
  override obstacles
• Integrated regulation - done for the sake
  of outcome
• Intrinsically motivated - behaviors
  that are exciting, interesting, and
  performed for satisfaction alone
C. Improve capacity to change by
increasing positivity, resilience, and
self-efficacy
                              p       p
                            Hope & optimism
                            Self-efficacy
                            Resilience

                            Theories:
                            Positive Psychology
                             ope syc o ogy
                            Hope Psychology
                            Social Cognitive Theory
                            Appreciative Inquiry
D. Facilitate process of change
(constructive development)
(    t     ti d    l       t)
                     Vision, goals, plan
                     Accountability
                     Just-in-time learning
                     Rising above challenges


                     Theories:
                       a st eo et cal
                     Transtheoretical Model
                     Appreciative Inquiry
                     Hope Psychology
                     Immunity to Change (Kegan)
                     Goal-Setting Theory
                     Solution-oriented Therapy
                     GROW model
Coaching developmental cycles

                      Coaches help clients
                      move from Point A to
                      Point B.
Mount Lasting Change
              y g prove?
What are we trying to p
Theoretical foundation of coaching skills and processes
1. How does coaching work?

Coaching outcomes
1 How do we know that coaching works?
1.
2. Does coaching work?
3. What is the return on the investment in coaching?

Optimization of coaching outcomes
1. What in coaching works?
2. When and with whom does coaching work?
3. What might work better?
  Categories of coaching outcomes
1. Performance – reaching a destination
   (sales target, new job, run a marathon, weight loss)

2. Skills – developing new skills or abilities
   (managing stress, handling adversity, leadership,
                   cook
   learning how to cook, ability to focus)

3. Behaviors – establishing new behaviors or habits
                  relations, management,
   (interpersonal relations management health
   and wellness)

4.
4 Development – increasing consciousness through
   new perceptions, beliefs, meaning, values (confidence,
   hope, optimism, self-awareness, insight)
Coaching outcomes metrics
How d we k
H   do        that     hi      k ?
         know th t coaching works?

Executive & Life
1. Performance – business or life goals, workplace
   well-being, stress/anxiety scores
2. Skills/behaviors – mindfulness, goal attainment scaling
   (GAS) – skills goals with behavioral markers
3. Development – self-reflection, insight, self-efficacy,
   autonomy
Healthcare
1. Performance - biometrics for physical and mental health
2.
2 Skills/behaviors - health and wellness
3. Development – self-efficacy, motivation and meaning,
   positivity, readiness to change
Tony Grant, PhD (first coaching psychologist)
Director f Coaching Psychology Unit
Di t of C       hi P    h l    U it
University of Sydney
University of Sydney Coaching Research Program

•   Eight outcome studies: 6 randomised, 2 between-subject

•   Range of theoretical papers
     – Coaching Models; Mental Health and Goal Attainment;
       Commentary papers
                 yp p

•   Additional coaching-related empirical work
       Self reflection                                Solution
     – Self-reflection and Insight; Stages of Change; Solution-
       focused vs. Problem Focused Coaching
     – Mindfulness and Perspective-taking in Leaders
                                        p    , p
     – Over 100 articles and book chapters, reports and > 100
       conference presentations
The Solution-Focused Cognitive-Behavioural Model

                  Goal


    Environment                 Behaviour


                  Positive
                  Attentional
                  Focus

      Thoughts                  Emotions
        g        g
Measuring Coaching Outcomes

•   BEHAVIORS: Goal Attainment Scaling (GAS)
     – Simple scaling; Levels of attainment
•   PERFORMANCE: Presence/Absence of Mental
    Distress
     – DASS: Depression, Anxiety, and Stress Scale
•   PERFORMANCE: Presence/Absence of Well-being
     – QOLI; PWB; SWB; PANAS; Hope; Cognitive
       Hardiness; Workplace Well-being Index
•   DEVELOPMENT: Metacognitive Processes
     – Self-reflection and Insight Scale
Life coaching group program study


                       work ,
  Q: Does Coaching “work”, and how does it impact
     on self-reflection and insight?

      – N = 20 (Adults 35.6yrs)
      – 13 wks, 50 min weekly, group-based “GROW”
        sessions

  •   Self-Reflection Insight S l Q lit f Life; Mental
      S lf R fl ti & I i ht Scale; Quality of Lif M t l
      Health; Goal Attainment
                                            (Grant, 2003)
     Goals and Quality of Life

80
                y
          Quality of Life
70
          Goals
60

50

40

30
20

10
0
              Pre                Post
    Depression, Anxiety & Stress
7                                    Depresion
6                                    Anxiety
5                                    Stress
4

3

2

1

0
          Pre                 Post
Self-Reflection & Insight


  70
  65
                        Self-Reflection
  60                    Insight
  55
  50
  45
  40
  35
  30

          Pre
          P                 Post
                            P t
  Solution-focused, cognitive-behavioural
      hi i di id l
  coaching individual program (RCT)
• Q: Does coaching work when screening and
     l di      ti i   t f       t l h lth i      ?
  excluding participants for mental health issues?

   – Randomised controlled study; N= 67 (Adults 38.5yrs)
   – Screened for mental health problems – 22 excluded
     (25%)
   – Intro. evening, 10 wks 45 min weekly individual coaching


• Goal Attainment; Psychological Well-being, Mental
               j              g
  Health, Subjective Well-being; Emotional
  Intelligence
                                   (Spence & Grant, 2005)
                       Goal Attainment
                  4
                              Coaching Group
                              Control Group
         nment




                 3.5
Goa Attain




                  3


                 2.5
  al




                  2


                 1.5
                              Pre              Post
                          y
    First randomized study of
    external executive coaching

Q: Is executive coaching effective at enhancing workplace
   well-being during organisational change?

•   Solution-focused, cognitive-behavioural executive coaching
    with 360 feedback
•   45 executive and senior managers from large public health
    service

                              (Grant, Curtayne, & Burton, 2009)
Executive Coaching, Goal Attainment
& Well-being
•   Half day
    Half-day leadership development w/shop
•   Organisation in major change process

    –                (HS-LSI)
        360 feedback (HS LSI)
    –   Goal Attainment Scaling (GAS)
    –   Cognitive Hardiness Scale
    –   Depression, Anxiety and Stress Scale
    –   Workplace Well-being Index

•   Four coaching sessions over 8 to 10 wks
•   Control group got coaching ten weeks later
Goal Attainment
Resilience
                Depression

            6
                                               Group 1
                                               G
                                               Group 2
            5


            4
 epresion




            3
De




            2


            1


            0
                  Time 1     Time 2   Time 3
Workplace Well-being
Conclusions from Tony Grant

“The quantitative results of the (second) randomized study
provide support for the notion that executive coaching can
increase goal attainment, enhance resilience, ameliorate
depression and stress, and increase workplace well-being.
The participants’ q
     p     p                     p         gg
                  qualitative responses suggest that
executive coaching may well be a valuable tool in helping
Individuals deal with the uncertainty and challenges
                            change.
inherent in organisational change ”

“Overall there is emerging evidence that coaching can be
an effective positive individual change methodology.”
Executive coaching vs internal coaching

  International Journal of Evidence-based Coaching &
  Mentoring; Aug 2009:
  The Eff t f     E      ti C     hi     Performance
  Th Effect from Executive Coaching on P f
  Psychology, Moen, Skaalvik; Norwegian University of
  Science & Technology

  External executive coaching improves psychological
  variables affecting performance such as self-efficacy,
      l tti     intra-personal causal attributions of
  goal setting, i t          l      l tt ib ti      f
  success, and self-determination need satisfaction.

  The outcomes of internal coaching based leadership
  are not as strong as those from external executive
  coaching.
Coaching works…(Human Resources Program
Evaluation Handbook: Chapter by Peterson, Kraiger, 2004)

  Based on dozens of case studies, hundreds of personal
  testimonials i scores of organizations, and di
  t ti     i l in        f      i ti                  threads
                                            d diverse th d
  of research, coaching has a positive impact on people and on
  business results.

  Coaching is more effective in helping people improve their
  performance in areas of leadership, communication,
  interpersonal,                                      training.
  interpersonal and cognitive skills than management training

  Studies (summarized in Kampa & White, 2002; Kampa-
  Kokesch & A d
  K k                              id   b t ti l id       that
          h Anderson, 2001) provide substantial evidence th t
  well-designed coaching makes a meaningful difference in skill
  learning, job performance, and organizational results.
The state of executive coaching research
Int’l Coaching Psychology Review, Passmore, Gibbs; 2007


     Lessons from 50 years of studies of counseling
     psychology research:

 •   Meta-analysis of 475 controlled studies – 80% of
     clients better off than untreated subjects



     Recommendation:
     Coaching research needs to be completed with
          l     f 100    i i      i     d i d
     samples of 100+ participants in randomized
     control studies.
Coaching Research in Healthcare


•   Randomized Controlled Studies (12)
•   Non Randomized Study (1)
•   Qualitative Reports (4)
•   Case Study (1)
•   Project Demonstration (1)
•   Descriptive Articles (7)
•   Medical Education (2)
Coaching Research:
Manage, Treat, and Prevent Disease

• ADHD              • Depression
• Asthma            • Male caregivers of
• Cancer pain
          p           dementia patients
• Cardiovascular    • Osteoporosis
  disease           • Physical activity
• Compromised       • Spinocerebellar
  urinary bladder     degeneration
   y
  syndrome          • Weight loss
• Diabetes
Conclusions: Coaching Research Studies

  There is evidence in the medical
  literature that coaching alone is
  effective at improving health outcomes:

  –   Cardiovascular disease
  –   Diabetes
  –   Asthma
  –   Cancer pain
  –   Weight loss
Conclusions: Common strategies of
coaching research in healthcare studies

•   1:1 relationship
•   Goal setting and commitment
•   Accountability over time
•   Live sessions
Paper in preparation
Health Integrated – telephonic health coaching
•   30 behavioral health therapists who are trained and
    certified health coaches
•   Coaching clients have depression + co-morbid
    medical conditions; 1,000+ for each population
•                           visits admissions,
    High ROI (reduced ER visits, admissions hospital
    stays, and other urgent care)
•   Significant improvement in depression and
    productivity scores

          Population Type           Average Return on Investment
            Commercial                     2.0 2.5
                                           2 0 – 2 5 to 1

        Medicare Advantage                 2.5 – 3.5 to 1

       Medicaid Managed Care               3.5 – 4.0 to 1
Mental Health Functionality - PHQ-9 Scores in Diabetes


                           PHQ9 - Diabetes
             rease
      53% Decr
      5




                     Enrollement
                     Enrollment       1 Year Post
In press: exploratory study of wellness
     hi     ith           i
coaching with cancer survivors
 •   Three cohorts (n=30)
        Delaware
      – D l
      – Vermont
      – Illinois
 •   Breast, prostate, colorectal cancer survivors
 •   90 minute initial coaching session and five
     30-40 minute sessions over three months.
 •   Data collected at baseline, 3, 6, 12 after
     completion of coaching
 •   Statistically significant improvements in depression
                 y g
     scores, exercise behaviors, and quality of life scores
HADS‐Depression
1: Surveys completed  at baseline
2: Completion of the wellness coaching intervention (at 3 months)
3: Six months after intervention ended
4: Twelve months after intervention ended
Mindfulness training and health coaching
    (2008) Spence, et al: Coaching: An International
    Journal of Theory, Research and Practice

•   45 adults randomly assigned to three groups for 8 wks
•   Two groups received alternative delivery of MT and
    cognitive-behavioural, solution-focused coaching; Third
    group participated in a series of health education
    seminars.
•   Goal attainment was significantly greater in the
    facilitative/coaching format than the educative/directive
    format.
•   No statistically significant difference in results related to
    timing of MT
 Coaching outcomes studies underway

1. Midwest Hospital – 2 year randomized study of 144
   employees with metabolic syndrome, complete late
   2009
2. Oakwood Hospital – 5 year randomized study of 400
   women with cardiovascular risks complete in 2012
3. Emory University – pilot post bariatric surgery
5. Methodist Hospital – 2 year employee health risks
   a d e g t oss
   and weight loss
6. Mayo Clinic – ongoing study of wellness coaching for
   employee health risks and weight loss
7.
7 MGH Back Bay & Harvard Vanguard clinics – pilot
   of wellness coaching for chronic disease management
Future Goals for Coaching Research in
Healthcare


•   Standard definition of health and wellness coaching
•   Consistency of coaching protocols
•   Standardized coach training
•   Larger studies in multiple clinical indications
•   Long term follow up
•   Distinction between “light” and intensive coaching
•   New developmental outcomes metrics which predict
    sustainability
What can we conclude, at least
preliminarily?
1. Coaching can be an effective mode of facilitating
   change – performance, skills, behavior, and
   development

2. Coaching increases goal attainment – engagement
   in new behaviors related to skills development

3. Coaching improves psychological factors that predict
   higher performance

4. Coaching improves the capacity to change by
   increasing positivity, resilience, and self-efficacy
              y g prove?
What are we trying to p
Theoretical foundation of coaching skills and processes
1. How does coaching work?

Coaching outcomes
1 How do we know that coaching works?
1.
2. Does coaching work?
3. What is the return on the investment in coaching?

Optimization of coaching outcomes
1. What in coaching works?
2. When and with whom does coaching work?
3. What might work better?
The Evidence for Coaching
in Leadership & Healthcare

Margaret Moore/Coach Meg
Founder & CEO,
Wellcoaches Corporation
www.wellcoaches.com www.coachmeg.com
coachmeg@wellcoaches.com

Co-Director, Institute of Coaching
McLean Hospital, Harvard Medical School
www.instituteofcoaching.org
      g p y                          g
Bibliography – Executive/Life coaching
•   Kauffman, (2005) Demystifying Coaching Research; Proceedings of the Second
    ICF Coaching Research Symposium, Washington, DC: International Coach
    Federation, 161-168.
•   Drake, D. B. (2009). Evidence Is a Verb: A Relational Approach to Knowledge
    and Mastery in Coaching. International Journal of Evidence Based Coaching
    and Mentoring, 7(1), 1 - 12.
•   Grant Bibliography – 1937 to 2008
•   Green, L. S., Oades, L. G., & Grant, A. M. (2006). Cognitive-behavioral, solution-
    focused life coaching: Enhancing goal striving, well-being, and hope. The
    Journal of Positive Psychology: 1(3), 142 - 149.
•   Grant, A. M., Curtayne, L., & Burton, G. (2009). Executive coaching enhances
         attainment
    goal attainment, resilience and workplace well-being: a randomised controlled
    study. The Journal of Positive Psychology: Dedicated to furthering research and
    promoting good practice, 4(5), 396 - 407.
•   Moen, F. & Skaalvik, E.(2009). The Effect from Executive Coaching on
    Performance Psychology. International Journal of Evidence Based Coaching
                     y      gy                                                     g
    and Mentoring, 7 (2), 31- 49.
      g p y           g
Bibliography – coaching in healthcare
•   The integration of mindfulness training and health coaching: an exploratory
    Study; Gordon B. Spence*, Michael J. Cavanagh, and Anthony M. Grant
    Coaching Psychology Unit, School of Psychology, University of Sydney,
    Australia Coaching: An International Journal of Theory, Research and Practice
    Vol. 1, No. 2, September 2008, 144-162
•   Newnham-Kanas, C., Gorczynski, P., Morrow, D. & Irwin, J. (2009). Annotated
    Bibliography of Life Coaching and Health Research. International Journal of
                                    Mentoring, 7(1)
    Evidence Based Coaching and Mentoring 7(1), 39 - 103  103.
•   Frates. E. (2009): Coaching in Healthcare Research Report Harvard Medical
    School Coaching in Leadership & Medicine conference
•   Palmer, S. (2003): Health coaching to facilitate the promotion of healthy
    behavior; International Journal of Health Promotion & Education, Vol 41, No 3; p
    91-93

								
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