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Quality Improvement Coaching in Healthcare

Just like anything we do in our job, life, sport etc., we perform best when we are fully committed and motivated to achieving the outcome or task.

Why is this topic important you may ask; what has coaching got to do with ensuring quality outcomes are met? I spent many years as a quality and development manager. I remember feeling despondent and desperate at times because despite all the policies, processes, forms, and tools that were provided, the teams continued to be non-compliant in terms of some quality outcomes.

Being an educator, I took to what came easily to me – teaching as a possible solution – so I provided the rationale and guidance to help these teams pick up their game. Although this did lead to some quality improvement, I wish I knew what I know now, that education is only the tip of the iceberg.

Years later I decided to complete a coaching programme which resulted in my ‘aha’ moment. I realized the value of using coaching principles in helping teams improve their quality outcomes. Just like anything we do in our job, life, sport etc., we perform best when we are fully committed and motivated to achieving the outcome or task.

In fact, I also realized that coaching is not new to quality improvement in healthcare and has been successfully implemented in various international projects such as those driven by the World Health Organization (WHO:2018).

Challenges in Healthcare Quality Improvement

In quality management we tend to use standardized models and frameworks, which is not necessarily a bad decision because quality systems are aligned to measures based on evidence, and their implementation is aimed at achieving strategic goals and promoting the organizations competitive advantage.

However just as healthcare organizations are diverse in nature so are the facilities within an organization or the divisions within a facility, yet for control and measurement purposes, we tend to implement a one size fits all quality system/s.

There is also a commonness between healthcare organizations and within an organization and this is characterized by the common goal of achieving the lowest cost of providing patient care at the highest quality of care possible. There is also the common quality driven outcome of optimum patient experience that forms the foundation of most quality healthcare initiatives or projects. The key focus being identifying, understanding, and implementing key quality principles and concepts towards achieving the required patient responses/outcomes.

The quality management team has the responsibility to ensure that employees have the tools, guidelines and instructions and direction they need to successfully implement the quality improvement processes. So, what could go wrong – all they need to do is just follow the instructions and provide the proof of results?

Quality teams follow through by monitoring progress and conducting formal assessments and maybe providing some additional training and guidance where they can. Yet the gap remains between planning and implementing; between the where the quality experts are and where the employee teams are.

But how do you get it right, how do we get the end users, the people responsible for delivering the results to share the same vision, to take the necessary steps and engage a vested interest?

Another factor to consider is that often QI projects are undertaken in response to problems identified – the aim being to solve the problem and sign off the issue, but the problem does not go away, or other problems are created, or worse still it appears on paper as resolved but real information or data are camouflaged.

According to Archer (2011) the issue here is that organizations focus on ensuring compliance, but this is at the expense of employee team enablement and their adoption of shared business values. Therefore, an effective solution is to introduce coaches who are deployed for ‘just in time’ training, mentoring and guidance during the quality project implementation.

Quality management teams comprise of quality experts who they live and breathe QI; finding solutions and establishing a plan for improvement is a no brainer, however, for another professional with a different business function, QI may not be such a walk in the park. They need more guidance and motivation and encouragement rather than just direction and instruction. Adopting a punitive approach leads to staff inevitably hiding issues or concerns and providing falsified information (Healthqual: 2017).

This is where the value of coaching comes into effect; not to replace but to help close the gap between the quality plan and its implementation thereby promoting the success of the project (WHO: 2018).

The coaches are present and available to assist and inform teams so that they can successfully implement quality initiatives in line with their unique and diverse settings and situations while getting the most value from the standardized systems and methods that are in place.

The Role of Perception

As individuals we see things or rationalize differently, what I see as doable or the right way, others may not agree with, see, or understand. It’s like wearing the same glasses with different colored tints, the color influences our choice.

Another example is optical illusions, if I put up a sketch and ask a few people what they see within the first 5 seconds, often they will see different images. This is because many aspects can affect what and how we perceive such as past experiences, familiar activities, assumptions, and world views that impact our decision and how we respond. The same concept can be applied to employees who to change their actions, must first change their perception.

Coaching as the Value Add

‘Coaching is regular hands-on support to motivate and help teams of healthcare workers to improve quality of care at the health facility.’ (WHO:2018)

The aim of coaching is to maximize a person or persons performance by helping them develop focused solutions to problems/issues. It is a mutually voluntary interaction between people, where the coach has neither responsibility, accountability, or authority over the outcomes of the team, but are there to generate change, optimize performance and encourage development (McKeever & Rider: 2014).

To get real commitment and buy in, the QI team must help the staff make sense of the framework provided and how it would work in their unique environment. We all think that what we do is unique, our circumstances and work are unique, so how can someone who has no clue what we do, tell us how to manage and monitor our work. Therefore, the QI team is often regarded with skepticism.

In adopting a coaching approach, the QI team helps the staff filter their different thought processes, the challenges, actual situation, and uniqueness. The goal being to focus on solutions: how can actions be changed, or criteria modified. Its not a ‘just do it’ approach but one that requires listening and engaging towards a common goal: a positive impact on patient experience (Healthqual:2017).

The valued aim of coaching therefore is to move quality improvement from external direction and guidance to internally driven quality initiatives (Archer:2011).

Coaching methodologies have a common entity which is solution focussed – it is not about the problem or issue at hand but rather about the ‘now what’. However, the coach does not come up with the solutions but helps the staff explore solutions and agree on the best possible actions to take.

Coaching Principles (adapted from Health Coaches Academy:2020)

  1. Help staff create a specific quality improvement plan that addresses their unique environment, situation, and challenges.
  2. Encourage staff to own the responsibility for their performance and outcomes thereby promoting a team culture and mutual values.
  3. Support self-directed lasting improvement and changed behavior which encourages and recognizes the contribution of individuals.
  4. Help staff identify goals and values aligned to patient outcomes and experience which will help them understand the impact of their actions or the lack thereof.
  5. Help staff identify and overcome the barriers that prevent them achieving their quality improvement outcomes because often we do not see the fences or blind folds that block progress.
  6. Mentor the teams through education and providing information to help them make informed decisions.
  7.  Promote motivation to change by helping the teams push forward despite setbacks and delays.
  8. Hold the teams accountable for their actions and committed to achieving results by setting clear timelines.

Benefits of Coaching

  1. Promotes a higher level of engagement and commitment from the staff because their opinion matters; decisions are made by them and are related to their goals.
  2.  Promotes a stronger team culture as staff start to work together and make mutually agreed on decisions.
  3. Staff are more productive and willing to do more because they have a vision, and their actions are their choice.
  4. The relationship between staff and management is improved as staff feel respected and acknowledged.
  5. There is an overall heightened creativity with staff thinking beyond what they used to, exploring new options.
  6. The safe coaching environment encourages increased risk taking and exploration of different ideas and processes.

Coaching Skills for QI (Healthqual:2017)

  1. Building trust 

Creating a trust relationship is vital. Staff must be able to trust that the coach is vested in their success and not merely a representative of management. For staff to be willing to move outside of their comfort zones, they need to feel free and safe to evaluate their actions.

2. Communication

Coaching is about listening and guiding through asking the right questions to clarify ideas and perceptions and to promote decision making. Coaches avoid advising or directing because it’s about empowering the staff to own their actions and be accountable for the outcomes. Coaches, therefore, adopt a non-judgemental and respectful attitude towards the individuals and teams they work with.

3. Conflict Resolution Skills

Depending on the group dynamics there can be differences of opinion and conflict among staff members in a team that will need to be effectively dealt with, because a cohesive team will ensure a shared vision and values.

4. Team Building

The coach must promote the team working together, respecting each member’s contribution, and embracing a shared approach to achieving success.

5. Feedback

Constructive feedback will help the team move forward, prevent de-motivation, and encourage overcoming barriers.

6. Expertise

The coach does not need to be an expert in the area or discipline of the team but must have the required quality improvement expertise especially related to the organizations quality management system and approaches.

7. Meeting and presentation skills

The coach must be able to manage the meetings held with staff and be able to present information and training as needed.


The quality expert responsible for assessing the team’s performance should not be the coach, to promote trust and objectivity. The seamless integration of quality assurance and coaching processes is critical to producing sustainable success.

A coaching session is effective when the staff feel free to provide input on delivering quality, identifying where they went right or wrong, and coming up with the solutions to correct the prevailing issues. The staff are also equipped to be accountable for their actions but most importantly, coaching promotes and encourages effective two-way communication.


Archer, S. (2011). The coach approach to quality management. Paper presented at PMI® Global Congress 2011—North America, Dallas, TX. Newtown Square, PA: Project Management Institute.

Brody, M. 2017. Courageous Coaching isn’t Easy, but its your Job. Association for Talent Development, Pennsylvania, USA.

Healthqual. 2017. Coaching for Quality Improvement, toolkit.  UCSF Institute of Global Sciences.

Hendler, R. 2007. Quality in Healthcare: concepts and practice. ResearchGate.

McKeever, J. & Rider, N. 2014. Quality Improvement Coaching to build capacity in Health Departments. Journal of Public Health Management and Practice. Lippincott Williams & Wilkins.

Sussex, P. 2015. Key role of coaching in business growth.

WHO. 2018. Coaching for Quality Improvement, Coaching Guide. WHO-South East Asia.

About the Author

Peggy holds an MA in Health Sciences and is a Health Transformation Coach. She has extensive experience in critical care nursing both national and international, nursing and education management and education quality and development management. She has a personal interest in establishing standards and processes that promote quality healthcare at the bedside. Peggy has published on reflective practice and quality initiatives in national and international journals and presented at various global conferences. 

She currently works as a Nursing Specialist and Transformation Coach including commissioning new higher education institutions; curriculum; standard and policy development; and coaching.

Peggy Naicker on LinkedIn

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