Coaching: unlocking the untapped potential

“We cannot solve our problems with the same thinking we used when we created them.” Albert Einstein

Working in imaging and oncology services across the UK is currently challenging. The cumulative effect of years of underfunding, both in the workforce and capital expenditure, the coronavirus pandemic and long-standing recruitment issues, among others, have resulted in a major workforce problem.

Operating in tandem with this is an increasingly volatile, uncertain, complex and ambiguous (VUCA) clinical environment.

Despite these multifactorial, changing and sometimes contradictory issues, current policy, planning and strategy are often centred on the “bums on seats” fallacy. It is not an outrageous response. In fact, most evidence would suggest that for clinical imaging and oncology services to remain viable, an exponential growth in the workforce is imperative¹. It is, however, flawed. 

In VUCA-driven environments, health services are haemorrhaging both new and experienced staff, often at a faster rate than staff are entering the profession, creating persistent workforce shortages. It is increasingly apparent that the NHS does not have enough staff to meet demand².

Figure 1

Figure 1. A bucket metaphor for the attrition of radiographers in the current climate

It is no longer feasible to just focus on workforce numbers. The focus on workforce growth has not eased the legitimate pressures felt by radiographers up and down the country. There remains huge potential to solve workforce issues through unlocking our human capital. 

Capability and capacity already exist in the current clinical imaging and oncology workforce. Results vary but it is generally agreed that the human capital that exists in an organisation remains mainly “untapped”³. It is not a problem isolated to our profession, increasingly recognised outside human resources domains. The inherent talent and human capital that exists in our workforce needs to be harnessed. 

It is a fair assessment to note that recent direction has recognised the imperative to invest in the current workforce¹, albeit through the narrow lens of education, training and/or instruction. It would be unwise to suggest otherwise, but education and training (formalised and other) should complement other developmental tools – it is not a panacea. It is often expensive, too, which results in staff having to take time out of a department to undertake formalised learning opportunities. 

This unidirectional approach can result in sporadic and emergent upskilling where pockets of career progression occur, often driven by visionary service managers rather than a deliberate and strategic development approach. There is also an equity and selection issue here. It can be challenging to ensure equality of opportunity for further education and training.

Coaching is an attractive and, arguably, more holistic complementary approach to staff development. It is not well understood or researched in the radiography community. It follows, then, to provide a definition: “Coaching is the art of facilitating another person’s learning, development, well-being and performance. Coaching raises self-awareness and identifies choices. Through coaching, people are able to find their own solutions, develop their own skills, and change their own attitudes and behaviours. The whole aim of coaching is to close the gap between people’s potential and their current state.”⁴

This definition overlies six founding principles, which help to delineate coaching:

Table 1

Table 1. Six principles of coaching (adapted from Rogers⁴)

Coaching is perhaps the most misnamed and misunderstood development tool. Therefore, a prudent step in gaining a collective understanding is to outline what coaching is not. 

Coaching is not mentoring 

Coaching and mentoring are often conflated, indeed, they both sit under the umbrella of dialogic “development approaches”⁵. This means they are both similar in that they use conversation through a shared dialogue, usually between two individuals, to explore professional growth, learning and development. Both methods also involve setting goals, solving problems and developing the skills and abilities of the coachee or mentee. Understanding the difference is important. 

First, and most importantly, the philosophical underpinnings of each lie at opposite ends of the continuum. Coaching is founded on the belief of human agency – an individual makes their own choices and responsibility lies with the self. In practice, coaches use non-directive means to enable individuals to “know what to do”⁴ as only they have lived their own experience and only they can action and live with the results. 

Mentoring is different in that the exchange of knowledge originates from the expert and is passed to the novice. Solutions, choices, options and guidance are sourced externally – from the mentor rather than intrinsically generated as with a coaching relationship. Practically, this means that the mentoring process is often much longer in duration than a coaching intervention. Time is needed to impart the wisdom gleaned from a “lifetime” of experience. 

However, as the coaching process is “just in time” need based, a course of coaching tends to be time bound, focusing on specific goals. Another key difference is that the mentor-mentee relationship is often one of power difference. The mentor is often more senior in the organisation and probably more influential. They have expertise in the discipline of the mentee. In contrast, the coach comes “to the table” as an equal with the client. They often may not have expertise in the discipline of the coachee. 

Coaching is not counselling 

Counselling involves helping those often in a persistently distressed and disabling state. Coaching requires individuals to have a state of readiness – best understood as a “growth mindset”. This is why coaching is not well suited as a tool to work with people requiring remedial support or facing formal performance-related issues. 

Coaching is not training

Parallels can also be drawn between coaching and training. As Rogers⁴ asks on page 19 of her book:  “If coaching is about learning, and it is, then how is it different from training?” Training is defined by planned and intended outcomes, meaning goals and learning activities are pre-set. This is the key difference to coaching, where a coach has no set curriculum.

Coaching is not consulting

Another close relative to coaching is consulting. Again, there are key distinctions that determine the differences. Consulting is philosophically centred, almost exclusively, on problem-centric models and ways of thinking. Coaching is defined by appreciation with roots in positive psychology and self-actualization⁶. Consultants normally work on the “external” tangibles: systems, processes, organisation culture, for example. Coaches, meanwhile, focus on personal and internally generated issues⁴.

Using a coaching model helps to structure discussions with a radiographer in a coaching session. Models are primarily designed to act as a guide for the coach, helping the coach and coachee to stay focused on relevant issues and preventing the coaching session from drifting off into a conversation that has no clear purpose or goal⁷. 

The main purpose of a model is to delineate each stage of the coaching conversation – the beginning, the middle and the ending phases – in addition to being an aide-memoire for the coach to check levels of motivation and ensure barriers have been surfaced and addressed⁷. The GROW model is one of the most well-known coaching session structure models. Popularised by Whitmore⁸, the model aggregates a coaching session into four distinct parts, as outlined in Table 2.

Table 2

Table 2. The GROW Model (adapted from Grant⁷)

This model is useful as the delineating of the SMART (specific, measurable, achievable, realistic and timely) objectives can also be aligned to service objectives that are high priority. This might include exploring with the radiographer the relevance of the goals for patients, their direct team and wider department. This can also support the prioritisation of objectives to include multiple stakeholders in addition to the individual being coached. 

As with all coaching models, it is necessary to explore the pragmatics of applying them in the real world. Many models give the impression that coaching is a linear process – appealing to the novice or “have a go” coach looking for a clear and simple cookie-cutter approach to coaching. 

In reality, Grant⁷ suggests that the conversations are iterative, frequently oscillating as the coach and coachee untangle their convoluted thinking: “The GROW model might be more accurately represented as GRGROGROOGROWOGORW.”⁷ In addition, the GROW model has been rebranded as the RE-GROW model to construct meaning from previous coaching sessions (R-review and E-evaluate). The review and evaluate sections of the model clearly and explicitly link the coaching from one session to the next, avoiding the risk of becoming a series of disjointed conversations.

In an optimal organisational and departmental culture and climate (see the next section), the benefits of coaching are unequivocal – to the individual radiographer, the organisation and the coach. Initially, the effects of coaching are probably most obvious to the individuals directly benefitting from coaching development. This is sometimes noted in the literature as “first generation coaching”⁹. More than 70% of individuals have reported benefits from improved work performance following coaching¹⁰. This might be observed through increased goal achievement through annual appraisal or perhaps a decrease in mal-aligned workplace behaviours. The explanatory driver for these changes, however, is attributed to an intangible increase in employee self-awareness and self-confidence, a more holistic view of the individual benefits of coaching (as shown in Figure 2). 

Figure 2

Figure 2. Internal and external model of development during coaching¹¹

Some 80% of people who receive coaching report increased self-confidence¹⁰. As self-awareness and self-confidence develop through coaching dialogue, there are several positive benefits to the individual, such as improved leadership skills, assertiveness, understanding of difference, improved resilience and a better work/life balance. 

As a coaching intervention lifecycle develops the coaching culture, the scope and impact of that benefit extends beyond the individual to the organisation. Rider⁹ noted this as a “second-generation benefit”. The implementation of coaching initiatives in the organisation improves staff retention, supports organisational development and helps to identify and develop high-potential employees. 

An often-forgotten benefit is that the coaches themselves can bring benefits to the organisation. The third generation of coaching achieves the benefits of the first and second generation, but also harnesses and disseminates the learning the coach gains from the organisation, to the benefit of the service and its people, thus realising the maximum benefits of the coaching investment (Royal Bank of Scotland Group case study⁹).

While there is a broad acceptance of the benefits of coaching¹², without an organisational and departmental culture and climate that support a coaching culture, any benefits can be eclipsed. The climate (how a place feels) and the culture (the practices, values and norms underpinning the climate) need to be conducive to authentic, ethical and psychologically safe workplaces. Considering the cultural type of a workplace may help service leaders to decide whether coaching would be an appropriate developmental approach. 

A department’s culture is often colloquially defined as “the way we do things round here”. Culture can be transmitted across the department through a “cultural web”¹³ of stories, symbols, power structures, organisational structure, control systems, rituals and routines. Each context of this web needs to be gauged and understood before any workforce development intervention, such as coaching. Handy¹⁴ broadly categorised organisational culture into four distinct categories (Table 3). 

Table 3

Table 3. Handy’s¹⁴ four organisational cultures

Organisations whose cultures are predominately power or role centric most often do not provide an environment in which a coaching culture can thrive. Typically, departmental readiness for coaching will include a pervasive growth mindset of individuals at all levels, where feedback is welcomed.

There is a requirement for “human agency” for successful coaching, whereby situational awareness and reflexivity are central to the skills development of the coachee. Work environments where Tasks and People are prioritised support individual decision making. These organisational cultures are favoured for a coaching development intervention. 

Another important condition needed for successful embedding of a coaching culture is endorsement and sponsorship from the organisation’s executive/management, that is, “from the top”. In practice, this might be framed through inclusion of coaching in management strategy, executive behaviour and principal modelling aligned to coaching culture and resource allocation for adequate training of coaching instruction. 

In addition, it is critical that the values of the department align authentically throughout the workplace climate. In practice, this can be seen through employees living the organisational values through the stories that they share – are people, past and present events talked about admiringly inside the company? Organisation climate and culture are pervasive. They must be understood, aligned and, in some cases, modified for development interventions, such as coaching, to succeed.

One of the best arguments for dialogic humanistic development approaches such as coaching is that it supports learning in real-world environments. It provides a mirror to our actions – a frame to enhance our meta-learning or how we “learn how to learn”. Traditional learning scaffolds cognitive expansion but often requires application “stretch” in clinical imaging and oncology departments. This means that while we can agree that knowledge through traditional education, application and skill or how we use what we know is essential, our character or values – how we behave and engage in the clinical environment – and, finally, how we reflect and adapt are of equal importance in radiography. This is known as four-dimensional education¹⁵ as represented in Figure 3.

Figure 3

Figure 3. Four-dimensional learning¹⁵

Meta-learning or “how we reflect and adapt” is needed to maximise our knowledge, skills and behaviours and will become increasingly required to navigate our VUCA-influenced clinical environments to ensure the best care for patients. Through coaching conversations, radiographers can develop, explore and enhance their meta learning ability.

In conclusion, leaders across imaging and oncology services need to harness new ways to create hope while unlocking and retaining the talent that exists in the radiography workforce.

Coaching is, therefore, no longer an added luxury in the development and retaining of radiographers across the UK but essential for stemming the flow of talented and skilled professionals away from our profession. Coaching is poised to become a critical part of our staff development portfolio to support both radiographer capability and capital. 

Dr Amy Robertson is Professional Officer for Education and Accreditation at the Society and College of Radiographers.

References

1. Richards M, Maskell G, Halliday K and Allen M. Diagnostics: a major priority for the NHS. Future Healthcare Journal. 2022. 9(2), 133.

2. Nuffield Trust. The NHS Workforce in Numbers. Facts on staffing and staff shortages in England. 2018.

3. Deloitte. Unleash Workforce Potential. 2021. Available at Unleash the Workforce | Deloitte Global. Accessed 11 February 2023.

4. Rogers J. Coaching Skills: a Handbook. 2012. McGraw-Hill Education (UK).

5. Chartered Institute of Personnel and Development. Coaching and Mentoring. 2020. Available at Coaching and Mentoring | Factsheets | CIPD (cipduat.co.uk). Accessed 11 February 2023.

6. Taylor E. Positive psychology and humanistic psychology: a reply to Seligman. Journal of Humanistic Psychology. 2001. 41(1), 13-29.

7. Grant AM. Is it time to REGROW the GROW model? Issues related to teaching coaching session structures. The Coaching Psychologist. 2011.7(2), 118-126.

8. Whitmore J. Coaching for Performance. 1992. London: Nicholas Brealey.

9. Rider L. Coaching as a strategic intervention. Industrial and Commercial Training. 2002. Nov: 1.

10. International Coaching Federation. International Coaching Federation Global Coaching Study. 2016. 

11. Wales S. Why coaching? Journal of Change Management. 2003. 3:3; 275-282.

12. Institute of Leadership and Management. Creating a Coaching Culture. 2011. Available at www.i-l-m.com. 

13. Johnson G et al. Exploring Corporate Strategy. Eighth edition. 2007. FT/Prentice Hall.

14. Handy C. Gods of Management. 2009. Souvenir Press.

15. Fadel C, Bialick M and Trilling B. Four-Dimensional Education. 2015. Available at https://policycommons.net/artifacts/1767468/four-dimensional-education/2499114.