Written By: Kristin Baird, RN, BSN, MHA
Every day physicians, nurses and other providers engage in multiple interactions with patients, family members and other staff members. Those interactions have a significant impact on the relationships between providers and those they encounter. Unfortunately, though, providers rarely get feedback on how those interactions went—what they did well, what they might improve, or how they may have been perceived by those with whom they interacted.
Shadow coaching can help. Shadow coaching pairs a provider with a coach, or “shadow,” who goes along with them and observes their interactions. While it can be a little intimidating to have someone trailing you, and watching every move, in the Baird Model, healthy coaching relationships are really designed to be a supportive means of fostering learning, transformation and growth.
How Shadow Coaching Works
Shadow coaching happens in real time which, as we know, is the best way to provide personalized, actionable feedback—both positive and constructive—to support on-the-spot practice and improvement. Coaches are active observers who give immediate feedback on things like micro messaging—the subtle and often unintentional messages you may be conveying both verbally and nonverbally. These messages are so subtle that people often don’t even realize that they’re sending them. That’s why the feedback we’re able to give, in real time, after we leave a patient room, is so powerful. We can give pointers that are implemented in the very next encounter. Being able to see physicians and nurses change their behaviors in real time based on our feedback is extremely gratifying—for us and for them!
One of the key things we help with is the ability for providers to better “read the room.” Providers are often so focused on their the task at hand that they miss subtle cues that would provide an opportunity for them to delve more deeply into what patients were experiencing or were concerned about. Reading the room also applies to family members. When the provider learns to pick up, and respond to cues from family members, it creates greater engagement and reflects empathy.
These behaviors are often such a natural part of the interaction that the providers doesn’t even notice the impact they may have on patients or family members.
For instance, Dr. Keith Mausner, one of our physician consultants for Baird Group, made an observation after shadow coaching several hospitalists recently. He noted that many providers have a tendency to focus more on their computers than their patients. He jokes that the patient gets in the way of the doctor/computer relationship. Unfortunately, while he may say it in jest, it’s often very true!
Shadowing Works in Multiple Settings and Types of Interactions
Shadow coaching works well in virtually any situation where associates are interacting with their customers, internal (e.g. fellow employees) or external (e.g. patients and family members). It offers the advantage of a third party, neutral observer, who can provide objective feedback about the interaction. Baird Group encourages shadow coaching for:
- Leader rounding
- Hourly rounding with nurses
- Hospitalist rounds
- Emergency department physicians
- Providers in medical practice environments
Observation in these settings is the backbone of effective shadow coaching. Through observation, coaches are able to cite specific examples and personalize the feedback they provide based on both provider and setting. During shadowing we observe:
- Engagement with the patient; how does the provider establish rapport and trust?
- Both verbal and non-verbal indicators of empathy; do words, tone and body language demonstrate empathy?
- Verbal and non-verbal communication
- Gestures of respect
- Cues from the patient and how well the provider picked up on those cues
While coaching is part tactical, it is also motivational and inspirational. Tactical coaching focuses on building specific skills; for example, teaching verbal and non-verbal methods for demonstrating empathy. The motivational and inspirational elements of coaching come into play as coaches reinforce the positive and help the individual being coached connect back to purpose.
Better Quality Not More Time
One of the common objections we’ll hear from providers about changing their communication and interaction habits is the fear of it taking more of their already limited time. That perception is far from the truth! What we point out as we accompany providers as shadow coaches are the things that really enrich the quality of these encounters without adding to the quantity of time required.
We’ve seen people make some incredible leaps in bedside manner once they understand how their words and behaviors are being perceived. I love seeing the immediate progress that takes place as people have the “a-ha!” moments.