The Curious Coach’s Questions: Coaching Skills for Healthcare Leadership

April 29th, 2015

Curiosity and Open-Ended QuestionsThese vital competencies should headline skills labs for healthcare professionals with the dual intent of enhancing their own abilities while developing others.

Our quiver of leadership skills is incomplete until we add coaching inquiries, delivered from a true attitude of curiosity, allowing us to learn together with those we lead:  patients, clients, employees, coworkers.  Precious moments spent to ask for input may seem wasteful in a pressured environment, especially when directives could be delivered more quickly.  However, the time allocated to ask, listen, and understand will ultimately save future problem solving efforts and increase personal engagement.

Too often, we assume we understand the motivations of individuals in our lives, when in fact, knowing the rationale behind their behavior will offer new perspectives as to how they think and prioritize.  Fully appreciating their thought processes will also allow us to help them reason through any gaps or potential pitfalls, assisting them to fully understand their own tendencies and patterns.

Let’s explore an example of the benefits of a spirit of curiosity and open-ended questions.

You are a Curious Coach type of healthcare manager.  Two additional personnel were added to staffing for the Saturday day shift and you have been nastily notified by the CFO about this budget excess.  Rather than charging forward and delivering an ultimatum to the weekend staff about adhering to the budget guidelines, a coaching stance would recommend the following set of questions:

Begin with inquisitiveness and an open mind, rather than an anxious or blaming intention:  “Please tell me about what was happening last weekend.”  If that question doesn’t lead to information related to staffing issues, continue with: “I heard about the additional RNs on Saturday, and since I wasn’t there, I am curious about what thoughts went into staffing decisions over the weekend…”   And wait for a response.

How will the Curious Coach reply to different responses?

1.  Inappropriate Use of Resources Response

If the response is “Gee it was Nurses Week!  We had a potluck planned; and we deserve an additional couple of staff to make it an easy day because we are tired and upset!” then there are several options for further questions: “Yes I know it’s been busy with unexpected patient deaths –And people are heroes for working on holidays and Nurses Week” But after acknowledging the need for support and relief, add “what are some other ways that we could support our team instead of using our staffing budget dollars when they are not needed for patientsWe can’t continue to use staffing for that purpose.” And wait for a response, and/or explain the budget situation if necessary. A subsequent and more directive question could be “Would you bring our need for a break or stress relief to our unit-based council to decide on the best ways to approach this need? 

2.  Clinical Planning Response

If the response is “We had 2 dying patients and families disagreeing over end-of -life treatment so we had to prepare for codes, and/or ICU transfers, AND we were slammed with 6 ER admits at change of shift” then a reasonable response is “Thank you for the great patient-family centered foresight! I’m wondering what or who else was missing?  In the future, what other people or professionals could we use to help us during these kinds of challenges on the weekends or even at admission? What could we do to prepare for this kind of situation in the future?”  The team can begin some longer term problem solving to garner extra support for critical end-of-life treatment and patient care planning on weekends.

Now, Curious Coach, aren’t you glad you approached your colleagues with respect and support instead of being contaminated by the CFO’s irritation? An immediate directive response is rarely needed except in case of emergency.  Maintaining an accusatory stance or pre-judging a team member’s motivations or decision-making capabilities would not serve to educate or change behavior.  Curiosity brings a leader to understand the true rationale for decisions, and helps trace healthier paths for decision-making within a transformative team environment.

For additional coaching tools and questions, consult Ruth Hansten’s most recent of her seven books:  The Master Coach Manual on at

For more information about your own leadership coaching, or developing an internal coaching program, email, or 360.437.8060,,

(This Blog Posting has been previously published on LinkedIn Pulse, 4/29/2015 by Ruth Hansten)

A Cure for Leadership Loneliness?

March 20th, 2015

A Cure for Leadership Loneliness? 

An unanticipated surprise in my first leadership role was the unwelcome abrupt detachment from my former collegial teammates.   Jettisoned from the warm cocoon of a backup group, I was seen as a “suit.”  I discovered that my new supervisor was a limited confidant because she was simultaneously judging my abilities with unrelenting concern. (My leadership style was decidedly less autocratic than existing corporate culture.)  My search for a supportive and helpful person to discuss my role and responsibilities led me to lateral colleagues.  I was soon disappointed to recognize that those individuals could not be completely trusted because we were competing for limited resources and respect. Even though I hunted for a mentor, no one within the organization stepped forward to partner with me to focus on my work or my professional advancement with loyalty, caring support, frank feedback, or sponsorship. 

Recent studies about female job advancement and pay equity show ongoing gender disparity and also highlight a gap in mentorship and sponsorship opportunities for women.  Leaders, especially females, frequently lack a specific advocate guiding and cheering them forward.  (See Healthcare Dive for an informative overview:

Healthcare leaders make numerous decisions each day while charting the course for their units, departments, and organizations.  Healthcare leaders’ abilities affect the organization’s and employees’ vitality as well as the health of the communities that they serve.  These important roles mandate effective assistance, reinforcement and encouragement. 

Solitary reflection about our performance can feel isolated and desolate. Without a thinking partner to actively listen, ask probing questions, and make observations, an executive can miss important progress, ignore danger signs, overlook potential growth opportunities

A leadership coach, whether internal or external, will perform the role of your own special active listener, fulfilling the requirements of behind-the-scenes confidant and supporter.  Confidential discussions, observations, feedback, education, challenges, questions: all of these are the potential strategies the coach uses to help the leader learn, grow, and achieve her goals. 

McNally and Luken’s research related to the efficacy and return on investment for coaching found that 100% of 64 healthcare leaders felt more competent and confident post-coaching, and over 50% were more likely to stay in their positions, with significant benefits achieved in comparison with program costs. (Leadership Development: An Internal-External Coaching Partnership. McNally and Lukens March 2006 Journal of Nursing Administration 36:3).

Leaders that affect the lives of so many people and communities deserve a trusted professional beside them to listen, encourage, measure progress, and help establish optimal strategies to achieve their goals. Collaborating with a coach can help transform the loneliness of leadership into a partnership for personal growth, professional effectiveness, dynamic progress, and vital engagement.  

 For more information about your own leadership coaching, or developing an internal coaching program, email, or 360.437.8060,,

Or visit to review the Master Coach Manual

4 Benefits of Developing a Coaching Culture

February 17th, 2015

4 Benefits of Building a Coaching Culture:

If your ultimate vision is of an organization brimming with superior thinkers and doers, teams of people inspired with joy and resolve toward their common purpose, then begin developing a coaching culture. Once basic required skill competencies have been assured, a team is ready to be coached.

Effective coaches learn to ask open-ended questions, helping their teams discover through guided queries and feedback rather than using a 19th century assembly-line approach of task check-lists and intensive management scrutiny.  In a coaching culture there exists a shared expectation and respect that individuals possess the ability to think through possible actions. Undergirding the concept of coaching is a respect for our colleagues and their ability to stir up their personal freedom to perform and to choose their course. Shared decision-making and creative inspiration replaces employees biding time waiting to ask for instruction or approval.  When leaders learn to coach, they learn to pause, wait, and listen, rather than always providing expedient answers.  They learn how to ask questions that truly develop the individuals on their teams, rather than stultifying them with pat answers that could impede creative new strategies.  Leaders that have spent the time and effort learning how to coach, teaching their teams coaching competencies, list these benefits:

  • A coaching culture saves time (ultimately),
  • Coaching organizations may reduce employee turnover,
  • Using coaching skills makes leadership roles less stressful,  more fulfilling, and
  • Coaching-competent teams promote the odds of goal achievement.

1)  A Coaching Culture Ultimately Saves Time:  When employees have been coached themselves and learn to coach others, this saves teams time.  On behalf of the leaders, not having to stop and “tell” everyone what to do, how, when makes for effective and efficient use of their energies.  A coaching culture means people have been trusted to make good decisions by guided inquiry rather than waiting, suspended in time, for managers’ instructions.  Leadership efforts can be placed on promoting steps toward the strategic plan instead of day to day “putting out fires” because knowledgeable employees have felt empowered to make necessary improvements at the point of service.

2) An Organization with a Coaching Culture Experiences Improved Employee Engagement:  Every leader would like to reduce employee turnover of the preferred kind of employee:  those stars that choose to think clearly and grow, learn, adapt, and work toward the shared organizational vision. People that have been coached know that their leaders value and trust their ability to think and to find the answers, and are confident that they are respected.   Personnel that perceive the freedom to act within shared values and mission-connected guidelines rate their autonomy highly in soaring employee engagement and tenure.

3) The Leader/Manager’s Job is Easier and More Fulfilling: Your management/leadership role is less stressful if team members and colleagues see themselves as powerful people able to influence changes in their workplace.  In  healthcare coaching cultures, team members serving at the point of care conduct themselves as assured professionals.  The same attitudes, competencies, and skills learned in coaching education and practice are those that lead to effective interdisciplinary teamwork and shared governance.   Effective team members are coached to self-manage, developing self-awareness, recognizing their internal locus of control as they gain knowledge and skills.

4)  Coaching Organizations Develop Higher Probability of Strategic Plan Achievement:  Patients and families that experience care from competent calm experienced professionals are more satisfied, and better apt to understand and follow care instructions.  What potential patients (all of us) wouldn’t want to be served by those that enjoy their work and can make professional decisions with alacrity, thereby increasing efficiency efforts?  Workforces ready to reflect, develop, make decisions, offer and receive feedback, are energized to work effectively toward shared goals, and raise the odds of success.



What does it take to develop coaching skills?

Being coached yourself is the best first step. Contact Ruth Hansten for information, at, or 360.437.8060.

There’s Treasure Buried in this Leadership Habit

February 5th, 2015

Rich rewards can be reaped by incorporating reflection into your leadership routine.  Any resistors out there?  Full disclosure demands that I state that I am a reformed, recovering Instant Decision-Maker Just-Do- It You-Can-Have-it-All Diligent Worker.  I grew up in a home with 2nd generation immigrants just off the homestead with the belief that if you worked harder you would be better off in Oh So Many Ways. No one sat to consider outcomes or options or to review, because we believed,  if you did sit then certainly the farm and your family would suffer.  As a single working mom I incorporated immediate streamlining of all tasks and processes with costs/benefit analysis as effective brain training for hospital administration, but also useful for rapid fire decision support regarding PBJ sandwiches QD versus a housecleaner twice a month. (Housekeeper acquired.)  Brisk efficiency and instant analysis (minus even momentary reflection) won.

Doing the tasks took over;  the chaos of immediate needs and adaptive changes were overwhelming.  But I was lacking the leadership moments necessary to ask critical thinking questions such as:

  • Are we achieving the results we would like? If not, why not?
  • What outcomes can we celebrate?
  • What’s working and what’s not working?
  • What could we do differently if we were to deal with a similar issue again?
  • What recommendations should be incorporate into our future work together?

Healthcare personnel (interdisciplinary teams) in departments I led were pausing for several minutes toward the end of a work session, to evaluate care outcomes, celebrate, and determine what they would recommend the team would do differently if they were to have a similar assignment.  I noted improvement in teamwork and critical thinking development, but I had not integrated reflective practice with regularity into my own leadership life. My business coach encouraged me to stop, sit, and reflect just for 2 minutes to start. Even one minute was too hard for me; I found myself manufacturing “to do” lists in my brain rather than evaluating outcomes and processes, thinking about course corrections, deciding on next steps.  I discovered I was repeating similar gaps and missteps because of a constant task work=value ethic.

How can you carve out the time for answering the crucial leadership questions about what you can celebrate and what you want to change? The benefits are numerous:

  • Consider course corrections before it’s too late to change the momentum
  • Avoid repetition of mistakes.
  • Streamline next steps due to clarity of intended outcomes and plan going forward.
  • Take deep breaths and/or put your feet up. (Health benefits!)
  • Celebrate the impact of what you do=immediate mood lift.
  • Reflection is essential for critical thinking development.

In the Master Coach Manual, we provide tools to help you stop and reflect on the onsite processes that improve clinical outcomes.   www.Hansten.com;

We recommend refection as an integral practice for coaches and coachees alike.  Contact us at for information about being coached or creating a coaching culture., or visit

“Ruth in the Room” Audio: Leadership, RN Professional Practice

December 10th, 2014

Today in our 54 minute conversation about 2014,  Ruth Hansten and 10 participants discussed an overview of 2014 trends, celebrated improvements in patient outcomes and safety, and discussed methods to help nurses and other healthcare leaders and educators to improve their understanding of their own roles and professional practice.

Ruth discussed the questions she has heard recently in her work;

1) Making Assignments:  Why worry about MAs and NACs reporting to several RNs? (Ruth referred the group to the online resource:,  delegation #part 3 that discusses Making Assignments.)

Ruth also shared the improvement in HCAHPS scores by using block assignments, and thanked Kristen Lang-Coleman at Wellstar Kennestone neurospine unit for submitting her research on process improvements through RROHC.

2)  Reporting Procedures: The group discussed the positive impact of multidisciplinary rounds and also the hazards of  NAs reporting to each other without the RNs hearing what is being said. We are still having issues with lack of understanding of the impact of doing or not doing tasks.

3) Nursing Leadership at the Point of care: “Why should I be held accountable; it takes too much time. I should just do it myself. ” Ruth has also heard that nurses expect the MD should be doing the supervision in ambulatory care, even though that process isn’t really occurring and in some states (such as WA) it’s clear the RNs are held accountable for supervision.

4) Leaders as Coaches:  accountability with outcomes.  A KEY issue that occurs with leadership is we assume that people “know” what could happened down the road if we don’t warm the patient, keep glucose under control postop, turn, ambulate,  etc.  They don’t. They are often overwhelmed by tasks.  (See Ruth’s Nurse Leader article in the August, 2014). We all have to keep your eye on the outcome!

Ruth also encouraged people to consider registering for the January 6, 2015 Professional Practice Specialist Course; a 20 week instructor guided self-study designed for novices to executives to focus on professional growth and critical thinking.