A Five Step Model of Appreciative Coaching: A Positive Process for Remediation

Abstract

Appreciative inquiry is a collaborative approach to generating solutions that identify and enhance what works instead of focusing on barriers and pitfalls. This method can optimize individual, economic, and organizational performance. Helping struggling students, residents, or colleagues by intentionally focusing on strengths has the potential to create a coaching relationship, which facilitates lasting change in behavior. The authors share their extensive experience as remediation coaches for medical learners at all levels, describe the psychological foundations of appreciative inquiry (self-actualizing, congruence, unconditional positive regard), and discuss the coaching context, roles, and process. They recommend ways to assess the culture of the organization and lay out the conceptual theoretical foundation of appreciative inquiry. Taking us through a stepped approach to remediation coaching based on five (constructivist, positive, simultaneity, poetic, and anticipatory) principles, they share practical advice and easily implemented tools to assist those who need to take on the remediation coach role.

“Individuals are mysteries to be appreciated. We do not need to see our client as problems to be solved or as deficient in some way. Our job is not to fix them. Our job is to partner with them in a positive, generative approach in which they are the agents of their own change.” [1]

Appendices

Appendix A: Pre-coaching Appreciative Assessment

Coaching Questions: These are natural opportunities for reflection and empathic inquiry throughout the coaching process. They can be provided to the client prior to the initiation of the relationship, later, or both. The key is to use them intentionally, flexibly, and to be sure both the coach and client understand the question, the response, and the relevance to the coaching dilemma or situation.

• 1. Your greatest accomplishments: List your three greatest accomplishments to date

  • What made these stand out for you, what made you feel so proud?

  • How can you use what you’ve learned from your successes in the current situation?

• 2. Your role models: Who are your role models or the people you aspire to be like?

  • What attributes do you most admire and appreciate?

  • What attributes have you adopted?

• 3. You, your relationships, your work

  • What five adjectives best describe you?

  • What are the most positive aspects of your practice? Your life?

  • Five things you love to do, hate to stop doing, can’t wait to do again—things that energize you

  • What do you love most about being in healthcare?

• 4. Dream of the ideal future

• Imagine that a family member came to you and asked, “I’m looking for a new physician, what should I look for?” What would you say?

• Over the years you have observed colleagues at work. When you observe an interaction that stands out in your mind for how good it was, what is it that you notice?

• Focusing on your own patients for a minute, when it comes to their visits with you, what do you hope they will report to others about how you interview?

• When a visit has ended that didn’t go as well as you would have liked it to go, what do you usually think was missing?

• Over the years, are there things that you have read about the medical interview or that teachers or colleagues have said to you that stand out in your mind as guiding principles? In our current media jargon these might be thought of as sound bites.

• During the course of his/her career a physician will conduct more than 100,000 clinical interviews. Focusing on your own beliefs about what is important in the interview, are there things that you try to do during every visit? What are they?

• Imagine that you were asked to give a lecture to third year medical students about medical interviewing just before they began their clerkships.

  • What would you emphasize to them?

  • What would be the three or four messages that you would focus on in your lecture as being critical to survival in the new healthcare environment?

• When you are with a patient and you feel stuck, who do you talk to about it: colleagues, family members, friends?

  • Imagine that we had these people seated at a table having a meal together and talking about your strengths with patients and colleagues. What would they be talking about?

What do you want your patients, their families, and your colleagues to say about you when they describe the kind of care you deliver?

As you consider your responses to the above questions, what would classify as the key attitudes, values, and skills needed to the physician of your dreams?	Which of these are strengths that you consistently use in your practice?	Which of these are areas you would like to develop further?
I promise	–	–
I promise	–	–
I promise	–	–
I promise	–	–
I promise	–	–

Appendix B: My Learning Objectives _____________________________________

Limit to four objectives in the role of diagnostician, relationship-centeredness, or team collaborator

SMART (specific and measurable, motivating, aggressive yet achievable, related to goals of the organization, timely) learning objective			Start date	Completion date
Barriers and obstacles	Evidence of accomplishment	Actions and behaviors you will take to overcome barriers	Resources needed for successful accomplishment	Strengths to draw upon
–	–	–	–	–

Appendix C: Feedback Format

Coach_________________ Client ___________ Date ________

Objectives for this skills practice:

• 1______________________________________

• 2______________________________________

The following behaviors are contributing to your clinical effectiveness. Please continue doing them.

For you to increase clinical effectiveness, you should consider beginning or doing more of the following: