Clinical coaching used to improve individual and team performance in RSONs

An RSON Series

CLINICAL COACHING PILLAR

The work of the Rural Surgical and Obstetrical Networks (RSON) is split out into five pillars: Clinical Coaching, Continuous Quality Improvement, Remote Presence Technology, Evaluation, and Scope and Volume. In the October 2019 issue of BC Rural Update, RCCbc spoke with Dr. Jude Kornelson, Lead of the Evaluation Pillar, to learn how evaluation is being integrated into the RSON project.

Over the next year, BC Rural Update will be featuring the work of each of these pillars, and will engage the providers leading each pillar to discuss the ongoing work taking place within these RSONs.

When the founders of the Rural Surgical and Obstetrical Networks (RSONs) were designing the foundations of the project, they were interested in exploring how clinical coaching might be of use in supporting communities participating in the project. To learn more about the potential benefits of clinical coaching, the RSON planning committee reached out to UBC Rural CPD’s (RCPD) coaching and mentoring team – a collaboration of physicians, community healthcare providers, and UBC RCPD staff – as this group was already actively exploring how to develop and deliver coaching as a quality improvement (QI) tool. Clinical coaching has proven to be more than a support within the RSON program – it is functionally the platform that links and enables the work of the Continuous Quality Improvement, Remote Presence Technology, and Maternity pillars within the RSON program.   

Clinical coaching is based on the concept of providing supportive relationships in education. Individuals who work with a coach undertake voluntary improvement(s) to enhance self-selected areas of performance, receiving feedback that can be integrated into personal practice. Feedback from the coach is confidential and is not integrated into any formal assessment frameworks – it is solely for the provider’s personal learning. Although coaching in the RSON context is generally done one-on-one, it has wider impacts on the surgical and obstetrical teams as a whole. “People are often looking at the practice improvements being implemented by their peers and colleagues,” says Dr. Bob Bluman, co-lead for the Clinical Coaching Pillar and member of the UBC RCPD coaching and mentoring team, “they’re curious and want to learn what you’re doing differently, and that encourages the practice improvement to spread through the different teams.”

RSON’s Clinical Coaching pillar empowers community teams to spend their coaching budget as they see fit, which allows the group to direct effort and education to where it’s most needed or wanted from year-to-year. Coachees (individuals undergoing coaching) may select their own coaches, whether it’s a peer from within the same community, a regional specialist with whom the provider may already have a relationship, or a willing urban colleague with desirable experience and/or skills[i]. Coaches in the program are trained by UBC RCPD on coaching best-practices with respect to building supportive relationships, giving effective feedback and goal setting strategies and are supported throughout their participation in the program. Other distinctive features of the RSON Clinical Coaching stream include:

Coaching availability to all members of the surgical and/or maternity teams in the community: coaching may be offered to a wide variety of providers supporting rural surgery and/or maternity services, including enhanced surgical skills family physicians, general surgeons, family practice anesthetists, family physicians providing non-operative maternity care, surgical nurses, maternity nurses, and midwives (if applicable).

Bi-directionality of coaching: learning activities can take place within the rural community, at a regional or urban centre, or both locations. In this model, both the coach and coachee may travel, enabling participants to understand practice contexts, build relationship, and increase volume of practice if needed.

Coaching facilitation through RSON’s Remote Presence Technology (RPT): The RSON program uses tools that allow coaches to support coachees through a virtual, real time interface that can be brought into multiple settings, including the emergency department or the operating room. RPT enables the coach to both observe the coachee during an activity as well as “see” what the coachee sees, creating a more interactive experience that echoes the in-person performance improvement process

While clinical coaching can elevate the performance of the individual, it is not meant to be an alternative to a Year 3 Residency Enhanced Skills Program, nor is it intended to be used to address skills remediation. The RSON clinical coaching stream facilitates skills maintenance and extension as well as focuses on building on and establishing mastery of skills that are currently in the community.  

“Coaching is a non-threatening way of building relationships,” says Dr. Kirstie Overhill, co-lead of the Clinical Coaching Pillar and member of the UBC RCPD coaching and mentoring team, noting that fostering relationships allows members of the community, the region, and the local health authority to build mutual trust, which then “disseminates information and knowledge, and forms a collaborative practice within the region as well as the community.” Through clinical coaching, regional centres can see what’s taking place at the smaller community sites, while regional/urban coaches – who become familiar with the community providers’ skills and context – become advocates for sustainment of the local service. Through individual striving for excellence in surgical and/or obstetrical practice, everyone benefits: providers achieve increased confidence in themselves and their team; communities have an extra tool to improve rural recruitment and retention; relationships between communities and regional centres are strengthened; and, most importantly, rural patients can continue to access health care services closer to home.

If you are interested in accessing clinical coaching or mentoring but are not practicing in an RSON community, you can approach UBC Rural CPD to discuss receiving coaching through their CAMP (Coaching and Mentoring Programs) offering. For more information about CAMP, email camp.rcpd@ubc.ca.

RSON BACKGROUNDER

The Rural Surgical and Obstetrics Networks (RSON) is an initiative that seeks to stabilize, support, and enhance the delivery of quality healthcare to vulnerable rural BC rural populations, including Indigenous populations. It provides sustainable local/regional surgery programs “closer-to-home” in geographic areas served by Enhanced Surgical Skills Family Physicians (ESS FPs) or a solo General Surgeon through enhancing existing care networks shared with referral centres. Through this work, these rural surgical and obstetric networks support enhanced critical care, emergency, and trauma services while also supporting closer-to-home maternity care, including vaginal birth and Caesarian section.

The local/regional RSON model seeks to improve both patient and provider experiences of care by:

  • understanding holistic risk and cost associated with travel so mitigation strategies can be put in place;
  • supporting networks of high quality, highly effective maternity and surgical teams to provide the right care at the right time by the right providers
  • supporting rural providers to practice full-scope of rural generalist medicine
  • enhancing and supporting relationships between team members within the geographic network
  • providing a robust evaluative framework for quantitative and qualitative metrics applied to both maternity and surgical care
  • providing culturally and rurally appropriate care closer-to-home

RSON is an initiative supported by the Joint Standing Committee on Rural Issues (JSC) that is operationalized through the Rural Coordination Centre of BC working in collaboration with the health authorities, the Ministry of Health, UBC Rural Continuing Professional Development, and the Centre for Rural Health Research


[i] There is also an option to have a coach selected on your behalf, if that is the individual’s preference.