I hosted this seminar as part of the Emerging Leaders Development Program at the VA Palo Alto Health Care System. Goal: To familiarize participants with the challenges and best practices of coaching and developing employees. Through discussion and instruction, participants will understand the importance of providing employees with personal guidance that will allow them to acquire new skills, advance professionally, and improve patient and customer outcomes.

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Coaching and Developing
Employees
Edward R. Mariano, M.D., M.A.S.
Professor of Anesthesiology, Perioperative and Pain Medicine
Stanford University School of Medicine
Chief, Anesthesiology and Perioperative Care
Veterans Affairs Palo Alto Health Care System

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Financial Disclosures
• None

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Goal
• To familiarize students with the challenges and
best practices of coaching and developing
employees. Through discussion and
instruction, students will understand the
importance of providing employees with
personal guidance that will allow them to
acquire new skills, advance professionally, and
improve patient and customer outcomes.

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Objectives
• Describe the importance of coaching in talent
development, retention, productivity, and
continuous improvement
• Discuss and apply the challenges and best
practices of coaching and employee
development
• Demonstrate various coaching models

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My Journey
• 1995: UC Davis Undergrad
• 1999: Georgetown Med
• 2003: Anesthesiology
Residency at Stanford
• 2004: Pediatric
Anesthesiology Fellowship

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My Journey
• 2004-10: UCSD
– Started a regional anesthesia
program
– Acute pain service
– 1st fellowship in regional
anesthesiology in California
– Clinical research program
– Division Chief with 8 faculty, 1
nurse, 4 fellows

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My Journey
• 2010-present: VAPAHCS
– Expanded anesthesia and
respiratory care services
– New acute pain service
– New perioperative care model
– New research programs
– Continuous improvement
– Approximately 90 staff and
fee basis employees

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Anesthesiology and Perioperative Care
Clinical Care
Scholarship
Leadership
Education

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Mission Statement:
To provide the highest quality Veteran-
centered care by leading, educating, and
innovating in anesthesiology, perioperative and
respiratory care, and pain medicine
Vision Statement:
To be the model for change and evidence-
based medicine that improves Veterans’ health
and well-being
http://www.paloalto.va.gov/anes_mission.asp
Anesthesiology and Perioperative Care

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Clinical Care
0
5000
10000
15000
20000
FY11 FY12 FY13 FY14 FY15 FY16 FY17
NUMBEROFENCOUNTERS
ANESTHESIA OUT-OF-OR WORKLOAD FY11-17
TOTAL
419
420
427
434
441
PERIOP
PAIN
REGIONAL
NON-OR
PHONE

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Clinical Care
15535 15331
16858
15472
18719
23390
FY12 FY13 FY14 FY15 FY16 FY17
RT Encounters

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Scholarship
0
5
10
15
20
25
30
35
40
45
50
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
Publications in Peer-Reviewed Journals Cited on PubMed
Anesthesiology/Critical Care Pain

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Leadership within VA Palo Alto
• Operating room (Chair)
• Pain (Chair)
• CPR (Chair)
• Research and development (Chair)
• Invasive procedures (Co-Chair)
• Clinical product review (Co-Chair)
• Professional standards board (Vice-Chair)
• Peer-review (Vice-Chair)
• Transfusion (Member)
• Medication management (Member)
• Infection prevention and control (Member)
• Laser safety (Member)

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Leadership Outside VA Palo Alto

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What Leadership Isn’t

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Introduction to Coaching

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Coaching Starts with You

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What Coaching Is and Isn’t
Coaching IS
• Learning and
development
• Guiding someone
toward his or her goals
• Sharing of experiences
that help achieve an
outcome
Coaching ISN’T
• Simply correcting
behaviors or actions
• Explicitly directing
someone to complete a
task
• Being the expert with
all the answers
Adapted from Coaching People, Harvard Business School Press, 2006

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The Coaching Continuum
Directive
Coaching
Supportive
Coaching
Adapted from Coaching People, Harvard Business School Press, 2006

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Discuss Examples

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Barriers to Change
“Us” “Them”

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Why Develop Employees?

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Who Needs Development?

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Performance and Potential
1 2 3
4 5 6
7 8 9
Adapted from Developing Employees, Harvard Business School Press, 2009
Low Medium High
LowMediumHigh
POTENTIAL
PERFORMANCE

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Performance and Potential
1 2 3
4 5 6
7 8 9
Adapted from Developing Employees, Harvard Business School Press, 2009
Low Medium High
LowMediumHigh TOP
Employees
POTENTIAL
PERFORMANCE

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Top Performers
• Understand their motivations
– Intrinsic vs. extrinsic
• Provide them challenges and learning
experiences
• Help them find mentors (near and far)
• Monitor them for burnout

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Is “Burnout” Really Loss of Identity?
https://www.beckershospitalreview.com/workforce/why-physician-burnout-jumped-to-54-over-3-years.html

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Performance and Potential
1 2 3
4 5 6
7 8 9
Adapted from Developing Employees, Harvard Business School Press, 2009
Low Medium High
LowMediumHigh
POTENTIAL
PERFORMANCE
SOLID
Workers

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Solid Workers
• Test them out with “stretch” assignments
• Listen to their ideas
• Recognize their accomplishments and hard
work
• Find ways to keep their jobs interesting

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Performance and Potential
1 2 3
4 5 6
7 8 9
Adapted from Developing Employees, Harvard Business School Press, 2009
Low Medium High
LowMediumHigh
POTENTIAL
PERFORMANCE
UNDER
Performers

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Under Performers
• Differentiate performance from attitude or
conduct
• Set expectations for them
• Provide directive coaching with timely
feedback
• Decide early if it’s up or out

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Return on Management
Simons & Davila. Harvard Business Review, 2005
ROM
Productive
Energy Released
Time and Effort
Invested

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Avoid This Situation
Attention
Under Performers Everyone Else

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Questions?