Chapter 20
Ambulance Providers and Suppliers
Learning Objectives
Basic services provided by an ambulance supplier
Fraud types committee by ambulance suppliers
Components of compliance program tailored to ambulance suppliers
Risk areas facing ambulance suppliers
Anti-kickback risks with referral sources
Compliance policies and forms
Model ambulance supplier compliance program
Introduction
Functions performed by an ambulance
Levels of ambulance service
Companies providing ambulance services
Examples of fraud by ambulance companies
OIG Compliance Program Guidance for ambulance suppliers
Elements of a Compliance Program for Ambulance Suppliers
Development of compliance policies and procedures
Designation of a compliance officer
Education and training programs
Internal monitoring and reviews
Responding to detected misconduct
Developing open lines of communication
Enforcing disciplinary standards through well-publicized guidelines
Policies and Procedures
These documents represent the written standards of conduct for daily operations of the ambulance company.
They should be reviewed periodically, at least annually, and updated as needed.
The reviews should compare the standards with the actual practices within the organization.
Training and Education
Cross-training of employees as a means of raising their overall awareness of compliance across job functions.
Interactive training to enhance employee learning by allowing them to ask questions and receive feedback.
Use real life examples of compliance problems presented by personnel who have experienced them.
Review of the Claims Submission Process
Periodic reviews of documentation and information, medical necessity, coding, co-payment collection, and payor reimbursement.
Identify compliance errors, and seek source & causes of the errors.
Review claims before submitted.
Review claims denials for patterns.
7
Review of Coding & Billing Systems
How transport is documented and by whom
How information is entered into the supplier’s automated system
Coding and medical necessity determination protocols
Billing system processes and controls, including edits or data entry limitations
Claims generation, submission, and subsequent payment tracking processes
Review of Coding & Billing Systems
Stage 2: Contemplation
People engage in cognitive processes about the behavior.
A key concept in Contemplation is decisional balance, defined as a “mental weighing” of the importance of the pros and cons associated with changing behavior.
Avoiding Sanctioned Employees or Contractors
Query exclusion and debarment lists before hiring or contracting with new people or entities
Check those lists annually regarding current employees or contracted entities
Identification of Risks Unique to Ambulance Suppliers
OIG Compliance Guidance identifies most common compliance risks faced by ambulance suppliers
Other risk areas unique to the ambulance services industry, the local market, or the company itself
Stay up-to-date with risks by regularly checking OIG publications, OEI reports, and OAS reports
Specific Medicare Risk Areas Facing Ambulance Suppliers
The OIG outlined these specific risk areas for ambulance suppliers in its Compliance Program Guidance.
Medical necessity
Upcoding
Faulty or incomplete documentation
Restocking
Specific Medicaid Risk Areas Facing Ambulance Suppliers
All states that receive federal Medicaid funds are required to make arrangements for transporting Medicaid recipients to and from medical appointments.
This results in the use and coverage of some transport methods not covered by Medicare, such as wheelchair vans, taxi cabs, and ambulettes.
Care must be taken to ensure that Medicare is not also billed for such transport services already covered by Medicaid.
Kickbacks to Induce Referrals for Ambulance Service Requests
Structure referral arrangements to fit within AKS “safe harbors”
Set prices at FMV, without considering volume of potential referrals
Do not offer gifts or other benefits to referral sources
Do not accept gifts or other benefits from parties seeking referrals from the company
High Risk Referral Arrangements for Ambulance Suppliers
Public EMS sponsors
First responders
Hospitals and nursing facilities
Patients
Sample Ambulance Supplier Compliance Plan
Review the sample compliance plan for an ambulance supplier at the designated internet address
Compare the topics it covers and the requirements it makes with the suggestions in this chapter
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coaching
Coaching v. mentoring T
ake a look in the New Oxford Dictionary of English and you will see very similar entries for coaching and
mentoring: Verb to coach: “To train or
instruct (a team or player).” Verb to mentor: “To advise or
train (someone, especially a younger colleague).”
The Institute of Directors uses time frames as an indication of the difference between the two disciplines: “Mentoring implies a longer, less formal and structured relationship which, nevertheless, can be extremely powerful and beneficial over the medium- to long-term.”
But, for those in the know, there is a wealth of difference between coaching and mentoring, which extends far beyond age and experience or length of relationship as the defining factors.
Before exploring the specific distinction between coaching and mentoring, it is important to define what we mean by these terms – and the background to their emergence on the training and development agenda.
Growing trend The term ‘human resources’ appeared about 25 years ago as an offshoot of the personnel department, at a time when the recession hit and a specific resource was required to deal with the treatment of redundancies.
Joe Adams joins in the big debate
As a result, HR was historically associated with the negatives rather than positives of handling a company’s ‘people power’. However, as HR has become established as a dedicated function that aids the growth and development of an organisation’s employees, there has been a shift in perceptions and an acceptance of the significant value a good HR team and its proposed strategies can add to the business.
Coaching and mentoring has really come to the fore in the last 12 years and this surge of interest can be attributed to a number of trends. Senior executives had become converts to the benefits of training and invested heavily in training for their teams – but overlooked the blatant need to ensure they themselves were reaching their full potential by extending their own personal growth and development.
Age became acknowledged as an unacceptable barrier to success and, consequently, more rising young stars hit the corporate headlines as their entrepreneurial flair led them to achieve senior roles.
Regardless of age, it also became apparent that there is no ‘handbook’ to becoming a CEO, just an acceptance of the huge responsibility associated with this role – a responsibility that many felt ill-equipped to deal with simply because they did not have the ‘life experience’ behind them to help formulate the right strategies destined to benefit the business.
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coaching
This, combined with a recognition of the positive impact sports coaches and acting coaches could have on performance levels, led to the growth of an industry specifically geared to providing similar guidance and motivation to succeed in the business/ executive arena.
The IoD states: “Coaching is taken for granted in the world of sport, where individuals and teams have a coach to provide motivation, enhance skills and refine performance. Ultimately, coaching aims to bring out the best in an individual to enable the team to work better as a whole. The same can be said of business and its leaders.”
Common goals The common goal shared by both coaching and mentoring is that the individual must demonstrate a desire to achieve personal growth through a process of self- realisation/actualisation. In the simplest terms, this means that the individual needs to get closer to knowing who he is – by improving his understanding of who he is and what he stands for, he will be better equipped to deal with situations.
The IoD defines this as: “Executive coaching services work most effectively when the individual has clarity about the issues to be addressed. These might be personal ‘gremlins’ perceived to obstruct performance – certain issues that are best addressed on a one-to-one basis rather than in a formal director training session – or knowledge, skills and behaviours that the individual will need in order to progress into a future role.”
The process of coaching or mentoring enables an individual to come to terms with his strengths and weaknesses and to have a clearer understanding of his specific role within the business. Having a closer handle on his ‘life’s purpose’ via on-to-one training will push him to setting goals to help him arrive at his chosen destination – in essence, candidates are encouraged
For those in the know, there
is a wealth of difference
between coaching and
mentoring
70 TJ January 2010 www.trainingjournal.com
coaching
to develop their own personal mission statement for the business.
To coach or to mentor? The fundamental principle of coaching is that it is question- based. The coach does not need to have any specific ‘sector’ experience but instead needs to be suitably skilled in asking ‘open’ questions and avoiding closed ones.
Coaching therefore extracts all the various options available to the coachee through questioning, encouraging him to select the option he feels best fits the issue. As a result, he effectively takes ownership of the exercise because he ultimately decides upon which course of action is most appropriate.
In contrast, mentoring is solutions-based. Because the solutions to an issue are identified and presented by the mentor, it is much faster paced than coaching. The mentor is able to guide the conversation in a manner that will enable the mentee to profit from the mentor’s experience in context with his issue.
Traditionally, because of the intrinsic need for the mentor to assume the role of storyteller and draw on the experiences that have shaped his corporate life to demonstrate relevance to the situation the mentee is in, it is likely that he will have the gravitas of CEO or MD status.
As mentoring has become more widely acknowledged as a highly effective people development tool, the number of ‘mentors’ stepping up to the role has increased. Sadly, there are many who are simply not qualified to take on such a significant challenge. There is a growing concern that candidates from an HR background who present themselves as prospective mentors – but who are unable to offer the essential ‘corporate life’ experience so critical to a mentor’s ability to achieve results – are undermining the relevance and saliency of mentoring, since they are incapable of delivering the true benefits of a good mentor.
It is perhaps by acknowledging that mentoring is a ‘speedier’ process that it is possible to understand the increasing value – and therefore appeal – of mentoring over coaching in the business world, where so frequently tangible results are required in the shortest possible time frame.
Mentoring will help the individual get quicker results but, with the right coaching, it is possible to achieve the same results. It is largely down to the CEO to decide whether a course of coaching or mentoring is the appropriate route to take to achieve the desired outcome.
Where does coaching/mentoring add most value? While coaching and mentoring clearly has application to all levels of staffing, ranging from the
new recruit to established senior players, where will an investment in coaching or mentoring reap highest rewards?
An investment in this type of training and development is most relevant from middle management up but will have most potency at the very top. Instilling added confidence, a renewed hunger for personal achievement and effectively clearing any obstacles that threaten the route to success are an absolute priority for effective leadership – and ultimately every company will allocate the majority of its leadership responsibilities to the top tier of management.
Mentors and coaches are regularly placed under increasing scrutiny to demonstrate a return on investment and no more so than in these times of economic downturn. There is an argument that says, if a business is in trouble, surely the most critical priority is to ensure that its leader is fully equipped to steer it back to corporate success.
Ultimately, whether the trainer invokes a programme of coaching or mentoring, the underlying requirement is for the individual to take time out to examine his thinking to ensure he makes the right decisions for the good of the business. Giving due consideration to the importance of deliberation and the art of examining issues to find the desirable solution is at the heart of good coaching and mentoring.
Perhaps the following words from Martin Luther King Jr best encapsulate the very essence of both disciplines: “Rarely do we find men who willingly engage in hard, solid thinking. There is an almost universal quest for easy answers and half-baked solutions.”
Joe Adams is chief executive of management consultancy Adams & Associates. He can be contacted on +44 (0)20 8680 0766, at [email protected] or via www.adamsandassocs.com
An investment in this type of training and development is most relevant from middle management up but will have most potency at the very top
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HUMAN RESOURCES
L et’s begin by stating the obvious: a medical practice manager, by definition, is an individual who man- ages a medical practice. Does it make sense, then, that a practice manager’s first thought is to manage?
Of course. That is as it should be. When it comes to appoint- ment scheduling, inventory control, equipment, facilities, finances, contracts, patient records, and so forth, managing is exactly what practice managers need to do.
However, the more human aspects of medical practice management sometimes call for a different approach. Managing will not always foster, nurture, and draw out the very best from the medical practice team. Sometimes, employees will benefit much more if the practice manager functions less as a manager and more as a coach. As Green1 succinctly puts it, “We have to be both coaches and man- agers. To lead effectively, we need to know when to wear which hat.”
MANAGING VERSUS COACHING
When we manage others, we generally tell them what to do to get a job done. Usually, managers act from greater
experience, knowledge, or training than those they man- age. In some cases, the manager has done the very job of those he or she manages, and manages from the strength of that experience. Nonetheless, the manager’s position is from above, and his or her primary tools are command and control. Managers get things done by directing and monitoring staff performance. They set the bar for their employees. They share their expectations and require- ments through tasking, directives, and initiatives, and by measuring outcomes.
Coaching is a most effective approach whenever we are trying to develop the best in others.
Certainly, it makes sense to manage in situations where immediate needs are paramount and when we need to achieve specific outcomes efficiently and quickly. As Stack2 suggests, “Your team members look to you for answers, and rightly so in critical circumstances.” Managing can also be
Staff Coaching: Using Active Listening and Powerful Questions to Unleash Your Staff’s Potential Laura Hills*
Although the terms coach and manage sometimes are used interchangeably, they are, in fact, very different from one another. This article explores that differ- ence and argues that coaching is the best approach to take when medical prac- tice managers wish to develop the best in their employees. This article explores active listening as an essential skill in coaching. It describes 8 characteristics of active listening and offers 10 tips practice managers can use to listen actively when they are coaching their employees. This article also suggests that practice managers ask their employees powerful questions. It describes the characteris- tics of powerful questions and offers 50 powerful questions practice managers can use. Finally, this article provides five tools to keep coaching conversations going, practical strategies practice managers can use to take their coaching skills to the next level, and a quick-reference chart describing when to manage and when to coach medical practice employees.
KEY WORDS: Coach; manage; active listening; powerful questions; employee development; retention; loyalty; employee engagement.
*Practice leadership coach, consultant, author, seminar speaker, and President of Blue Pencil Institute, an organization that provides educational programs, learning products, and professionalism coaching to help professionals acceler- ate their careers, become more effec- tive and productive, and find greater fulfillment and reward in their work, 10618 Regent Park Court, Fairfax, VA 22030; phone: 703-691-8468; e-mail: [email protected]; website: www.bluepencilinstitute.com; Twitter: @DrLauraHills. Copyright © 2018 by Greenbranch Publishing LLC.
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Hills | Staff Coaching 303
a useful approach when employees have never undertaken a task before and whenever they need a leader to tell them what to do and how to do it. Adds Stack, “Sometimes a team just needs someone to coordinate, while everyone else does their piece of the project.”
Coaches get things done by guiding staff performance, by anticipating and clearing obstacles from their paths, and by supporting their employees’ immediate and long-term career goals.
Coaching, on the other hand, is a most effective ap- proach whenever we are trying to develop the best in oth- ers. The coach does not direct others. In fact, the coach doesn’t set an agenda for the coaching; the person being coached does. As Green1 explains, “Coaching involves ex- ploring, facilitating, partnership, long-term improvement, and many possible outcomes.” The coach’s position is be- side the employee, and his or her primary tools are active listening and powerful questions. Coaches get things done by guiding staff performance, by anticipating and clearing obstacles from their paths, and by supporting their employ- ees’ immediate and long-term career goals. Stack explains that when you coach, “You teach your people the ropes as necessary, acting as a mentor rather than autocrat, and otherwise make suggestions in real time concerning what they can do to tweak their behavior toward an optimum.” When employees don’t quite reach a standard or goal, coaches may praise what they did well, but they will also shine a light on where employees showed weakness. They focus attention on what employees can improve, but they won’t tell them how to do it. Whenever possible, they will pull next steps from the employees themselves, rather than tell them what to do.
Coaching can help practice managers to engage their employees, to foster employee loyalty, and to improve employee retention.
Medical practice managers who use a coaching ap- proach with their employees will develop more effective teams in the long run. That’s because they will develop better people. Coaches change people’s lives, often in profound ways. As Harski3 explains, “Good coaches show team members their potential, help them find confidence
in their work, point out the value of what they do, and inspire them to be the best versions of themselves.” They help employees feel that someone is in their corner and that with that needed support, they can improve and grow. Adds Harski, “Every time we coach an individual, we as leaders have that opportunity to have an impact on him or her.”
There’s another slightly less obvious benefit of coaching medical practice employees; coaching can help practice managers to engage their employees, to foster employee loyalty, and to improve employee retention. Most employ- ees want to continue to work in a place where they feel that they are able to achieve their own career goals and where they feel supported in their own development. A practice manager who coaches employees can help them feel that way about the medical practice. As Stack succinctly puts it, “Coaches create the kind of engaged, empowered employ- ees needed for survival today.” In the end, employees are more likely to stay with an employer who they feel brings out the best in them.
ACTIVE LISTENING IN COACHING
Active listening is an essential skill in coaching. Yet, lis- tening is probably the most overlooked, misunderstood, and undervalued communication skill. As Hills4 suggests, “Most of us take listening for granted and don’t think much about our listening skills.” Unfortunately, we can fall into passive, uncritical, distracted listening all too easily. When that happens, our listening becomes short and shallow, Hills warns.
When we listen actively, we must concentrate fully to absorb all of what it is the speaker is saying, even when we want to do otherwise, even if the speaker is dull or illogical or all over the place.
On the surface, active listening appears to be a simple skill. We listen all the time, so we reason: how hard can it be to listen actively? However, we listen actively only when we’re paying really close attention. That means that our minds can’t wander, even for a little while. We can’t drift into our own memories. We can’t start generating solutions for the issue at hand. And we can’t mentally argue with the speaker. When we listen actively, we must concentrate fully to absorb all of what it is the speaker is saying, even when we want to do otherwise, even if the speaker is dull or illogical or all over the place. We must
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pay careful attention to the speaker’s body language and how the speaker uses the space he or she occupies. We must also consider what the speaker is not saying.
For most of us, listening actively will require new habits, care, and consistent effort.
Active listening is challenging for a couple of reasons. For one thing, many of us assume that we listen well enough and don’t try to improve our listening skills. For another, most of us have had little or no training in active listening. As Hills suggests, “Listening is rarely taught or intentionally practiced and it is almost always assumed.” Another reason that active listening can be difficult is that listening is the easiest communication skill for us to fake. Says Hills, “Some of us have become masterful at pretending that we’re listening when we aren’t.” For these reasons, many people find it difficult to stay engaged in active listening even when they want to. Old habits do
indeed die hard. For most of us, listening actively will require new habits, care, and consistent effort.
Although active listening is challenging, it is absolutely essential whenever a practice manager steps into the role of coach. In fact, as Aguilar5 argues, “Active listening is the highest priority skill for a coach to master and it must be mastered prior to success using any other strategy.” This is so, Aguilar says, because the core of active listening is empathy. Says Aguilar, “It’s not so much about the exact words that you use as the listener, it’s about the feeling behind them. It’s about who you are being when you use them—are you being a caring, compassionate coach? Or are you being someone who is trying to be right . . . ?” Active listening is a needed foundation for building trust and con- nection between you and your employee. Coaches who use active listening effectively can guide their employees into personally challenging coaching explorations, even into “the scary realm,” Aguilar says. From there, employees may be able to experience deep insights and make big changes that ultimately will lead to their personal growth, she says.
THE EIGHT CHARACTERISTICS OF ACTIVE LISTENING IN COACHING
The International Coaching Federation (ICF)6 defines ac- tive listening in coaching as the ability to focus completely on what the client is saying and is not saying, to understand the meaning of what is said in the context of the client’s desires, and to support client self-expression. Of course, as a medical practice manager, your coaching “client” will be your employee. Nonetheless, the ICF offers good advice that medical practice managers can use when they coach their employees. Specifically, the ICF says that any coach who listens actively does the following: 1. Attends to the client and the client’s agenda and not to
the coach’s agenda for the client; 2. Hears the client’s concerns, goals, values, and beliefs
about what is and is not possible; 3. Distinguishes between the client’s words, tone of voice,
and body language; 4. Summarizes, paraphrases, reiterates, and mirrors
back what the client has said to ensure clarity and understanding;
5. Encourages, accepts, explores, and reinforces the cli- ent’s expression of feelings, perceptions, concerns, beliefs, suggestions, etc.;
6. Integrates and builds on the client’s ideas and sugges- tions;
7. ”Bottom-lines” or understands the essence of the cli- ent’s communication and helps the client get there rather than engaging in long, descriptive stories; and
8. Allows the client to vent or “clear” the situation without judgment or attachment in order to move on to the next steps.
When to Manage, When to Coach
Knowing when to manage and when to coach your employees will be critical to your effectiveness as a practice manager. Stack1 offers the following suggestions:
Management is needed when:
77 A crisis requires quick, positive results. 77 You are handling new, inexperienced personnel, espe- cially those tackling a task for the first time.
77 The team needs to complete (and may be resisting) low-level or unpopular tasks.
77 You are meeting difficult deadlines when every min- ute counts.
Coaching is needed when you wish to:
77 Support your team while guiding them in their career goals.
77 Work together with your team to define and facilitate the best strategies for your team and your organ- ization.
77 Share your mission, vision, and goals in a transparent way with your team members and invite them to join you in your quest for success.
77 Facilitate everyone’s progress toward the goals you’ve mutually set, as well as toward organizational goals.
REFERENCE
1. Stack L. Managing vs. coaching: in today’s workplace, you really need both. TLNT. July 7, 2014. www.tlnt.com/ managing-vs-coaching-in-todays-workplace-you-really- need-both/. Accessed November 21, 2017.
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Hills | Staff Coaching 305
According to Lee,7 two conditions must be present for a coach to listen actively, as the ICF has described above. The first is calmness. Lee suggests, “A calm mind will free you from the anxiety and need to try to be helpful.” When your mind is calm and at rest, all thoughts are silenced, to help you focus on the one thing that matters: listening. The second condition that Lee suggests will help you listen ac- tively is curiosity. Says Lee, “A healthy level of curiosity will heighten your interest in the person you’re speaking to.” If you are curious, you will naturally pay close attention and ask the right questions to make the coaching conversation productive, Lee says.
TEN TIPS FOR LISTENING ACTIVELY
When it comes to active listening, as with most skills, there is no substitute for practice. You’ve got to close your mouth, focus your mind, and listen purely for comprehen- sion, and you’ve got to do this repeatedly to hone your active listening skills. To help, Hills4 suggests the following 10 strategies:
1. Eat well and get plenty of rest. It’s challenging to lis- ten actively when your stomach is grumbling or you’re exhausted.
2. Commit to being fully present. Consciously decide to put aside the task you’re working on or whatever is on your mind. Don’t attempt to multitask. Give the speaker your full attention.
3. Put aside biases. You may have a history with some employees or topics that bias you for or against them. Let go of prejudgments and keep an open mind.
4. Choose a venue with good ventilation and a comfort- able temperature. When you can control the listening venue, make sure that the room is neither too warm nor cool and that the air circulates. Poor air quality can impede your ability to pay attention.
5. Turn off electronic distractions. Make sure you won’t see or hear anything to derail your active listening.
6. Don’t interrupt. Let the speaker complete the thought. Allow time for silence when the speaker stops. Pause and reflect before you respond. This is difficult for many of us, but essential for processing the messages we’re receiving.
7. Focus on meaning, not words. Don’t let a speaker’s occasional malapropism, mispronunciation, or gram- matical error derail you from the message. Don’t be distracted by words with an emotional charge. Recog- nize your hot buttons and defuse them.
8. Stay with it. Listening in spurts and then taking breaks may cause you to miss important information or cues. Recognize when your mind is wandering and inten- tionally pull it back to the listening task.
9. Listen between the lines. Search for meaning that isn’t necessarily put into the speaker’s spoken words. Pay attention to nonverbal communication (e.g., facial
expressions, gestures, and speed, volume, and tone of voice) to see if you can tease out meaning.
10. Paraphrase to check for comprehension. Ask the speaker to elaborate on any point that isn’t clear to you.
ASKING POWERFUL QUESTIONS IN COACHING
As the title of this article suggests, there are two tools medical practice managers can use to unleash their staff’s potential through coaching: (1) active listening and (2) powerful questions. At first glance, it may seem that powerful questions are simply questions that have the potential to make a profound impact. While this is true, it is helpful for us to explore more specifically what power- ful questions are and what they can do. Let’s look at this in three ways.
First, Vogt8 suggests that powerful questions are distin- guished from ordinary questions by nine characteristics. According to Vogt, powerful questions are those that: 1. Stimulate reflective thinking; 2. Challenge assumptions; 3. Are thought-provoking; 4. Generate energy to explore; 5. Channel inquiry; 6. Promise insight; 7. Are broad and enduring; 8. Touch a deeper meaning; and 9. Evoke more questions.
Following Vogt, a coach would focus on the depth and quality of response the questions elicit. Powerful questions would be those you ask to dig deeper and to expand your employee’s thinking. They are also questions that are likely to propel the coaching conversation forward.
Second, the ICF suggests that coaches who have the ability to ask powerful questions do so to reveal the in- formation needed for maximum benefit to the coaching relationship and the client. According to the ICF, a coach using powerful questions asks questions that: 1. Reflect active listening and an understanding of the cli-
ent’s perspective; 2. Evoke discovery, insight, commitment, or action (e.g.,
those that challenge the client’s assumptions); 3. Are open-ended and create greater clarity, possibility, or
new learning; and 4. Move clients toward what they (the clients) desire.
The ICF suggests that powerful questions are not those that ask clients to justify or to look backward. What is sig- nificant here is that powerful questions are designed first and foremost to be beneficial to the client, not to serve some other purpose.
Finally, Miglino9 suggests three characteristics of power- ful questions. These questions are:
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1. Open-ended: They’re not yes or no questions and they often begin with the word what. Example: What oppor- tunity is here?
2. Challenging: Powerful questions may cause a little discomfort.
3. Free of judgment: They are curious questions with no agenda behind them.
Miglino’s focus on discomfort is important. Personal and professional growth sometimes requires us to go places that we’d rather not go. Be mindful, however, that a coach is not a therapist. If you uncover concerning is- sues through your use of powerful questions, discontinue the coaching session and refer the employee to a qualified mental health professional for appropriate help. Do not overreach your capabilities.
As we consider the use of powerful questions in coach- ing, it becomes clear that powerful questions are not those that can be answered easily or quickly. Powerful questions require a thoughtful response, one that has the potential to lead the employee to new and better insights. Clearly, the medical practice manager who asks power- ful questions must have the employee’s trust. Otherwise, the employee is unlikely to open up to the coaching experience. The coach also must be very careful in tone, demeanor, and words not to come across as accusatory. There are many ways to ask an employee, “Why did you hesitate just now?” or “What do you think was behind your behavior?” Asking powerful questions well is a skill that can be learned and honed. Practice asking powerful questions with someone you trust and who can provide you with high-quality feedback. For examples of power- ful questions, see the sidebar “50 Powerful Questions You Can Use to Coach Your Employees.”
FIVE TOOLS TO KEEP THE COACHING CONVERSATION GOING
When you coach an employee, there may be lulls, stalls, and even dead ends in your conversations. The Coach- ing Tools Company10 recommends having a plan in place for those challenging moments. When coaches get stuck, the trick is to take a deep breath and ask a question to get the employee to show you the next step. The Coaching Tools Company recommends that you trust the coaching process and trust your employee to know what is best for him or her. Specifically, develop a bag of coaching tricks that includes the following five tools. They can help you to propel the coaching conversation forward. 1. Catch-all questions for when you don’t know what to
ask: Examples: What would be the best question I could ask you now? If you were coaching yourself, what would you ask yourself now? I don’t know where to go with this; where would you go?
2. Softeners for tough questions: Examples: I’m curious… Just for a moment…Let’s suppose…I was wondering… Would it be OK for us to play with this?
3. Phrases for dealing with talkative employees: Ex- amples: I’m going to interrupt you here. So, tell me what finally happened. In a nutshell, what is the issue? If we were to take a helicopter view, what would you need me to know? If you could sum up the situation in one word or phrase, what would it be?
4. Responses to “I don’t know”: Examples: Just feel into the question for a moment. Just let me know when you’ve thought of something. What’s it like for you not to know right now?
5. Wrap-up phrases to end a coaching session: Examples: What do you feel was the most beneficial part of today’s session? What was your biggest win of today’s session? What specifically that you’ve learned here today can you use/will help you most as you move forward?
TAKING YOUR COACHING SKILLS TO THE NEXT LEVEL
Coaching will be attractive to medical practice managers who are looking for new ways to develop their employees but also to those who wish to grow professionally and per- sonally. In fact, coaching can add an exciting new dimen- sion to your career. At this time, coaching is not regulated by any country or state. You do not need to be credentialed to coach, and you may begin coaching your employees, or for that matter anyone, any time that you feel that you are ready to do so. However, you may find that you would like to learn more about coaching and improve your coaching skills. If so, there are many ways to do this.
For example, many books, articles, and videos are available that will help you broaden your understanding of coaching. If coaching is new to you, this may be a good place for you to begin. You may find it particularly help- ful to watch videos of actual or mock coaching sessions so you can get a feel for how coaching typically looks and sounds. Another good strategy is to engage a coach personally so you can experience the power of coaching first-hand. You also may find it helpful to practice coach- ing one or more people you know and who you can trust to give you useful feedback. That will give you some valu- able experience before you take your coaching live with your employees.
If coaching becomes important to you, you may want to pursue coach-specific training, either face-to-face or online. Look for an excellent, reputable program. You also may want to work one-on-one with a coach-mentor who can help you improve your coaching. Ultimately, you may choose to pursue membership in a professional coaching organization such as the International Coaching Federa- tion, and even to pursue coach credentialing. Truly, with
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Hills | Staff Coaching 307
coaching, there is no limit to what you can learn and how much you can help others. Y
REFERENCES 1. Green H. Know when to manage and when to coach. Forbes . May 1,
2012. www.forbes.com/sites/work-in-progress/2012/05/01/know- when-to-manage-and-when-to-coach/#5806995223be. Accessed November 21, 2017.
2. Stack L. Managing vs. coaching: in today’s workplace, you really need both. TLNT. July 7, 2014. www.tlnt.com/managing-vs-coaching-in- todays-workplace-you-really-need-both/. Accessed November 21, 2017.
3. Harski C. Why the coach approach beats the manager mentality. Entre preneur . February 18, 2014. www.entrepreneur.com/article/231568. Accessed November 21, 2017.
4. Hills L. They’ll eat out of your hand if you know what to feed them: the 30 essential communication skills that give highly successful career
The best and most powerful questions will grow organi-cally from the coaching conversations you have with your employees. However, the list below of 50 powerful coaching questions can help you learn what powerful questions sound and feel like. Identify those that you feel will be most useful with your employees. Practice them aloud so you can ask them comfortably during your coach- ing sessions. 1. What’s missing from this picture so far? What is it we’re
not seeing? 2. What do we need more clarity about? 3. What’s most important to you about it and why do
you care? 4. What assumptions do we need to test or challenge
here in thinking about it? 5. What opportunities can you see in this? 6. What would it take to create change on this issue? 7. What would be the biggest impact if you achieve
your goal? 8. What’s emerging for you? What new connections are
you making? 9. What’s been your major learning, insight or discovery
so far? 10. If there was one thing that hasn’t yet been said in order
to reach a deeper level of understanding/clarity, what would that be?
11. If our success was completely guaranteed, what bold steps might we choose?
12. On a scale of 1 to 10, how excited do you feel about taking these actions? What would make it a 10?
13. What’s your favorite way of sabotaging yourself and your goals? If you were going to sabotage yourself on this project, how would you do it?
14. What are you trying to prove to yourself? 15. What small steps can you take to get you closer to
your vision? 16. What do you think the moral of that story is? 17. What are you waiting for? 18. What part of what you’ve just said could be an
assumption? 19. If I were in your shoes and asked for advice, what
would be the first thing you’d tell me? 20. What mistakes have you made today?
21. Where do you have unrealistic expectations of yourself?
22. What parts of yourself are you keeping bottled up but are dying to let out?
23. What’s keeping you from taking action? 24. How can you get the skills/knowledge/information
you need? 25. What should I say to you if I spot you doing this? 26. What do you want more of/less of in your job? 27. What are you tolerating/putting up with? 28. Can you imagine your desired outcome? Describe it
to me. 29. Where are you not respecting yourself right now? 30. How could you bring more creativity, fun, and joy in
your work? 31. If the same obstacle came up again, what would you
do? What can you learn from this? 32. What other areas of your work/life may be affected by
this change? 33. What do you not want me to ask you? 34. What’s the problem in a nutshell? In one sentence? In
a word? 35. What are you avoiding? How does this impact you in
your work? In your life? 36. Where could you be more forgiving and understanding
of others? Or yourself? 37. What might need to change? 38. Let’s take your concern to its logical conclusion. What’s
the worst thing that can happen? 39. If you secretly didn’t want to achieve your goal, what
would you do? 40. How would you like to be held accountable? 41. What would happen if you raised your expectations? 42. What are you not saying? 43. What do you consider to be your role in our practice?
In your life? 44. What do you need to stop saying yes to?’ 45. What part of you is not being acknowledged? 46. What would you be willing to give up to achieve this? 47. How do you feel in your body when you say that? 48. How are you going to maintain momentum? 49. What would you like to express in your work more? 50. If you dared say it aloud, what would you make happier
in your career? In your life?
Fifty Powerful Questions You Can Use to Coach Your Employees
308 Medical Practice Management | March/April 2018
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professionals their edge. Fairfax, Virginia: Blue Pencil Publishing. 2014.
5. Aguilar E. Active listening: the key to transforming your coaching. Education Week Teacher . April 27, 2014. http://blogs.edweek.org/ teachers/coaching_teachers/2014/04/active_listening_the_key_to_tr. html. Accessed November 27, 2017.
6. International Coaching Federation. Core competencies. www.coach federation.org/credential/landing.cfm?ItemNumber=2206&_ga=2. 257311243.1266885387.1511884288-274713144.1511884288&RDtoke n=18557&userID=. Accessed November 27, 2017.
7. Lee HT. The most important coaching competency: active listening. Coaching Journey: Journey to Your Next Level . http://coaching-journey.
com/the-most-important-coaching-competency-active-listening/. Accessed November 28, 2017.
8. Vogt E. The art and architecture of powerful questions . Javeriana University Decisiones. www.javeriana.edu.co/decisiones/Powerful Questions.PDF. Accessed November 28, 2017.
9. Miglino M. Powerful questions. International Coach Academy. August 18, 2014. https://coachcampus.com/resources/powerful-questions/. Accessed November 28, 2017.
10. The Coaching Tools Company. 549 powerful coaching questions. www.thecoachingtoolscompany.com/wp-content/uploads/2015/04/ 549-Powerful-Coaching-Questions-FREE_u.pdf. Accessed November 28, 2017.
Don’t Let Internet Critics Spoil Your Reputation
A Social Media Guide for Physicians and Medical Practices
Establishing, Managing, and ProtEcting Your onlinE rEPutation:
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Table of Contents Chapter 1: Disrupting the Healthcare
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Chapter 2: Your Online Reputation Today Chapter 3: Defining Your Online Identity
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Chapter 4: Creating Your Digital Footprint Chapter 5: Rating Sites Chapter 6: Safeguarding Your Online
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Chapter 7: Professionalism in the Digital Age
Chapter 8: Connect and Be Heard: My Journey from Social to Mainstream Media
Reproduced with permission of copyright owner. Further reproduction prohibited without permission.
Top of Form
Class Café
The “Class Café” may be used on an ongoing basis throughout your course for discussions with your peers that do not necessarily relate to the formal content of this course. While your Instructor will be in the Café during the first week to interact with you in an effort to get to know you and your peers, this space is intended to be an informal place for peers to interact, and thus your Instructor may not monitor this area of the classroom beyond Week
In your work environment, do you feel you are working at your full potential? Or is there something getting in your way? According to Gallup (2017), in 2016 almost 70% of U.S. workers were not engaged at work. Just imagine how much it costs organizations to have employees working below their potential. One way to overcome this discrepancy is through rich coaching and mentoring experiences. Coaching and mentoring can help unlock a person's potential so that his or her performance can be maximized.
This week, you will familiarize yourself with the definitions of coaching and mentoring, focusing on the similarities and differences between them. You will then take some time to think about situations in which coaching, and mentoring would be effective. Finally, you will have the opportunity to work with a partner to begin practicing your coaching and mentoring skills.
To prepare for this Discussion, pay particular attention to the following Learning Resources:
· Review this week’s Learning Resources, especially:
· Coaching & Mentoring – See Attachment
· Staff Coaching - See Attachment
· Mentoring vs Coaching - Mentoring vs Coaching: Which do you need? [2022] | Diversity for Social Impact™
Hunt, J. M., & Weintraub, J. R. (2017). The coaching manager: Developing top talent in business (3rd ed.). Thousand Oaks, CA: Sage Publications.
Flaherty, J. (2010). Coaching: Evoking excellence in others (3rd ed.). Burlington, MA: Elsevier Butterworth-Heinemann.
Bottom of Form
Assignment:
Post a cohesive paragraph discussing your experiences with coaching and/or mentoring. Your introduction must include the following:
· What is your experience with coaching?
· What is your experience with mentoring?
· What do you hope to learn in this course?
· How can we meet your expectations?
· How will you know that your expectations have been met?
· 3 -4 paragraphs
· No plagiarism
· APA citing

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