27 November 2023
Dr Fiona Day discusses how she carried out her research into the impact of psychologically informed leadership coaching on the mental well-being of senior doctors, medical and public health leaders.
When healthcare organisations and individual clinicians actively engage in research, they see better outcomes for both their patients and their staff [1]. I hope that one day we will be able to show the same benefits for coaches, mentors and supervisors, and for our clients.
As a doctor by background, I am used to designing, funding, and evaluating clinical audits and research projects, and I wanted to embed the same rigour in my coaching practice as I did for my medical practice. My coaching clients are senior doctors, medical and public health leaders, who have a mix of goals relating to their professional lives, from leadership development, career decisions and work-related (non-clinical) wellbeing needs.
I wanted to collect and use scientifically valid data so I could start to measure the impact of my coaching practice in the form of data for audit rather than as a formal research study.
Ideally, measuring the impact of an intervention involves a randomised controlled trial, but this is usually not possible for a sole practitioner. I chose instead a more pragmatic but less scientifically-based approach: collecting ‘before and after’ data.
The aim
The aim of my ‘pre–post’ study was to investigate whether psychologically informed leadership coaching impacted on the mental well-being of senior doctors, medical and public health leaders.
The methods
For any intervention study, you need to be able to identify the population, the intervention and the outcomes. In my study, they were as follows:
The population – I collected data on a self-selected, consecutive series of 80 private clients. This included a complete dataset of both before and after outcomes, plus some basic demographic data, such as location, age, gender, and ethnicity. The age range was 30–63 years (mean 44.5, mode and median, 45.0). Thirty-seven participants were male (46.3%). The proportion of non-white ethnicity was 21.3%. Participants with self-disclosed or suspected current or recent moderate or severe mental illness were excluded for ethical reasons.
The intervention – I collected data on the number of hours of psychologically-informed coaching with me, and the type of goals which were identified by the clients. Participants undertook an average of 8.7 hours of bespoke 1:1 psychologically informed leadership coaching. Self-identified goals were chosen by the participants and were primarily focused on:
• identifying future career direction
• improving work–life balance
• improving leadership competence, including at board or system level
A minority of participants’ goals (less than 10%) specifically focused on improving mental well-being. All sessions were in 1:1 format.
The validated outcome measure – Given the range of goals that my clients wanted to work on, I chose a wellbeing related measure, as I felt that improving wellbeing was something which potentially all clients have the capacity to benefit from. There are several scientifically validated wellbeing scales to choose from. I chose the Short Form Warwick-Edinburgh Mental Wellbeing Scale. This is a positively worded, seven-item interval scale which is a simple to use, internationally recognised and scientifically validated measure of mental well-being. You need to have a paid license to use it.
I did all the data entry myself into an Excel spreadsheet and took advice from a local professor of psychology on how to undertake the statistical analysis, as I was a bit rusty and wanted to be sure I was doing it correctly.
The results
The mean wellbeing score before the intervention was 21.4 (SD=3.28). The mean wellbeing score after the intervention increased to 24.5 (SD=3.38). A paired samples t-test found that the increase in metric well-being scores after the intervention was statistically significant (t=−9.52, p<0.001; Cohen’s d=3.14).The mean improvement was +17.4% (median 115.8%, mode 100, range −17.7% to+202.4%).
Sixty-three participants achieved a meaningful positive change (79.8%). Fourteen participants achieved neither a meaningful positive nor a meaningful negative change (17.5%). Three participants achieved a meaningful negative change (3.8%), all of whom reported positive outcomes from the intervention in their qualitative feedback.
Before the intervention, 43.8% of participants had low wellbeing (<19.5 metric, n=35), 51.2% had moderate wellbeing (19.6–27.4 metric, n=41), 5.0% had high wellbeing (>27.5 metric, n=4). After the intervention, 8.8% had low wellbeing, 75.0% had moderate wellbeing, and 16.3% of participants had high wellbeing.
All domains of wellbeing were positively impacted by the intervention. The greatest improvement was in ‘feeling optimistic about the future’ (average of +0.79 improvement), and being ‘able to make my mind up about things’ (average of +0.60 improvement).
There was no correlation between net change in score and the number of coaching sessions in the intervention (r=0.163). There was a weak negative correlation between metric scores before and after the intervention (r=−0.445).
The conclusion
Psychologically informed leadership coaching may be an effective way to improve mental wellbeing outcomes in senior doctors, medical and public heath leaders. The contribution of psychologically informed coaching is currently limited in medical leadership development research.
What I did next
I wrote the paper up in full and submitted it to the peer reviewed journal, BMJ Leader. The process of writing it up, responding to peer reviewer comments, and chasing up the editorial team took about nine months, and to be honest was a labour of love. However when it did finally get published, I felt proud of my efforts and grateful to have had the opportunity to contribute to the coaching research field.
While there is a significant body of research on the impact of coaching on leadership development, this is still underdeveloped in the healthcare field. I hope that my study will have an impact in terms of stimulating more research in this area and also giving confidence to potential clients that coaching can improve the wellbeing of medical and public health leaders.
I’m now a pro bono participant coach in an international coaching research study.
I enjoyed getting involved in research so much that I am now recording specific (consented and with the blessing of my insurer) coaching sessions for an international coaching linguistic study, QUESCO. They are always keen to build links with coaches and coaching academics – contact Professor Graf if you are interested: [email protected].
About Fiona Day
Dr Fiona Day (MBChB, FFPH, CPsychol) is a Medical & Public Health Leadership Coach, Chartered Coaching Psychologist, an EMCC Master Practitioner and former board-level medical and public health leader. She is also a qualified supervisor.
Read the full research study, or visit the Fiona Day Consulting website for more information.
Photo by Vlada Karpovich