Coaching — A Progressive New Paradigm

Coaching. This word has only recently entered the lexicon of the dental practice management industry. It seems we're a little late. According to recent feature articles in The New York Times(1), the Wall Street Journal(2), Fortune Magazine(3) and Investors Business Daily(4), to name a few, the corporate world considers coaching to be an important and necessary activity. I know of senior executives at IBM, Cisco and Lucent who have received directives from their CEOs that read, "Coaching skills are now to be considered an essential part of our repertoire." Many of these same companies are hiring coaches to fill in perceived leadership gaps. At the university level as well, many traditional business curricula now include coaching as part of their leadership training.(5) Beyond what we might consider traditional, Coach University, founded in the early 80's by Thomas Leonard provides telephone-based training and a rigorous certification process. The International Coaching Federation, a 5 year-old organization based in Washington, D.C. is a very rapidly growing organization of 6,000, that has popularized this new discipline through its highly successful (sold-out) annual conferences.

It is ironic that while this activity is entering the mainstream very few people can either define it or talk about how the skills of good coaching can be applied to what we do. We continue, it seems, to be stuck in a systems-based, techno-centered paradigm of traditional machine-like practice management.

  1. David Cay Johnston, "Hard-Case Study Approach To Executive Training," The New York Times, August 23, 2000
  2. Joann S. Lublin, "Building A Better CEO," Wall Street Journal, April 14, 2000
  3. Betsy Morris, "So You're A Player, Do You Need A Coach?," Fortune, February 21, 2000.
  4. Gary Stern, "A Coaching CEO Can Be That Winning Edge," Investors Business Daily, February 28, 2000
  5. Georgetown, University of California, George Washington University and Wharton
What is coaching? Coaching to do what?

Coaching is a helping art geared to the development and improvement in the overall functioning of people. Since it is people who comprise organizations, these "people improvements" directly improve how organizations function. It's a simple idea that dates at least to Abraham Lincoln's concept of government — of the people, for the people and by the people — but it has profound meaning for the entire business world. Many in our profession forget that we not only work on people, but as importantly with them. And of course we can't forget the most important aspect: we are people too, and our own needs must be met. In my experience Lincoln got this people business right.

As a coach, of course I need to enthusiastically support and motivate my client, but my goal is to leave her or him a long-term excellent performer. Therefore I am always working to help my client become self-correcting and self-generating. Short-term stuff is a mistake. Giving clients the right answers, in the long run, is counterproductive. Cookbooks (or systems manuals) do not let us fully appreciate that our business really is about people and building their competence.

Sometimes we learn what something is by knowing what it is not. Coaching is not to teach, nor to manage, and not even to lead. Yet many recognized teachers of practice management in our profession are calling themselves coaches- but they're not, at least as I define the term. They are motivators, management consultants and trainers. All have a place, but the products of each are quite different. A recent Dilbert cartoon poked fun at the "motivators." Looking exhausted, Dilbert eyes a recliner and says, "I think I'll lie down until the motivation wears off."

The weight loss organizations (Jenny Craig, et al) see the repeated failures of this motivational track: ten pounds off, twelve pounds on and a new layer of cynicism added. Great...for business, but not necessarily a great scenario for success.

We must behave based on who we are and what we see, not what other people (or organizations) tell us to do. But it is even deeper than that, for each of us "sees" the world differently. For many the world is fraught with terror; others welcome change, even chaos! Quick-fix motivational answers rarely ever change behavior long-term because by their nature they do not see us as individuals. Thus they rarely help us develop the competencies necessary to change, to see things differently.

And there is more to it than that. Sustainable behavioral changes require great courage as well as tremendous support. According to the organizational psychologists Kagen and Lahey, authors of The Way We Talk Can Change The Way We Work, who stress the need to be aware of both our assumptions as well as the contradictions that confront us, "We know of no successful McDonald's approach to substantive personal learning at work or anywhere else. No drive-through weekend or summer institute can by itself change our minds for the long run."

A coach will not absolve you of hard work (the opposite may be closer to the truth), but will guide you to do the right kind of work. More than guidance, she or he will help you fashion a language and a way of observing behavior that is a prerequisite for sustainable change. Yes, it is arduous, but not nearly as frustrating and painful, as the repeated failures we experience when we embrace self-help programs, no matter how well meaning or well intentioned they seem. In some perverse sense the better the program's intentions, the worse the results because the frustration and pain of failure are covered over by a layer of guilt for having let these nice people (or organization) down.

What is so different about coaching, anyway?
Why do we need any outside help at all?

Precisely because many of those motivational, mechanical, and technique-laden approaches have not been successful is the reason that we need a new and fundamentally different system. "We don't do what we're doing in our day-to-day life now simply because we were given information and encouragement," says James Flaherty, a leading innovator in the coaching profession. I urge you to think about this. It explains the failure of many traditional approaches to human growth, and is, in my mind, the clearest and most powerful argument for a new and fundamentally different system.

Coaching is results-based and verifiable. Unlike many of these other approaches that function as super cheerleaders. (Place a ten on your forehead! Think only positive thoughts! Tell yourself you're wonderful when you look into the mirror in the morning!) It employs a fundamentally different methodology. Coaching develops and utilizes a language and a set of practices and self-observation exercises that can change how we see ourselves in the world, not just in our minds. The rigor of the coaching process is that it helps the client observe their behavior, not simply explore their feelings.

In some sense coaching is existential in outlook. A skilled coach will help a client open up a world of possibilities by clearing away the muck that so constricts the ability to think in the present. To borrow self-help jargon, a coach's job is to help a client "think outside of the box."

Coaching uniquely addresses a question that is fundamental to all existence and yet is hardly ever seriously addressed: "What is a human being?" Would you build a house without knowing the tensile strength of the steel girders or use wood without knowing whether or not it was waterproof? Of course not! Yet although the basic unit of all of the human improvement programs — and indeed, of all organizations — is a human being, we hardly ever ask this most basic of questions.

How do you define a human being?

I could define a human as an animal possessing a nervous system, a body that employs an opposable thumb, and a brain capable of emotions- or simply as an animal that has the ability to be self-reflexive and the unique capacity to love. All of these would be right. But we are far more, and far different, than the sum of our parts.

One way to define the uniqueness of our specie is to examine the reason we exist. Medard Boss, in Existential Foundations of Medicine and Psychology, writes, "Remember that existence consists solely in its possibility for relationships." Of the people, for the people, and by the people.

In a recent conference call with colleagues we discussed how to build attendance at a meeting. We talked, of course, about content, location, fees, etc, but mostly we talked about the relationships we have with folks we are going to invite. We must think of everything we do — with our practice, family and friends — in terms of relationships. A certain prominent local-turned-international bank has trademarked the motto, "The right relationship is everything." I won't comment on whether or not they deliver — but we should, and successful coaching will enable us to do so.

I'm still not convinced that this soft fuzzy feeling stuff will help my business. Could you talk to that?

The recent book, The Service Profit Chain, by James Heskitt and others at Harvard Business School, proved for the first time and with great scientific rigor that the primary source of value in a service business (I hope I don't need to remind you that we are in the service business) lies in the relationships that we have with our employees. Heskitt uses a metaphor called the "Satisfaction Mirror." The employee and the customer express their pleasure or displeasure with the business by looking at each other as if through a mirror.

According to Heskitt and his colleagues, the strongest statistical correlations were between:

  • Profit and Customer Loyalty
  • Employee Loyalty and Customer Loyalty
  • Employee Satisfaction and Customer Satisfaction

What this means for us, in practical terms, is that the most powerful and reliable lever in our office is the morale of our staff. When we improve employee loyalty and employee satisfaction we improve customer satisfaction and in turn, we increase profit. But it is not just the Heskitt research that is telling us this. Each year all of the major business magazines publish lists of companies that employees rate as "the best to work for." It is no coincidence that these companies are industry leaders. It is now widely recognized that what used to be considered the soft stuff is now a crucial determinant of success.

Let me tell you one more story. At a recent study club meeting the not-infrequent complaints of many of my colleagues surfaced. Staff problems abounded: their staffs were not self-starters, they were greedy, rarely on the same page as the doctor, not helpful to new staff members, and so on and so forth. One doctor actually called his staff ingrates for refusing to realize how lucky they were to be working for him. Are these attitudes conducive to employee satisfaction?

Hardly. This attitude reflects something that Flaherty calls the Amoeba Theory of Management. Amoebas, if you remember your high school biology, are one-cell protozoa that move toward sugar and away from irritating stimuli. We call this the pain-pleasure principle (from Freud) and it has evolved to become the basis of most management systems today. We use our traditional reward systems (bonus, profit sharing, etc) as sugar. And this is as it should be, many would say — money, after all, is the driving force in the world. Well, of course money is important, and I am in no way saying that folks shouldn't be well and properly paid. What I am saying emphatically is that all of us work for many things that are intangible and more important than the almighty dollar. Try satisfaction, try the belief that we are making a difference to individuals and the world, try that our jobs are done with integrity and contribute to our self-esteem and are in service of our values. That is the pleasure side of the pain-pleasure principle.

Now for the pain (punishment). There are plenty of ways that we punish. Obviously, we can do this by withholding money but most often we withhold emotional stuff: praise, support, proper training and more. What's worse is that we don't even know another way of doing it. Human beings are neither widgets or Its. Even the most enlightened among us — those of us that call our employees "team members" and take them to courses and dinners — while certainly well intentioned and somewhat helpful, are not doing enough to build the intimate and heartfelt connections that are embodied in coaching.

Coaching is a contact sport. We need to really get down and dirty with people, to appreciate their issues and respect their humanity, and to work from the perspective that enabling people to grow is a quite wonderful and rewarding thing to be doing. I can find something to love in every human being. That love shows up as mutual respect, trust, and freedom of expression. A clean, honest, and real connection is required. Greed, power, and the need to gratify our own egos sully the relationship. Our staffs will see through these things in a New York minute.

I propose that we abandon simplistic and sometimes demeaning management systems and put in their place a system much more suited to working with human beings; organisms that are multi-celled, complex and often unpredictable. When we do that, all of the lines — the bottom one, the middle one and the top one — will improve.

What are the specific goals of this methodology?

According to Flaherty, the goals are as follows:

Long-Term Excellent Performance: This means that the person is meeting the objective and verifiable standards of excellence. This is not a matter of opinion. A conversation or a dental visit was either good or lousy. Any reasonably competent person would know the difference.

Self-Correction: This means that a well-coached person can make independent adjustments based on his or her assessments. Carrying big and threatening sticks is no longer necessary.

Self-Generation: This means that the person is able to find ways to improve on his or her own in the area where the coaching took place. In short, it means we work with adults and as adults.

Could you describe the principles of coaching?

Yes. They are as follows:

  • Relationship
  • Pragmatism
  • Two Tracks
  • Always/Already
  • Techniques Don't Work


One cannot coach another human being in the absence of a relationship that embodies some particular qualities. The relationship must be mutually satisfying in that there is a shared commitment. By commitment I don't mean one of these meaningless "mission statements" that has been foisted on the staff by an enlightened boss. That is quite a different thing than sharing beliefs and values in an appropriate context — and from that experience creating new perspectives on old problems, new methods of practice, and new levels of compassion expressed in every interaction.

Whenever I talk about this principle I think about the range of relationships that exist within my dental office and the way that our staff meetings have generated a context in which coaching can take place. I try to foster mutual trust, mutual respect and freedom of expression, free of self-interest and manipulation. This is certainly easier said than done. However, I have seen real and palpable growth, and I experience joy in the effort itself.


This principle rests squarely on the notion that we are interested in outcomes, not some fanciful theoretical construct. There is a process of correction that is ongoing and is based on our results. The operative word is our- since the failure of the staff person is the failure of the coach. The challenge of this principle for the coach is that one has to learn, unlearn and relearn in the face of new challenges.


This principle is related to pragmatism in the sense that the learning is ongoing. "Two tracks" refers to the notion that the coach has to work with both the staff person and with him or herself. Assumptions have to be questioned and new ones made on both counts. The minute you think you have found the Holy Grail of a perfect relationship, you haven't. It also recognizes that both the client and the coach may encounter breakdowns on the way and that neither is exempt from growing pains. Actually many accomplished coaches believe the coaching relationship must include the client's problem or a sterile and lifeless learning environment will develop. Another way of saying this is that one has to be wary of things going too well or at a pace that seems unsustainable.


This principle is in some ways the most obvious, and yet it presents the greatest challenges. It postulates that human beings are not blank slabs. We already have learned ways of doing things. We have world-views consistent with how we act, and we have developed ways of defending against change. Although we are regularly told that change is good and necessary for growth, change nonetheless terrifies us and we unconsciously resist. Therein lies the struggle.

This is even true with our children who, while they are probably less resistant than grown-ups, still have their own agendas. You only have to think of teenagers to realize how difficult this activity can be.


Coaching, as I'm sure you have surmised, is both difficult and extraordinarily rewarding. People need to be engaged with hearts, minds, and creativity. That said, we must resist techniques of pacification, techniques that feign empathy but more often than not leave us enraged. We are driven crazy by the insincerity and fecklessness of the airline counter person who has been taught to say "I hear you" when we are going ballistic after being told that our flight has been cancelled. We disdain folks in high political office who "feel our pain" as they inform us of some terrible tragedy. Baloney, we think.

Yes, sometimes we have to use our old manipulative techniques, but we must be careful, because the techniques are often so easy to see through.