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Coaching for a growth mindset to improve the quality of healthcare" /> <meta name="DC.Identifier" content="10.1136/bmjqs-2023-016456" /> <meta name="DC.Date" content="2024-04-01" /> <meta name="DC.Publisher" content="BMJ Publishing Group Ltd" /> <meta name="DC.Rights" content="© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ." /> <meta name="DC.AccessRights" content="restricted" /> <meta name="DC.Description" content="> Perfection in this science, or rather art [i.e. medicine] takes longer to be mastered than human life [affords]—Maimonides, philosopher and physician, Middle Ages.1 A veritable quality improvement (QI) industry has emerged that centres around initiatives to improve patient outcomes or health system performance. These initiatives often target high-risk and high-cost disease states,2 with common foci of reducing waste,3 ‘hot-spotting’4 and readmissions.5 While these initiatives can help improve health system performance across the Quintuple Aim,6 they often fall short of achieving sustained improvements in outcomes at scale due to short attention spans, limited resources and shifting priorities or incentives.7–9 Furthermore, improvement initiatives can have unintended negative consequences that increase staff burnout and inadvertently exacerbate health human resource challenges,10 highlighting a need to clarify what we are trying to achieve and how. So long as there are patients suffering, there will be room to improve health systems, and opportunities for the clinicians working in those systems to improve their care. In his popular commentary in the New Yorker on coaching for physicians, Atul Gawande described how his skills seemed to improve almost daily in his early years of practice but plateaued a few years later. He reflects that while expertise in medicine is dynamic, the system requires that doctors build and sustain it for themselves.11 Simply put, doctors are taught about the importance of evidence-based medicine, but even though change in practice is inevitable, they have comparatively little training on (or ongoing support for) sustainably improving the ways in which they carry out their work. Gawande highlights how top performers in other industries rely on coaches to provide feedback to help them improve. Despite this, there is uncertainty regarding what coaching should target and how it should be operationalised in healthcare.12 Coaching …" /> <meta name="DC.Contributor" content="Laura Desveaux" /> <meta name="DC.Contributor" content="Noah Ivers" /> <meta name="article:published_time" content="2024-04-01" /> <meta name="article:section" content="Viewpoint" /> <meta name="citation_title" content="Practice or perfect? 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Könings;citation_title=In-the-Moment Feedback and Coaching: Improving R2C2 for a New Context;citation_pages=27-35;citation_volume=12;citation_year=2020" /> <meta name="twitter:title" content="Practice or perfect? Coaching for a growth mindset to improve the quality of healthcare" /> <meta name="twitter:card" content="summary_large_image" /> <meta name="twitter:image" content="https://qualitysafety.bmj.com/sites/default/files/highwire/qhc/33/4.cover-source.jpg" /> <meta name="twitter:description" content="> Perfection in this science, or rather art [i.e. medicine] takes longer to be mastered than human life [affords]—Maimonides, philosopher and physician, Middle Ages.1 A veritable quality improvement (QI) industry has emerged that centres around initiatives to improve patient outcomes or health system performance. These initiatives often target high-risk and high-cost disease states,2 with common foci of reducing waste,3 ‘hot-spotting’4 and readmissions.5 While these initiatives can help improve health system performance across the Quintuple Aim,6 they often fall short of achieving sustained improvements in outcomes at scale due to short attention spans, limited resources and shifting priorities or incentives.7–9 Furthermore, improvement initiatives can have unintended negative consequences that increase staff burnout and inadvertently exacerbate health human resource challenges,10 highlighting a need to clarify what we are trying to achieve and how. So long as there are patients suffering, there will be room to improve health systems, and opportunities for the clinicians working in those systems to improve their care. In his popular commentary in the New Yorker on coaching for physicians, Atul Gawande described how his skills seemed to improve almost daily in his early years of practice but plateaued a few years later. He reflects that while expertise in medicine is dynamic, the system requires that doctors build and sustain it for themselves.11 Simply put, doctors are taught about the importance of evidence-based medicine, but even though change in practice is inevitable, they have comparatively little training on (or ongoing support for) sustainably improving the ways in which they carry out their work. Gawande highlights how top performers in other industries rely on coaches to provide feedback to help them improve. Despite this, there is uncertainty regarding what coaching should target and how it should be operationalised in healthcare.12 Coaching …" /> <meta name="og-title" property="og:title" content="Practice or perfect? Coaching for a growth mindset to improve the quality of healthcare" /> <meta name="og-url" property="og:url" content="https://qualitysafety.bmj.com/content/33/4/271" /> <meta name="og-site-name" property="og:site_name" content="BMJ Quality & Safety" /> <meta name="og-description" property="og:description" content="> Perfection in this science, or rather art [i.e. medicine] takes longer to be mastered than human life [affords]—Maimonides, philosopher and physician, Middle Ages.1 A veritable quality improvement (QI) industry has emerged that centres around initiatives to improve patient outcomes or health system performance. These initiatives often target high-risk and high-cost disease states,2 with common foci of reducing waste,3 ‘hot-spotting’4 and readmissions.5 While these initiatives can help improve health system performance across the Quintuple Aim,6 they often fall short of achieving sustained improvements in outcomes at scale due to short attention spans, limited resources and shifting priorities or incentives.7–9 Furthermore, improvement initiatives can have unintended negative consequences that increase staff burnout and inadvertently exacerbate health human resource challenges,10 highlighting a need to clarify what we are trying to achieve and how. So long as there are patients suffering, there will be room to improve health systems, and opportunities for the clinicians working in those systems to improve their care. In his popular commentary in the New Yorker on coaching for physicians, Atul Gawande described how his skills seemed to improve almost daily in his early years of practice but plateaued a few years later. He reflects that while expertise in medicine is dynamic, the system requires that doctors build and sustain it for themselves.11 Simply put, doctors are taught about the importance of evidence-based medicine, but even though change in practice is inevitable, they have comparatively little training on (or ongoing support for) sustainably improving the ways in which they carry out their work. Gawande highlights how top performers in other industries rely on coaches to provide feedback to help them improve. Despite this, there is uncertainty regarding what coaching should target and how it should be operationalised in healthcare.12 Coaching …" /> <meta name="og-type" property="og:type" content="article" /> <meta name="og-image" property="og:image" content="https://qualitysafety.bmj.com/sites/default/files/highwire/qhc/33/4.cover-source.jpg" /> <title>Practice or perfect? 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highwire-citation-bmjj-title clearfix"> <div class="highwire-cite-title">Practice or perfect? Coaching for a growth mindset to improve the quality of healthcare</div> <span class="highwire-cite-access"><span class="highwire-citation-access highwire-citation-access-check" data-pisa-id="qhc;bmjqs-2023-016456" data-atom-uri="/qhc/33/4/271.atom" data-request-view="full"></span></span> </cite> </div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-panel-tabs-container col-narrow-12 clear" > <div class="pane-content"> <div data-panels-ajax-tab-preloaded="jnl_template_bmjj_tab_art" id="panels-ajax-tab-container-highwire_article_tabs" class="panels-ajax-tab-container"><div class="panels-ajax-tab-loading" style ="display:none"><img class="loading" src="https://qualitysafety.bmj.com/sites/all/modules/contrib/panels_ajax_tab/images/loading.gif" alt="Loading" title="Loading" /></div><div class="panels-ajax-tab-wrap-jnl_template_bmjj_tab_art"><div class="panel-display panel-1col clearfix" > <div class="panel-panel panel-col"> <div><div class="panel-pane pane-highwire-markup author-affiliates col-narrow-12 author-affiliates-corresp article" > <div class="pane-content"> <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div xmlns:xhtml="http://www.w3.org/1999/xhtml" class="contributors"><ol class="contributor-list" id="contrib-group-1"><li class="contributor" id="contrib-1"><a href="http://orcid.org/0000-0003-3429-1865" class="bmjj-markup-orcid-logo" target="_blank">http://orcid.org/0000-0003-3429-1865</a><span class="name">Laura Desveaux</span><span class="xref-aff">1</span><span class="xref-sep">,</span><span class="xref-aff">2</span>, </li><li class="last" id="contrib-2"><span class="name">Noah Ivers</span><span class="xref-aff">3</span><span class="xref-sep">,</span><span class="xref-aff">4</span></li></ol><ol class="affiliation-list"><li class="aff"><address> <sup>1</sup> <span class="institution">Trillium Health Partners Institute for Better Health</span>, <span class="addr-line">Mississauga</span>, <span class="addr-line">Ontario</span>, Canada </address></li><li class="aff"><address> <sup>2</sup> <span class="institution">Institute for Health Policy, Management, and Evaluation</span>, <span class="institution">University of Toronto Dalla Lana School of Public Health</span>, <span class="addr-line">Toronto</span>, <span class="addr-line">Ontario</span>, Canada </address></li><li class="aff"><address> <sup>3</sup> <span class="institution">Women's College Hospital Institute for Health System Solutions and Virtual Care</span>, <span class="addr-line">Toronto</span>, <span class="addr-line">Ontario</span>, Canada </address></li><li class="aff"><address> <sup>4</sup> <span class="institution">Department of Family & Community Medicine</span>, <span class="institution">University of Toronto</span>, <span class="addr-line">Toronto</span>, <span class="addr-line">Ontario</span>, Canada </address></li></ol><ol class="corresp-list"><li class="corresp" id="corresp-1"><span class="corresp-label">Correspondence to</span> Dr Laura Desveaux, Trillium Health Partners Institute for Better Health, Mississauga, Canada; <span class="em-link"><span class="em-addr">laura.desveaux{at}thp.ca</span></span> </li></ol></div></div></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-markup abstract-with-bc" > <div class="pane-content"> <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" id="content-block" xmlns:xhtml="http://www.w3.org/1999/xhtml"><span class="related-urls"></span></div></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-custom pane-1" > <div class="pane-content"> <p><a href="https://doi.org/10.1136/bmjqs-2023-016456" target="_new">https://doi.org/10.1136/bmjqs-2023-016456</a></p> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-altmetrics" > <h2 class="pane-title">Statistics from Altmetric.com</h2> <div class="pane-content"> <div data-badge-details="right" data-badge-type="medium-donut" data-doi="10.1136/bmjqs-2023-016456" data-hide-no-mentions="true" class="altmetric-embed"></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-bmjj-jumplinks" > <div class="pane-content"> <div class="highwire-list-wrapper"><div class="highwire-list"><ul></ul></div></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-custom pane-2 permissions-box" > <h2 class="pane-title">Request Permissions</h2> <div class="pane-content"> <p>If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.</p> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-panels-ajax-pane-content permissions-box pane-highwire-permission-link" id="request-permissions"> <h2 class="pane-title"><span class='panels-ajax-pane-title' data-pid='new-70fd4c70-563e-4b94-ae3b-2a97f3980c13'></span></h2> <div class="pane-content"> <div class='panels-ajax-pane panels-ajax-pane-new-70fd4c70-563e-4b94-ae3b-2a97f3980c13' data-pid='new-70fd4c70-563e-4b94-ae3b-2a97f3980c13'></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-markup" > <div class="pane-content"> <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article extract-view"><span class="highwire-journal-article-marker-start"></span><ul class="kwd-group"><li class="kwd"><a href="/keyword/healthcare-quality-improvement" class="hw-term hw-article-keyword hw-article-keyword-healthcare-quality-improvement" rel="nofollow">Healthcare quality improvement</a></li><li class="kwd"><a href="/keyword/continuing-education-continuing-professional-development" class="hw-term hw-article-keyword hw-article-keyword-continuing-education-continuing-professional-development" rel="nofollow">Continuing education, continuing professional development</a></li><li class="kwd"><a href="/keyword/audit-and-feedback" class="hw-term hw-article-keyword hw-article-keyword-audit-and-feedback" rel="nofollow">Audit and feedback</a></li></ul><div class="section intro" id="sec-1"><h2 class="">Introduction</h2><blockquote id="disp-quote-1" class="disp-quote"><p id="p-1">Perfection in this science, or rather art [i.e. medicine] takes longer to be mastered than human life [affords]—Maimonides, philosopher and physician, Middle Ages.<span class="xref-bibr">1</span> </p></blockquote><p id="p-2">A veritable quality improvement (QI) industry has emerged that centres around initiatives to improve patient outcomes or health system performance. These initiatives often target high-risk and high-cost disease states,<span class="xref-bibr">2</span> with common foci of reducing waste,<span class="xref-bibr">3</span> ‘hot-spotting’<span class="xref-bibr">4</span> and readmissions.<span class="xref-bibr">5</span> While these initiatives can help improve health system performance across the Quintuple Aim,<span class="xref-bibr">6</span> they often fall short of achieving sustained improvements in outcomes at scale due to short attention spans, limited resources and shifting priorities or incentives.<span class="xref-bibr">7–9</span> Furthermore, improvement initiatives can have unintended negative consequences that increase staff burnout and inadvertently exacerbate health human resource challenges,<span class="xref-bibr">10</span> highlighting a need to clarify what we are trying to achieve and how. So long as there are patients suffering, there will be room to improve health systems, and opportunities for the clinicians working in those systems to improve their care.</p><p id="p-3">In his popular commentary in the New Yorker on coaching for physicians, Atul Gawande described how his skills seemed to improve almost daily in his early years of practice but plateaued a few years later. He reflects that while expertise in medicine is dynamic, the system requires that doctors build and sustain it for themselves.<span class="xref-bibr">11</span> Simply put, doctors are taught about the importance of evidence-based medicine, but even though change in practice is inevitable, they have comparatively little training on (or ongoing support for) sustainably improving the ways in which they carry out their work. Gawande highlights how top performers in other industries rely on coaches to provide feedback to help them improve. Despite this, there is uncertainty regarding what coaching should target and how it should be operationalised in healthcare.<span class="xref-bibr">12</span> <div class="oas-ads oas-ads-mid pull-right"><div id="dfp-ad-mpu-wrapper" class="dfp-tag-wrapper"> <div id="dfp-ad-mpu" class="dfp-tag-wrapper"> <script type="text/javascript"> googletag.cmd.push(function() { googletag.display("dfp-ad-mpu"); }); </script> </div> </div></div></p><p id="p-4">Coaching … </p></div><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div><a href="https://qualitysafety.bmj.com/content/33/4/271.full" class="hw-link hw-link-article-full-text" data-icon-position="" data-hide-link-title="0">View Full Text</a></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-markup footnotes" > <div class="pane-content"> <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div xmlns:xhtml="http://www.w3.org/1999/xhtml" class="section fn-group" id="fn-group-1"><h2>Footnotes</h2><ul><li class="fn-other" id="fn-1"><p id="p-25"><span class="fn-label">Twitter</span> @lauradesveaux</p></li><li class="fn-other" id="fn-2"><p id="p-26"><span class="fn-label">Contributors</span> The authors contributed equally.</p></li><li class="fn-other" id="fn-3"><p id="p-27"><span class="fn-label">Funding</span> The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.</p></li><li class="fn-conflict" id="fn-4"><p id="p-28"><span class="fn-label">Competing interests</span> None declared.</p></li><li class="fn-other" id="fn-5"><p id="p-29"><span class="fn-label">Provenance and peer review</span> Not commissioned; externally peer-reviewed.</p></li></ul></div></div></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane 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