Dr. Chris was a brilliant, successful healthcare executive who was well-liked and respected by her staff. Yet she failed to operate successfully in a new environment. Executive coaching helped Dr. Chris alter her behavior so that she could again lead her team to achieve success.

It seemed like a perfect fit: Dr. Chris (not her real name) had the exact and unusual talent and experience necessary to solve a very expensive and potentially disastrous dilemma. She had been hired by an insurance company that was responding to competitive pressure by following an unusual strategy. It had recently purchased several hospital groups and several large physician practices. Three historic competitors were now working toward the success of one enterprise.

Each had always operated in its own self-interest:

• The doctors were accustomed to fighting with insurance companies to get enough hospital days for their patients.
• The hospital administrators took their job to be filling beds and having their expensive medical equipment used at an optimal rate.
• The insurance company understood its task to be expanding the size of its client base while simultaneously minimizing payouts to hospitals and doctors.

Bold Strategy
Begins To Unravel

The initiators of this bold strategy were two executives, one of whom was a physician. They imagined that their own clarity and purity of purpose would be sufficient to nullify any difficulties, turf battles, or resistance in the huge corporation they had assembled. But in such operations, rarely does the outcome flow as smoothly as the plan. This case proved no exception.

The three groups began feuding with each other. Each had a different set of values and different priorities, and each thought itself to be the most centrally important part of the corporation. None of the groups felt as if it were being heard or supported by executive management. Expenses were soaring, as redundancies of specialization and equipment were rampant. Losses were nearing a million dollars a week - and accelerating.

The two company leaders pinned their hopes for resolving these conflicts on Dr. Chris. She had a unique ability to convene a meeting of doctors and hospital administrators for a day and produce a consensus document summarizing best practices for treating a particular illness such as adult onset diabetes or childhood asthma. In preparation for the meeting, she read, digested and integrated all the most recent research and theoretical papers on each illness.

She also brought to the meeting an experienced, trained staff who could listen to the proceedings and provide each attendee with a document containing all that was learned and approved. Everyone left these meetings ecstatic. Physicians felt free to treat their patients with the best possible methodology; hospital administrators felt as if their facilities were being put to the best possible use; and, interestingly enough, the consensual best practices also were very cost-effective for the insurance company. What could be better?

Leadership could envision the eminent demise of red ink: physicians flocking to join their company, and the public waiting patiently in queue to sign up as subscribers. But this is not what happened.

One day, I received a call from the firm's human resources department. They asked if I were available to coach Dr. Chris, who had been hired in at a high executive level. I was given enough background to understand her position. But such was the culture of this company that I was told only in the vaguest terms the difficulty that had precipitated the call for my assistance. As usual, I arranged a time to visit Dr. Chris on site, as well as to interview her boss, peers, and subordinates. But in a way, these interviews were superfluous, because after meeting her for a few moments, I was able to pinpoint the problem.

I interviewed her boss and found out that although she was polite, he was profoundly disappointed and personally offended by Dr. Chris. He could not articulate the reason for his displeasure and didn't speak about the emotions storming just beneath his surface. Instead, he pointed to a lack of fit.

Dr. Chris's staff painted a very different picture. Each felt that she was the most supportive, rational, intelligent, and humane person they had ever worked for. She made decisions, set priorities, and assigned work in ways that they all found vastly superior to those of their former bosses, whom they considered to be politically motivated bureaucrats. Her peers admired her brilliance, and yet were not sure if she could achieve success at the company over the long term.

The Core of the Problem

Dr. Chris was a very strong and brilliant individual who had no notion about how to work in a large corporation populated by people with strong egos and conflicting agendas. It wasn't that she had contempt for business politics - she was oblivious to it.

When I met her, she was wearing a long, flower-patterned, silk tent dress that looked as if it could be worn by the owner of a bed and breakfast in Big Sur, California. She wore a Mickey Mouse watch, but not just any Mickey Mouse watch: It was an expensive and rare specimen, one of many in her vast collection. In contrast, her peers wore designer suits from New York and Paris.

The difficulty in an executive coaching intervention is almost never in discovering the problem. It lies, rather, in presenting it to the executive being coached in a way that:

• The executive recognizes it as a problem.
• The executive understands that she can do something about it.
• The executive is committed enough to make deep and lasting changes.

The changes are intended to generate the products of coaching, which are that:

• The client emerges as a long-term excellent performer.
• The client can later continuously improve independent of the coach.
• The client adopts self-corrective behavior.

These products go well beyond simply solving a particular problem or reaching a specific goal. They leave the client able to solve subsequent problems and achieve future goals. All this must be accomplished in a way that makes the executive client feel fulfilled; otherwise, she will seek employment elsewhere.

It was apparent that the executive leadership of this company faced a major dilemma. It desperately needed the expertise of Dr. Chris, but individually and collectively could not tolerate her style. Intellectually, they appreciated her work, but in a visceral, somatic, emotional way, they were deeply offended by her lack of sensitivity to their rituals and mores. And from a practical standpoint, they did not have the individual skills to resolve this conflict themselves or even articulate it.

For her part, Dr. Chris simply noticed that her boss did not want to spend time with her, and that people looked a little bit put off by her in meetings. She did not have the observational distinctions necessary to succeed in a corporate culture. I could see both sides of this problem, and took my challenge to be to make the following critical connections:

Connection #1: From presenting the problem to its actual behavioral manifestations.

Connection #2: From the observed behavior to understanding the origination of the behavior. This requires the use of a cogent coaching model.

Connection #3: From the assessment model to a successful presentation of the situation. Successful means that the executive client views the problem as resolvable, sees what she could do to bring about what she intends to accomplish, and is enthusiastic and committed to the program.

Connection #4: Between the presentation and new "practices." This is behavior which the client continues to repeat, with the intention to improve. Practices are carried out according to set standards, and corrected according to those standards. The central position of practices in coaching rests upon the undeniable tenet that all lasting human change must be biological. Practices are what take insights and translate them into competence by having them become somatic. (Think about how you learn to drive a car or to play tennis or piano, or even how you learn to follow a complex conversation. In all these cases, your responses have to be immediate and cannot be interrupted by analytical thought. Spontaneous response in a learned activity is exclusively the product of practice.)

The flow of these connections must be seamless. The executive client must see that by taking on these practices, the difficulty will be resolved, and what was seen in the assessment will be addressed. In other words, the coach must design this flow in a way such that the executive client has insight into a new gestalt. The power of the program comes from building upon this insight with efficacious practices that fit in a unique way with the temperament of the client and the environment in which she finds herself.

In this case we're talking about, I used the following model, drawn from the work of Jürgen Habermas, a contemporary German philosopher and social theorist. I selected this model for its clarity and because, as a scientist, Dr. Chris could appreciate the categories employed in it. Diagram # 2 shows the model with explanation.

I drew the "I-We-It" triangle on an easel pad, and explained each domain to Dr. Chris. I then emphasized that competence in each domain was essential for executive success. Based upon my day of observing her, I cited specific examples of her competence in each domain. Then I zeroed in on the "We" domain, which constituted the real problem.

The Foreign
Culture Analogy

I pointed out that each "We" domain is a culture analogous to a national culture, and that when we visit another country (which Dr. Chris had frequently done), we can inadvertently insult people by ignoring their customs or way of living. This is the case even when the people we're visiting are kind and accepting.

She started to make connections between her entering this "foreign culture" of the insurance company and what it was like for her when she visited European nations. She asked, "You mean that every time I dress like this, everybody around me is feeling insulted, even if they don't say it, and maybe can't even tell so themselves?" "Yep," I said.

I then used a new metaphor for the "We" domain. I said that the "We" domain is like a human body that will defend itself against anything that it considers to be "Not Me." The auto-immune response consists of rejecting the offending substance by expelling it or neutralizing it. And, given that the insurance company considered her to be a foreign substance, the auto-immune response was being triggered here. "Yikes!" she said. "What can we do about this?"

At that point, I knew that I had made all the critical connections noted above. She could see how the observations and assessment model being employed shed light on her difficulties in a way that she could correct. I took a sigh of relief, because I in no way wanted to insult this brilliant woman, nor did I want to dilute the truth of what I had observed.

She was fully open to the practices I suggested. They consisted of new ways of presenting herself and new ways of conversing. She also took on a practice of building alliances, studying the history of the organization, and eliciting support. These were not new practices to her, since she had done the same things when she traveled.

She took immediate and strong action, and almost immediately stemmed the tide of opinion that had been turning against her. People began to feel more comfortable working around her. Her support coalesced, and she went on to great success in developing and publishing best practices for the most frequently occurring syndromes. There were bumps on the road, of course, but we returned continually to the "I-We-It" model, and, after a while, Dr. Chris could diagnose her own difficulty and take effective action.

In sum, the task of an executive coach is initially and primarily one of being able to dispassionately observe, and then cogently design corrective practices based upon what is observed for a unique individual in a particular environment.

Bibliography

• Flaherty, James J. Coaching: Evoking Excellence in Others. Norton, MA: Butterworth-Heinemann, 1999.
• McCarthy, Thomas. The Critical Theory of Jürgen Habermas. Cambridge, MA: The MIT Press, 1978.
• Varela, Francisco J., Evan Thompson, and Eleanor Rosch. The Embodied Mind. Cambridge, MA: The MIT Press, 1993.
• Wilber, Ken. Sex, Ecology, Spirituality. Boston, MA: Shambhala, 1995.