Discussion

6Discussion

This chapter brings together some of the emerging themes from the case studies and explores them in more depth. Topics that have their roots in professional mentoring are also included. The discussion is not meant to provide definitive answers but to expand the issues and promote reflection. The aim is to provoke thinking.

The book was written with the intention of showcasing practical applications of mentoring within dentistry in the UK. We feel it’s time to stop paying lip service to mentoring, coaching, and reflective practise. The time is right to re‐energise these core skills and ensure they form a solid foundation for quality relationships within the profession. In this way, the authors believe standards will be raised at individual, practice, and organisational levels, across the profession. We believe that many of the lessons learned here are also applicable across the wider healthcare professions as well.

To quote the EMCC (2020): ‘Coaching is the best methodology to create awareness about any resistance for change. … Mentoring has proven to be an effective catalyst for change…’

The dental profession has so much to offer; yet sometimes it can appear that its’ status and power is diminished as the ‘Cinderella’ service in health prevention, treatment, and care. The global pandemic of Covid‐19 has illuminated the considerable strengths, flexibility, and transferable skills of dentistry, as well as the significant demands placed upon it.

Talking with medical professionals on the front line of emergency care shows how important it is for everyone to stay focused in their use of PPE: hour after hour. Dental professionals redeployed during the first wave of the pandemic have proved themselves to be exemplary in this area because it’s an approach to practise that they are well used to. Their focus and attention to detail make them role models for systematic application of PPE, with a detailed focus on its correct use in different situations.

This is an argument for coaches and mentors to spread their wings outside the profession, as well as raising standards within it. The factors described in the case studies, for example, are not solely confined to the domain of dentistry. We argue that dental professionals benefit greatly from shared learning across the wider health sectors, and wider coaching and mentoring professions and vice versa. This is reflected in our own experience of delivering education and training. The case studies also show how much the profession has to offer the wider coaching and mentoring community; for example, the topic of the six measurable steps of reflective practice in case study five.

By achieving recognised qualifications or credentials, such as the Post Graduate Certificate (from awarding bodies such as the CMI or the ILM) or from the ICF, dental professionals can apply their skills in other fields too. The more academic options (e.g. CMI, ILM) support the critical thinking relevant to the development of a mentoring and coaching service to professional standards; helping define policy and support the professionalism which the GDC demands. ICF and similar credentials focus more on the skills of a coach and their practical application. For dental professionals looking at coaching and mentoring as a future career option, or as part of their professional portfolio, these routes are flexible and not mutually‐exclusive, which supports better career choices.

Beyond One‐to‐One: Coaching and Mentoring Groups and Teams

Over the years delivering training in coaching and mentoring, we invite participants to plan how they will apply these skills, and to reflect on how they best work in the professional environment.

While coaching or mentoring may have started as a dialogue between two people, it quickly became much more: whether reflecting the greater need for communication, collaboration, and alignment between colleagues. Taking into account financial drivers, one to many coaching and mentoring sessions are now an accepted format.

Group Coaching and Mentoring

Group coaching and mentoring is for people who aren’t necessarily part of the same organisation or team, although they can be. They do not share, necessarily, the same personal goals, but come together to benefit from the coaching and mentoring experience.

For example, a group of dental professionals may have the profession in common yet have very different career aspirations: to take their careers forward in speciality, practice ownership or corporate environments. In these situations, group coaching can be a way of validating, acknowledging, and supporting peoples’ aspirations – especially if there is no family or cultural background in the profession. Coaching questions can support people to focus on their goals, values, and development gaps, to help them make those aspirations a reality.

Group mentoring can offer real‐life examples and ideas for ways to grow an individual’s career; for people to share ideas and explore the pros and cons.

Group sessions also support peer learning: providing the peer motivation and encouragement that a one‐to‐one session lacks.

Group coaching and mentoring is a valuable experience particularly as a way to introduce people to the concepts and experience of coaching/mentoring. Taster sessions in groups like this help demonstrate that it’s possible to discuss even sensitive subjects in a safe space. Focused on individual aspirations and goals more than team coaching (discussed below), in our experience, many people who first encounter coaching or mentoring in a group, find it easier to ask for one‐to‐one support too, and to work better in teams where coaching and mentoring is offered.

Team Coaching and Mentoring: Shared Goals and Direction

Team coaching refers to people who share a common task, goal or direction; whether they work together in the same location, share a common boss, or are coming together for a project, with the intention of achieving a specific goal.

Less focused on individual aspirations than group coaching or mentoring, team coaching also involves leadership: its vision, shared values, and team development. The power of the team can be unleashed when coaching, using reflective practise and action learning, and all can turn aspirations into a successful reality.

Often, while teams talk the rhetoric of ‘plan, do, review’ for team projects, most of the time is spent ‘doing’ with the plan phase under‐valued and the ‘review’ stage reserved for exploring ‘what went wrong and who’s to blame?’

Team coaching and mentoring is an investment in future success; it helps pull the team together and head towards the goal, as well as creating a strong bond between team members.

Team coaching is, however, a specialist coaching and mentoring activity, demanding an understanding of team dynamics, and balancing the tasks with the team’s social cohesion and an understanding of leadership coaching – such that every member of the team realises their potential.

For example, collaboration and communications are easy terms to pay lip service to, yet team coaching needs to address issues like co‐operation versus competition; the giving or withholding of information; shared plans, lived values, and so on.

Team mentoring gives team members the opportunity to get help and support for their roles, but sometimes it takes courage to do this in a team environment. Where bosses or managers lead by example, and are transparent about their own involvement with coaching and mentoring, team members find it easier to engage with these activities.

Coaching in Virtual Environments

The sudden transfer to virtual environments, such as ‘voice over internet’ audio or video calls, during the initial stages of the COVID‐19 pandemic, hastened the already‐popular use of these systems for coaching and mentoring.

In the days before video calling was ubiquitous, many coaches would say that they had never ‘met’ their coaching clients in person. Face to face meetings, whilst desirable, are not essential in the mentoring/coaching process. The skills of receptive listening, reflecting, asking questions, and offering support do not demand in‐person meetings, and coaching is highly effective without them.

Mentoring benefits from in‐person contact, with activities like work‐shadowing, demonstrating technique or other activities – although Soumya and Ramachandra (2011) tell us that ‘technological advances are helping change the way students learn’. The haptics technology allows students not only to ‘treat a virtual patient’, but also to receive objective feedback about the procedure during and after the ‘treatment session’. ‘Virtual environments are impacting traditional methods of direct contact mentoring and methods of delivery’. This also depends on the particular type of mentoring that is provided. For example, in our experience career mentoring can be successfully provided using remote methods.

What people value most is the empathy, trust, and safety of the coaching and mentoring conversations; the feeling that someone believes in their capabilities and potential. These are not confined to in‐person conversations, and can be built in other ways – both visually and by telephone.

Coaching in Organisations: Organisational Dynamics, Does Size Matter?

The dental profession has changed dramatically in recent years. It reflects four global revolutions in technological advancement: in information technology (IT), energy, manufacturing, and the wider Life Sciences sector. Not forgetting the rise in dental bodies corporate. Each of these revolutions will impact the dental profession in some way, and probably more rapidly than we think. For example, new methods of manufacturing, such as 3D printing, has already arrived in many dental technician laboratories and dental practices, which in turn creates a focus on the costs of, and access to, energy.

Since the expansion of the dental corporates in the UK, the definition of what it means to be a dental practice has also changed radically. Whilst the possibility of improved purchasing power and capital investment makes these organisations more viable, the risk is the loss of personalised care and the influence on professional autonomy.

Coaching to develop people skills and improve staff management; to create better leaders are all possible within the organisational coaching context. Supporting people to see that today’s leadership now comes from influence, rather than control; that there is more than one agenda at play – with competing priorities – makes leadership and management more confusing. Many dental professionals, used to the traditional practice working environment, may struggle with this shift in focus and priorities; coaching and mentoring to support people through change is a key intervention.

Coaching and Mentoring Boundaries

Coaching and mentoring has the potential to raise standards at individual, practice, and organisational levels, yet there are boundaries to consider and these interventions are not a magic solution to every issue.

For example, coaching a member of staff is not a substitute for a manager’s clear target setting, performance management, and direction. Nor does it absolve anyone of communicating clear information or taking difficult decisions. A coach or mentor may support the thinking process behind a decision, but the responsibility for taking, and communicating, a decision, lies with the coachee/mentee themselves.

Some writers, e.g. Goleman et al. (2002) describe coaching as a ‘leadership style’ and the authors themselves teach coaching for managers to use it as an additional skill set to improve people‐management behaviours.

But there are times when coaching or mentoring are not appropriate: for example, the ICF identifies the imbalance of power between a manager and a direct report. In this situation, where there are common drivers, whether that’s a financial target, a deadline or a rulebook; there may be conflicts of interest. This means that managers can be ‘coach‐like’ but are not operating as independent, objective, professional coaches.

The good news is that dental professionals are typically used to reflecting on ethical issues and potential, or actual, conflicts of interest. Knowing one’s own professional boundaries – what one is trained, equipped, qualified, and experienced to do – makes it easier to identify those activities outside of one’s competence.

The typical discussion area we cover in our training programmes are the boundaries between the therapeutic talking professions, such as counselling, psychotherapy, and so on, and coaching and mentoring. The simple response is that coaching is rooted in the recent past and the present, with an emphasis on desired future outcomes. It does not typically explore the distant past (e.g. ‘childhood’), but may use the past to find examples of issues and challenges to change future behaviours. Mentoring uses the past as a valuable resource of personal and professional experience on the part of the mentor with the hope that this may be of value to the mentee in the future.

Good mental health and wellbeing is vital, and many coaching and mentoring clients will also seek support from mental health professionals, at the same time as pursuing a coaching programme. The two are not mutually‐exclusive.

What our coaching and mentoring students often express is a concern that ‘coaching for emotions’ is akin to therapy. There’s a key distinction to be made here: when we are receptively listening to people, that’s a natural human behaviour. The training we receive to listen well and be open and receptive to others is an enhancement of something we already do, quite regularly, and naturally. Whenever we discuss things of importance, we’ll share details. We’ll also share how we feel about the topic. We may also speculate on how others are feeling too. Again, these are all natural parts of a normal, everyday conversation.

Learning coaching and mentoring skills is simply using our receptivity, our listening skills, our presence, our supportive attitude, to pay extra attention to what someone is trying to achieve, through what they are saying (and how they say it). It may feel like a great conversation, boosting confidence; we may feel like we are expressing anger, frustration or other concerns – because our emotions are engaged in the conversation. Learning to be a better coach or mentor is simply learning how to engage, positively, with other peoples’ feelings and help them see how these are having an impact – whether for good or otherwise. It’s a powerful and extremely helpful skill to develop, without crossing any professional boundaries.

This is not to say that, when creating a coaching and mentoring policy, we do not address the risk management issues; see case study ten, for an example of the thinking on this topic. Case studies one and nine also address the issue of the boundaries of coaching and mentoring, in their situations and context.

How and When to Use Coaching and Mentoring

Whether delivered in groups, teams or one‐to‐one, coaching, and mentoring enables professional growth through personalised learning. This means that it can be used at different times during a career, and in different ways, as the case studies show.

Over the last 20 years, the authors have identified a range of different situations where coaching and mentoring have been used successfully, some elements that support these conversations and some of the barriers that prevent them.

Word of mouth has been the single most powerful driver of coaching and mentoring: when someone experiences for themselves the benefits of having someone to take their goals, aspirations – and fears – seriously, and helps them find solutions, it can be a life‐changing experience. However, there are signs of a slow uptake of coaching and mentoring in the dental profession; see case study four, for example. The question arises of whether training in this field seems less relevant or tangible to dental professionals, who prefer CPD in technical or clinical fields and find it easier to see the relevance of those CPD activities. Or whether this is because dental professionals find it hard to ask for help, and perhaps doing that is stigmatised within the profession. Another possibility could be that we need to sharpen up our application and understanding of the term ‘mentoring’. Traditional understanding of mentoring as being the passing of knowledge and skill from one experienced practitioner to another could be interpreted as mentoring being simply giving advice. If this is the interpretation, then almost any experienced practitioner can be a mentor. Modern mentoring is so much more than giving advice, in fact that aspect has taken a back seat to the other skills that trained mentors can bring to a relationship. We need to value mentors and mentoring and not assume the role can be automatically undertaken without additional skills training.

It is as important to understand when and where coaching and/or mentoring might be relevant and helpful, as it is to know how to provide coaching and mentoring services well. The calls from within the profession for structured ‘peer support’, that offers skilled guidance at the local level, help set the framework for its greater use.

The role of professional organisations, like the ICF, Association of Coaching and EMCC, or qualification bodies, like the CMI or ILM in the UK, or universities that both teach coaching and mentoring and make it available to their own staff, have all helped define and shape the coaching and mentoring professions, making it accessible to a wider range of people and identifying what makes it work so well.

The rise of neuroscience has played its part too, as people understand the brain better, and appreciate how it learns. While our reptilian brain operates out of fear, or to fulfil immediate desires, our mammalian brain helps us nurture ourselves and others. It’s in this part of our brain – the ‘meaning making machine’ combining our rational thinking and our feelings – that deeper learning becomes embedded.

By creating learning cultures in organisations that celebrate reflective practice, productive conversations, and collaborative communication, we can all create a higher performance and learning environment for everyone.

Barriers to Introducing Coaching and Mentoring

Attitudinal Barriers

At their very best, dental teams are made up of highly qualified and well‐trained clinicians, support staff with people and practical skills and well‐run administrative systems. Yet these very systems and skills can be a barrier to personal and professional development.

If someone believes they ‘should’ be able to cope – despite the major and volatile change in today’s world, they will create their own barrier to seeking help and support. One theme arising across the case studies, is that of prevention, as well as early detection and addressing of issues of concern. Case studies six and seven particularly, consider these issues of prevention and supportive development.

If a fellow professional believes themselves and their colleagues ‘shouldn’t fail’, the support that is available will not be widely shared as a resource – whether through internal communication systems, or by word of mouth.

The introduction of coaching and mentoring services is not just about the practical organisational tasks, it’s also about the attitudes to these types of services. As a profession, dentistry needs to get past these outdated attitudes. To remove current stigmas around seeking help, a change of attitude is needed.

There’s also a positive element to this issue. Coaching and mentoring is not just about prevention of poor service, remediation when things go wrong or development to improve practise; it’s also about excellence.

Taking a positive approach is also the best way to break down stereotypes: whether that’s attitudes towards one part of the dental team, towards women, or people of colour. Holding limiting beliefs about peoples’ potential will hold back the whole team. Supporting up‐skilling across the team through career development plans for all our colleagues will naturally address traditional stereotyping. We’re none of us immune to bias, but we can look beyond the labels we place on ourselves and colleagues and move forward faster and more effectively.

At a time of rapid change in technology and life‐sciences, we can all play a part in developing new ways to improve peoples’ health and prevent disease; make treatments easier and more appealing and reduce the challenges and burdens of working within the dental profession that currently arise.

As a result of this innovation, new opportunities will arise for dental professionals to expand their skill base and work in new ways.

Structural Barriers

Having policies and systems that support coaching and mentoring is the first, most important step to removing structural barriers to coaching. Another typical barrier is finance: the fear of the cost of such programmes. While the evidence exists to demonstrate extremely high value returns on investment in coaching and mentoring, this barrier still remains.

Typical Benefits of Coaching and Mentoring

In our own unpublished findings (Forton 2020), for clients that have introduced a ‘coaching culture’, that is, have trained a number of people in coaching and mentoring skills to a suitable standard inside the organisation (with or without their achieving credentials or qualifications), a range of typical benefits have been identified:

• Recruitment and retention benefits – for example by providing induction programmes that include coaching and mentoring.
• Leadership development benefits – in the healthcare sector, the number of managers from medical backgrounds passed their leadership training sooner with coaching support.
• Cost savings – identifying – and winning – new income streams, cutting internal, and external costs, reducing overheads.
• Reductions in ‘grievances’ and employment litigation.
• Improved health and safety (e.g. measured by number of incident‐free days).
• Faster achievement of team and project goals, without loss of quality or ‘cutting corners’.

The case studies support reflective practise, self‐awareness, and critical thinking – all vital for independent professionals. The goals include helping reduce complaints and litigation, especially those career‐defining incidents that can easily be prevented, thus saving time, emotional strain, and money.

Impact of Coaching and Mentoring

Prevention

A consistent theme across the case studies is the impact of prevention of a range of issues, by, for example, raising awareness of the need for high standards, and by the early detection of – and addressing – issues quickly.

Neutralising

Coaching and mentoring can be used to reduce internal and external threats. Internally, it can de‐escalate conflict, which reduces management and human resource time, and the potential for legal costs. An external example is patient complaints, which not only cost time and money but drain people’s morale. Preventing and neutralising complaints improves staff and patient relationships.

Remediation

Everyone makes mistakes and coaching and mentoring can support fitness to practise issues and remediation, when the individual recognises, and is willing to act and make change. Mentoring can support the ‘how to’ and coaching approaches support reflective practice, or the ‘why’.

Performance Conversation

One of the conversations that supervisors, leaders, and managers find hardest, is to give constructive support and feedback. Learning to listen to staff members, encouraging reflection, and supporting success can have dramatic improvements and both coaching and mentoring approaches support this.

Development Conversation

Part of every performance conversation should include development, with the aim of achieving excellence. This is not just for the benefit of the individual, although taking an interest in people’s career goals supports engagement and loyalty, it has a business benefit too. Supporting people to see career options, whether to specialise or generalise, whether to stay in a clinical field or branch off into non‐clinical roles, these will all play to an individual’s strengths and are more likely to inspire motivation, innovation, and commitment.

Themes from the Case Studies

The following section reviews and shines a light on some of the key themes to emerge from the case studies. Whilst each case study describes a unique project they share some important messages. We have highlighted some take away messages from each theme at the end of each section.