When strategy and hypothesis are not enough… the importance of implementation

This month has seen me involved in some focussed work on designing a coaching intervention trial, offering collaborators the opportunity to contribute to the evidence base for the value of coaching to doctors.

The evidence for coaching in executive leadership and business have been well set out by the gurus of leadership coaching and need no rehearsal here (Daniel Goleman – The New Leaders), but the specific evidence for benefit to clinicians is less well developed despite publications in this area (a few selected references are listed below).

As with all research it is important to have a hypothesis – that is to say what does the study aim to prove; what is its strategic intent? Equally important to understand however, is how the hypothesis, if proven, will be implemented in the real world.

It’s this last question which got me thinking about some stark evidence presented at a meeting I attended over a year ago. It astounded me to discover that it takes up to 17 years for 14% of published evidence to translate into medical clinical practice! Seventeen years! It follows then, that if the impact of strategy (or in the context of a trial, the impact of a proven hypothesis) is to be of any value to the community it’s trying to serve, we have to consider the challenge of implementation at the outset of the project or study period.

We are of course talking here about how to achieve the widespread adoption of change at a systems level, and therefore, as I spend time thinking about the best trial design to examine the hypothesis that coaching interventions increase clinicians’ resilience and empathy, my mind is firmly on the definitions and questions in the table below.

The real challenge here, is how best to promote the widespread adoption of coaching practice into the clinical community, given that we hypothesise that coaching will be valuable and effective in the clinical setting.

Table: The Widespread Adoption of Change – Important Definitions and Caveats

These are sobering points to consider. Great strategy and vision go nowhere without implementation and for me the most important insight from this table is the capacity and the readiness of the target audience itself to make the change.

This is where the major difficulty lies. It’s not the efficacy of the intervention itself that is likely to be a stumbling block, but it’s the capacity and readiness of the clinical community and the systems which support them, to implement the change.

“Vision without action is merely a dream. Action without vision just passes the time. Vision with action can change the world”

Joel A Baker

Daniel Goleman, Richard Boyatzis and Annie Mckiee. The New Leaders.

Dyrbye, L. N et al. Effect of a professional coaching intervention on the well-being and distress of physicians. JAMA Internal Medicine, 2019. 179(10), 1406–1413.

Boyatzis, R et al. Competencies of Coaches that predict client behaviour change. Journal of Applied Behavioural Science 2024, Vol. 60(1) 19–49.

Table reproduced with permission Dr Simon Barry Cardiff