While your environment may not allow the time for a full coaching conversation, utilizing all of the tools and theories related to behavior change, you can take the “coach approach”, even in a short patient visit, with these tips in mind: 1. Be a Role Model. Engage in upgrading your personal health behaviors in order to walk the walk. Be patient and understanding in discussing how to change when change is hard. 2. Be Present. Give your undivided attention to a patient, not distracted by your thoughts, infinite to-do list, papers, or computer screen. Stop the clock for a few moments and cultivate a deep level of presence so that you listen with all of your brain’s resources. 3. Share Positive Emotions. Ask patients about what is going well in their lives, in their health, what they are enjoying most, what puts a spring in their steps, what they are most grateful for. Positive emotions improve the brain’s potential to learn, strategize, and find creative solutions for challenges. 4. Improve Self-Compassion. In our high-achieving culture, most people are highly critical of themselves, not accepting, judgmental, or compassionate toward their own suffering and failings, all of which assist in regulating negative emotions. Model self-compassion for your own suffering, and radiate compassion for the messiness of being human, and the many challenges that make it hard to take good care of one’s health. 5. Elicit Motivation. The bigger the why the easier the how. Help people dig deep to find what they treasure most about their lives and why health is an important resource, the means to what they desire most in life. 6. Improve Confidence. Motivation goes to sleep when confidence is low. Help patients articulate several ways that might work to overcome challenges, which builds confidence and hope. Whether you think you can, or think you can’t, you are right, says Henry Ford. 7. Welcome and Learn from Setbacks. Help patients adopt the growth mindset, not a success/fail or self-esteem based mindset. Every step is simply an experiment. Every result brings more learning. Problems are opportunities in work-clothes, said Henry Ford. 8. Foster Creativity. Brainstorm possibilities to overcome challenges in a light and playful manner in order to generate new ideas, the wilder the better until new energy and insights emerge. 9. Catalyze Insights. View your role as a catalyst of your patient’s insights, not the know-it-all expert. Facilitate the generation of insights through provocative open questions and creative reflections. Get out of sales and into fishing. 10. Set a behavioral goal. Help patients define and commit to a behavioral goal. Any action, even small behavioral steps, starts momentum for the change journey. It’s easier to change course when there is momentum than to overcome inertia.

We’ve all wanted to help friends or family members through a tough situation, right? Our hearts are in the right place; we truly want to make their lives better, easier. That’s a good thing – if we choose to help in a way that actually benefits them. Check out Kate Larsen’s blog on THE ARROGANCE OF FIXING PEOPLE.

In her article, “BASIC PITFALLS OF USING NVC,” Miki Kashtan reminds us of the importance of the spirit in this approach to communication. The practice of NVC, or Nonviolent Communication, is less about the “doing” of coaching and more about the “being” of coaching. When we get caught up in the mechanics of doing it, rather than the intention of the outcome, we may lose sight of the ultimate goal – compassion. In fact, many organizations and practitioners of NVC have moved away from the language of “nonviolence” to using “compassionate communication”.  That better describes what we are moving toward as coaches, rather than what we are moving away from. As described on the Center for Nonviolent Communication WEBSITE: NVC is the natural state of compassion when no violence is present in the heart. NVC reminds us what we already instinctively know about how good it feels to authentically connect to another human being. With NVC we learn to hear our own deeper needs and those of others. Through its emphasis on deep listening—to ourselves as well as others—NVC helps us discover the depth of our own compassion. If you are a coach who is new to “practicing” compassionate communication, we encourage you to begin with the intention to connect. Far more meaningful than the how of the methodology (identifying feelings, needs, strategies and observations), is the why of it. Use introspection to center your focus on deepening your listening as pathway to connection: – What is alive for me as I approach this coaching conversation? – What am I feeling? – What can I do to have my needs met so that I may shift focus to the needs of my client? – How can I honor my clients feelings throughout our conversation? – What is my intention?

“The human soul doesn’t want to be advised or fixed or saved. It simply wants to be witnessed — to be seen, heard and companioned exactly as it is. When we make that kind of deep bow to the soul of a suffering person, our respect reinforces the soul’s healing resources, the only resources that can help the sufferer make it through.” – Parker Palmer Read more from Parker Palmer in THE GIFT OF PRESENCE, THE PERILS OF ADVICE. For consideration: How can you make a deep bow to your clients? What resources does your client have that deserve great honor? How does your desire to “fix” undermine the needs of your client?

Are you burned out? Margaret Moore explores burnout, and physician burnout, in Institute of Coaching July 2016 coaching report: OW.LY/PP3R301ZESS

In addition to a reliance on a breadth and depth of psychological theories on behavior change, our coaching protocols also honor what we can learn from other disciplines, such as design and innovation. In reviewing Fast Company’s recent article on the concepts of design, SEVEN ESSENTIALS FROM THE HARVARD INNOVATION LAB, there are many principles which overlap with a masterful coach approach. 1. “Be A Sponge…Innovators are intellectually curious and thrive on absorbing new information that may help their ideas.” Curiosity is also one of the most important ingredients to great coaching – both in coach and client. It begins with the coach putting aside assumptions about who the client is and what the client can do, which supports the client in being more curious in the exploration of who they are and what they are capable of. 2. “Narrow Is A Good Place To Start…If you want to lay the groundwork for a big idea, focus on developing one segment of it until it has strong roots.”  Yes, coaching encourages the visioning of large, compelling outcomes.  And, we also acknowledge that a bridge to those outcomes must be built upon actionable goals that are grounded in a client’s competence and confidence. 3. “Ideas Are Great—But Execution Is What Matters…the real opportunity for innovation lies in how you make it happen.” Building a client’s competence and confidence comes from designing goals that have a clear and measurable outcome which deeply explore the support and structures needed to succeed. We ask, “What are people, places, things, habits and mindsets needed to achieve the outcome you want?” and then gather those resources for execution. 4.”Getting Better Is Messy…being creative and innovative means that you’re going to try many things that don’t work.”And, even the best laid plans can’t predict all of the pitfalls of experimenting with new behaviors. This is why we treat “goals” as “experiments”, each test an opportunity to observe, learn, adjust and try again. As coaches, we are collaborative designers and architectural partners in our client’s lives, ensuring the scaffolding is place to build the pathway to the client’s dreams.

OUTCOMES ACROSS THE VALUE CHAIN is a peer-reviewed article published in July 2016 examining a corporate wellness intervention for over 150,000 employees.  Health coaching was offered only to those employees at greater risk meaning about 49,500 were eligible.  After learning about health coaching about half decided to give it a try and of these 78% (~19,800) completed the recommended four coaching sessions within one year. The program was highly successful with coached participants significantly (p < .05) improving: •    Systolic and diastolic blood pressure •    BMI •    LDL-cholesterol, triglycerides, and glucose •    Absenteeism and employment termination (involuntary or voluntary) •    Medical utilization (emergency room visits, hospital admission, and hospital lengths of stay) •    Medical costs Besides reporting these tremendous outcome improvements after coaching, the authors created a unique system of health engagement to classify participants.  They considered high engagement as regular health coaching, education, and goal achievement while low engagement involved a lesser experience with these practices.  In other words, high engagement meant fully buying into behavior change activities and succeeding at the process. At the study’s end, nearly 15,500 participants were classified as high engagers.  It should be no surprise that high engagers got the best results averaging 3.9% better (one-year change scores) improvement than controls across all 33 outcome variables measured. This study was very impressive not only because of participant number (nearly 20,000 making it the largest-ever study of coaching) and great outcomes, but also what we can learn from how coaching participants were selected and categorized.  Employees who had the most to gain, and who became fully engaged in the coaching and behavior change processes, were most successful in this wellness program.   Such an interpretation of these findings might inform both large employers and individuals (as well as health and wellness coaches) about who is ready to become invested in the coaching process. Whether you are working with a big company or a single client, here are some important take-away points from this landmark study that might help you: •    Largest peer-reviewed study of health and wellness coaching published to date •    Significant improvements in nearly all of 33 outcome variables (including medical costs and employee turnover) for high engagers over one year (see the citation for all variables1) •    Only high-risk employees were offered health coaching and not all of these were ready to make change (nearly 65% of those initially interested in coaching turned into high engagers) •    Those who fully engaged in the behavior change process produced the best results •    If an employee/client is not prepared to fully engage then coaching may not be as effective as it otherwise might be – consider first investing in those with the best likelihood of success •    Measurement of Readiness-to-Change (Transtheoretical Model) may be a key predictor of client success in the coaching process (but this hypothesis awaits confirmation from future research) Listen to a WEBINAR REGARDING THE RESEARCH. Outcomes Across the Value Chain for a Comprehensive Employee Health and Wellness Intervention A Cohort Study by Degrees of Health Engagement D. Adam Long, PhD, Roger W. Reed, BSN, and Ian Duncan, B Phil J Occup Environ Med. 2016 Jul;58(7):696-706 DOI: 10.1097/JOM.0000000000000765.

Join Margaret Moore and Eddie Phillips for their Harvard Health book launch event, SEPTEMBER 8, AT THE HARVARD COOP. Their  book, ORGANIZE YOUR EMOTIONS, OPTIMIZE YOUR LIFE, will be released on September 6 by publisher William Morrow. Read the INTRODUCTION AND FIRST CHAPTER NOW.

We learned from the Oscar-winning Pixar movie, Inside Out , that multiplicity of mind is natural and normal. In my 2013 paper: COACHING THE MULTIPLICITY OF MIND, A STRENGTHS-BASED APPROACH, I proposed a new model of the human psyche that is an adult version of Inside Out , positing that the human psyche has nine internal life forces, speaking as our inner “voices,” with distinct agendas including needs, values, and capacities. Our emotions then operate as a sensory system signaling whether the agendas of each life force are being served (generating positive emotions) or not served (generating negative emotions). I am on a mission to organize my inner dialogue and emotions and then help others do the same. I arrived at this model via my own deep personal work as a student of internal family systems practice, a therapeutic approach that teaches one how to discern among and tune into unique inner voices. I’ve confirmed the presence of nine common voices with hundreds of clients and shared the model in the co-authored Harvard Health book, ORGANIZE YOUR EMOTIONS, OPTIMIZE YOUR LIFE . Every morning, I do a roll call tuning into each of the nine voices and decoding the mixed emotional weather report served up before breakfast. I then start the day fresh with new insights, and more peace, calm, and equanimity. What I want to share with you today is a next iteration of this work, which is to suggest that there are healthy, counterbalancing, Yang (controlling) and Yin (letting go) states of each of the nine life forces. It’s important that coaches tap into the optimal state of each “subpersonality” during coaching sessions. This is what I mean by this blog’s title: A Coach’s Mind: Inside Out . Let’s take a spin and see how this might work. 1. Let’s start with the voice of Autonomy. This life force is the captain of the proverbial human ship. It is concerned most about marching to our own drummers, being authentic and free to make the choices which best serve our values and interests, and control our destiny. As Sammy Davis Jr. sang beautifully, “I gotta be me.” Autonomy is the master of self-interest first, prone to rebelling when others, particularly those who do not “get us” or share our values, tell us what to do. Decades of research led by psychologists Ed Deci and Rich Ryan has identified autonomy as the primary, organismic drive of humans. Coach’s Mind: A Yin state of Autonomy. Put self-interests aside and support another’s autonomy. A Yang state of Autonomy : Be in control, be right, have things go our way. 2. Let’s tune into the Relational voice who exists to serve others and puts others first, showing genuine empathy and concern. The Relational helps others thrive and perform at their best. Having high social and emotional intelligence, the Relational is a team-player and knows how to build win-win relationships, collaborations, and partnerships. Being loyal and trustworthy are high priorities. Coach’s Mind: A Yang state of Relational: to serve others, put others first, tune completely into others’ interests and states. A Yin state of Relational: Let go of putting others first, pleasing or avoiding conflict with others. 3. The next voice is the Standard Setter, is responsible for internal standards of performance and achievement, setting ambitious goals and meeting them. It is concerned with self-worth. It also tracks external standards to make sure we are valued, get respect and validation, and we are treated fairly .  It can be a hard taskmaster, a tough (inner) critic. It makes us persist through ups and downs to accomplish big things. It cares about what others think, concerned with social comparison, and wears whatever mask is needed to get social validation and approval. Coach’s Mind: A Yin state of the Standard Setter. Let go of personal achieving or winning. Let go of judging and criticizing ourselves and others. Tune into humility. A Yang state of the Standard Setter: Set ambitious goals, compete, perform, persevere, and win. Criticize and judge performance, ours and others. 4. Now onto the voice of Confidence, dedicated to being strong, competent and confident. It is the lion on the team, showing off its knowledge and skill. Hope and optimism spring from confidence in oneself and others relative to the challenges ahead. Confidence (or lack of), which can result from a too-high performance standard be next up, the Standard Setter, can lead us to procrastinate and suffer from self-doubt. Coach’s Mind: A Yin state of Confidence. Let go of demonstrating competence and power. Support building of competence and confidence of others. A Yang State of Confidence: Show competence, prove knowledge and skills. Show how strong and powerful we are. 5. Enter the voice of the Adventurer, the fearless explorer, tuning into opportunities, realities, and surprises in the internal and external world with an open and curious mind. Enjoying novelty, the Adventurer is deeply inquisitive, welcoming and embracing change and risk. It’s ever-ready supply of curious energy is a big source of resilience when things don’t go well, helping us recover and adapt quickly. Coach’s Mind: A Yang state of the Adventurer, open-minded and curious, in wide open receive mode and not active send mode. Exploring, taking risks, pursuing change. A Yin state of the Adventurer: Let go of curiosity, novelty, risk taking, and pursuit of change. 6. Let’s check in with the Creative voice which loves to play, to generate, to create and invent. It functions well in chaos and enjoys spontaneity, finding brilliant ideas just in time. The Creative life force delivers out-of-the-box approaches and innovations, with a good dose of creative humor, to help address enormous challenges. Coach’s Mind: The Yang state of the Creative . Foster emergent and collaborative spontaneity, nonlinear thinking, and creativity. The Yin state of the Creative: Switch off or turn down creative impulses. 7. The Executive Manager is the voice of your inner organizer, planner, analyst and strategist. Juggling many balls in parallel, the Executive Manager can stay clear and calm in the face of an overwhelming volume of demands. It can synthesize massive amounts of data into an integrated solution. Getting to the bottom line, it can distil a situation into its bullet points, bringing order to chaos over and over and over. Coach’s Mind: A Yang state of the Executive Manager. Help others discover more clarity and order. A Yin state of the Executive Manager: Switch off or turn down need for clarity and order. 8. Second to last is the voice of the Body Regulator, focused on safety, stability, and balance, including physical and mental health. The Body Regulator is down-to-earth and grounded. It values sustainability, for self, others, and our planet. A Coach’s Mind: A Yin state of the Body Regulator. Let go of stability and homeostasis. Embrace imbalance. A Yang state of the Body Regulator: Stability, homeostasis, and balance. 9. Last is the voice of the Meaning Maker, which stands back and tunes into meaning and purpose, zooming in to consider the import of a small moment or zooming out to find patterns and make sense of large moments. It channels the greater good, the transcendent or spiritual dimension, asking “what is the larger lesson of this situation?” The Meaning Maker is the wise mentor, mature sage, and inner coach, offering gratitude and awe, nudging us to consider all perspectives. Then it offers the wisdom hiding behind agitation, just what is needed for this moment. A Coach’s Mind: A Yang state of Meaning Maker: seek higher purpose, a transcendent perspective, awe and gratitude. A Yin state of Meaning Maker: Switch off or turn down making of meaning and seeking or purpose. As you will have noted, I am suggesting that the Coach’s Mind draws on the “Yang” states of the Relational, Adventurer, Creative, Executive Manager, and Meaning-Maker, and the “Yin” states of Autonomy, Standard Setter, Confidence, and Body Regulator. Originally published by the Institute of Coaching: HTTP://WWW.INSTITUTEOFCOACHING.ORG/BLOGS/COACHS-MIND-INSIDE-OUT

Our UNDERSTANDING of the human mind, including where it came from, it’s true NATURE, and how it works and evolves, is primitive. In the absence of scientific understanding, the lexicons for MINDFULNESS and MEDITATION are rich with evocative metaphors. We search for perfect images or words to describe or evoke various experiences and BRAIN STATES that free us even for a few moments from the messiness of being human. Now pop stars are calling us in cool ways to calm and clear our minds: “IT’S ALL ABOUT THE BREATH,” “FEEL THIS MOMENT.” In MINDFULNESS PRACTICES we sit in the here and now and gently watch the passing inside weather. Thought clouds or windy surges of emotions rush in and pass by. Unhooking from the inner weather leads to experiencing the moment fully. You may also get occasional glimpses of a stillness of being, resonating with the sky behind the clouds. Quantum biologists call this resting energy state, recently shown to be widely prevalent in biological molecules, “QUANTUM CRITICALITY.” Daoists call it “Dao,” a pervasive stillness of the individual and collective consciousness. While I cherish tuning into the moment and even an empty state of mind, I have always felt a nagging dissatisfaction with letting thoughts and emotions go. I am curious about the nature of the thought clouds, windy emotions, and the ever-changing emotional weather report. Judy Collins captures my sentiments in her song BOTH SIDES NOW: I’ve looked at clouds from both sides now From up and down and still somehow It’s cloud’s illusions I recall I really don’t know clouds at all A yearning to understand the inner clouds and windy emotions led me on a journey four years ago to “turn the lights on” in my inner world, starting with study of INTERNAL FAMILY SYSTEMS (IFS) practice developed by Dick Schwartz. In the IFS model, which is focused on healing, the mindful mind, or “self,” witnesses and orchestrates an internal family of “parts” or subpersonalities that are the source of thoughts, emotions, and behaviors, healthy and unhealthy. As a biologist (17-year CAREER in biotechnology), immersed in the awe-inspiring order of mother nature, I was certain that there is a strengths-based scaffolding for the internal family. Gradually I unpacked and organized my inner world. I found nine independent life forces or characters, now depicted as MY PERSONAL EMOJIS. To convey this experience, I published a hypothesis paper: COACHING THE MULTIPLICITY OF MIND: A STRENGTHS-BASED APPROACH, followed by a new Harvard HEALTH book, ORGANIZE YOUR EMOTIONS, OPTIMIZE YOUR LIFE, co-authored with Harvard physician Eddie Phillips, and writer John Hanc. For four years I have done a daily roll call as my early morning mindfulness practice, which decodes my emotional weather report and brings some clarity and calm. I have taught the practice to hundreds of COACHING clients, helping them tune into a “radio frequency” of each life force. Now I use the metaphor of a solar system; I experience the psyche as having a sun at the “core” and eight planets, each in its own unique orbit. My mind seems like the energy field of a solar system. When I want to quiet my mind I ask my “planets” to go out to orbit, like sending kids out to play, so I can have a quiet moment. In my flights of imagination, I wonder whether the solar system is the source of elements and energy forms and states that self-organized on earth into life forms, and four billion years later, populate our minds. Now we are back to a metaphor and a question: Is there a solar system in the mind’s sky?

Originally printed in Family Circle, October 2016 If you’re arguing with your partner… Take a step back and consider what needs your mate may believe are not being met. It’s likely one of you is feeling a little controlled or neglected. Talk things out with compassion to address what requires more attention. When you have a large project looming at work… Figure out what must get done today and successfully tackle it so you build momentum to keep going Pause for mental breaks to reboot your focus, and think about what the task means to you so you’ll feel re-energized. If you’re overwhelmed with family tasks… Seek outside help and be honest with your kids, explaining that while you would do anything for them, you need some time for self-care They’ll understand and you’ll teach them about balance and personal preservation.

The story goes: a prominent thinker, perhaps William James or Bertrand Russell, delivered a lecture on the nature of the solar system. In response, an elderly woman proposed an alternate theory, that the world is flat, sitting on a turtle, and it is turtles all the way down. Her wacky notion has a kernel of wisdom for leaders in healthcare today. The emerging profession of coaching in healthcare is well on its way to identifying the “turtles,” the mechanisms of coaching that ignite and foster personal engagement in healthy living (1, 2, 3, 4), giving us the resources to perform at our best. What we wrote in a 2006 white paper: THE OBESITY EPIDEMIC, A CONFIDENCE CRISIS CALLING FOR PROFESSIONAL COACHES, is standing the test of time. Health and wellness coaches (5), and the deployment of coaching techniques by health providers, are contributing to population health by: accepting and meeting us where we are today asking us to take charge, take hold of the steering wheel of our lives helping us define a higher purpose for well-being helping us uncover our natural impulse to be well guiding us in doing the mindful thinking and doing work that builds confidence helping us tap into our innate fighting spirit addressing mental and physical health together helping us draw a personal blueprint for well-being helping us set realistic goals; small victories lay the foundation for self-efficacy harnessing our strengths to overcome our obstacles helping us view challenges as opportunities to learn and grow helping us build a support team inspiring and challenging us to go beyond what we would do alone. Population health is our destiny. It’s time to lead. Let’s go first. While we have no map yet to guide us toward successful healthcare reform, perhaps better described as transformation, there is no doubt as to our destination. Population health is our destiny. To lead in healthcare then is to coach ourselves and all we serve, including providers and patients, to cultivate personal health and well-being. Going first means that the first population to get healthy is the population of healthcare workers who take great care of those whose health is compromised. At a recent HARVARD MEDICAL SCHOOL CONFERENCE FOR WOMEN HEALTHCARE LEADERS, I presented on coaching in healthcare, proposing that population health depends on a coaching culture in healthcare (6) from top to bottom: A culture where one’s own self-determination is well served by investing in the self-determination of others. A culture that transforms burnout into full engagement in well-being. A culture that is accepting and empathetic while inspiring autonomy and heartfelt purpose. A culture that draws out the intrinsic motivation of leaders, providers, and patients, and pours the energy into building confidence and habits of well-being. A culture of well-being that unleashes the adventurous and creative forces that will power us toward the transformation of healthcare. Our best path to the triple aim (7) is not just reform, fixing what’s not working. Let’s unleash a triple aim of human biology. Connect. Grow. Thrive. At its simplest, the recipe for a coaching culture is based on eliciting that which makes humans thrive, which then unleashes our most innovative, adventurous, and purposeful minds. Start with a genuine “I have your back” (8) connection, then add the ingredients that help people grow and engage in the habits that generate more thriving (9). Leaders, providers, and patients will begin to thrive in more moments, more hours, days, and maybe the rest of our lives. Then we are on the way to transforming healthcare. Harvard physician JULIE SILVER, who organized the conference for women healthcare leaders, started #QUOTEHER, and called on us to be more visible by contributing our own quotes. Here are three “Coach Meg” quotes, my call to action for coaching in healthcare. In healthcare, it’s coaching all the way down. Population health is our destiny. It is time to lead. Let’s go first. Engage biology’s triple aim. Connect. Grow. Thrive. References & Resources 1. Moore, Boothroyd. 2006. THE OBESITY EPIDEMIC: A CONFIDENCE CRISIS CALLING FOR PROFESSIONAL COACHES. White paper published by Wellcoaches Corporation. 2. Wolever et al. 2013. A SYSTEMATIC REVIEW OF THE LITERATURE ON HEALTH AND WELLNESS COACHING. Global Advances in Health and Medicine. 3. INSTITUTE OF COACHING, McLean Hospital, a Harvard Medical School affiliate 4. Moore, Jackson, Tschannen-Moran. 2015. COACHING PSYCHOLOGY MANUAL. Endorsed by the American College of Sports Medicine and published by Wolters Kluwer. 5. PRESS RELEASE announcing partnership of National Consortium for Credentialing Health & Wellness Coaches and National Board of Medical Examiners to deliver national standards and national certification of health and wellness coaches and support deployment of professional coaches and coaching competencies across the spectrum: clinical, organizational, and community settings. 6. Wolever, Moore, Jordan. 2016. CHAPTER 29. COACHING IN HEALTHCARE. The Sage Handbook of Coaching. 7. Institute of Healthcare Improvement. 2016. TRIPLE AIM OF HEALTHCARE – affordable, quality care, optimal health for all 8. Amy Edmondson, PhD, Harvard Business School. TEAMING AND PSYCHOLOGICAL SAFETY. 9. Moore, Phillips, Hanc. 2016. ORGANIZE YOUR EMOTIONS, OPTIMIZE YOUR LIFE. A HARVARD HEALTH BOOK published by William Morrow.