Newly appointed senior NHS leaders must provide top-quality patient care within ever tightening budgetary constraints. Support is crucial if they are to succeed. Anne Gill and Dr Adrian Myers consider the contribution coaching can make

The challenges confronting chief executives and senior leaders in the NHS are daunting even for the best and most experienced of leaders. Such challenges include providing high quality patient care within strict financial constraints, responding to increasing demands on their services and delivering transformational change while operating under intense scrutiny from the public, the media and the regulators (Rose, 2015; Timmins, 2016; Janjua, 2014).

For newly appointed senior leaders, the challenges can be overwhelming, and without available support, many can struggle to succeed. This has contributed to a leadership crisis in the NHS, reflected in the constant churn of senior leaders (Janjua, 2014) and difficulty in recruiting directors (Timmins, 2016).

The scale and complexity of senior leadership transitions are well documented (Watkins, 2013; Freedman, 2011; Van Velsor & Leslie, 1995) with most derailments occurring following a transition to a more senior job, often attributed to an inability to adapt or change (Freedman, 2011).

In 2016, Anne Gill conducted field research with seven newly appointed senior leaders in the NHS. The findings suggest that coaching is playing a powerful role in helping leaders cope with the adaptive challenges of transitioning to a more senior role.

Senior leaders found that taking time out for reflection and thinking was invaluable in helping them broaden their perspective and become more flexible and adaptable in their approach – factors that contribute to successful leadership transitions (De Meuse et al, 2010; Hogan et al, 2010).

The feeling of being overwhelmed by the complexity and scale of what senior NHS leaders have to deliver, appears to be the most troublesome for them during their first few weeks in the role. One newly appointed chief executive recalls his first conversation with his coach: “Everyone thinks I’m a hero that’s arrived to turn around the organisation in 10 minutes and the demands are just crazy.”

These experiences are consistent with the second phase of Nicholson’s (1984) role transition cycle, where people encounter ‘shock’ during their first few weeks in their new position, as they suddenly realise the disparity between their old and new role. This can lead to distress, resulting in a lack of focus and difficulty with prioritising.

One of the ways in which coaching can help the distressed leader-in-transition is by allowing them to offload their worries and then, through questioning, help them get clarity of focus. One chief executive illustrated this clarity well: “They will let me talk non-stop, usually for about 20 minutes, to get it all out, and then they’ll try and make sense of it, make some structure of it, establish priorities.”

This supports the findings by Kombarakan et al., (2008), that the coach can “assist executives to organize their thinking” (p7). This also reflects the research from the Hunter Healthcare/HSJ survey (2015) that new chief executives need a “safe and secure sounding board, someone who they are comfortable to talk to and admit at times they don’t know what they’re doing” (p20). In one chief executive’s words, “It’s having a safe place in which to talk about these things and reflect on them yourself; it’s an opportunity to spill your guts out on the table and hear yourself saying things.”

Taking time out for reflection and thinking “provided an opportunity to have an outside conversation with someone that was prepared to give you an objective view of how things were and to challenge”. Cox (2013, p103) argues that challenging the “original perceptions” of the client is fundamental to coaching and is part of the transformation journey that leads to new perspectives and actions.

The research findings reveal the importance of providing a safe and supportive space where feelings of anxiety and self-doubt at the weight of expectation to quickly deliver results under the intense scrutiny of the external regulators, to manage competing demands and deal with powerful stakeholders, can be offloaded. These concerns and anxieties seemed to be the catalyst for reflection on their leadership task, a chance to explore alternatives, and to try out new ways of doing things. Through this experiential learning the leaders were able to develop the confidence, resilience and capacities to take hold of their new role and make it their own.


  • Anne Gill is an executive coach and consultant and was supervised through this study by Dr Adrian Myers at Oxford Brookes University as part of an MA in Coaching and Mentoring. A fuller version of this article is available in the June 2017 edition of the International Journal of Evidence Based Coaching and Mentoring



  • E Cox, Coaching Understood, London: SAGE Publications, 2013
  • J Creswell, Qualitative Inquiry & Research Design (3rd ed.), Johanneshov, Sweden: MTM, 2013
  • K De Meuse, G Dai and G Hallenbeck, ‘Learning agility: A construct whose time has come’, in Consulting Psychology Journal: Practice and Research, 62(2),pp119-130, 2010
  • A Freedman, ‘Some implications of validation of the Leadership Pipeline concept: Guidelines for assisting managers-in-transition’, in The Psychologist- Manager Journal, 14(2), pp140-159, 2011
  • J Hogan, R Hogan and R Kaiser, ‘Management derailment: Personality assessment and mitigation’, in American Psychological Association Handbook of Industrial and Organizational Psychology, 3, pp555-575, 2010
  • What Makes a Top Chief Executive? Hunter Healthcare’s insights for senior leaders series/HSJ (2015) pp1-23
  • A Janjua, Leadership Vacancies in the NHS. What Can be Done About Them? The King’s Fund, London, 2014
  • R Kaiser and S Craig, ‘Do the behaviors related to managerial effectiveness really change with organizational level? An empirical test’, in The Psychologist-Manager Journal, 14(2), pp92-119, 2011
  • F Kombarakaran, J Yang, M Baker and P Fernandes, ‘Executive coaching: It works!’, in Consulting Psychology Journal: Practice and Research, 60(1), pp78-90, 2008
  •  Nicholson, ‘A theory of work role transitions’, in Administrative Science Quarterly, 29(2), p172, 1984
  • L Rose, Better Leadership for Tomorrow, NHS Leadership Review, 2015
  • The Future of NHS Leadership. Ending the Crisis in NHS Leadership, HSJ, June 2015, pp1-11
  • N Timmins, The Chief Executive’s Tale, Views from the front line of the NHS. London: The King’s Fund, 2016
  • E Van Velsor and J Leslie, ‘Why executives derail: perspectives across time and cultures’, in Academy of Management Perspectives, 9(4), pp62-72, 1995
  • M Watkins, The First 90 Days. Proven Strategies for Getting up to Speed Faster and Smarter. Updated and expanded. Boston, Mass: Harvard Business School Press, 2013
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