From Fixer to Coach: A Mindset Shift for Healthcare leader
In healthcare, we are trained to act. We assess, decide, intervene. This mindset often saves lives. But when it comes to developing people, that same mindset of acting quickly, giving answers or stepping in can limit their growth. As medical professionals, we are well trained in the fixer mindset. For example, a new nurse is struggling to manage a sick patient. As a leader, you tell the learner what exactly needs to be done in the moment. While in theory this is the best-case scenario for the patient, it often is a knee-jerk response. This default fixer mindset does not set up the learner for success in future scenarios. Healthcare leaders need to expand how they lead and tap into a coaching mindset. It’s time to move from fixing the problems to coaching through them. Fixing solves today, but coaching builds tomorrow.
The Coach in Me
As a pediatric hospitalist, I have spent the past 10 years studying, practicing, and teaching coaching in graduate medical education. At Johns Hopkins All Children’s Hospital, I designed and led the development of a pediatric residency coaching program and have presented nationally and internationally on coaching philosophy, mindset and practical strategies. My scholarship has centered on building sustainable coaching programs, grounded in the growing evidence that coaching is a highly effective, transformative approach to developing healthcare professionals.
And yet, even with years of experience, I still feel the pull of the fixer mindset. It’s an internal tug-of-war to believe in the methodology, lean into the practice and live the message. I was not trained to have a coaching mindset during residency, so why should we be training the next generation this way? Because the way we were trained is not the way we have to lead.
What is coaching?
At its core, coaching is not about giving answers; it’s about developing thinking. As the Accreditation Council for Graduate Medical Education describes it, coaching is “a process of inquiry and reflection that creates awareness and responsibility for change.”1 In practice, it is a distinct approach from advising or mentoring, grounded in the belief that learning is never finished. Coaching supports trainees in reaching their full potential by fostering accurate self-reflection, incorporating external feedback, and promoting intentional goal setting. While long established in fields like business and sports, coaching is now gaining traction in health professions education as a powerful, growth-oriented strategy to develop clinicians.
A Coaching Mindset
You may be thinking… Really? Another strategy or mindset to learn as healthcare providers? Yes. And I get the skepticism. You might be wondering: What is all the hype about coaching? Is this just the latest trend or fad? Is it like “gentle parenting” – but for clinicians? Is this the softer way to manage Gen Z? Fair questions and I get it! But let’s be clear. Coaching is not about being softer. It is about being more intentional, more precise and ultimately more effective.
As a physician who trains pediatric residents, I often fall short and default to telling and fixing as it is efficient and familiar, especially when time is limited. This is the classic teacher-centric approach and not a learner-centered one. The practice of coaching requires patience, a growth mindset and trust in the process. And importantly, the evidence does not lie. Early results show it is particularly effective in hierarchical systems, where developing independent thinking is essential. As the American Medical Association notes, “coaching is gaining ground in medical education for how it can head off burnout, boost retainment and improve quality of care.”2 In high-demand environments like nursing, where burnout and turnover remain critical challenges, a coaching mindset offers a practical way to support both performance and well-being.
How to Coach
Feeling inspired? Ready to embrace a paradigm shift, from fixer to coach. The good news is that coaching strategies are straightforward to learn. The challenge is putting them into practice. And yes, coaching takes practice. We are trying to override patterns that have been deeply ingrained in us. Sometimes coaching feels like taking the scenic route in a place where we’re used to sprinting. But it turns out, that’s where the learning lives.
Clinical Skills Coaching Questions
In the NICU, it’s easy to default to giving answers:
- “Increase the FiO₂”
- “Hold the feeds”
- “Call RT”
Coaching sounds different:
- “What are you noticing?”
- “What do you think is driving this?”
- “What would you try next?”
The difference is subtle, but powerful. One manages the moment. The other builds the clinician.
Communication Skills Coaching Questions
After a difficult family interaction when emotions are high and communication breaks down, it’s easy to jump in and correct.
Powerful coaching questions:
- “How did that feel?”
- “What do you think went well?”
- “What might you do differently next time?”
These three questions can be applied to almost every coaching conversation. They do more than refine communication. They build insight, confidence, and facilitate goal setting.
Remember, change comes from self-insight. The learner or trainee must identify, see and agree with the opportunity for growth. An effective coach facilitates a safe and supportive environment where the learner can reflect, recalibrate and set goals to implement change. A coaching mindset creates the conditions that fuel growth and unlock potential.
Micro-Coaching Moments
Coaching is not meant to add more to your already full plate. The evidence-based strategy can be implemented in short time frames. Healthcare is fast paced, but coaching can be executed in micro-moments. You do not need an hour-long session. You need better conversations that lead with curiosity. I encourage the coaching pause. Remember, the message we have all heard, but often forget. Listen to understand, not respond. And, yes this strategy works at home too.
For example: A preterm infant requires gradually increasing oxygen support, but escalation is delayed. A traditional fixer response might be, “You should have called earlier.”
Coaching sounds different:
- “What were you noticing as the FiO₂ increased?”
- “What were you weighing?”
- “What will be your trigger to escalate next time?”
These questions clarify thresholds and build clinical judgment, turning a delay into stronger decision-making for the future. The fixer solves the immediate problem. The coach empowers the clinician.
Why does a coaching mindset matter?
Coaching is increasingly recognized as an effective strategy in nursing, not only for developing clinical skill, but for strengthening engagement, resilience, and retention. In the nursing literature, coaching is described as “a valuable tool in developing nurse leaders and clinical staff,” while also improving confidence, empowerment, and workplace relationships.3 In nursing education, its impact is equally compelling with a 2024 Journal of Nursing Education scoping
review reporting “significant improvement in student academic and holistic success,” highlighting its effectiveness in supporting well-rounded learner development.4 Coaching has been associated with improvements in resilience and work environment in nursing practice. These capabilities are especially important in high-acuity environments such as the NICU. In a profession facing persistent burnout and turnover, coaching offers more than a communication tool. It is a practical, evidence-informed approach to building stronger clinicians, healthier work environments, and a more sustainable team. Through coaching we can better care for ourselves and ultimately, for our patients.
In medicine, our instinct, both innate and trained, is to step in and fix. The real impact of coaching involves stepping back and helping others think. By embracing a coaching mindset and approaching with curiosity, we shift from reacting to reflecting and from giving answers to developing thinking. Intentional leadership begins when we pause, carefully choose our mindset, and decide to coach.
Citations:
- Accreditation Council for Graduate Medical Education. Coaching in Graduate Medical Education. Published 2019.
- Smith TM. To implement coaching in GME, look to those who’ve done it. American Medical Association. Published August 26, 2024. Accessed March 30, 2026. https://www.ama-assn.org/education/changemeded-initiative/implement-coaching-gme-look-tho se-who-ve-done-it
- Richardson C, Wicking K, Biedermann N, Langtree T. Coaching in nursing: An integrative literature review. Nurs Open. 2023;10(10):6635-6649. doi:10.1002/nop2.1925
- 4. Mingo SR, Fitch O, Tierney L, Nesbitt D. Promoting Academic Success in Nursing Education Through Academic Coaching: A Scoping Review. J Nurs Educ. 2024;63(8):515-524. doi:10.3928/01484834-20240501-02
About the Author:
Dr. Taryn Hill, MD, MEd, FAAP, is a double board-certified pediatrician in General Pediatrics and Pediatric Hospital Medicine, specializing in the care of hospitalized children. She earned her bachelor’s degree from the University of Texas at Austin, a Master of Education from Arizona State University while completing Teach for America Corps, and her medical degree from the Texas A&M Health Science Center College of Medicine, followed by completion of residency at The Johns Hopkins Hospital. Dr. Hill founded and co-directed a nationally recognized pediatric residency coaching program and has presented nationally and internationally on academic coaching in graduate medical education.
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