Perfection in this science, or rather art [i.e. medicine] takes longer to be mastered than human life [affords]—Maimonides, philosopher and physician, Middle Ages.1

A veritable quality improvement (QI) industry has emerged that centres around initiatives to improve patient outcomes or health system performance. These initiatives often target high-risk and high-cost disease states,2 with common foci of reducing waste,3 ‘hot-spotting’4 and readmissions.5 While these initiatives can help improve health system performance across the Quintuple Aim,6 they often fall short of achieving sustained improvements in outcomes at scale due to short attention spans, limited resources and shifting priorities or incentives.7–9 Furthermore, improvement initiatives can have unintended negative consequences that increase staff burnout and inadvertently exacerbate health human resource challenges,10 highlighting a need to clarify what we are trying to achieve and how. So long as there are patients suffering, there will be room to improve health systems, and opportunities for the clinicians working in those systems to improve their care.

In his popular commentary in the New Yorker on coaching for physicians, Atul Gawande described how his skills seemed to improve almost daily in his early years of practice but plateaued a few years later. He reflects that while expertise in medicine is dynamic, the system requires that doctors build and sustain it for themselves.11 Simply put, doctors are taught about the importance of evidence-based medicine, but even though change in practice is inevitable, they have comparatively little training on (or ongoing support for) sustainably improving the ways in which they carry out their work. Gawande highlights how top performers in other industries rely on coaches to provide feedback to help them improve. Despite this, there is uncertainty regarding what coaching should target and how it should be operationalised in healthcare.12

Coaching …