As healthcare systems continue to navigate complexity, workforce strain, and financial pressures, many are building internal leadership development capabilities, including internal coaching. It can be a smart investment for some levels of the organization and to help scale a coaching culture. But when it comes to coaching senior executives, many of your peers are still engaging external partners. Why?
It’s not because internal coaching isn’t working. It’s because when it comes to your C-suite and senior executives, the stakes—and needs—are fundamentally different. Not all coaching is created equal, and not all coaching relationships serve the same purpose.
At MEDI Leadership, we are asked by some in the industry: “If we’ve started to invest more in building our internal coaching from within, should we keep using external coaches?” The answer isn’t about choosing sides. It’s about recognizing that different leadership challenges require different types of support, plus a desired level of confidentiality with a safe space to think out loud where one can be more vulnerable with a trusted coaching partner, with the agenda only being their success.
Internal vs External Coaching: Building a Complete Ecosystem
Think of your coaching strategy like building a world-class medical team. You need generalists who can handle the day-to-day work across your organization, and you need specialists who bring deep expertise to complex cases. Internal coaching serves as your generalist support: building leadership capacity, delivering essential tools, and providing performance accountability across the organization.
Typically, internal coaches support emerging leaders or managers. Often these are more leadership training and development type of programs with possible light touch or transactional coaching with someone with a coaching accreditation.
Executive leaders desire and require something different: a strategic thought partner, trained to challenge and support them without bias or perceived agenda. Executives tell us what they need most is:
- A thinking partner for high-stakes decisions. When you’re weighing a merger, navigating a crisis, or restructuring the organization, you need someone who can challenge your assumptions without an agenda and keep things between the coach and C-suite executive.
- Deep expertise in healthcare leadership complexities. Generic leadership coaching falls short when you’re dealing with critical financial pressures, getting teams out of counter-dependence or “unstuck,” repairing damaged strategic relationships, or the myriad, unique dynamics of leading in a healthcare environment.
MEDI President Lee Angus often refers to Counter-Dependence when team members get irritated with one another or there isn’t enough movement on key objectives. “Leaders sometimes can’t get their teams unstuck on their own,” he explains: “It’s important to recognize when to call a trusted guide to steer you out of the wilderness when you can’t see past the trees blocking your path.”
- True confidentiality, without organizational politics. There’s a reason therapists don’t counsel their own family members. Sometimes you need an outside perspective to explore vulnerabilities, test ideas, and work through challenges without fear of internal repercussions or judgment. Particularly if the coaches are working within that health system. There are times when a C-suite executive would not want an internal coach that reports to someone that reports to them.
This is where external coaching becomes indispensable. We’re not in your reporting chain, we’re not evaluating your performance, and we’re not trapped in your organizational politics or complexity. That neutrality creates space for the kind of honest reflection and strategic thinking that drives real self-awareness and transformation.
What Executives Say About the Impact of External Coaching
Our healthcare industry clients consistently report that the external coaching relationship feels different. “I can be real with my coach in a way I can’t inside my system,” one Chief Executive Officer shared. “It’s the only place I can talk about what’s keeping me up at night without filtering myself.”
Even organizations with strong internal coaching programs see significant, measurable value in combining both internal and external coaching. When used intentionally, internal coaches can support director-level leadership development, while external coaches serve as trusted partners to senior leaders steering the organization through change, growth, and pressure.
It’s like having both generalists and specialists on your medical team. Each brings distinct value, and is essential to your organizational health.
Questions to Ask When Evaluating Coaching Options
When evaluating your coaching options and investments, four questions can help clarify your best step forward:
Can this coach challenge and support my executive leaders with an objective and curious lens?
Internal coaches, no matter how skilled, carry the weight of organizational relationships, hierarchies, and agendas. There are times when this may be beneficial but often, for executives, we are told it can get in the way of deep transformational change.
Will leaders feel safe enough to be vulnerable in this relationship?
Real growth happens when executives can explore their blind spots, test unpopular ideas, and work through their deepest leadership challenges.
Does the coach have healthcare-specific experience that builds immediate credibility?
Healthcare leadership is unlike any other industry. Your coaches should understand that reality.
Is the coaching methodology transactional or transformational?
Both might have their place, but executive coaching should drive both behavioral and systemic change.
Coaching length and duration also matter: For sustainable change and impact to occur, coaching needs to take place over a long period (often 12 months or so) with multiple touchpoints, including in-person or deeper dive sessions, and with an accelerating cadence for calls.
Having the access to a coach through a scheduled cadence is important but there is also real value in having unlimited access to the coach for issues emerging in real time. Stakeholder and sponsor calls are also critical to the process as they allow for more of a 360-degree view versus just the coachee perspective.
If your coaching doesn’t include the deeper methodology over a longer period, chances are it’s a transactional approach to coaching around one or two leadership competencies or opportunities.
Something worth noting: Team coaching isn’t the same as team building. Team building activities can boost morale and help people get along better. Team coaching addresses how your senior teams actually function: how they make decisions under pressure, navigate conflict, and lead change across complex clinical and operational environments. That level of intervention often requires an external coach with both system-level expertise and advanced facilitation skills.
Making the Strategic Choice
Healthcare leaders are right to scrutinize every budget and prioritize internal investments. But for C-suite and senior executives navigating today’s challenges and healthcare industry complexities, external coaching is not a “nice to have” perk—it’s a highly desired and strategic necessity.
When your top leaders can think more clearly, lead authentically, and act decisively, that impact ripples through every department, every patient interaction, and every strategic initiative.
The choice isn’t internal or external coaching. It’s about building a complete leadership coaching ecosystem where the right level of coaching serves the right level of leadership—so your organization can thrive at every level.
