The Auerbach REFS Model for Coaching Change with Emotional Intelligence

Case Example

The Case of Dr. Marcia Lee

Background
Dr. Marcia Lee is a senior director at a large regional hospital, overseeing multiple departments. Amid rising patient volumes and a mandate for cost reduction, the hospital initiated a major organizational change—the implementation of a new electronic health records (EHR) system across all units. This change promised long-term efficiency but was incredibly disruptive in the short term. Staff were anxious about the learning curve and potential errors, and initial rollouts in some departments had been rocky. Dr. Lee was tasked with leading the EHR implementation in the critical care units, a role that put her at the center of both high stakes and constant pressure.

As a leader, Dr. Lee was conscientious and results-driven, but she struggled with stress tolerance. In the past, she had handled stress by working harder and longer—her perseverance and focus were key strengths. However, she also overused them when under pressure—often at the expense of sleep and personal life. With this EHR project, her stress levels hit new highs. She was fielding daily complaints from physicians and nurses, dealing with technical glitches, and feeling intense pressure from executives to stay on schedule. She began experiencing chronic headaches and found herself snapping at colleagues in meetings (unlike her usual composed self). Morale in her team dropped, as her anxiety was impacting others. Recognizing the risk of burnout and leadership breakdown, a trusted colleague of Dr. Lee introduced her to her executive coach that she had met through the hospital's leadership development program.

Coaching Intervention
In coaching, Dr. Lee identified that her primary stress triggers were feelings of losing control, loss of reputation and fear of failure in patient-critical operations. The coach helped Dr. Lee use reality testing (Part 1 of REFS) to separate facts from catastrophic thoughts. For example, Dr. Lee discovered she was internally framing the EHR rollout delays as "I'm failing, and patient safety will be ruined," which amplified her panic. Through coaching conversations, she reappraised the situation: the delays were in fact expected hurdles that could be solved with systematic problem-solving, and her team had successfully managed patient safety through many previous challenges. This cognitive reframe helped her manage her anxiety—an example of Lazarus's appraisal theory in action.

Next, the coach and Dr. Lee focused on building a stress management toolkit tailored to her life as a healthcare leader. She decided to try a quick mindfulness routine by taking 3 minutes at the start of each workday to do deep breathing in her office, using an app to guide her in a slow inhale-exhale pattern. She also set an alarm twice during the workday to briefly stand, stretch, and take a few calming breaths. Initially, Dr. Lee was skeptical of such approaches, saying "I have no time for that", and "that won't help", but due to the relationship with her coach, she agreed to try. Within two weeks, she noticed a difference—her headaches were less frequent, and she felt less "on edge" walking into meetings. Neuroscience validates her experience: even short sessions of controlled breathing stimulate the vagus nerve, reducing physiological stress arousal.

The coaching also addressed Dr. Lee's tendency to overwork, and refuse to delegate. Together, they designed a plan where she delegated one non-critical project to a capable junior manager and carved out Wednesday evenings for an enjoyable activity (a dance class she loved but had dropped). At first, she felt uneasy stepping back—a common feeling for leaders learning to let go—but her coach helped her be accountable to her plan. As weeks passed, she not only found her energy improving from these breaks, but the junior manager excelled with the new responsibility, boosting overall team capacity. This experience reinforced to Dr. Lee that seeking support and pacing herself were signs of strategic leadership, not weakness.

Throughout the project, the coach used empathy and perspective-taking to help Dr. Lee manage emotional contagion. In particularly tense moments—such as when a physician sharply and loudly criticized the new system and Dr. Lee directly in a staff forum—Dr. Lee recognized her rising frustration and used a pause technique from coaching: she silently counted to five and took a breath before responding. This brief pause prevented a strong, sharp emotional retort and allowed her to reply with a bit more empathy (Part 2 of REFS), acknowledging the physician's concerns while calmly reiterating the plan to address issues. By modulating her tone and demeanor, she validated the colleague and diffused the immediate tension. Her team noticed her cooler head; one nurse commented in a later one-on-one, "I appreciate how you're staying calm and solution-focused—it helps the rest of us not panic." This was a turning point: Dr. Lee realized that showing up as calm was contagious. Just as stress can spread, so can composure. With the coach's help, she also identified a supportive colleague that she could vent privately with and regain perspective.

Outcomes
Over the five-month coaching engagement, Dr. Marcia Lee's Stress Tolerance significantly increased. She reported feeling more "in control of my reactions" even with the change and sometime chaos that was happening in the system. The EHR implementation ultimately succeeded in her units—not without issues, but without any major patient care incident. Her improved stress management had tangible ripple effects: her team's engagement scores, measured in a post-project survey, were higher than other units, and many cited confidence in leadership as a reason. With the support of a competent coach, Dr. Lee avoided burnout and modeled resilient leadership. She continued to practice many of her new habits, turning them into ingrained routines. Six months later, during a debrief with her coach, she reflected: "I used to think being stressed was just part of the job, but now I see managing stress is key to this role."

Dr. Lee's case illustrates how developing Stress Tolerance through coaching can transform a leader's effectiveness. By combining cognitive work (reality checking and reframing), neuroscience-informed techniques (breathing, mindfulness), and behavioral changes (self-care, delegation), Dr. Lee strengthened her capacity to navigate turmoil. In doing so, she not only improved her own well-being but also emerged as a stabilizing presence for her team during a critical transition.