It’s something almost no one enjoys, but critiques are essential for our development. Here are some things to do and to avoid.
“Morning Matthew! Could I catch up with you after the handover?”
I was a newly minted consultant in emergency medicine. I needed to give Matthew some feedback on a patient he’d seen a few weeks ago. After an assessment, he had sent the patient home, but he had failed to acknowledge the blood tests in the patient file, nor acted on the results. The patient had acute renal failure.
I had been meaning to talk to him for weeks, but our shifts had not aligned. In the meantime, I had been in contact with the patient in the community and their ongoing care had long been sorted.
During handover, I realized with a sinking feeling that Matthew was just finishing a night shift. I might have been green, but I knew post night duty was not the best time for this conversation.
After handover, we walked into the communal consultant office space. We didn’t sit down. I showed him the clinical notes and blood results that I had printed.
“Do you remember this patient?”
These are the worst words you could ever say to a doctor in emergency medicine.
Matthew’s face fell, along with my expectations of a positive interaction.
“I noticed when I was signing off the pathology that her renal function was down from her previous presentation, but you didn’t acknowledge that in your notes and also sent her home?”
Matthew bristled at my words and tone. He retorted that he worked very hard for the department and none of his efforts were ever appreciated. He stalked off. I felt awful. We never finished that conversation.
Who often feels dread when either expecting to give or receive feedback?
Who has had a bad feedback experience?
When I talk to medical staff, the answers to these questions are almost universally “yes”.
I once had a line manager deliver my 360-survey feedback scribbled on a scrap of paper, with a green fluoro marker highlighting the one or two people who thought I was awful. I don’t remember anything else from that feedback conversation.
I wanted to give feedback on the feedback!
Every day, feedback opportunities surround us in the workplace. It may be the encouragement we give to a junior doctor to broaden a differential diagnosis when they present a case; or the congratulations given for an efficiently performed procedure in an anxious patient.
Feedback is essential to help us develop. It’s important in all directions – up, down and sideways. It’s important because we judge ourselves by our own perception and the intention of our behaviour and this may not represent what others see and experience.
What are the challenges of and barriers to effective feedback?
- Generalised feedback not related to specific facts
- Lack of advice on how to improve behaviour
- A lack of respect for the source of the feedback
- Fear of upsetting colleagues and damaging professional relationships
- Defensive behaviour/resistance when receiving feedback
- Physical barriers, noise, improper time, place or space
- Personal agendas
- Lack of confidence
It becomes apparent when you are navigating the challenges of providing feedback how important it is to provide specific examples of behaviours and the desired behaviour changes, especially when a person cannot connect with the feedback, doesn’t respond to the feedback, or won’t commit to addressing the behaviour.
“When you team lead a resus, the nursing staff have noticed that you don’t appear to listen to their concerns about the deteriorating patient. Moving forward, I would like to see you acknowledge and address the issues raised by nursing staff. Perhaps a closed-loop or a repeat-back communication method would be useful here, to let the nursing staff know that you have heard their concerns.”
If the behaviour pattern repeats, despite the feedback, it’s time for another conversation. Again, with specific examples of the behaviour and the desired change of behaviour. It’s the time to outline the next steps if the behaviour does not change, such as suggesting the clinician attends a communication workshop or offer some direct supervision of the clinical scenarios involved to provide some real time objective feedback.
It may be that no one has ever broached the subject before with the clinician before. This demonstrates how important it is to have the difficult conversations and the cost of avoiding them.
Have feedback conversations regularly – and make some of it positive! Feedback requires trust; there’s great benefit in having spent some time filling a person’s proverbial bucket before you have to tip something out.
In practice, learners value feedback more when delivered by someone they respect, so the first question you need to ask yourself is, are you the right person to be giving the feedback? Additionally, you need to work out your motivation for giving the feedback: is it to help the person grow and develop or is it because they’ve annoyed you and you want them to know exactly what they did wrong?
Give feedback as soon as possible after an event. Make sure you ask permission first: the recipient needs to be in the right frame of mind for it to be effective.
The sh*t sandwich, where you couch the difficult stuff between two layers of praise, is dead – the literature shows that the recipient comes away just remembering the “bread”. Encourage a reflective style of feedback; the most powerful insights are the ones individuals generate themselves. If they don’t self-generate the feedback, you might need to probe a bit….
- Ask how they might have handled the situation differently?
- Ask how the other person in the situation might have felt?
If they still are not able to generate the insight that you are after, you might need to challenge with the question: “Can I offer you another perspective?”
By the end of a feedback session, the recipient should have a clear understanding of what is required and how they are going to move forward.
These kinds of tips are a great start to giving feedback, but if you are a line manager or in a position where you are developing more junior staff, I urge you to seek out further training in giving feedback because feedback given well can drive your team on to bigger and better things.
One last tip: leave the fluoro at home.
Hardavella, G., Aamli-Gaagnat, A., Saad, N., Rousalova, I., & Sreter, K. (2017). How to give and receive feedback effectively. Breathe, 13(4), 327-333.
Dr Bethany Boulton is an emergency physician working on the Sunshine Coast and a founding member of WRaPEM (Wellness Resilience and Performance in Emergency Medicine), dedicated to bringing the non-technical skills of medicine to the fore
