By: Tyler Reimschisel, MD, MHPE
In my last column, I mentioned that we would address conflict management within a team in future articles. In this article, I will begin a review of conflict management by first introducing core concepts on feedback in general. One of the most important aspects of teamwork is the ability of team members to give and receive feedback because it helps to ensure that the individual members within the team and the team as a whole are continually striving for quality improvement. Yet the feedback needs to be effective in order to support the improvement process, and in this article, I will summarize what I believe are the characteristics of effective feedback. I used the references throughout this article, and I recommend reviewing them for additional information about effective feedback.
Based on my experiences as an educator, administrator, clinician, parent and spouse, I have found there are several interrelated elements to effective feedback. To begin, it is important to clarify that the purpose of feedback should be to guide future learning and reflection. Specifically, the recipient should learn what they did well so they can reinforce those behaviors and where there are opportunities for improvement so they can make iterative changes. As Wood comments, “feedback is designed to influence, reinforce or change behavior, concepts, or attitudes” (Wood, 2000). In addition, the individual providing the feedback should also be prepared to learn what they do well and how they could improve their clinical care, teaching, managing, leading or other efforts.
Implicit in this overarching purpose of feedback is the need for the recipients and providers of feedback to have a growth mindset. They should enter any feedback encounter, whether brief or more formal, with the anticipation that everyone will learn through the process. One practical way to make sure everyone is in the right mindset is for the feedback provider to ensure that the feedback is expected by the recipient before it is provided. A simple statement will suffice, such as “I would like to provide feedback on your clinical presentation. Could we take a few minutes to discuss this?” This is particularly important if the feedback may include suggestions or a perspective that may be challenging for the recipient to receive and integrate into their work.
Effective feedback should also be timely. Within the constraints of the clinical setting or workplace demands, feedback about a situation should be provided as close in time to the situation as possible. This is important because the feedback needs to include data about specific actions, dialogue, or other behaviors, and it can become hard to remember those details as the situation becomes more distant.
Another benefit of providing and receiving timely feedback is that in most cases the feedback itself can be relatively brief since it is focused on a single situation. This is very helpful for teams that are busy, and I think almost all teams struggle with having too much to do given their time constraints and other obligations. Effective feedback does not always need to be scheduled, formal or time-consuming. One of the most common concerns I hear about providing feedback is that it can be challenging to find time to do it in the midst of all of our work. This is why I emphasize that the vast majority of feedback should be frequent and short. In this way, it is much easier to establish a culture of feedback since it is no longer seen as something that always requires a lot of time.
The feedback that is provided is frequently based on the expectations that the provider has about the recipient’s performance. Therefore, it is very important that the expectations are appropriate for the level of education, training and experience the recipient has. This seems simple enough, but we frequently identify gaps in performance based on unrealistic expectations of the person who will be receiving the feedback. Providing feedback based on unrealistic expectations is typically not very helpful since it does not consider the recipients' zone of proximal development (the individual’s most proximate growth in terms of their knowledge, skills and/or attitudes). Consequently, the person providing the feedback should strive to ensure that the expectations of the recipient’s performance are appropriate and consistent with the recipient’s education, training and experience.
Perhaps the most important element of effective feedback is that it should primarily be based on observable behaviors and actions, not judgments, inferences or assumptions that may be made about those behaviors and actions. If I am going to provide feedback about a meeting, conversation, clinical encounter, educational session or teamwork experience, I want to focus on providing feedback on what would be captured by a video of that event. Videos capture images of actions taken as well as verbal and nonverbal communications. They do not capture thought processes, attitudes, judgments or inferences. Therefore, my feedback should primarily be about what can be recorded by a video.
Certainly, there are times when feedback will include our inferences, assumptions or judgments about a specific event or encounter. But in those situations, it is absolutely crucial that we explicitly state the inference or assumption that we have made and then reference the observable data that led us to make that inference or assumption. In this way, the person receiving the feedback can better understand the basis for the feedback that is being provided. For more guidance on how to test inferences and assumptions, please refer to the recent Tips for Higher-Impact Teamwork column on this topic.
Since feedback should be about observable data and provided as timely as possible, effective feedback is based on first-hand information, not information that is passed from observer to recipient via a third party. I will discuss this more in a subsequent article on addressing conflict within a team, but for now, I will simply posit that this element of productive feedback means that there is direct communication between the individuals involved in the event or encounter. A supervisor, leader, director or another objective, third party individual who was not present for the event can participate in the feedback, especially if it is likely that the conversation could become contentious. However, it should not be the responsibility of that third party to provide feedback regarding a team situation that they were not a participant in.
This brings me to my last point. Since feedback can be challenging to give and receive, it is important that it be provided and received respectfully and compassionately. Ultimately, feedback should be about a person’s actions and behaviors, not about the person themselves. When we receive feedback, especially feedback that is critical of our performance, it is typically very challenging to distinguish feedback about our performance from who we are, our personalities and how we view our worth and merit. With this in mind, when providing feedback, I urge all of us to focus on observable actions and not the person themselves.
In this Tips for High-Impact Teamwork column, I have reviewed some of the features that I think are characteristic of effective feedback. I welcome your feedback on other aspects of feedback that you have found helpful. In the next article in this series, I will explore the three most common types of feedback—destructive, constructive, and deconstructive—and explain why I think deconstructive feedback is most productive.
References:
Ende J. Feedback in clinical medical education. JAMA 1983; 250(6):777-781.
Gigante J, Dell M, Sharkey A. Getting beyond “good job”: how to give effective feedback. Pediatrics 2011; 127(2):205-207.
Wood BP. Feedback: A key feature of medical training. Radiology 2000; 215:17-19.