By: Tyler Reimschisel, MD
Last month in this column, I provided an introduction to giving and receiving feedback within a team. This month I would like to review the three basic types of feedback: destructive, constructive and deconstructive. This conceptual framework for the common types of feedback is based on Robert Kegan’s work as described in How the Way We Talk Can Change the Way We Work (Kegan, 2002) and other writings.
Destructive feedback is just as it sounds. It tears down, shames or degrades the person receiving the feedback. This can include yelling or insulting the feedback recipient. One of the worst aspects of destructive feedback is that it is focused on the person receiving the feedback instead of being focused on the actions, behaviors or the performance of that person. The feedback is personal. Yet destructive feedback has no benefit to the learner. Given the negative impact that this form of feedback has, it is never warranted or justified. Unfortunately, based on my experience as a team coach, this type of feedback is ubiquitous, especially in the clinical learning environment.
The second type of feedback that Kegan discusses is constructive feedback. Compared to destructive feedback, it certainly seems much better. In fact, this is the form of feedback that is taught or encouraged the most. One of the ways that it is better is that the person providing the feedback considers the interests of the feedback recipient and seeks to build up or provide benefit to them.
But this type of feedback has significant limitations, especially in situations where there are differences of opinion or alternative approaches about how to say something or complete a task or project. For example, giving or receiving constructive feedback can be problematic when discussing a challenging patient care situation, during the review of a heated discussion with a colleague, or when debriefing a code in the hospital. Constructive feedback is frequently ineffective or even detrimental in these situations because the person providing the feedback frequently frames the feedback as if their perspectives or interpretations are unequivocal facts. The feedback is implicitly viewed as a “gift” to the recipient that they should graciously accept without qualifications. It is as if the “supervisor” has “super vision” or is all-knowing. The feedback is hierarchical in that it does not take into consideration the recipient’s point of view or other perspectives.
But in most, if not all, situations, there can be multiple and different, yet valid, perspectives on how to approach the dilemma, complete the project, provide care to the patient, or manage the conflict. Although learners may not have as much experience or know as much about the given situation, their perspectives and input may still have merit and should at least be considered. In these situations, constructive feedback can be perceived by the recipient as condescending or presumptuous since it does take into account perspectives beyond the person’s providing the feedback.
Think back to a time when you received feedback during a challenging situation or from someone you disagreed with. What were your thoughts and how did the feedback make you feel? Did the feedback help you improve or grow in your knowledge, skills and attitudes? Given the way constructive feedback is framed and provided, it is less likely that you could openly take the feedback and integrate it into your work in order to improve in the future.
Another form of constructive feedback is unexplained compliments. Statements like “Nice job,” “Really good work,” or “I am really pleased with your presentation” all seem like very positive examples of feedback. Who wouldn’t like to receive this type of feedback? Yet the limitation of this type of feedback is that it is stated as fact without any rationale or justification. As I mentioned in last month’s article, one of the purposes of feedback is to continue to improve and grow. With unexplained compliments, it is unclear what specific aspects of the work or performance led to the compliments. Although the recipient of the compliment may have a momentary good feeling, without more explanation it is unclear what they should continue doing in the future to excel.
The sense that the person providing constructive feedback is all-knowing and the lack of specificity with this type of feedback are two reasons that I strongly prefer deconstructive feedback to the more popular and common constructive feedback. In my experience, I have found deconstructive feedback is by far the best type of feedback.
Deconstructive feedback starts with the premise that feedback should be focused on specific behaviors and actions, not on the person receiving the feedback themselves (Minson, 2022). In other words, it should not become personal. The care provided to a patient, the quality of the presentation or the value of the work completed may have been done well or not, but the feedback should not be about whether the person completing these tasks is a good clinician, employee, student, educator, or colleague.
It is called “deconstructive” because it disassembles the specific situation or event into discrete and observable data. “Observable” data is that which could be recorded with a video camera, and it includes verbal and nonverbal communication. Therefore, the person providing deconstructive feedback focuses on observable data when giving the feedback. They do not focus on the recipient’s thoughts or attitudes since those aspects of the recipient cannot be recorded by a camera.
If feedback needs to be provided about aspects of the recipient’s performance that cannot be recorded, then the person providing the feedback should state that the feedback is an inference or assumption and justify their inference or assumption with several examples. For example, “it appears to me that you are not engaged in this project because you have been texting on your phone, you have not completed several assignments on time, and you have not responded to at least three of my emails.” In this case, “disengagement” is an inference since it cannot be recorded, and the person providing the feedback states several examples that provide the rationale or basis for the inference.
Similarly, since deconstructive feedback is focused on specific situations or examples, it contextualizes the feedback to those situations or examples and does not generalize. There is no place in effective feedback for comments like, “You always…” or “You never…” Those types of generalizations should be avoided since one cannot provide enough specific examples to defend such a broad statement. (In next month’s article I will discuss how to provide deconstructive feedback about a pattern of behavior, but generalizations are still unwarranted in those situations.)
Perhaps one of the most important aspects of deconstructive feedback is that it recognizes that there are multiple perspectives about a given situation or event. The person providing feedback has one perspective, but other observers could or would have additional perspectives. In addition, the recipient of the feedback also has a perspective that should be considered. Consequently, deconstructive feedback involves a dialogue or conversation between the person(s) giving and the person(s) receiving the feedback. The best way to demonstrate that there are multiple perspectives and each can have merit is for each person to explicitly state that what they are saying is their perspective. Comments can be prefaced with “From my perspective,” “As I see it,” or “Based on my experience.”
It is important to also keep in mind that the purpose of deconstructive feedback is to learn and grow as the feedback is discussed. Conversely, with constructive feedback the purpose is explicitly or implicitly about how the individual providing the feedback can “help” the recipient of the feedback. But with deconstructive feedback, if it is done well, both the recipient and provider of the feedback can learn and improve. As I provide effective deconstructive feedback, I can learn more about the person receiving the feedback as well as my own inferences and assumptions, how I may see a situation differently than another person, and how I can improve my teaching or clinical practice.
One of the easiest and best ways to implement deconstructive feedback is to ask genuine questions. Schwarz defines a genuine question as one in which the person asks a question that they do not know the answer to (Schwarz, 2013). For example, in deconstructive feedback, genuine questions could include “How did you think that clinical encounter went?” or “From your perspective, what aspects of the presentation went well and what could you improve?” On the other hand, nongenuine questions are statements that take the form of a question. They include comments like “You didn’t really think that that was going to work, did you?” and “What the *H^@! were you thinking?” Schwarz points out the nongenuine questions can be easily identified by applying the “you idiot” test. If it sounds right to add “you idiot” to the end of the question, then it is a nongenuine question. In my examples, it sounds natural to add this phrase to the end of each of the questions! Since nongenuine questions are frequently passive-aggressive and are meant to criticize, demean or tear down the recipient, they are examples of deconstructive feedback and should not be included in feedback since they are inappropriate, unprofessional and counterproductive.
In conclusion, let me provide a way to start practicing deconstructive feedback. I think it begins with how you frame the feedback. Instead of simply saying, “I am going to provide feedback now,” take a few moments to establish that you will be approaching the feedback differently. Let’s take the example of my providing feedback on a patient presentation in clinic. Before the presentation itself, I typically say something like: “As you are presenting I won’t interrupt you, but I will be taking notes about things that I think you do well and possible opportunities for improvement from my perspective. Please try not to be distracted. After the presentation, I will ask what you think you did well and what you could improve in the future. Then I will share my perspective. Does this sound OK to you?” In this way, I have created a shared mental model that the feedback will involve a two-way conversation as I will be sharing my perspective as well as listening to the perspective of the learner.
I have taught and team coached for many years using the deconstructive approach to feedback. Based on my experience and perspective (he says deconstructively), it is exceptionally effective and impactful. Yet I have also heard many concerns or overt resistance to this approach, though only by individuals who have never practiced it. Comments include “It takes too long!” “It minimizes the expertise of the experienced clinician.” “We can barely get our clinical staff to provide any feedback, let alone deconstructive feedback.” In next month’s Tips for High-Impact Teamwork column, I will try to address many of these concerns as I provide additional examples of deconstructive feedback. For now, over the next few weeks, I encourage you to begin practicing the deconstructive approach. Please feel free to email me at firstname.lastname@example.org with your questions or to share your experience trying out this approach.
Kegan R and Laskow Lahey L. How the Way We Talk Can Change the Way We Work. Wiley & Sons, 2002.
Minson JA and Gino F. “Managing a polarized workforce.” Harvard Business Review. March-April, 2022.
Schwarz R. Smart Leaders, Smarter Teams. Jossey-Bass, 2013.