THE ART OF FEEDBACK WEBINAR SYNOPSIS

Feedback is an essential aspect of highly effective healthcare teams. TeamSTEPPS® is an Agency for Healthcare Research and Quality (AHRQ) program created with best-practices from high-stakes industries. This document serves as a synopsis of the webinar presented by Bree Watzak, PharmD, BCPS and Misti Carter, PhD, JD.

Why Feedback is Important in Healthcare Teams

Feedback Definition– American Academy of Communication in Healthcare

“Specific, nonjudgmental information comparing a trainee’s performance with a standard, with intent to improve performance”

The framework shown below is based on four learnable and teachable skills: Leadership, Communication, Situational Monitoring, and Mutual Support. Situational monitoring can be described as knowing and seeing what is happening within your team, while mutual support is the action of knowing how to help your teammates as you monitor situations. The communication piece ties all four skills together. At the center of these four teachable/learnable skills is your patient. As teams perform more together and improve the four major components of communication, leadership, situational monitoring, and mutual support, other skills begin to develop, such as knowledge, performance, and attitudes.

Outcomes of Team Competencies

Knowledge:

  • Shared Mental Model- “We are on the same page”

Performance:

  • Adaptability, Accuracy, Productivity, Efficiency, and Safety

Attitudes:

  • Mutual Trust- Knowing you are on a team to provide patient care and that feedback is meant to improve this patient care
  • Team Orientation- Knowing your own skills, knowing the skills of others, and knowing where you are in the team

Models for Effective Feedback

Feedback is not a demand for change. The feedback itself should just be data. Ungiven feedback can build up until the point of conflict.

Types of Feedback

  • Informal- When? Day-to-day conversation/interaction—What? Can be given on any aspect of a person’s professional performance/conduct — Who? Usually given by any member of a multi-disciplinary team—How? Generally given in verbal form
  • Formal- When? Annually or during a major workplace complication– What? Generally, a very structured, in-person assessment/performance review. — Who? Can be offered by any member but is usually done by peers or supervisors– How? Sometimes in the form of a written assessment or write-up
  • Formative– Done for the purpose of learning and discusses a learner’s progress at a particular time during a course or during the acquisition of a new skill
  • Summative– Looks at what has been learned, measures their performance against a standard, might come with a mark/grade/numerical assignment of information to judge or rank individuals in a summative way

Models of Feedback

  • The “Feedback Sandwich”: Starting with something positive, moving to something that could be considered negative feedback, and then close with more positive feedback. Like the “OREO” model-
    • Open with Praise
    • Reflect on Performance
    • Evaluate the Performance
    • Offer Feedback
  • “Chronological Fashion” Feedback: Starting from the time someone has been at your workplace, work chronologically and verbally observe their learning from beginning to end with them.
  • The Pendleton Model: Introduced in 1984, and is a learner-centered model. This model holds that there should be a plan or action put into place where the facilitator of the meeting brainstorms with the trainee for the next steps toward progression. Facilitator should check in to see if the trainee is ready for feedback, give background, and come up with the plan.
  • The “DART” Model- Academy of Communication in Healthcare: Small Talk Before Big Talk
    • Data- Observation; use “I” statements
    • Ask the Learner’s Perspective- Facilitate self-reflection, seek understanding of where they are coming from
    • Respond- Acknowledge, empathize, support, redirect from self-criticism, facilitate discovery- Great opportunity for PEARLS:
      • Partnership
      • Empathy
      • Appreciation
      • Respect
      • Legitimation
      • Support
    • Tell- Point out the performance gap/impression made. What do you need?
  • Eight-Step Feedback Formula- Candid Culture
    1. Introduce the Conversation: Ask a question to ensure they are available for feedback, implement the micro-yes (seen in next section)
    2. State Your Motive
    3. Describe the Behavior: “I have noticed…” and other “I” statements
    4. State the Impact of the Behavior: Who will benefit from the behavior or behavior change?
    5. Ask the Other Person for Their Perception of the Situation: Cocreated conversation; take advantage of the chance to offer feedback and receive it; iron out differences in perception
    6. Make a Suggestion or Request: If they knew another way to do it, they would do it that way.
    7. Build an Agreement on Next Steps
    8. Say “Thank You” and preserve the relationship

The Secret to Giving Great Feedback

  1. The Micro-Yes and Create Buy-In: Begin your feedback by asking a question that is small but important. For example, “Do you have a couple of minutes to talk about how that last conversation went?” This cue is a pacing tool that lets the brain know that feedback is coming and allows a moment of “buy-in” where the respondent can answer the question. By answering the question, the respondent receives a feeling of autonomy.
  2. Give Data and Avoid “Blur Words”: You should be giving specific examples of what you saw or heard and cut out any words that are not There are words called “blur words” that can mean different things to different people and are non-specific. Rather than using blur words in your feedback, translate them into objective points. Specificity is also important in positive feedback, as it allows for the recipient of the feedback to know what behaviors to increase and diminish.
  3. Show Impact: Here, you should name exactly how that data point from step 2 impacted you. For example, “Because I did not get that email by 11:00 AM (data point), I was blocked by my work and could not move forward (impact statement).”
  4. End with a Question: Great feedback givers wrap up their message with a question, such as, “Well, how do you see it?” or “This is what I am thinking we should do, but what are your thoughts?” This creates commitment rather than compliance and allows the monologue to stop and problem-solving to begin.

Discover Tools for Providing Difficult Feedback

Barriers to Effective Feedback

  • Generalized Feedback not Related to Specific Facts: have some data points ready to go for conversations
  • Lack of Advice on How to Improve Behavior: If they knew what to do, they would already be doing it.
  • A Lack of Respect for the Source of Feedback:
  • Fear of Upsetting colleagues
  • Fear of Damaging Professional Relationships
  • Defensive Behavior/Resistance When Receiving Feedback
  • Physical Barriers: noise, or improper time, place, or space
  • Personal Agendas
  • Lack of Confidence

Reflective Listening

  • Seeks to understand the other
  • Listens for speaker’s meaning and emotions
  • Active listening
  • Respect for the person’s inner wisdom
  • There is value in the conversation that goes beyond the answer to your question

The Ladder of Inference

  1. Take Actions
  2. Form Beliefs- Sam is lazy
  3. Draw Conclusions- Sam does not care about his job
  4. Interpret Data- Maybe Sam does not care about his job
  5. Selected “data”- Sam was late on Monday, Tuesday, and Wednesday
  6. Observable “data”- Sam is late- Focus here rather than going up the inference ladder