Giving and Getting Feedback: Two Perspectives

Receiving timely, non jugmental, accurate, well-intentioned feedback may be one of the most valuable enablers of professional and personal development. This doesn't come naturally to everyone, but good leaders focus first on self-development so they can coach and mentor others.

An Opportunity for Personal and Professional Development
By Michael Tronolone, MD, Chief Medical Officer, The Polyclinic

Receiving timely, nonjudgmental, accurate, and well-intentioned feedback may be one of the most
important enablers of professional and personal development. Physicians, by virtue of their professional standing, often find themselves in leadership positions: leading a practice, a surgical team, a department, a clinic, or other group of people.

As part of their leadership skills toolbox, good leaders have the ability to effectively give and receive feedback.This
doesn’t come naturally to everyone, but good leaders focus first on self-development so they can coach and mentor their team.

The purpose of feedback is to help an individual develop. Feedback should not be confused with performance reviews or corrective actions. Feedback is not judgmental. It can be both positive and critical. Effective leaders are good at both, and they practice both in a balanced way. This is a form of coaching and mentoring that ultimately helps others achieve seemingly impossible personal and/or professional goals.

For leaders, feedback is part of the relationship that they have with their teams and a tool for enhancing team performance. It is a two-way street and should be built on trust and respect. Effective leaders are open to feedback and should encourage it for two reasons:

First, this presents an opportunity for a leader to model how to constructively receive and incorporate feedback, and second, it gives the other party an opportunity to practice giving feedback in a safe environment. These are key steps in personal and professional development.

Positive personal feedback is often more rewarding to an individual than public praise. Public praise of an individual may be seen as more of a message to the others about his or her lesser performance. In some instances it may come off as rather perfunctory or obligatory. This is not to say that public praise is to be avoided, but it should be followed up with personal positive feedback when it is delivered close in time to the behavior in question.

For most of us, giving critical feedback is more difficult than giving positive feedback. When faced with a situation where one must give critical feedback, it helps to remember that the purpose for the feedback is not to embarass or chastise individuals but rather to give them insight into their behaviors that will help them become more effective professionally or personally, or both.

Tips for Giving Feedback
Be timely. 
Feeback is most effective when it is delivered close in time to the behavior in question.

Be limited and specific: Feedback should be limited to a recent specific behavior or incident; preferably, a behavior or incident that you have directly observed. Do not layer on multiple examples of similar behaviors from the distant past or behaviors that have been reported by third parties.

Be prepared: Know exactly what you want to say and how you want to say it. Practice if you need to. Schedule a time where neither party will be interrupted or distracted.

Be factual and accurate: Gather as much firsthand information as you can get. If there are gaps in information, acknowledge that during your discussion and allow the person to fill in those gaps. This is a good technique to get him or her engaged.

Be nonjudgmental: Do not ascribe intentions to behavior. Try to get the person to make a judgment about his or her own actions. Questions such as “Can you see how someone might interpret your intentions?” can move an individual into a reflective space where he or she can develop a personal insight.

Maintain your cool: Do not allow yourself to be drawn into a debate or an argument. De-escalate. Keep on message. Your objective is not to win an argument but for the individual in question to hear what you’re saying and internalize the feedback in a constructive way.

Remember, one of your key roles as a leader is to coach and mentor your team members. This starts with a commitment to your self-development. Be open. Practice these tips and ask your team for feedback on how you are doing with giving and receiving feedback.

Creating a Shared Vision of Improvement: A Strategy for Taking Action
By Alfred Seekamp, MD, Chief Medical Officer, The Vancouver Clinic

One of my greatest passions is ensuring high-quality, patient-centered care at all levels of our organization. In my
role as Chief Medical Officer at The Vancouver Clinic (TVC), I have had ample opportunity to talk to physicians and
advanced-practice clinicians about their patient experience scores. I approach the conversation as an advocate for the provider’s success, thereby engaging them in creating a shared vision of improvement and a strategy for taking action.

There are eight steps I regularly follow that decrease provider defensiveness and increase the sense of alignment going forward:

1. Initial Discussion: I personally e-mail or call providers with low patientexperience scores. In advance of the
meeting, I talk to them about the purpose of the meeting and ask them to think about improvement strategies and
obstacles. At TVC, patient-experience data is available on our intranet. It is unblinded and includes raw scores,
percentile ranks, and comments for individuals and departments throughout the organization. I review the data prior to the meeting, looking for trends, areas of success, and potential barriers to improvement. All providers have access to this data, and they can see each other’s scores. This is done because providers need to be become comfortable with increasing data transparency. In time, patient-experience data will be made available to patients.

2. The First Meeting: I typically schedule a one-hour meeting in my office. I have the meeting in my office because I want to stress its importance. I greet the provider warmly and thank him or her for coming. We sit around a table and have an interactive conversation, much as a doctor and a patient would.This also provides me with additional feedback about a provider’s body language and verbal skills.

3. Connection with Purpose: I start our conversation by asking the provider what he or she enjoys most about the practice of medicine. I then tie his or her personal motivation to why it’s important to improve the patient experience.It’s not about just improving scores; it’s about improving our service and the quality of care that we provide.

4. Coaching on Customer Service: I let providers know of four simple behaviors they can easily adopt to maximize their patient-service interaction. They are:
• Smiling
• Eye contact
• Tone of voice
• Asking the patient if there is anything else that you can do for him or her.

While these seem simple and straightforward, it’s amazing how often they are not consistently done.

5. Building on Successes: I look for areas in the patient-experience survey that people are already doing well. Providers are often open to building on and improving things that they are doing.

6. Identification of Barriers: I explore if the provider feels there are barriers or system issues that prevent him/her
from being successful. I explore if the provider feels there are system issues impacting his or her success, including sufficient appointment time length, adequate staff, or other resources. If other providers are also being
affected, a group problem-solving session develops physician-led solutions.

7. Identification of Goals: I encourage providers to set goals that are SMART (specific, measurable, achievable, results-focused, and time-bound) and link them to their personal purpose, which is a powerful source of motivation. I also offer a variety of resources to providers, including individual coaching (which is provided at organizational expense).

8. Wrapping Up and Looking Forward: At the end of the meeting, I thank the person for coming, reemphasize the things he or she is doing well, compliment him or her on goal-setting progress, and give reassurance that I believe in the individual. I schedule a follow-up meetings in three to six months, document the conversations in their personnel files, and send the providers an e-mails thanking them for chatting with me, summarizing their
commitments, and asking them to contact me along the way if they have questions.

I thoroughly enjoy helping my colleagues to succeed in practicing medicine. I am committed to helping motivate them by connecting their patient-experience goals to their individual purpose and to the organizational vision.