Welcome to this presentation on giving feedback.

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I’m sure that we’ve all given feedback, and that we all have our own style – our own way of doing it. Just like anything else we do, a few people will be naturally good at giving feedback, most will be able to learn how to do it better, and unfortunately some people will be pretty hopeless at it, no matter how much they practice. I suppose what we should do first is think about what we’re trying to do when we give feedback. You could write a list now.

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If you have written a list then it would probably include: • Motivate • Develop • Maximise potential • Raise awareness of strengths • Highlight blind spots • Encourage reflection and open discussion • Identify actions to enable improvement. This is true whether we are giving feedback to an individual, or an organisation. It’s really important to make sure that an individual or organisation is aware of their strengths. When times get tough it’s their strengths that they can rely on and build on. It’s also important that feedback highlights blind spots – these might be hidden strengths that they aren’t aware of, but are apparent to ‘outsiders’, or they may be weaknesses that they can’t (or don’t want) to see. Sometimes a strength is also a weakness. The senior manager who pays great attention to detail, might also have a tendency to micromanage and not give staff enough autonomy; the organisation with a stable, supportive workforce, might be resistant to change and new blood. Through ‘feedback’ we aim to encourage this sort of reflection and open discussion with the hope of enabling the person, or organisation to identify what they can do to improve.

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Putting all that a bit more simply we could say that meaningful feedback is the fuel that drives improved performance.

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Have a think - Do you think that the feedback that Cheryl is giving will help the contestant improve his performance?

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We sometimes think that if we say nice things, then that is good feedback – but actually the most useful and meaningful feedback is that that helps someone improve – this might mean that they go from ‘bad’ to ‘ok’; or it may mean that they go from ‘good’ to ‘excellent’ – but either way it helps them improve. In order to do this the feedback needs to be focussed and detailed. If you can pick out a specific example it helps them believe that you have really observed them carefully. It needs to be soon enough after the event so that both parties can remember what you’re referring to. If you have children I’m sure they’ve asked you to watch them doing tricks, sports or gymnastics and I’m sure at times you’ve said ‘Yes, very good’ with your head in a book. They’ll often say Mum watch, really watch.... they want meaningful feedback, so that when you say it’s good, they can believe you.

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If you’re a fan of cookery programmes you’re probably quite familiar with the way the judges comment on the food. It’s timely, done as soon as the dish is cooked; detailed; usually constructive and focused on things which can be improved upon. So next time you watch X-Factor, Bake off or another talent show competition have a think about the quality of the judges feedback.

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So who should give feedback? Would you trust Gary and Alan to give feedback on the singing, baking or dancing? Do you trust their opinion on football?

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For feedback to be credible, it needs to come from someone whose knowledge, skills and attitudes are respected – a role model or an ‘authority’ in the field. You’ve been selected by the RCOG or Deanery, because you have the appropriate attributes to fill this role – so feel confident about yourself, and your views. Having said that there are still some things to be careful about when you give feedback.

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When planning the visit, it’s worth deciding and agreeing what feedback will be given and when. Obviously any serious patient (or staff) safety issues, or probity issues, must be addressed immediately – that day, and with someone who has the authority to deal with them. You’ve got a responsibility as a doctor to do that. Feedback needs to be timely. People or organisations are often anxious to hear, or at least to get a flavour of what you are likely to say. Do they need to look for another job? Will they get in trouble? Will your visit sort out their problems? We’ve already mentioned that it’s good to give examples, and both parties need to be able to remember what you’re referring to. And it’s no good giving feedback so long after the event, that the problems have sorted themselves out, people have retired or left, or hospitals have been closed. A good idea is to provide some verbal feedback at the time, followed by a written report – but agree what you’re going to do in advance. It’s also worth agreeing who you will give feedback to. You don’t want to embarrass anyone publically, and yet your feedback needs to be honest. This is particularly important when you’ve been asked to look at issues in relation to teamwork or leadership.

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So do be sensitive to the impact your feedback will have, both on the people in the room at the time of the verbal feedback, and those who aren’t there at the time, but will only hear about it at a later date – and may not even ever see the written report. Thank people for their input, and for being open and honest with you – acknowledge that this might have been difficult. Gain their confidence that you’ve understood their situation, the constraints they’re working under, the barriers to change – this helps you establish your credibility. Start with some positives – highlight their strengths – the ones they know about and if you can find some that they weren’t aware of. Then you can go onto the areas which need to be improved – the ones they’ve identified, and others that you’ve identified. Focus on what can be changed, it’s great if you can find something that can be changed easily – a quick win – but often by the time the RCOG or Deanery are visiting the quick wins have been exhausted.

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Compare and contrast these two videos on giving feedback to a colleague.

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Remember that to remain credible, and to be listened to, you have to be honest. People can often tell when someone is lying. Also don’t overload people – particularly verbally – there is a limit to what people can take in. Stick to a few main points and say when you think you’ll be able to provide the written report. It needs to be a bit like the news headlines with a more detailed report to follow. They can always ask questions.

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However, even if you provide meaningful feedback in a sensitive way, there is a risk that your audience might not like what they hear – so it’s worth considering what barriers there are to giving and receiving feedback. You could write a list now.

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- Most of us don’t like upsetting people, particularly if we can see they are trying hard under difficult circumstances. - Or we might be scared that we’ll be shouted out – will I get out of here alive – it’s not pleasant, especially when you’re on someone else’s patch. - You might be conscious that there is a risk that you would betray someone’s confidence, particularly if they have given you a real insight into the problem. Although you can give people an assurance that you won’t name anyone, comments are sometimes attributable. - Or get someone into trouble for spilling the beans, or appearing disloyal. Most of us are very conscious of the need to be sensitive because we don’t want to do more harm than good, perhaps by completely destroying someone’s confidence, or disenfranchising a team to the point where they won’t engage. People often don’t want to listen to negative feedback and you can get reactions such as anger, denial, blaming each other or ‘the management’, or excuses ‘We’ve been put in an impossible situation’ - and I think it’s perhaps for this reason that it’s good to show that you understand their situation at the outset. This helps you establish your credibility, and also shows that you’re on their side and actually want to help.

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Watch the video and think about how the consultant: • Shows she understands the registrar’s situation • Encourages reflection • Overcomes barriers • Uses concrete examples • Encourages improvement.

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So have a plan before you provide the feedback – stress that you’re there to help (it might not feel like it to them), redefine the purpose of the visit – why you were invited. Establish your credibility by discussing current problems and constraints – these are the problems that were highlighted to us, by you. And then go through the strengths, discuss possible problems, and talk about how they might move forward after the visit to generate their own solutions. Finally document it all again in a written report.

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Remember feedback works best when it’s sought, the local team need to own their own problems and generate their own solutions. Your job is then done – you’ve fuelled the improvement.

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