The Art of Effectively Receiving Feedback in Team-Based Care

Holly Nelson-Becker PhD, LCSW

Stacie Levine MD

Objectives

• Identify the positive role of feedback in improving performance and attaining professional goals more quickly and easily

• Discuss barriers to receiving feedback, including how to prepare for, remove, and manage these barriers

• Use methods to obtain feedback effectively

Why an art?

• If done well-- feedback can be the most important tool for learning, enhancing skills, and developing as a professional

• If done poorly-- feedback risks alienation and leaves clinicians stuck or confused

• Feedback is a relational process as much as it is about content

• How feedback is given and heard facilitates or impairs the learning process and future relationships

Theoretical model of relations among basic values and higher order value types

Adopted from Schwartz et al. (2012)

Feedback definition

• Formal and informal

• Nonverbal/verbal

• One of the best ways to improve our ability to give feedback well is by improving our understanding of what it takes to receive feedback well

Opening exercise

• Think of a piece of feedback in the recent past that you found tough to receive

• What immediate thoughts went through your mind as you received this feedback?

• What were your physiologic reactions?

• How did you respond?

Case #1

LB, a home-based PM physician, is meeting with, AJ, the medical director, to review QI initiatives that were put in place 6 months ago. AJ has a reputation of “running a hard line”. He informs LB that her team performed 20% under promised clinical targets. LB’s team had been missing one of their seasoned nurses due to a protracted medical illness. Nevertheless, LB is visibly upset and leaves the meeting feeling it was all her fault.

Three feedback triggers

1) Truth Triggers – set off by the substance of the FB

2) Relationship Triggers – tripped by the particular person giving the FB

3) Identity Triggers – Neither content, nor person giving FB. About us

Case # 2

ML is a new APN hire for the inpatient palliative medicine team. Although she had limited training in HPM throughout school, she has gone out of her way to attend conferences and shadow all team members to gain clinical experience. She asks SW, the PM program director, for feedback about her performance. When she tells her she is “meeting expectations” she leaves feeling confused. “I don’t understand, doesn’t she see what I have been doing to catch up to everyone on this team!” she says.

Case #3

JW is the chaplain on the PM consultation team at a community-based hospital. A hard-worker, he has taken it upon himself to improve the EMR template for chaplains and makes every effort to attend important family meetings. One day he asks the team social worker for feedback on the work he has been doing. “You are great! I wouldn’t change anything.” she says. JW decides that was not very helpful and moves on to seek advice from someone else.

Three kinds of feedback

1) Appreciation

2)Coaching

3) Evaluation

What helps? First, understand the feedback

Coming from? Going to?

Label Data and observations? Expectations? Interpretations? Implicit rules?

What are they expecting I do differently? What are the consequences?

Case #4

EJ and KL are home-based PM APNs in the same company. EJ has been with this company for much longer than KL and has noticed she is having some difficulty getting along with the team social worker. “I feel like the two of you are not communicating effectively,” he tells her. KL returns with, “Actually I’ve been told by the CNAs I am a great communicator. You haven’t been to IDTs in awhile so I wonder where this is coming from?”

What else helps?

• See your Blind Spots

• Don’t “Wrong Spot”

• Avoid Switch Tracking

Navigating the feedback conversation: three parts

O

P

E

N

BODY

C

L

O

S

E

Open

• What is the purpose of this conversation?

• What kind of feedback would I like?

• What kind of feedback is the giver trying to give?

• Is the feedback negotiable or final? A friendly gesture or a command?

Body

• Listen

-Ask clarifying questions

-Paraphrase what the giver is trying to say

-Acknowledge their feelings

-Be curious, ask for examples

Body

• Assert – a mix of sharing, advocating, and expressing

• Manage the conversation process

• Problem-solve

Close

• Clarify commitments

• Create action steps

• Identify benchmarks

• Follow-up, new strategies

Get going

• Name one thing “What is the one thing you see me doing that gets in my own way?”

• Listen for themes

• Ask what matters to them

• Try small experiments

Case #5

Coach your coach

• Find ways to collaborate

• Put your ideas out there

• Discuss your feedback temperament

• Explain growth areas you are working on

• Terms of effectiveness rather than ambition

• Don’t be a feedback fanatic

A clinician who learns from feedback has/is:

• Sense of self-relatedness

• Mindful

• Concern for others; agenda is welfare of patients

• Ability to hold his/her personality flexibly

• Intuitive, self-aware, thoughtful

• Able to take care of self

• Open, creative

A clinician who learns from feedback

• Seeks as much patient engagement as possible within constraints

• Doesn’t run away from tough stuff

• Pushes the limits of his/her own reliable performance

• Overcomes automatic thinking

• Plans, strategizes, tracks, reviews evidence, changes outcomes

Summary: Components of receiving feedback well

• Sorting and filtering

• Learning how the other person sees things

• Trying on ideas, even if they seem like a poor fit

• Shelving or discarding the parts of feedback that seem off or not what you want right now

Summary: Feedback is a relational process

• The first step in giving and receiving feedback is to ASK for it

– What can I do to improve?

– How can I say this better, do this better?

– Inviting feedback sets up a dynamic of reciprocity

– I want to know what you think so I can improve