Feedback and how to give it effectively

Effective feedback can have a powerful, positive and lasting effect.

As a junior co-pilot in the 70’s, I was given some feedback by the crew administrator when I arrived for a flight. He interrupted his chat to another pilot and greeted me with a smile and the comment “Ah, Denis, you are very well turned out.”

I don’t know what prompted this unexpected feedback, however it had an effect which lasted for the rest of my career. It had raised my awareness that in any situation my appearance and behaviour could have an effect on others. It also demonstrated how powerful effective feedback can be.

Working in Healthcare, I have observed people giving feedback: usually on technical points, but occasionally on behavioural issues. Some feedback was about reinforcement of effective behaviour, and some was about improvement.

Case 1

A scrub nurse was under training and when the surgeon asked for the suture, she passed it the wrong way up. The surgeon corrected her and continued. He asked for another suture and again the scrub nurse passed it the wrong way; the surgeon then took the time to trace the direction of curve with his finger to help the nurse remember the correct direction, and the next time she got it right.

These are examples of appropriate feedback in the moment.

Sometimes someone may ask unexpectedly how they are doing, and giving feedback in the moment can be tricky.

Rather than trying to think of what to say, it may be helpful to ask them “what is working for you at the moment?” Or if they ask for advice ask them, “have you had a problem like this before and what did you find worked?”

Case 2

Observing a Skills and Drills simulation in a maternity unit, the alarm was sounded and staff rushed to the room. It went well and the mother who was simulating having a fit was treated with the appropriate drugs. In the debrief the trainer focused her feedback on the order the drugs were drawn up by the nurses: unfortunately, the Consultant disagreed and it looked like a lengthy technical discussion was developing. The coach intervened and took over the debrief, pointing out to a junior midwife how effective she had been when calling for silence and attention when another midwife was briefing the Consultant and her team on the situation.

A simple but helpful model for structuring feedback is BOOSTS

Balanced – discussing what went well (reinforcement feedback) and what didn’t go so well (Improvement feedback). In this simulation things went well so it was appropriate to focus on reasons why it had gone well: ie, the junior midwife taking a lead role to reduce distractions and get attention at a critical time.

Observations rather than inferences: what was said, e.g. “can we have attention”

Objective – Description rather than judgement. The behaviour rather than the person e.g. “It was helpful when you …”

Specific rather than generalising e.g. “You were an effective part of the team particularly when you …” versus “that was great.” Limit the amount of information to what the receiver can take in rather than the amount you would like to give.

Timely – An appropriate time and place. In this case, it was during the formal debrief. When possible, when they are in a calm receptive state.

Summarising. What is the key message you want them to take away?

Feedback given effectively BOOSTS learning!