Key issues in relation to effective feedback

Introduction

Nurse leaders are required to provide feedback to their staff within healthcare settings. If feedback is not provided effectively, it can be destructive to the team, lead to conflict and demoralise staff. This article explores some of the key issues in relation to effective feedback, and the implications within practice.

What is effective feedback?

Effective feedback is regarded as an essential aspect within practice. It focuses on enabling staff to maximise their full potential at different levels of their personal and professional development. It is a process of self-assessment that enables staff to develop an awareness of the key areas that require further development, as well as improve performance. Feedback provides an essential dialogue between the member of staff and their manager, and if completed effectively can enhance the process of learning and development (Kaufman et al, 2000, London Deanery, 2012).

The invaluable information obtained during the feedback session enables both the individual and the manager to address key developmental needs identified. If feedback is not given regularly, staff may assume everything is going well, and continue with their current level of skills and performance which may not necessarily be appropriate (Brown and Cooke, 2009, London Deanery, 2012).

Issues in relation to effective feedback

Whether feedback is given formally or informally, there are several issues to consider which can make a difference to the effectiveness of the process.

The issues that nurse leaders need to consider to ensure that feedback is given appropriately include the following:

  • Feedback should be given when required.
  • Feedback should be given as soon as the event takes place and not left for too long, otherwise it may be less effective. If there are important issues to be addressed, they can be dealt with there and then.
  • Feedback needs to be positive and preserves the person’s self-esteem as this can make a difference as to how effective it will be.
  • Feedback requires privacy, particularly if the issues to be addressed may be regarded by the person as negative.
  • Feedback needs to be part of the communication process, a dialogue between two individuals, which focuses on developmental needs, and is given in an environment that promotes trust.
  • Focus on the here and now and not on previous mistakes unless this is a recurrent problem.
  • Suggest alternative to the behaviours, or ways of achieving the desired outcome if the focus is on changing behaviours that may be perceived as negative.
  • Be clear, specific and give objectives and goals which are achievable.
  • Do not overload the individual with too many issues that need to be addressed (Hesketh and Laidlaw, 2002; Brown and Cooke, 2009).

 Models of effective feedback

A common model of effective feedback used in healthcare is Pendleton et al (1984) which focuses on the following:

  • Check the person wants the feedback and is ready.
  • Allow the person an opportunity to give feedback first on how they feel they have done and give a background and on performance.
  • Allow the person to state the key issues they feel they have done well.
  • The manager then states the key issues they feel the person had done well.
  • The person then states the issues they feel they need to improve on.
  • The manager then states what they feel the person needs to improve.
  • Both will agree on this and formulate an action plan to address the key issues identified.

 Barriers to giving effective feedback

  • Fear of upsetting the member of staff or damaging the staff - manager relationship.
  • Fear of doing more harm than good.
  • The person receiving feedback may react negatively in a resistive or defensive manner when receiving criticism. If this is not handled effectively could result in feedback being disregarded.
  • If feedback is too generalized and not focused or specific can hinder the process.
  • Merely giving feedback but not enough guidance on how to resolve the problem identified.
  • Feedback that lack consistence.
  • Lack of respect for the source of feedback (Hesketh and Laidlaw, 2002, Brown and Cooke, 2009). 

 Giving feedback – what should be involved

  •  Do first of all establish the member of staff’s agenda.
  • Do obtain information from other people involved.
  • Do ask the member of staff to determine what they feel they have done well. Encourage them to focus on what they feel were/are the positive aspects of their behaviour or performance.
  • Do state what you feel are the positive aspects of the member of staff. This aspect may be difficult but it is an important to ascertain this first.
  • Do give the member of staff specific aspects of their performance, what they have done in the past.
  • Do ensure that you actively listen to the member if staff and maintain eye contact. Observe the member of staff’s verbal and nonverbal cues.
  • Do focus on building a rapport with the person, and use communication skills, such as paraphrasing, summarising, mirroring and good use of questions.
  • Do ask the member of staff what they think are the areas that need to be improved.
  • Do ensure that the feedback given relates the person’s learning.
  • Do inform the member of staff what you feel are the areas they need to improve. This needs to be constructive.
  • Never outline a negative aspect of a member of staff, without clear evidence and specific plan on how you feel that the person should implement the process of personal and professional development.
  • Do try and offer a clear distinguishing between the performance and the individual.

 (London Deanery, 2012)

 Giving feedback – what should be avoided

  •  Do not dismiss the member of staff’s emotional response as they may be upset about what is being said to them, or become angry.
  • Do not criticise the person, without providing clear justification or direction on how the issues identified should be addressed.
  • Do not state any or comment on the individual’s personal attributes, particularly personality traits that cannot be changed.
  • Avoid providing generalisations.
  • Avoid commenting on anything that is not true or personal opinions; focus on facts, not assumptions. It is important to be specific and provide any alternative ways to improve the behaviour.

 (London Deanery, 2012) 

 Conclusion

The issues addressed above highlight the importance of giving feedback which if not managed effectively can have implications on staff. The key issue nurse leaders need to remember about feedback is that the process needs to be managed well to maximine benefit to the staff. Most importantly, it enables them to provide constructive feedback and guidance to staff, which if done effectively can enhance, rather than hinder progress, performance and development.

References

 Brown, N and Cooke, L (2009) Giving effective feedback to psychiatric trainees. Advances in Psychiatric Treatment 15: 123-128. Available at: http://apt.rcpsych.org/content/15/2/123.full [Accessed 19 January 2014].

Hesketh, E.A and Laidlaw, J.M (2002) Developing the teaching instinct: feedback. Medical Teacher. 24: 245–8.

London Deanery  (2012) What is Feedback. Available at: http://www.faculty.londondeanery.ac.uk/e-learning/feedback/barriers-to-giving-effective-feedback [Accessed 19 January 2014].

Kaufman, D.M., Mann, K.V, Jennett, P.A (2000) Teaching and Learning in Medical Education: How Theory Can Inform Practice. Association for the Study of Medical Education: Edinburgh.

Pendleton, D., Scofield, T., Tate, P and Havelock, P et al (1984) The Consultation: an approach to learning and teaching. Oxford University Press: Oxford.