These days if I want some positive feedback, I look on eBay; I rarely get any at work. But as a hospital consultant I am responsible for giving feedback to colleagues, trainee doctors, and medical students on a regular basis. Quite rightly, I am encouraged to do this properly, so I am expected to receive training to achieve this. I learn that feedback should be timely, focusing on the positive and on behaviours that can be changed, not personality traits. It must be for the benefit of the recipient, not the giver, so I need to be sensitive to the impact of my message and encourage reflection.
Hospital consultants need to complete a multi-source feedback as part of their cycle of appraisal and revalidation. Patients, consultant colleagues, junior doctors, nurses, managers, secretaries and housekeeping staff can complete these forms. They invite feedback on a wide range of topics from probity to prescribing. You are then encouraged to reflect on the results with the help of a trusted colleague.
I have recently gone through this process in preparation for revalidation. The feedback I received from patients was consistently excellent, but I was surprised that my feedback from colleagues included a single “poor” score in nine of the nineteen domains including the one for “probity/honesty/trustworthiness”. I am unable to determine if these poor scores are from one colleague with a grudge or a number of different responders, since their identity is not disclosed. There is nothing in the free text section to give me any clue as to what the concerns might be. I reported myself to the survey director and asked them to investigate. My concerns were dismissed and I was told to be reassured by the overall very positive feedback. They refused to ask the responder(s) to justify their scores as this would breach the promise of anonymity they were given before completing the survey. But how can I possibly reflect on the “poor” scores without knowing what the issues are? How can I reassure the General Medical Council that my standards of probity, honesty, or trustworthiness are satisfactory when one of my colleagues has clearly posted a concern?
And what is the point of all these endless cycles of feedback? There is scant evidence that they result in any positive outcomes. [1] On the contrary, I have seen colleagues distraught by some of the negative comments they have received, which rarely have context, are almost always unattributed, and frequently breach all of the rules for giving good feedback. We have created a feedback system that allows people to make negative comments about their colleagues, concealed behind a cloak of anonymity and with no accountability. It is a worthless endeavour both in terms of rooting out bad practice and encouraging good practice. Would anyone be satisfied that a pilot was fit to fly a jumbo jet on the basis of positive feedback from the cabin crew?
But there is an alternative…coaching. [2] You choose your coach; it is someone you trust who has expertise in your field of work. Their sole aim is to make you as good as you can be in your line of work. They can help you to fix faults that you cannot see for yourself. I have found coaching a robust method of self-improvement. I do not give feedback anonymously and in my opinion; no one should be allowed to do so. The current model of anonymous feedback should be scrapped.
John Dean, Consultant cardiologist, Royal Devon & Exeter NHS trust
Competing interests: None declared
References:
- The feedback fallacy https://hbr.org/2019/03/the-feedback-fallacy
- Personal best http://www.newyorker.com/reporting/2011/10/03/111003fa_fact_gawande?currentPage=all