Performance Improvement Tip of the Day: The Importance of Giving Feedback

Three recent articles all underscore the importance of the feedback function in improving performance:

• Isn't feedback great: http://www.businessleaderslearning.com/archives/2011/07/18/tips/isnt-feedback-great/
• How to give negative feedback: http://leaderchat.org/2011/10/17/need-to-deliver-some-negative-feedback-5-things-to-keep-in-mind/
• "Taking a break" and "being slightly behind" motivates improvement: http://www.freakonomics.com/2011/10/17/call-it-a-comeback-why-performance-increases-when-were-losing/

Feedback is an important part of the "regulatory loop" without which we do not have a mechanism to self-correct. Successful change agents, managers, and performance improvement specialists all incorporate feedback actively into their repertoire as they recognize that very often behavior of their staff and colleagues needs to be modulated.

Formal feedback systems can include annual performance reviews and report cards, as well as punishment and censure for egregious behavior. However, there are often "minor" behavioral issues that do not rise to requiring this level of intervention. Some examples in the clinical setting:

• medical records not signed
• use of unapproved ("dangerous") abbreviations
• specific performance measures - such as CHF or Pneumonia - not met
• minor conflicts between staff members

In these cases, it is incumbent upon a department head or performance improvement specialist to provide feedback to the responsible clinician - usually physician or nurse - about an action that should have been carried out. When provided within a "non-blame" environment, and framed in a non-threatening manner, such feedback can "gently" suggest to the recipient that there are alternative behaviors that he/she should have undertaken.

In my experience working in numerous healthcare settings, most providers receive this feedback in a constructive manner, and are generally happy to have the assistance in identifying the "outlier" behavior.

In some cases, the recipient of feedback will engage in a dialog about why the selected episode is considered an "outlier". In most of these cases, the clinician is generally satisfied with the ensuing discussion - provided that the underlying rationale is made clear, the system for review is fair, and that the practitioner doesn't feel singled out.

In very rare cases, the recipient takes the feedback personally, and can become defensive, or offensive. The reaction can certainly be quite intense, and requires a healthy quotient of emotional intelligence in order to allay. However, even in these cases, I have found that the feedback still has its desired impact - the individual is now aware of the discrepancy in behavior, and is generally more likely to be compliant with desired behavior.