Performance Improvement Tip of the Day: The Power of the Feedback Loop

This article from WIRED magazine about the power of feedback loops nicely helps illustrate how this simple biological mechanism works to improve personal performance, and can be harnessed to improve the performance of teams and systems.



Dr. Joseph Kvedar, Director for the Center for Connected Health at Partners, talks about the feedback loop in this wonderful YouTube video. He talks about using the key feedback elements below to help patients change their behavior. However, the same feedback loop and elements can also be used in motivating behavior change for practitioners. When implemented wisely and within the construct of a well designed management system, this loop is a powerful contributor to improvement.

(1) Active Reflection: This occurs through the appropriate use of data, presented in a meaningful way, at the right time in order to make the intended recipient/ audience actively "sit up and take notice".

• This is the concept behind the TrendWatch presented earlier. 
• Critical information is displayed on one page - an important concept that ensures adequate visualization of the overall initiative. 
• This allows individuals and a team to understand how their performance is linked to outcomes and where their collective performance sits in the context of initiatives undertaken to improve performance. 

(2) Sentinel Effect: The idea that someone may be watching you can change your actions.

• Monitoring data regularly, providing feedback, and generating reports all create the signal to individuals and teams that their behavior is being monitored. 
• In my experience, this is sufficient to drive most individuals to change "undesirable" behaviors. 

(3) Social Norm Bias:

• This is the mechanism that drive the power of the SMART Profile system presented earlier. 
• Producing a Profile and sharing it regularly with team members provides the impetus for team members to gravitate their behaviors towards the "social norm" or "team average" or "benchmark". 
• When combined with the monitoring of data, provision of feedback, and generating of reports, profiling helps to keep desired behaviors in place. 

(4) Ability to Take Action: The individual must be able to take action to change the behavior that the feedback is intended for. Many improvement efforts fail because the feedback loop that they generate is on "irrelevant" items, or behaviors that any particular individual is unable to change, i.e., they may need to be changed at the group/ team/ systems level.

(5) Consequence: Consequence is ultimately what makes all of the above strategies successful when implemented within a "system". In most cases, consequence is a theoretical possibility and no consequential action is actually undertaken. However, the possibility must exist of consequence, which in the context of healthcare performance improvement may include the following:

• Coaching 
• Supervision 
• One-to-one meeting
• Letter on file 
• Censure 
• Peer review 
• Suspension