34th Annual Scientific Meeting proceedings

If ‘feedback is a gift’, why can it feel like a punch in the mouth?

We are familiar with the concept of feedback in physiologic terms, such as in the endocrine system. Negative feedback decreases activity in a feedback loop and positive feedback reinforces it. When we are discussing feedback in psychosocial contexts, however, the terms ‘positive’ and ‘negative’ are pejorative and, therefore, run the risk that the mere word ‘feedback’ feeds into our negativity bias. This means that the phrase ‘Can I give you some feedback?’ can be seen as a threat and trigger fight-flight-freeze-fawn responses. This may be especially true in those of us whose inner critics are already quite strong! For this reason, I prefer the terms ‘reinforcing’ feedback that encourages repetition of noted actions/behaviours and ‘aligning’ or ‘developmental’ feedback where we might consider trying different things in the future.

Why is this important? Understanding the risk of defensive responses in ourselves and others can help us begin to change and to examine how ‘feedback’ works best for us as individuals. We can develop our skills and learn how others prefer feedback to be structured, flexing our approach so that feedback is in the service of everyone, not just a means of shedding our frustrations.

To be able to accept feedback we need to be in a frame of mind that is neither hyper- or hypo-aroused. We need to be in a growth mindset and see constructive, well-delivered feedback as an opportunity to grow and learn. Similarly, if we are delivering feedback, we should be considering how it might be framed so it is both accepted and welcomed.

How you best receive feedback? What works for you? And, knowing this, how can you share this information with those around you so that you can all build knowledge, skills, behaviours and, most importantly, trust?

It can sometimes be hard to give feedback that you feel might upset someone, or provoke a reaction, which can then provoke a similar response in the ‘giver’. It is important to remember, therefore, that if feedback is in the service of the receiver, overcoming our reluctance to comment is right. Approaching these conversations with a compassionate mindset, to self and others, can diminish the likelihood of creating a cascade of unpleasant feelings. Phrases like ‘I appreciate this might be difficult to hear, but I think you should know that…..’, and ‘I can see this is upsetting but I think you would prefer to know.’ can be used to show empathy and frame your intent. Be mindful of your personal boundaries - don’t be drawn into the emotions- and practice self-compassion.

A structured feedback framework can be used to help develop your skills. One such is I-C-SAID-C (‘I see said C’):

Intention
Think about your motives for giving feedback. Is it in the service of the recipient or is it because you want to get something off your chest? If it is the latter, maybe think again. Or think carefully about how you are going to phrase and deliver the information.

Consent
Ask the person who is to accept feedback for their permission before you deliver it. In some cases, they may not be in the right emotional state to accept feedback in a reflective and developmental frame of mind, whatever your best intention. Or they may, for example, be focussed on an essential task. In most, cases, feedback on events passed is not immediately time critical, although close to the occurrence to be readily recalled is generally preferable. When would work best for them? Also think about the ‘Where’ of the delivery. Might a quiet, private space be better? Or, for reinforcing feedback might you wish to make a positive example of noted actions/behaviours?

Situation
Identify clearly the situation to which you are referring e.g., ‘When Dr Smith came into the prep room first thing this morning…..’

Action
State what you observed e.g., ‘I noticed that you were very aware of Dr Smith’s worried air and were quick to ask them if they were OK or needed anything.’

Impact
What was the effect of this? For example, ‘I noticed Dr Smith relaxed and felt supported and was able to share their concerns about that challenging case.’

Development?
What should we learn for the future? For example, ‘It was great to see you showing this empathy and compassion. This is something you do really well, and it is appreciated. Please don’t stop!’

Check
Ensure what is received is what was intended and that it is accepted. If necessary, ask the recipient to repeat it back.

Developing a feedback culture in a team requires practice and it will not always go well. It is easy, in those cases, to lose faith and for everyone to withdraw behind their defences and project invulnerability. It is important, therefore, to accept, as a team, that development of a feedback culture, which will ultimately improve both relationships and quality of work, requires practice, compassion and forgiveness of self and others. Maybe you can lead a conversation about this in your teams?