General Principles for Giving Feedback

Before the Feedback Session:

  1. Prepare for Feedback

It is important that practitioners get regular feedback on their communication and relationship skills throughout the year, not just in an annual review. Remember that a key principle of any development review process is ‘no surprises’.

It is helpful for the practitioner to know when feedback is coming, especially if it requires more discussion. It can be particularly disheartening for a practitioner to receive negative feedback when they are not expecting it. Ideally, you and the practitioner will be operating as part of a team or organisation where ongoing review and improvement of communication with patients is the cultural and organisational norm. They should know in advance that at least part of what is being observed in a given interaction is their communication ability and that they will receive feedback to help them improve.

In some situations you will have to give feedback without any opportunity to prepare, for example, if you observe particularly good poor practice or particularly bad practice. However even in these unplanned situations you can still use principles to inform how you give feedback.

  1. Find out if the practitioner wants to develop a particular aspect of communication.

In order to make the most of any time available, it is useful to find out in advance which particular abilities the practitioner is hoping to develop or has found problematic. A practitioner may have discovered through reflection or self review that they want to improve on a particular aspect. Identifying this beforehand enables the observer to listen out for it and then provide the most relevant feedback.

  1. Be clear about the purpose and outcome of the feedback.

Ensure that the practitioner understands the purpose of the feedback. Ideally, the purpose will be about supporting them to reflect on their own skills, encouraging them to try new approaches in order to continually improve their skills and enabling them to continually improve in a supportive environment.

The parameters for future action should also be clear. If issues arise, how can the practitioner be supported to address them? What limitations exist, for example, lack of time, expertise or development opportunities?

  1. Find out what the practitioner was hoping the interaction would achieve.

Make sure that you understand what the practitioner was hoping for from the interaction. That way, it will be possible to assess whether the communication strategies that they have used have been successful when measured against their own criteria. This will prevent you making comments based on your assumptions about the situation. Bear in mind that a person centred approach also involves the practitioner identifying what the patient expects and hopes to get out of an interaction and that a balance is required.

  1. Be clear on what is expected.

It is helpful if the practitioner and observer have a shared understanding of the criteria on which the feedback will be based. Both should know what is being reviewed, for example, standards, principles, models or elements of communication to be demonstrated.

  1. Gather appropriate evidence.

For regular, on the job, feedback to practitioners about individual conversations, your own notes or even better notes based on a simple checklist or framework completed by the practitioner themselves or by an observer (for example, you) will suffice as support for feedback.

For annual reviews of communication and relationships, it would be more appropriate to use evidence that demonstrates ongoing learning over the year, for example, reflective notes from the practitioner or from someone who has observed their skills developing over time, a series of completed observation checklists, feedback gathered from patients over a period of time (formal or informal) and so on.

The use of evidence for KSF annual development reviews is discussed further in the Guide to KSF and Communication and relationship Skills

After observing an interaction.

  1. Give feedback as soon as possible after the event.

Feedback should be timely, ideally given immediately after an interaction has been observed so that events are fresh in the mind and there is less opportunity for doubt over what actually happened. This also means that it should be easier to generate ideas for how a situation might have been handled differently.

  1. Ask the practitioner to reflect on their own performance first, and to be positive.

Asking a practitioner to reflect on their performance first before they receive feedback allows them to raise any shortcomings before they are pointed out by anyone else. This should reduce the chance of demoralising them. Some practitioners will be quick to highlight areas of difficulty. Help them to identify elements of their performance that they feel were good and should be continued as well as areas where they felt things went less well and could be improved. Make sure that the practitioner understands that learning through observation and feedback is a collaborative process and that their self-reflection is an important part of this.

  1. Ensure feedback covers positive aspects as well as areas for improvement.

There is an opportunity to learn from identifying elements of communication that have worked well and should be continued as well as elements of communication that could be developed or improved. This is especially true in a group situation where participants will have different strengths.

  1. Be descriptive rather than evaluative.

Focus on what was actually said and done rather than how you felt it went. Be careful to describe what happened and what the consequence was. Then encourage the practitioner to reflect on this. Avoid making assumptions about feelings and also adding your own feelings about an interaction. Avoid accusing or blaming the practitioner.

For examample, “When you turned to the computer screen, eye contact was broken and the patient stopped talking” rather than “You didn’t make a very good job of encouraging the patient to talk”.

  1. Focus on a few elements

If there are several issues that need addressing, choose the most pressing as it will not be possible for the practitioner to take in feedback on all of the elements at once and having too many areas highlighted for improvement could also be demoralising. Be selective and focus on two or three areas that could be changed and remind yourself to look out for the other areas on a different occasion.

  1. Be specific, not general

Make reference specifically to actual parts of the interaction rather than making vague generalisations. Give examples of what was actually said or done and what the patient response was.

For example, “When you asked an open question at the beginning you gave the patient an opportunity to explain their ideas and concerns in their own words” rather than “you started off well”.

  1. Refer to behaviours that can be changed and not personality traits

Focus on what is actually said and done and could be either repeated or changed another time. Be sensitive to elements of an interaction that relate personal characteristics or features that might not be changed. Try to phrase feedback so that the focus is non-judgemental and refers to the behaviour rather than the person.

For example, “Throughout the consultation you were talking a lot of the time and there weren’t many pauses” rather than “You are quite a chatterbox, you didn’t let him get a word in edgeways!”

  1. Encourage the practitioner to suggest and practise alternative approaches.

If the practitioner is struggling to think of different approaches, make suggestions or recommendations yourself. Encourage the practitioner to try these out saying the actual words they would use if they were faced with the situation again.