Demonstrate the Ability to Give Effective Feedback to a Colleague

The context

Although GPs normally work in a GP surgery, their situation is unique among all the specialities because their work ties in with many different services. This means that you could find yourself giving feedback either face to face or at a distance (Table 1). One of the reasons we give feedback could be when someone is unhappy, when there has been a complaint or when we have noticed that something could be done differently. However, feedback is not always negative and positive feedback to compliment someone who has done well is equally important.

OPEN IN VIEWER

Table 1.

Examples of the context for your feedback

Organization	Description of role	Examples of feedback
Primary care team	GP registrar GP locum Salaried GP GP partner Nurse practitioner Practice nurse Administrative staff Practice manager Health visitor District nurse Midwife Student (clinical or non-clinical)	Feedback on learning experiences Praise for good clinical care Constructive feedback to improve performance Congratulating the whole team after a cycle of audit shows improvement Clinical care, where things could have been done differently Errors in filing or medical record keeping
Hospital	Junior doctor Consultant Administrative staff	Suggestions to change prescribing behaviour in line with hospital/Primary Care Organization policy Feedback on the content of discharge letters from the GP to the secondary care team
Social services	Social worker Administrative staff	Gratitude for comprehensive written communication Praise for efficient highlighting of letters and medical coding that helps clinical care Child protection issues
Police/legal services	Police officer Patient's solicitor Employer's solicitor	Confidentiality issues Sharing of information and consequences for patient Praise for clarity of what is being requested of the doctor when requesting a medical report

Individual feedback

The most usual scenario for giving feedback to a colleague will be to an individual with whom you work or supervise. This is usually a one-to-one event. As doctors, we have often had a history of both giving and receiving feedback like this. Medical students start clinical experience in a practical way and rely on other more senior colleagues telling them what they are doing well and what they can change in their practice. Unfortunately, this is not always done as a structured process, so the feedback becomes ineffective.

Before giving any feedback, it is important that you spend some time reflecting on the reasons for giving feedback. For example, feedback might fall into the following categories:

Ideally, you should involve the recipient in the preparation for receipt of feedback. A common way to do this is to set ground rules. In a teaching scenario this can be easy because part of the icebreaker work at the beginning can be to set ground rules. In practice, this may not be possible. Be wary of colleagues who say ‘Just cut to the point’ because this might turn out to be a mistake that affects your working relationships detrimentally. One way to avoid this is to be more recipient centred. Some phrases that may come in handy are as follows:

The barriers to giving good feedback are similar to the barriers to effective communication generally. Your prior relationship with the colleague and any ‘history’ you share together will undoubtedly influence your feelings and the behaviour of your colleague. If you get on well and already have a good rapport, then the feedback is more likely to be taken positively. If you have no relationship, then it will be more important to try to establish a rapport prior to delivery of the feedback. If there are language barriers (e.g. English as a second language), you may choose to use your words carefully and explain any misunderstanding. Cultural barriers may mean that you or your colleague have certain expectations of when ‘criticism’ is appropriate and this may link into age differences, differences in your levels of experience or expertise. The gender of your colleague and the nature of your feedback may alter how you deliver your feedback.

A good framework to use in giving feedback is the Pendleton guidelines, which are described in the book by Pendleton et al. (1984) An adaptation of these is presented here:

Giving feedback that is effective, well received and enhances your professional relationships is akin to having good consultation skills with your patients. Done badly, giving feedback in a way that burns your bridges could find you are adversely affecting professional relationships with colleagues you may rely on for help in the future.

There are often scenarios in medicine when it is inappropriate to spend a long time planning and delivering feedback. For example, it is unlikely that a vascular surgeon will stop to discuss the right and wrong way to stop an artery from bleeding in theatre. Emergencies are a good example of when feedback might need to be swift and to the point. If this is the case, it is helpful to have a debrief later when the situation has resolved. This scenario is, however, unusual in primary care.

Multi-source feedback

This process describes feedback that usually comes from a number of other colleagues. Often there will be a standard questionnaire that the doctor or learner asks other colleagues to fill in about him or herself. The questionnaires may be completed anonymously and sent back to the mentor or trainer to collate and give to the learner in a face-to-face meeting (such as an appraisal). This is an involved and more formal process but if around 10 or more responses are received, this can give a good degree of feedback that is helpful to inform a doctor's practice. The process can be time-consuming for all involved and following the guidelines of Pendleton et al. in delivering the final feedback could be useful. If you find yourself giving the final multi-source feedback results, then it is important that you spend time preparing the physical and emotional environments (e.g. ensure you will not be disturbed, ensure confidentiality and set the scene for the meeting at the outset).

Feedback to others outside your immediate practice team

If your feedback is intended for an individual, then the route for communication is more likely to be face to face, telephone or a personal letter. Should you be trying to give feedback to an organization, it is more likely that your feedback will be by letter. At this point it is always worth trying to find the name and job title of the most appropriate person. Some examples of feedback and appropriate options are given in the four scenarios.

When feedback goes well

Once you have given your feedback, if things go well, you should feel a sense of reward. Giving feedback to colleagues is similar to learning consultation skills for use with patients. Once you have tried certain phrases that work for you, you will find yourself using them again in the future. Particularly, if an episode of feedback has caused you some anxiety during the preparation phase, and it subsequently goes well, you may end up feeling safer and more secure about giving feedback again in the future.

What to do when feedback goes wrong—an example

A GP was growing progressively frustrated at the long waits that his patients were suffering when he referred them for primary care counselling. Eventually, a patient who repeatedly attended at the surgery expressed his annoyance at the fact that counselling was taking so long to obtain. The patient felt ‘fobbed off’ by the secretarial staff at the primary care counselling service. The cumulative effect of patients complaining about the long waits made the GP sufficiently frustrated to ring the local mental health team and complain about this. The consultant in charge was consulting, so he left a brief message with the secretary saying that the system was inadequate and not serving patients at all. Owing to the way in which the message was relayed to the consultant, she felt hurt and offended. She subsequently wrote a letter to the GP expressing her surprise at the abrupt message that the GP left with the secretary about the poor referral pathways available to patients.

The GP later spoke to this consultant personally and found that the consultant was already aware of the same problems and was working with the Primary Care Organization to try to increase capacity. She was able to express her eagerness to help primary care mental health patients and the GP was able to feel reassured.

This story serves to show that sometimes when GPs or other colleagues are stressed or frustrated with the service, they can end up giving feedback in an inappropriate way. Spending time preparing how to give the feedback and in the correct way can save embarrassment and enhance working relationships later. GPs are an embedded feature of our health service and rely heavily on being part of a multidisciplinary team.

Summary

Take the opportunity to give feedback as often as possible because it will be good practice for a future career of working in a multidisciplinary team where more and more work is being done by telephone, computer referral systems and e-mail. Remember to keep a record in your own learning log or diary so that this can be discussed in appraisal and you are prompted to follow up the results of your feedback, where appropriate. Your feedback may result in a direct change, for example, a change in policy within your own practice or in secondary care. Feedback is an important component of professional honesty. Without the environment and organizational structures for us to give feedback to colleagues as individuals, colleagues within organizations and colleagues as managers/commissioners of services, we are in danger of serving the needs of our patients poorly. Often GPs are the first to notice issues with individual patients' care and in the care of specific groups of patients because of their unique position in the UK health care system. This perspective comes with the responsibility to be able to give honest and effective feedback.