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The Art of Giving and Receiving Feedback

In healthcare organizations, it is mission critical that leaders and managers possess the skills to deliver direct, honest feedback to supervisees and peers. Currently, many managers receive minimal training on how to provide concrete feedback plus coaching that can help team members improve their performance. As a result, many supervisees receive feedback that is conflicting, confusing, or no feedback at all. In this workshop, Grace Ng will discuss the current challenges in giving and receiving feedback, provide frameworks and tools that can be applied in feedback conversations, and share her vision for moving towards a culture of feedback and learning.

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The Art of Giving and Receiving Feedback

  1. 1. The Art of Giving and Receiving Feedback Advanced Practice Nurse Coordinators Retreat April 18, 2016 Grace Ng, MS, CNM, RN Nursing Director New York Simulation Center for the Health Sciences 1
  2. 2. No Conflicts of Interest to Disclose 2
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  4. 4. My Current Goals • Strengthen our ability to give and receive feedback • Empower leaders and mentors to approach difficult conversations in the workplace with confidence • Improve clinical practice quality • Improve patient outcomes 4
  5. 5. Learning Objectives • After this session, the participants will be able to: – Describe techniques for giving feedback that leads to learning (focusing on formative feedback) – Identify strategies that can strengthen our ability to receive feedback – Identify techniques for providing effective coaching – Discuss values and beliefs that leads to a culture of learning 5
  6. 6. Once Upon a Time…. 6
  7. 7. What About Your Experience? • Think of a recent experience where you had to give feedback to someone at work, but it didn’t go as well as you would have liked. • Share: What challenges have you encountered when giving feedback to others? 7
  8. 8. Ideal Pathway for Feedback 8 Feedback Given Feedback Received Improved Performance
  9. 9. Current Problem with Feedback 9 Feedback Given Feedback Received Improved Performance
  10. 10. Challenges in Giving Feedback • Desire/Perceived Ideal: – Give authentic, hard hitting feedback – Receiver will be grateful, can self-reflect and change behavior • Reality: – Giver struggles to deliver the message – Receiver often becomes “defensive” – Social/cultural barriers for giving and receiving feedback 10
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  13. 13. Basic Assumption • I believe that people to whom I need to give feedback: – Want to do a good job at work – Are capable of improving – Want to improve – Can take hard hitting feedback 13
  14. 14. Some Basic Tenets: Giving Feedback 14
  15. 15. A Definition of Feedback • Working Definition (van de Ridder, 2008): Information on how the performance compares to a standard • Purpose: – Help them perform better in the future 15
  16. 16. What about “Negative” vs. “Positive” Feedback? 16
  17. 17. Moving Towards a Systematic Approach • Set up expectation: feedback will happen • State the standard • Provide information on where they stand compared to the standard: – Below – Right at the standard – Exceed • Coaching – will discuss later 17
  18. 18. But… What about the Feedback Sandwich? 18 N8tip.com
  19. 19. What They Hear vs. What They Want 19Finkelstein & Fischbach, 2011
  20. 20. The Sandwich: Works to Undermine Your Feedback and Your Relationship 20 Schwartz, 2013
  21. 21. Assumptions of the Sandwich vs. Study Findings Assumptions • Negative feedback is easier to hear if it comes with positive feedback • Negative feedback need to be balanced with positive feedback • Use positive feedback to ease into the negative might reduce discomfort and anxiety Findings • Subordinates only want to hear the negative and don’t need the positive • Feedback is more effective without balancing • Supervisor: Easing in creates even more anxiety • Subordinate: sense supervisor easing in and becomes more anxious 21 Schwartz, 2013
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  23. 23. I saw, I think, I wonder A tool to approach the feedback conversation 1. Can I give you some feedback on… 2. I saw…. 3. I think… 4. I wonder… 5. I listen! ( 6. Obtain Permission for Coaching 7. Provide Coaching…. • Introduce the conversation • State observation • State concern/impact of the observation • Ask for the receiver’s point of view • Listening for understanding • Contracting • Tailored to the receiver’s point of view 23 Argyris & Schon, 1974
  24. 24. What About Receiving Feedback? 24 Feedback Given Feedback Received Improved Performance
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  26. 26. Bad News About Receiving feedback 1. No matter how direct, specific and timely – We are not wired to receive feedback easily – Fight or Flight: In the face of perceived threat 26
  27. 27. Bad News About Receiving feedback 2. In health professions education: – No explicit training on how to receive feedback 27
  28. 28. Three Good News About Receiving Feedback 28
  29. 29. Unpacking: Challenges in Receiving Feedback What makes feedback so hard to receive? –Truth triggers –Relationship triggers –Identity triggers 29
  30. 30. A Series of Re-Framing to Strengthening our ability to receive feedback 1. Know own tendencies 2. Disentangle the “What” from the “Who” 3. Shift towards “tell me more” 4. Sort towards coaching 5. Solicit feedback by asking for Just One Thing 6. Test out the advice 30
  31. 31. Improving Performance 31 Feedback Given Improved Performance Feedback Received
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  33. 33. Coaching that Doesn’t Quite Work 33
  34. 34. Moving Towards Effective Coaching • Comes after providing information on how performance compares to standard • Reveal intention to help • Modeling/Demonstration • Select an approach for coaching: – Frame-based coaching or action-oriented coaching 34
  35. 35. Framework for Coaching: Frames-Actions-Results Actions ResultsFrames • Goals • Assumptions • Feelings • Knowledge Base • Social Norms • Situation Awareness • Argyris & Schon, 1974, Adapted from The Center for Medical Simulation 35 Argyris & Schon, 1974
  36. 36. Old Frame Action Result New Frame New Action New Result 36 DiscussionandReflection ActionOrientedCoaching Adapted: Rudolph, J. W., Simon, R., Raemer, D. B., & Eppich, W. J. (2008)
  37. 37. Examples: Action-Oriented Coaching • Hold the laryngoscope like this, see how I’m holding it? Move your hand higher on the handle • I think you need to be more assertive: what I mean by that is, speak louder so others can hear you over the noise….If the other person doesn’t agree, push back 37
  38. 38. Example: Frame-Based Coaching • Involve deeper inquiry, discussion and reflection to investigate the basis of the performance issue: – Mary, I noticed you didn’t speak up when the count was off in the OR, and that led to the patient needed an x-ray and the surgeons had to go back in to find the missing needle. What was going on for you at that time? 38
  39. 39. Aligning Giving Feedback, Receiving Feedback, and Improve Performance 39 Giving Feedback Receiving Feedback Improving Performance • Focusing on providing information about how performance compares to standard • Moving away from The Sandwich • Understanding triggers in self and others • Strengthening ability to receive feedback • Coaching: Frame- based or action- oriented
  40. 40. Future Vision: Transforming Towards a Culture of Feedback and Learning Conventional Values • Avoid negative feelings, and stick with telling others what make them feel good • Believe mistakes are too shameful to discuss directly, should cushion it with something positive • Believe others should be able to self-reflect, that self- awareness/reflection is a virtue Transformative Values • Strengthen each other’s ability to say and hear both the positives and the negatives • Believe mistakes are puzzles to be solved and we can all learn from them • Believe others do want to improve, they need my help and support to practice reflection. So do I. 40Adapted: Argyris, 2002.
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  42. 42. 42 Grace Ng, MS, CNM, RNC-OB, C-EFM Grace.ng@nyumc.org www.nysimcenter.org Michellecederberg.com
  43. 43. References • Argyris, M., SchÖn, D., (1974). Theory in Practice. Increasing professional effectiveness. San Franciso: Jossey-Bass • Argyris, C. (2002). Double-Loop Learning, Teaching, and Research, Academy of Management Learning and Education,1(1), p. 206 • Finkelstein & Fishbach, A. (2011). Tell me what I did wrong: Experts seek and respond to negative feedback. Journal of Consumer Research. 39(1), 22-38. • Rudolph, J. W., Simon, R., Raemer, D. B., & Eppich, W. J. (2008). Performance Gaps in Medical Education. Academic Emergency Medicine, 1010-1016. • Schwartz, R. (2013). Smart Leaders, Smart Teams. How you and your team get unstuck to get results. John Wiley & Sons. New York: New York. • Stone, D. & Heen, S. (2014). Thanks for the Feedback. Penguin Group (USA) LLC. New York: New York. • Van der Ridder, J.M.M., Stokking, K.M., McGaghie, W. C., Th J ten Cate, O. (2008). What is feedback in clinical education? Medical Education. 42, 189-197. 43

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