If we take a learning perspective, feedback is about providing useful data to do things better. This information is necessary for how people and systems learn: How can we know what to improve and why, if we’re not clear on how we’re going now?

Most of us want feedback. We’ve trained hard, worked hard to get where we are, and we invest a lot in our work. Recognition and support for this is helpful. But feedback tends to get a bad rap. Probably because the provision of feedback is associated with what we’re not doing well or what we need to improve on, not with what we are succeeding at or achieving in role. What is frustrating about this from a learning and development perspective is what this says about the overall lack of feedback taking place. For while there are of course many instances of poor performance or opportunities for development, there are likely to be many more instances of good performance and skill mastery – and the opportunities to give feedback about these were not taken. So, we associate feedback with receiving negative information, and usually given out of the blue or one or twice a year.

Such lost opportunity for building improvement, culture and engagement! Talking about our work, our shared and collaborative tasks, and how we are going with these, are everyday opportunities to build strong professional relationships, trust in each other and psychological safety, and learn how we can improve how we do our jobs. But unfortunately, this is not the way it tends to be. Rather we tend to not give positive feedback, while also hesitating about giving negative or constructive feedback, until the problem has got too big and too hard. And we save them up to come blurting out in difficult conversations or conflict, or the once-a-year performance review. What’s problematic is that it then becomes hard to deliver the feedback well, and in a way that is effective for learning and behavioural change.  

This article will examine what helps make feedback useful for learning and share a few pointers for giving feedback effectively in the workplace. Part 2 of this article (forthcoming) will address receiving feedback and seeking feedback – and tips for getting the most out of feedback conversation in these scenarios.
 

Creating a feedback culture

This is essentially about adopting the view that feedback is part of work – part of your job, your role and responsibilities. It says that to work together well, it is essential that we can talk openly about what is working well and not so well and use this data to drive improvement. This means that I can talk to you about how I see you doing your tasks and the impact I notice, I can listen to you tell me about how I’m doing in my tasks and the impact you notice, and that I can ask you for feedback on something I’m curious about – perhaps a new procedure or role I’ve taken on.

Again, this idea can make us feel uncomfortable and edgy. It’s important to remember that with feedback at work we are talking about work, how we do the work and the impact of our actions to achieve the desired outcomes. It is not about the people per se who are doing the work. That is, the opportunity to learn at work is from hearing about the way you are approaching your role and set of tasks and executing them, not about your personality, likes or dislikes, for example.

Being clear about your role and holding your role as feedback giver/receiver is also important. It’s important to always check yourself: What is the core motivation behind me wanting to give this feedback? Is it a genuine care for the work, the collaborative nature of patient care, and a desire to make things better? Or something else?
 

So, what does good feedback look like?

Feedback can be useful for learning; it also can be motivational and enhance engagement. If it is intentionally designed to be helpful, it refers to specific and observable actions and behaviours and their impact, in your experience and on others, and can support an action plan towards improvement.
 

In general, feedback is effective for learning when it is:

1. Underpinned by good intentions. Research shows that “Expressing your good intentions changes how people hear what you say next “ [1]. That is, if the person listening thinks that your intention is to support them they are more likely to hear and accept what you say, rather than get defensive and reject the message. Using language that states the information from your perspective, e.g., “I saw that… “ or “When I heard you say…” Rather than a statement of fact or truth: “you said…” “you were...”.
    
2. Clear and specific. The language used is concrete and specific, by referring to observable actions and behaviours – for example, what you saw or heard. This helps us be disciplined to stick closer to events or behaviours that can be observed, rather than generalise to personality traits or other abstract generalisations.
    
3. Helps to structure future action. When we are specific about what was said or done that was helpful or unhelpful, then it is easier to be clearer about what actions and behaviours need to be used more often or stopped or improved on in the future. If someone is going to learn something to support their future behaviours, they need to know what to do, not just whether they are ‘going well or not well’ – a generalised comment that is very opaque and unhelpful for the receiver.
    
4. Includes reference to the impact of the concrete actions or behaviour. It is helpful for the receiver of feedback to understand the impact of the action or behaviour being referred to – to understand why it was helpful or not so helpful. Aiding understanding this way makes the feedback meaningful and motivating to engage with. For example, “When you stayed and listened to the patient after the others left I could see that his helped him feel more confident about the plan” or “ When you shared your experience of that difficult shift in the team meeting I could see that this was helpful for the junior doctors to hear, thank you for sharing that”.

The Situation Behaviour Impact Model for feedback is a widely used and respected model for giving feedback. The SBI model for feedback was developed by the Center for Creative Leadership (www.ccl.org). SBI™ stands for the ‘Situation-Behaviour-Impact model of feedback [2]. This is a model or framework for design or framing the structure of the feedback message to follow a sequence of three steps. The logic is that by taking the listener on this 3-step journey, it enables them to clearly understand what you are referring to, hear why you think this was helpful / not helpful and why. This process can then lead more productively to a conversation about what’s next – what the person can do now to either keep doing these helpful things or stop doing or improve on the not-so-helpful things. All of us are likely to feel quite defensive when receiving negative or constructive feedback, so having someone deliver a clear and accessible message is helpful.

The Situation Behaviour Impact model for feedback:

1. Situation: First, describe the context or situation you were in when you observed the behaviour you will refer to. 
    
2. Behaviour: Then describe the behaviour that you want to give feedback on in specific, concrete terms (things that you saw, heard, read)
    
3. Impact: Then describe how this had an impact on you (e.g., this made it very difficult for me to do X) and describe how this behaviour impacts the work: the joint task of patient care (e.g., and as a result of that I think that patient care was compromised).

Giving effective feedback is an important skill no matter your role or career stage. It is a skill that is an asset to any team. It is also something we all generally find quite difficult.

Think about your current colleagues in your team or department: Is there some feedback that you could give another person that would help support further learning and development and contribute to a more effective collaboration or outcome? Take some time to think about it and ensure that your feedback is clear and specific and can begin a constructive conversation around next steps and future actions that would benefit the work. Use the three-part SBI model above to begin your message – clearly grounding your feedback in a specific situation, about a concrete action or behaviours and explaining – from your point of view – why it was helpful/unhelpful to the collaborative endeavour.

Dr Anna Clark (PhD)
Dr Anna Clark is AMAV's Leadership consultant, coach and educator, currently offering individual coaching for doctors and directing the AMA’s professional development programs in leadership, the Emerging Leader Program and Middle Leader Program.

References

• [1] The simple way to make giving feedback easier | MIT Sloan
• [2] Situation behaviour impact: feedback | Mind Tools
• Building a feedback rich culture | Harvard Business Review