Display as participants enter and explain that this training was developed and created based on industry and educator input in conjunction with the Health Workforce Initiative Statewide Advisory Committee, California Community Colleges Chancellor’s Office, and Workforce and Economic Development Program. This is just one soft skills module of the comprehensive training package: “Hi-Touch Healthcare: The Critical 6 Soft Skills.” Hi-Touch Healthcare

Effectively Giving and Receiving Feedback

What to Expect in this Presentation Find the Ball Activity Overview of Feedback Rules for Effective Feedback Feedback in Healthcare Discussions The In-Law Scenario Reactions to Feedback Rules for Receiving Feedback Sparkling Moments Activity Quickly preview the session.

Importance of Communication and Soft Skills Communication is “the skill that can possibly have the greatest impact on effective healthcare delivery. It really is the key to clinical governance and demands as much attention, respect and sustaining as other seemingly ‘harder’ targets. However, often the mere mention of the importance of communication causes less than positive reactions in healthcare professionals.” (Jelphs, 2006, senior fellow at the Health Services Management Centre at the University of Birmingham) Explain that dismissing the value of learning about how to be a more competent communicator is not peculiar to the healthcare field, but a result of the “hindsight bias” or the “I already knew that” phenomenon. The hindsight bias is a phenomenon in which people overestimate their prior knowledge. To demonstrate the concept ask the participants if they have watched TV shows such as Jeopardy, Are You Smarter Than a 5th Grader and/or Who Wants to Be a Millionaire. Remind them of the context in which music is playing while the question or answer is displayed WITHOUT the answer to the question, but when the answer is provided everyone comments, “I knew that.” The reality is that they did not know the answer, but seeing the answer rang true to their personal experience which resulted in an overestimation of their prior knowledge. Because we have been communicating our whole lives and we have communication competencies, it is easy for us to hear information about effective communication and think “I already know that,” but it is important not to fall prey to the hindsight bias or to discount the value of enhancing one’s communication competencies.

Find the Ball Activity Need 4 volunteers All 4 volunteers will leave the room They will come back, one at a time, to find the golf ball Volunteers– please leave the room (See detailed procedures on pages 6–7 of the Trainer Manual that accompanies this PowerPoint.) Goal: To allow participants to see four distinct types of feedback applied in the same situation. This activity should demonstrate that a lack of feedback or just positive feedback is not beneficial. Materials Needed (quantities vary by group size) PowerPoint slides 5–8 1 golf ball Procedures: Ask for four volunteers from the group. Inform them that, one at a time, they will be called back into the room to search for a golf ball. Ask them to leave the room.

Find the Ball activity Each person will receive a different kind of feedback Silent Feedback Negative Feedback Positive Feedback Specific Feedback Continue to explain the activity after the 4 volunteers leave the room and cannot hear the instructions. Coach the remaining participants about their role in this activity: Silent Feedback: when volunteer #1 enters the room, the participants are to remain completely silent and motionless. Negative Feedback: when volunteer #2 enters the room, all participants should give negative feedback, no matter how close or far away the searcher is from the ball. Be sensitive to your group, but instruct them to give the kind of negative feedback that they might hear back in the workplace when someone is dissatisfied with their performance (and with certain audiences - ring hands, for example - this gets kind of raw ... make sure you know your group). Participants should NOT respond to any requests for direction or assistance (except with derision). Positive Feedback: when volunteer #3 enters the room, all participants should give positive but non-specific feedback (e.g., "attaboy," "way to go," "I really like how you get after it," etc.), no matter how close or far away the searcher is from the ball. Participants should NOT respond to any requests for direction or assistance (except with further exclamations of "you can do it" or "we have faith in you"). Specific Feedback: when volunteer #4 enters the room, participants should provide specific hints and suggestions for finding the ball, without giving it away. They should respond to yes/no questions. (Be sure to move to slide number 7 before bringing the first participant in the room so that they do not see the instructions on slide number six.)

Find the Ball Activity Need 4 volunteers All 4 volunteers will leave the room They will come back, one at a time, to find the golf ball Volunteers--please leave the room Hide the golf ball. Invite the participants in one at a time. Each volunteer receives the prescribed feedback noted above. Silent: Hide the golf ball in a not-too-difficult location within the room. Allow 2–3 minutes for the search. Negative: choose a more difficult spot. Allow 2–3 minutes for the search. Positive but General: choose a more difficult spot. Allow 2–3 minutes for the search. Specific: choose the most difficult spot. Allow 2–3 minutes for the search. Move to the next slide before bringing the first participant in the room so that they do not see these instructions.

Find the Ball debrief How did you feel while looking for the ball? What did you think/feel as a result of the feedback you received? How did the feedback you received affect your performance? How did the feedback you received affect how you felt about the individuals giving the feedback? If this was the type of feedback you received every day, how would you feel? Reflect about what type of feedback you have experienced on the job? How can you improve the feedback practices you have experienced at work? (Animated slide) After all 4 volunteers have come in one at at time, bring the 4 volunteers back and debrief and discuss the questions on the slide. Review the following questions: How did you feel while looking for the ball? What did you think/feel as a result of the feedback you received? How did the feedback you received affect your performance? How did the feedback you received affect how you felt about the individuals giving the feedback? If this was the type of feedback you received every day, how would you feel? Reflect on workplace experiences—what type of feedback have you experience at work? How can you improve the feedback practices you have experienced at work?

What is Feedback? Feedback is information Feedback is about performance or behavior Feedback leads to action, development of performance, or improved behavior Ask the group to explain what feedback is. Give the group time to answer. Explain: The key word is information…i.e. hard facts, concrete data, observable examples of performance and behavior etc. NOT personal hunches, NOT assumptions! Information is about performance or behavior (i.e. what the person does and how they do it) NOT ABOUT WHO THEY ARE. The goal of feedback is that it leads to action. If this does not happen, then there is no point in giving it. Feedback is intended to affirm or develop performance or behavior. This means that before delivering feedback, the deliverer must be clear as to the outcome they wish to see. If this is not clear to the deliverer, what hope has the recipient got? Without feedback, mistakes go uncorrected and effective performance is not reinforced.

Know what they are doing well Purpose of Feedback Know what they are doing well Know what to change The purpose of feedback: How can we expect individuals to change and develop if they don’t know that they need to change? Unless an individual receives feedback, how do they know what they are doing well so they can continue doing it?

Feedback Perception Most people really want to know how they are doing. They want to know if other people approve of what they are doing! Most people also really want to know if there is something they could do better or more effectively. Explain: Most people want and desire feedback. They even want constructive feedback. Most people want to know how they can improve their interactions and performance. The thought that people don’t want to hear ways to improve is incorrect!

Feedback is NOT! An end in itself A solution to problems Praise or blame/approval or disapproval Feedback DOES come from real life interactions. (Animated slide) Explain: Feedback is the first step in improvement. It is not the end goal! Feedback is identification of the issue or area of improvement. It is not a solution or plan for improvement. Feedback merely describes what was or was not accomplished. It is not praise or blame, nor offer approval or disapproval. Feedback is value neutral. Feedback is not derived from tests, exercises, or simulations. It comes from real life work and interactions.

Feedback in Healthcare Discussion Divide into small groups of 3–4 Compile a list of factors based on the question on the next slide Brainstorm for 5 minutes (See detailed procedures on page 8of the Trainer Manual that accompanies this PowerPoint.) Goal: To determine how giving feedback requires special attention and consideration. Materials Needed: PowerPoint slides 13–14 Procedures: Have the participants divide into small groups of three to four participants. Instruct the small groups to compile a list of factors based on the question on slide 14. Have the groups brainstorm for 5 minutes. Question on slide 14: What factors about the healthcare setting need to be considered when giving feedback? After the small group discussion, bring the group back together and allow the groups to share the ideas that they generated.

Feedback in Healthcare Discussion What factors about the healthcare setting need to be considered when giving feedback? After the small group discussion, bring the group back together and allow them to share the ideas that they generated. Possible other ideas include: Presence of patients: The healthcare worker giving feedback must not embarrass the healthcare worker receiving feedback in front of a patient. At the same time, the health care worker cannot be allowed to do anything that will endanger the health or well-being of the patient. This means that sometimes feedback is held back until the two can talk in private; in other cases, feedback must be given immediately in a diplomatic, supportive, yet honest way. How we give feedback: what we say, how we say it, when we say it—is critical to whether the feedback is effective and achieves the intended effect. HIPAA : make sure that when giving feedback that you are aware of your surroundings so as to not break HIPAA.

Rules for Effective Feedback Timely Selective Balanced Suggestions (not requirements) Descriptive Specific Explain: Feedback should be given as close to the event as possible – always taking into account the readiness of the person receiving the feedback. There might be a big list of feedback that the individual needs to hear, but be selective and address just one or two key issues rather than brining up too many at once. Always give good and bad. Don’t just focus on the negative. Find something good the individual is doing and find something they can improve on! No one is perfect Remember feedback is a suggestion, not a requirement. There is no contract! Be descriptive of what is being seen, not judgmental of the individual. Give information that leads to easy action for improvement. Avoid personal attacks and mixed messages. Give specific or focused feedback.

Example “I think you’re selfish in that you don’t listen to anyone else.” “I notice that you don’t look at people when they are talking to you.” Both of these comments can apply to the same situation, but the second describes what is happening while the first is judgmental. The first is more likely to provoke a defensive reaction, with little chance of any resultant improvement. The second gives information which the individual would find difficult to dispute, but relatively easy to take action on.

Positive Feedback Sandwich Explain a positive feedback sandwich: Start with a positive observation. Next provide a suggestion for improvement Finish with a second positive observation. Individuals a much more likely to hear the suggestion for improvement if they feel that the person is correct in the positive things they are told.

Asking Feedback Sandwich Tell Explain the Asking Feedback Sandwich: Ask the individual to assess their own performance. This starts a conversation and assesses the individual’s readiness for feedback and his/her level of insight. Tell what was observed including both positives and negatives. Use “I” statements of things that you observed. Ask the individual about his/her understanding and suggestions for improvement.

The In-Law Scenario Need 3 volunteers to read a scenario to the group. Narrator Mother-in-law New daughter-in-law (See detailed procedures on page 9 of the Trainer Manual that accompanies this PowerPoint.) Goal: To demonstrate that there are ways to give very negative feedback with a positive result. Materials Needed: PowerPoint slides 19–20 Three hard copies of the “In-Law Scenario” handout Procedures: Ask for three volunteers to read the scenario to the large group—one person will read the “Narrator” section, one person will read the “Mother-in-Law” statements and the third volunteer will read the “Daughter” parts of the scenario. After the scenario is completed, display slide 20 with the following questions: What did you observe? Was the mother-in-law honest? Overall was the interaction positive or negative? Did the mother-in-law offend the daughter-in-law?

The In-law Scenario debrief What did you observe? In what ways was the mother-in-law honest? Overall, was the interaction positive or negative? Why? Did the mother-in-law offend the daughter-in-law? Allow some discussion as the questions are discussed. Point out that the mother-in-law was honest, yet gentle and careful in how she chose her words. Point out that overall the exchange was positive and that had the mother-in-law chosen different words, the interaction could have become very negative. This role play is a humorous way of demonstrating that there are many different ways to communicate, and that our choice of words and how we say something can have a huge impact on whether or not the interaction is positive and effective.

Before you give feedback – Pause and ask yourself What is my intention behind giving this individual feedback? How do I feel about giving this feedback? How is the other individual feeling? Is s/he in the right frame of mind to accept this feedback? (Animated slide) Explain – It is important to evaluate why you are giving feedback and how you are feeling before trying to give effective feedback to someone else. Both people should feel calm!

Reactions to Feedback The individual receiving the feedback can react with – Anger Denial Blame Rationalization Acceptance Renewed Action Explain: The reactions of the individual receiving feedback can vary. Anger - They made just throw up their hands and say, I have had enough of this! Denial – This reaction often accompanies the initial shock of the feedback. They might say something like – I don’t see any problem with that! Blame – Trying to shift the blame to someone else and not accept any responsibility. They can say “It’s not my fault!” Rationalization – This is trying to find excuses and/or justification for their behavior. Acceptance – The individual is willing to hear and accept the feedback as a path for improvement. Renewed Action – The individual not only hears the feedback but they are willing to take action to improve!

Rules for Receiving Feedback Listen Be receptive Keep an open mind Investigate Acknowledge Explain: Listen carefully to what is being said. Make sure to have an open mind and be receptive to feedback. Have an open mind and don’t just automatically reject the feedback. Don’t be defensive! Don’t reject negative or positive feedback. Be willing to ask questions to clarify the feedback. Ask for examples to help understanding. Acknowledge the giver of the feedback and show appreciation for being willing to share the feedback

What to do you do with the Feedback Listen Understand Time Plan Explain that when receiving feedback it is important to: Listen to comments carefully and ensure you understand what is said. If not, ask for clarification, examples, and alternatives. Give the feedback time to sink in and put it into perspective. Build on your strengths. Address areas for improvement. Identify what you need to do to reach the higher standard. Make a plan based on feedback information and on your views of what is important to improve. For example - areas to improve, actions to take, sources of help, when to tackle them. Try not to feel devastated by small criticisms and try not to be defensive and make excuses for them.

Sparkling Moments Activity Break into pairs One person is A and the other is B Each partner follow the directions on the handout (See detailed procedures on page 11 of the Trainer Manual that accompanies this PowerPoint.) Goal: To allow participants to provide a look into outstanding moments in their own behavior and interactions and understand why those moments were outstanding. Materials Needed: One copy of the “Sparkling Moments” handout for each participant (on pages 11-–12 of the Trainer Manual). Writing utensil and paper for each participant Procedures: Break into pairs – one partner is A and the other is B. Give each participant a copy of the “Sparkling Moments” handout. Give participants a couple of minutes to read through the discussion prompts. Begin the “discussion phase.” Allow 3–5 minutes for Partner A to guide the discussion based on the prompts on the handout. Remind Partner A to take notes. Switch Roles. Allow 3–5 minutes for Partner B to guide discussion based on the prompts on the handout. Remind Partner B to take notes. Reflect—explain that each person will provide feedback to their partner. Give participants a few minutes to reflect on their notes. Begin the “feedback phase.” Allow 3–5 minutes for Partner A to provide feedback as described on the handout. Allow 3–5 minutes for Partner B to provide feedback as described on the handout.

Sparkling Moments Activity Discussion Phase: Partner A Partner B Reflect Feedback Phase (Animated Slide. Clicks reveal “phase” of activity and identifies when each partner takes a guiding role.) Sparkling Feedback Handout (on pages 11-12 of the Trainer Manual). Guide participants through the Discussion Phase as described on the handout. Remind the discussion guide to take notes. Partner A. Switch Partner B. Reflect. Remind participants that they will assume the role of feedback provider. Guide participants through the Feedback Phase as described on the handout. Report out as needed.

Thank you! Questions? Comments?