In a working environment, especially in a clinical teaching environment, quality communication is the oil that makes the machine run.   And at the heart of good communication among co-workers is the core ability to provide and accept focused feedback.

One of the keys to unlocking and using focused feedback is knowing the difference between activities and results.

“Know the difference between activities and results,” Jon Rand, Vice President of Partners in Leadership, advised a group of newly-appointed Chiefs Residents in Ophthalmology. “Activities are what you do – actions you take that lead to results. Results, on the other hand, are the desired and undesired outcomes of your actions or inactions.”

Most people focus on activities instead of results, according to Rand. He urged the Chief Residents to know the expected results first, then define the actions likely to achieve those results.

Rand pointed out that, while it’s human nature to believe that for me to win, someone else has to lose, creation of a “win-win” scenario is a more efficient way to achieve the desired result.

One of the most important ingredients for successfully achieving these win-win learning and teaching work scenarios during your year as Chief Resident is by giving – and receiving – focused feedback.  Focused feedback is feedback specifically focused around your accountability to achieve the desired results in the learning/teaching environment.

 Focused feedback
“Most of us go around with blinders on,” Rand observed. “We’re unable to see things with which we’re not familiar. The only way to see the big picture is to discover and appreciate what others are seeing and hearing. Make the effort to obtain the perspective of others. How? By asking!” he added.

Rand used a game to illustrate this point. A blindfolded player must throw a ball and hit a velcro target, even though he doesn’t know where in the room the target is located. The group must provide feedback to help the player achieve the desired result.

In the first game the blindfolded player threw balls randomly around the room to accompanying silence, then to negative boos and hisses, and finally to applause. When asked to describe the experience, he reported that this sort of feedback definitely changed his feelings about how he was doing in his attempts to hit the target, but in fact provided him with no assistance at all in actually succeeding in the task.

In the second game, volunteers verbally coached the blindfolded player as to the location of the target. Their hints included which direction to throw, how far off target the last throw was, how hard to throw, etc.

Eventually the blindfolded player was able to hit the target. With continuous and explicit feedback, he was able to form a clear sense of where the target was located and the best approach for hitting it.

Another critical object lesson here, Rand pointed out, is that with this persistent, detailed, accurate feedback, the player also begins to believe that he can hit the target.

How to make feedback positive
The word “feedback” is often perceived as a negative, according to Rand. Most people find it scary. Many of the Chiefs gave themselves a grade of “C” or lower when it came to asking for and offering feedback. Rand suggested that sometimes just changing the way you ask for feedback will turn a negative situation into a positive one.

Instead of asking “Do you have any feedback for me?” Rand suggested that you change the question to “What feedback do you have for me?”
Feedback filters
People in leadership roles such as Senior Fellows or Chief Residents must also be wary of their internal “feedback filters,” according to Rand. “It’s second nature to filter out any information with which you disagree or don’t understand,” he pointed out, “and you could be left with very little new and useful information at the end.”

Rand advised the Chief Residents to listen to feedback carefully, be sure to understand what they’re hearing, and be appreciative. “It’s important to be aware of the kind of experience you are creating for the other person. Will it create the best possible result?” he asked.

Learning how to give effective feedback is also part of accountability.  In one of the workbook exercises, many Chiefs revealed that they actually have feedback for others in their organization that they are not planning to give. Many indicated that they know people in their organization who have feedback for them, but they have not asked for it.

Rand pointed out that a leader’s ability to achieve results can be hugely affected by that person’s attitude toward giving and receiving feedback.  As a Chief Resident, it’s your job the create a work culture that is suffused with ongoing, positive and focused feedback.

The Feedback Game
To illustrate the concept of focused feedback, the group was asked to play another game. Each member of a group of 5 players was given an envelope containing a variety of cardboard shapes. The goal was for the team to assemble 5 equal-sized squares, one in front of each player. The only way a piece could be transferred from one player to another was for one player to offer a piece to another by holding it out – and for the other player to accept the piece by actually taking it.

As the game progressed, certain players in one group were able to construct equal-sized squares from their pieces, but others in the same group were not. This forced the team to look beyond their individual successes and be willing to give up some of their own pieces to help solve the larger problem facing the team as a whole – to allow everyone in the group to create a square.

Once all the teams solved the problem, they were asked to practice feedback. Players took turns describing exactly what they thought the others did to help solve the problem – and what they thought the others did to hinder the solution. They offered suggestions to each other as to what could have worked better.
Performance and Results
The ultimate goal of creating and sustaining a culture based upon focused feedback is improved performance and outcomes.  It is all about getting better results.

You will quickly come to understand what the key performance indicators (KPIs) are in your program.  You next task is to meet and exceed these performance measurements on a consistent basis.

Rand offers the following tips for achieving these results:

  • Directly ask other people in your program fo feedback
  • To get focused, constructive feedback try asking “what feedback do you have for me?” instead of “do you have any feedback for me?”
  • Feedback paths run up, down and across your program.  Get and give feedback to superiors, patients, direct peers, cross-functional peers and direct reports.
  • Thank people for giving you feedback.
  • Always act on feedback you receive from others and make sure they do the same for you.
  • If there are people in your organization that you know have feedback for you they haven’t shared yet, by all means ask for it!

About the Author:

Wesley D. Millican, MBA, CEO and Physician Talent Officer of CareerPhysician Advisors, LP, and CareerPhysician, LLC, provides comprehensive talent solutions for academic children’s hospitals, colleges of medicine and academic medical centers across the nation. He possesses a longstanding passion for career development of all young physicians and serves as a go to career resource for training program directors and their residents and fellows. In continuing his commitment to the “future of medicine”, Mr. Millican speaks nationally at residency and fellowship programs. His Launch Your Career® Series is a proven resource for today’s residents and fellows and has served as a go to resource for program directors over the last 15 years.