It’s towards the end of the shift, and a junior colleague comes to you with a worried look on their face. They have just witnessed concerning practice another colleague had demonstrated on a patient earlier in the shift. You thank them for highlighting this to you, and reassure them you will not bring it up with the colleague during that shift as it is not urgent and will potentially ‘give away’ who highlighted the concern.
I remember when I was starting out in my career, receiving feedback was one of my top three most uncomfortable and earth shattering experiences; up there with public speaking and admitting I had made a mistake.
Like most challenges in my life, the motivation to overcome them has stemmed from a place of disliking how uncomfortable it felt during said activity. For the compulsory experiences, I have had to find my own way to feel less-uncomfortable with them. For example, being honest with family when their loved one is dying and they ask you “is this the end?”. After learning that being honest and direct is actually the kindest thing you can do in such times of pain for both the patients loved ones and yourself. After all, if you are the opposite and indirect, you are being cruel to them and yourself.
So when I had to quickly find a way to feel less-uncomfortable when receiving feedback; I reflected on how to separate the emotions of the situation from the facts. To put aside the feelings and listen to the facts that affect the patient care and improve my professional practice.
Now that I am on the other side more often, by being the senior providing the feedback, I am able to utilise behaviour modelling to evoke the response I am looking for.
Is it manipulative if...it's with good intention? I have found after much experimentation that if you want to evoke a calm and patient response from the listener, you must demonstrate a calm and patient delivery. If you want to evoke a sense of urgency and frustration in your listeners, you will demonstrate an elevated and heightened delivery in your speech and body language.
So when it is necessary to correct the knowledge or practice gap for a colleague, I pause and think about the following three things 1) the right time, 2) the right place and 3) the right way.
The Right Time
In this example, the colleague I had to provide feedback to had just had a busy day and I was informed of the occurrence towards the end of the shift, not leaving me much time to work with that day. So straight away I thought its not the right time, when your towards the end of a busy shift, you wont want to listen, you will be more emotional and less factual. So I chose to bring it up the following day when I knew the colleague was working, I found a time and place when it was just the two of us and she had lunch and was not so busy, so already in a better physical and emotional state than the previous day.
The Right Place
Privacy, just the right amount. Not to much that they feel trapped, and not to little where they are self conscious others are listening. Other staff in the area also makes a difference. The person receiving the feedback may be more self conscious if they are concerned a certain staff member might walk around the corner. Also the colleague who witnessed the concerning practice was working in the same area, and didn’t want the individual to suspect they might have mentioned it.
The Right Way
In regards to the right way, well that was all about me. My delivery would dictate how much of an accepting and open response I would evoke in her. That’s where I lead by example, I brought it up with the line ‘I know you like to better your practice for the future...I just wanted to give you some more information on how to manage....’ I actually don’t even know if this colleague does like to consciously better her practice, but I said it because I believe it as a positive mindset for a practitioner to adopt. When you project positivity and professionalism, it is almost impossible for a colleague to argue with that attitude. Followed by ‘This is why we....’ ‘For next time...’ ‘Thank you for listening to me, I appreciate it.’ Finishing with this line is my secret weapon! When you mean what you say with positive intent and the person receiving the feedback feels you are genuine, its very hard to not take on board the clinically relevant advice. I don’t even know if she did listen to me but maybe by showing my appreciation for it, this will encourage her to walk away reassured that I valued her listening to my experience and that I meant well.
The more I delve into the study of Human Factors in Emergency Medicine, the more I learn of the subtle elements to communication that influence the outcome of the conversation and interaction being had; ultimately affecting patient care.
References
1. Belhaj, M., Kebair, F., & Said, L. B. (2015). Modelling and simulation of human behavioural and emotional dynamics during emergencies: a review of the state-of-the-art. International Journal of Emergency Management, 11(2), 129–145.
2. Truman GE. (2009). Behaviour modelling, instruction and exploration training approaches in group and individual contexts. Behaviour & Information Technology, 28(6), 493–524.
