Giving, receiving, thinking about and teaching feedback occupies a large proportion of my time, both at work and in my private life. I notice how people avoid it, crave it, botch it and do well and wonder at the variability of attitudes and capacity. Part of my vision for an improved world is doing it better and appreciating the value of feedback.
So I was pleased to recently work with a medical college in trial exams for candidates to practise and receive feedback about all aspects of their performance: medical knowledge, exam technique, communication with me, the simulated patient, and their overall competence.
My case was intense, requiring me to cry and be angry about the situation. As an acting job, it was excellent. I had a really lovely doctor to work with as he conducted the trial exam station.
Candidate after candidate struggled with both the medical knowledge and their capacity to communicate. They often freak out when confronted with a simulated patient who is crying and angry just like a real patient would be in the same situation. Usually they recover. I quickly discovered that the doctor with me had a very different view of good communication. I also learned that many candidates were having significant problems with the medical aspects of the case.
After all candidates had had their trial, we saw them again for two minutes of feedback. After hearing from the doctor how terrible everyone was, I was surprised to hear him start by telling people "you did well". He'd then list - in exhaustive detail - all the areas of failure. He sent them off by saying they "weren't too bad" or "but you did ok".
I was confused. The candidates looked confused. They really wanted to know about their performance. They were participating in this trial exam so that they knew where they had performed well and what they needed to improve. Instead they received a confusing message that left them with no information about what they should do next time. The next time would be when they sit the actual exam.
I took the opportunity to observe and think about what was going wrong and how I would coach the doctor on providing useful, effective feedback.
The first question I would ask would be "what's the purpose of the feedback you're about to deliver?" Then to further clarify, "what do you want to happen as a result of this person receiving your feedback?"
Answering these questions before any feedback conversation will help remove our sometimes overwhelming desire to be liked from the feedback conversation. Interestingly, if your purpose is clear and about helping the other person, they probably will like you because you've taken the time to give them effective feedback that will help them do better in their world.
Listening to the doctor deliver his confusing messages, I tried to discern his purpose; it seemed it was about fulfilling part of the process of the trial exam. Where's the value in that? Feedback is part of the process and there's no doubt there was an obligation on him to provide it, but if the purpose of feedback is merely procedural then no one will benefit. It will be hard to deliver and unhelpful to receive. At its worst, it may also have a negative impact on the relationship between people.
Consistently I find that a lack of clarity around purpose is where people stumble. And it's not just in feedback conversations. Any conversation can benefit from clarity of purpose. Where the conversation is a strategic one (rather than a casual one), it needs to be planned. If you do nothing else, be clear about the answers to these key questions:
1. what's the purpose of the feedback you're about to deliver?
2. what do you want to happen as a result of this person receiving your feedback?
It can change your life!
Showing posts with label feedback. Show all posts
Showing posts with label feedback. Show all posts
Thursday, 9 October 2014
Sunday, 13 July 2014
Lights, camera, action!
It's been a very big week. As usual, I was doing many different things for many different people, but this week included something out of the ordinary. I was making two films and my role was behind the camera.
I'm collaborating with a university in the field of clinical supervision and my partner and I pitched that we would make some films as a catalyst for discussion in the workshops that we will design and deliver.
We had two films to make and two days in which to make them. I wrote the script which was more like a blueprint for the narrative of each scene around which the actors would improvise. We had a director, camera operator and audio engineer. My partner was the clinical adviser on set, teaching the actors how to look like they were taking blood pressure and other vital signs and props master. That left me as producer, assistant director and floor manager. After two days, I was exhausted and gained a real appreciation for what it takes to make even a simple film. My job was all-consuming because I was flicking from creative story-telling to manager of the set, people and time frames.
At one point, I heard my name called by four different people. All I could do was take a breath and deal with each person.
Even my broadcast journalism skills had a workout. We did some vox pop interviews of students to get their stories and perspectives about clinical supervision and feedback. I stood beside the camera and chatted with four young men to get them to relax in front of the camera and to incorporate my question into their answer. I remembered the appeal that interviewing had for me all those years ago.
My next task is post-production. I'll sit with the editor and we'll use all the footage we took to tell the story that I wrote. I'm really excited to see how it turns out.
One of my lessons from this experience is that everything takes three times longer than you think and you just have to keep going until you're finished.
The other great thing I noticed was the need to have complete trust in the team you've assembled. Everyone must be doing their job and you must trust that everyone is doing their job. I had no capacity to step in and take over anyone else's job. If I had, that would have left a big gap where I was supposed to be. It's a great leadership experience, because everyone is required and no one can give less than 100% every time and all the time.
My partner took a photo on set which you can see on Instagram. He appeared as an extra, but I was too busy doing all of the things I've mentioned, that I missed taking a photo.
I'm collaborating with a university in the field of clinical supervision and my partner and I pitched that we would make some films as a catalyst for discussion in the workshops that we will design and deliver.
We had two films to make and two days in which to make them. I wrote the script which was more like a blueprint for the narrative of each scene around which the actors would improvise. We had a director, camera operator and audio engineer. My partner was the clinical adviser on set, teaching the actors how to look like they were taking blood pressure and other vital signs and props master. That left me as producer, assistant director and floor manager. After two days, I was exhausted and gained a real appreciation for what it takes to make even a simple film. My job was all-consuming because I was flicking from creative story-telling to manager of the set, people and time frames.
At one point, I heard my name called by four different people. All I could do was take a breath and deal with each person.
Even my broadcast journalism skills had a workout. We did some vox pop interviews of students to get their stories and perspectives about clinical supervision and feedback. I stood beside the camera and chatted with four young men to get them to relax in front of the camera and to incorporate my question into their answer. I remembered the appeal that interviewing had for me all those years ago.
My next task is post-production. I'll sit with the editor and we'll use all the footage we took to tell the story that I wrote. I'm really excited to see how it turns out.
One of my lessons from this experience is that everything takes three times longer than you think and you just have to keep going until you're finished.
The other great thing I noticed was the need to have complete trust in the team you've assembled. Everyone must be doing their job and you must trust that everyone is doing their job. I had no capacity to step in and take over anyone else's job. If I had, that would have left a big gap where I was supposed to be. It's a great leadership experience, because everyone is required and no one can give less than 100% every time and all the time.
My partner took a photo on set which you can see on Instagram. He appeared as an extra, but I was too busy doing all of the things I've mentioned, that I missed taking a photo.
Monday, 31 March 2014
Power dynamics and patient feedback
This morning I was working with one of the health sciences schools at a Melbourne university. I happened to be working with the same student I had a couple of weeks ago when my character was one day post-operative. I remembered the student, but I think he became confused as he wondered whether he was supposed to remember me (even though I was playing the same character). Sometimes what happens within a simulation takes on a life of its own.
The student who was working with me was professionally polite, but a little cold and formal. He needed to relax a little to build better rapport with my character who was gung-ho and very motivated to get on with her rehabilitation. In the feedback afterwards, I gave him a quick refresher on rapport building and he looked like he'd heard it all before.
The main thing I talked to him about though, was quite personal and is an example of why feedback from simulated patients is so powerful. The student had a cold and was sniffling and fighting nasal congestion throughout our consultation. On several occasions he apologised for his cold, which I noted as a sign that he was aware of what I might be noticing. Great. What wasn't so great was when he wiped his nose with his hand and then moved in to touch me as part of my treatment. I considered saying something during the consultation, but it didn't really fit with my character, so I suffered through the hand-to-nose-to-knee sequence several times, silently giving thanks that he wasn't my dentist.
When I gave the feedback he looked shocked and was very apologetic. He told me he wasn't aware that he'd been doing that. I know that hand hygiene receives heavy attention throughout health education and continues into the workplace, so I was surprised to see this behaviour. I suppose it highlights why there are signs everywhere with instructions about how to wash your hands or use hand sanitiser properly. (Don't forget to do the back of the hands too!)
I know that it would be rare for a real patient to tell their allied health professional to wash their hands after they wiped their nose. This is because of the power dynamics and powerful protocols in play, as we align to playing our designated roles.
How's your hand hygiene? Would you stop someone from treating you if they had wiped their nose just before touching you?
The student who was working with me was professionally polite, but a little cold and formal. He needed to relax a little to build better rapport with my character who was gung-ho and very motivated to get on with her rehabilitation. In the feedback afterwards, I gave him a quick refresher on rapport building and he looked like he'd heard it all before.
The main thing I talked to him about though, was quite personal and is an example of why feedback from simulated patients is so powerful. The student had a cold and was sniffling and fighting nasal congestion throughout our consultation. On several occasions he apologised for his cold, which I noted as a sign that he was aware of what I might be noticing. Great. What wasn't so great was when he wiped his nose with his hand and then moved in to touch me as part of my treatment. I considered saying something during the consultation, but it didn't really fit with my character, so I suffered through the hand-to-nose-to-knee sequence several times, silently giving thanks that he wasn't my dentist.
When I gave the feedback he looked shocked and was very apologetic. He told me he wasn't aware that he'd been doing that. I know that hand hygiene receives heavy attention throughout health education and continues into the workplace, so I was surprised to see this behaviour. I suppose it highlights why there are signs everywhere with instructions about how to wash your hands or use hand sanitiser properly. (Don't forget to do the back of the hands too!)
I know that it would be rare for a real patient to tell their allied health professional to wash their hands after they wiped their nose. This is because of the power dynamics and powerful protocols in play, as we align to playing our designated roles.
How's your hand hygiene? Would you stop someone from treating you if they had wiped their nose just before touching you?
Thursday, 13 June 2013
Being a woman in Australia today
It's a hard day to be a woman in Australia. Yesterday, we were confronted with the disgusting and demeaning description of our Prime Minister Julia Gillard based on body parts with a nasty sexual undercurrent. Today it's news of emails which are "derogatory and explicit" about women being circulated within the Australian Defence Force. We're told that some of the perpetrators are senior leaders within the ADF. All week the air waves have been filled with news about Jill Meagher's killer and his "career" of sexual violence against women and the failures of the parole system to keep violent offenders off our streets. The coach of the Australian male soccer team also said that "women should shut up in public".
Last night I heard a female commentator effectively saying that while ever female genital mutilation and so-called honour callings exist, no right to be upset about the emails, the "jokes", the snide disrespect and behaviour exists.
Now I'm hearing a male caller to radio saying that sexism seems worse because women scream about it louder these days.
EXCUSE ME! YES, I'M GOING TO PUSH BACK AGAINST SEXIST BEHAVIOUR AND SEXUAL HARASSMENT. IT'S NOT OKAY.
When it happens to the Prime Minister and other men with power and authority to act against the perpetrators do nothing, then a general attitude of disrespect flows through the rest of our community.
To me, sexism and sexual harassment are as offensive and damaging as racism. It hurts to be viewed as anything less than a person - a whole person with intelligence and emotions and talents. Why should I be viewed differently, treated differently, shown disrespect, have my competence criticised, merely because I am a woman? I can think of no good reason.
I remember turning up to the Australian Industrial Relations Commission once when I was a union official to represent a group of workers who were mainly men. A dispute had been notified because of the employer's breaches of the enterprise bargaining agreement which laid out employment conditions. Because of my capacity as a negotiator and advocate I was often sent to deal with things like this - I could solve the problem. As I approached the front door I saw this tall, strapping man waiting for someone. I thought there was a good chance that he was the workplace delegate.
I introduced myself and confirmed he was indeed the delegate.
His response was this: "Oh, so they sent us a girly," as he looked me up and down.
What a position to be put in. I was reduced to being a vagina and breasts which in his mind seemed to mean I also had no brain.
Luckily I was sure of my capacities and knew that I had the backing and respect of the senior men within the union. I gave him the opportunity to recover: "Sorry? I didn't hear you..."
He repeated the same statement.
I shook my head and told him to sit down and say nothing unless addressed specifically.
We were appearing before another "girly" while the employer was represented by a male lawyer.
I won the day on behalf of the members. From that moment, the delegate thought I was so fantastic I had to contend with him trying to follow me into my hotel room at the end of the day. He didn't succeed and from that time on he was my greatest champion.
Imagine a world where he had confidence about whoever the union sent to represent the members and judgments of competence would be based purely on performance. If I had been less experienced and lacked confidence, I could well have failed to perform as a result of his treatment.
At another time I remember being asked by a male employee (who was my junior) if I was considered to have large breasts. The question was asked in front of other people in a public place. After I caught my breath I looked him in the eye and asked him whether he was considered to have a small penis. He blushed and realised what he had done. I don't know if "tit for tat" is the right way to respond. I wanted him to feel what I was feeling, to see what it was like to be degraded in that way. It certainly had that impact.
In the lunch room today, I found myself eating lunch with four other women. I initiated a conversation about the anti-woman atmosphere. One of the women related a story of attending a law lecture in her first year at university and the lecturer proclaimed that women shouldn't practise law. She went onto finish her degree at another university and headed out into a law firm where she was one of two women in the team. "Team" lunches were held at a club that allowed only men and the boss regularly expressed frustrations about the problems caused by women practising law.
Even watching Celebrity Apprentice the other day, I noticed that in the team of four which had three men and one woman, it was the woman who fetched the soup.
I've worked with some wonderful men. I really enjoy working with men. I also enjoy working with women. I love working with people who are passionate about what they do and enjoy being around others who are passionate and able. I don't care if they're male or female. I certainly don't think all men lack respect for women but I do think there's a bad atmosphere at the moment and it starts with the leaders.
So I will make no apology for calling out sexist behaviour. I will do it loudly and I will keep doing it because that's the only way that people learn. I hope you will too.
Last night I heard a female commentator effectively saying that while ever female genital mutilation and so-called honour callings exist, no right to be upset about the emails, the "jokes", the snide disrespect and behaviour exists.
Now I'm hearing a male caller to radio saying that sexism seems worse because women scream about it louder these days.
EXCUSE ME! YES, I'M GOING TO PUSH BACK AGAINST SEXIST BEHAVIOUR AND SEXUAL HARASSMENT. IT'S NOT OKAY.
When it happens to the Prime Minister and other men with power and authority to act against the perpetrators do nothing, then a general attitude of disrespect flows through the rest of our community.
To me, sexism and sexual harassment are as offensive and damaging as racism. It hurts to be viewed as anything less than a person - a whole person with intelligence and emotions and talents. Why should I be viewed differently, treated differently, shown disrespect, have my competence criticised, merely because I am a woman? I can think of no good reason.
I remember turning up to the Australian Industrial Relations Commission once when I was a union official to represent a group of workers who were mainly men. A dispute had been notified because of the employer's breaches of the enterprise bargaining agreement which laid out employment conditions. Because of my capacity as a negotiator and advocate I was often sent to deal with things like this - I could solve the problem. As I approached the front door I saw this tall, strapping man waiting for someone. I thought there was a good chance that he was the workplace delegate.
I introduced myself and confirmed he was indeed the delegate.
His response was this: "Oh, so they sent us a girly," as he looked me up and down.
What a position to be put in. I was reduced to being a vagina and breasts which in his mind seemed to mean I also had no brain.
Luckily I was sure of my capacities and knew that I had the backing and respect of the senior men within the union. I gave him the opportunity to recover: "Sorry? I didn't hear you..."
He repeated the same statement.
I shook my head and told him to sit down and say nothing unless addressed specifically.
We were appearing before another "girly" while the employer was represented by a male lawyer.
I won the day on behalf of the members. From that moment, the delegate thought I was so fantastic I had to contend with him trying to follow me into my hotel room at the end of the day. He didn't succeed and from that time on he was my greatest champion.
Imagine a world where he had confidence about whoever the union sent to represent the members and judgments of competence would be based purely on performance. If I had been less experienced and lacked confidence, I could well have failed to perform as a result of his treatment.
At another time I remember being asked by a male employee (who was my junior) if I was considered to have large breasts. The question was asked in front of other people in a public place. After I caught my breath I looked him in the eye and asked him whether he was considered to have a small penis. He blushed and realised what he had done. I don't know if "tit for tat" is the right way to respond. I wanted him to feel what I was feeling, to see what it was like to be degraded in that way. It certainly had that impact.
In the lunch room today, I found myself eating lunch with four other women. I initiated a conversation about the anti-woman atmosphere. One of the women related a story of attending a law lecture in her first year at university and the lecturer proclaimed that women shouldn't practise law. She went onto finish her degree at another university and headed out into a law firm where she was one of two women in the team. "Team" lunches were held at a club that allowed only men and the boss regularly expressed frustrations about the problems caused by women practising law.
Even watching Celebrity Apprentice the other day, I noticed that in the team of four which had three men and one woman, it was the woman who fetched the soup.
I've worked with some wonderful men. I really enjoy working with men. I also enjoy working with women. I love working with people who are passionate about what they do and enjoy being around others who are passionate and able. I don't care if they're male or female. I certainly don't think all men lack respect for women but I do think there's a bad atmosphere at the moment and it starts with the leaders.
So I will make no apology for calling out sexist behaviour. I will do it loudly and I will keep doing it because that's the only way that people learn. I hope you will too.
Tuesday, 19 March 2013
Mind the gap! It's between now and the future, Yarra Trams.
Yarra Trams has responded to feedback about dangerous overcrowding at the tram stop between Federation Square and Flinders Street Station. My original story is here and the follow-up a couple of weeks later is here. As well as writing about the problem and my experience on my blog, I also provided feedback direct to Yarra Trams via their website and twitter.
After the follow up post, where my frustration at the lack of response must have been evident, a lovely and diligent customer service person from the feedback team contacted me. He was in regular contact to let me know the progress of the investigation of my issue. Gold stars on that front. Not only did he seem to genuinely appreciate feedback from a customer's perspective, he was prepared to engage in a conversation about what's happening.
So let's put this stop into perspective. Here are the numbers:
- the stop was refurbished to its current design and location in about 2002/2003.
- patronage of the tram network in Melbourne has increased 30% in the last seven years.
- 477,000 commuters "use or pass through" this stop each week.
That's a lot of people. The numbers support my argument and evidence that the stop is very busy. What I've experienced a few mornings recently is not a blip.
The current strategy to deal with overcrowding during the morning and afternoon peaks is to have customer service officers at the stop telling people to step back from the doors of the tram. Have a look at those photos of the crush again. Now review the current strategy. Now place inverted commas around the word "strategy".
That's it. That's what they've got.
This reminds me of one of the occasions I was trapped in lift by myself. I was in there for about 40 minutes. When the bloke arrived to get me out, he yelled into the lift, "Stand well back!" I went from being terrified (he's going to blow the doors open and I'll be killed in the blast) to amazed (oh wow, they're going to blast me out) to apathy (what's the point of moving back, there's no where to go, I'm going to die).
Relief flooded through my veins when I learned that there is also a long term strategy being worked on. Neither the details of that strategy nor the possible solutions can be revealed. The time horizon for "long term" is unspecified at this point, but I imagine the steps involve:
- Gaining awareness that there's a problem. Complete.
- Thinking about the problem, including consideration of a) whether there's really a problem. Part a) complete, overall phase still proceeding.
- Consult with commuters. Progress unclear.
- Formulate response to apparent problem, including options. Progress unclear.
- Liaise with stakeholders (Public Transport Victoria, Melbourne City Council etc). Progress unclear.
- Thrash out a deal in a way that resolves the actual problem rather than being subject to political expediency (although why these concepts should be mutually exclusive is a point of grave confusion. A long way off.
- Negotiate all aspects of implementation of the Solution. Are we there yet?
- Implement solution. Hmmm.
- Realise that solution would have worked five years ago, but is now inadequate with another 36% increase in tram patronage.
- Go back to step one.
Clearly all of this takes a really long time, but the actual time frame unclear. Luckily, there is a long term solution! In the meantime, we must be content with the "strategy" of telling people to stand back.
The next question I asked the nice man from Yarra Trams was, "And what's in between the current situation and the long term? You know, the mid term strategy?"
I think the answer was either "there isn't really one" or "it's the bit between now and the future" - probably an amalgamation of these two ideas. They shouldn't be in quotation marks - image they aren't there, I don't want to be accused of putting words in anyone's mouth. Happy to put ideas in their heads though. Oh, and it's definitely on the agenda. And it's a priority.
So "mind the gap" has taken on a new meaning. It's the gap between the current inadequate reality and the long term, far away foggy future; the gap between now and then, now and later. Yarra Trams would do well to mind the gap themselves.
To avoid wearing out my eyeballs (all that eye rolling every time I'm told to move back in a human sardine can), I'm going to experiment with waiting on the footpath and using the TramTracker app on my iphone (also available in android) to determine when I should attempt the move to the platform. I figure if I have eight minutes to wait until my tram, I could avoid adding to the platform crush but not waiting on the actual platform. I'm worried about the fatal flaw in this plan - it could take me eight minutes to get onto the platform to catch the tram! We'll see. Anyone else going to join me?
Yarra Trams says they love to receive feedback from customers. I believe them. They just need to move a bit faster! Why not give Yarra Trams what they love and tell them about your experience on the trams of Melbourne?
Tuesday, 19 February 2013
What's the point of all this feedback on myki?
I'm on the customer experience panel for the myki ticketing system. My motivation for spending time on this is that I am a committed public transport user. I believe in contributing to my community to make things better.
Each week I try to participate in all of the tasks requested. I dedicate my time to this and take it very seriously, participating sincerely and honestly.
Sometimes I feel like I'm beating my head against a wall, as changes seem to take such a long time to be made. Sometimes I wonder if changes ever will be made. The wheels turn very slowly.
Public Transport Victoria regularly provides news and updates in response to our feedback. Most of the time it's unremarkable. Occasionally I read something and think "oh, I'm glad they fixed that!". This week I just sat and shook my head.
Not long ago we had specifically been asked about how myki calculates fares and applies defaults. Apparently the panel's feedback must have suggested that the rules are complex and hard to understand. The essence of the message provided back to us was there's plenty of information about how it's done and here are all the places where you can read it!
Or on the subject of most people preferring to top up at a myki machine, their response was to tell us they will be launching a campaign to tell everyone about the other ways.
Perhaps out of context some of the impact of these communiques may be lost, but I worry that they are missing the point. If the default position is to defend the system as it stands, rather than thinking about how customer concerns could actually be addressed, I can not see how any aspect of the system will be improved, or what the point of the whole exercise is.
One of my friends today thanked me for continuing to engage with the underperformers who are running Victoria's public transport, saying I'm doing everyone a favour. I'm no longer sure about that because the result seems so lacking.
Each week I try to participate in all of the tasks requested. I dedicate my time to this and take it very seriously, participating sincerely and honestly.
Sometimes I feel like I'm beating my head against a wall, as changes seem to take such a long time to be made. Sometimes I wonder if changes ever will be made. The wheels turn very slowly.
Public Transport Victoria regularly provides news and updates in response to our feedback. Most of the time it's unremarkable. Occasionally I read something and think "oh, I'm glad they fixed that!". This week I just sat and shook my head.
Not long ago we had specifically been asked about how myki calculates fares and applies defaults. Apparently the panel's feedback must have suggested that the rules are complex and hard to understand. The essence of the message provided back to us was there's plenty of information about how it's done and here are all the places where you can read it!
Or on the subject of most people preferring to top up at a myki machine, their response was to tell us they will be launching a campaign to tell everyone about the other ways.
Perhaps out of context some of the impact of these communiques may be lost, but I worry that they are missing the point. If the default position is to defend the system as it stands, rather than thinking about how customer concerns could actually be addressed, I can not see how any aspect of the system will be improved, or what the point of the whole exercise is.
One of my friends today thanked me for continuing to engage with the underperformers who are running Victoria's public transport, saying I'm doing everyone a favour. I'm no longer sure about that because the result seems so lacking.
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