effective feedback & having difficult conversations
TRANSCRIPT
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Effective Feedback & Having Difficult Conversations
Jane Sturgess
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• Terminology
• Effective feedback
• Difficult conversations
Feedback conversations
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This will be interactive• You will need;• A pen and paper• An open mind
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• Terminology
• Effective feedback
• Difficult conversations
Feedback conversations
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What do you understand by the term feedback?
One or two comments each
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Feedback vs Evaluation• Don’t confuse • Don’t conflate
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Feedback
“helpful information or criticism about prior action or behaviour from an individual, communicated to the individual (or a group) who can use that information to adjust and improve current and future actions and behaviours.”
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Feedback
“helpful information or criticism about prior action or behaviour from an individual, communicated to the individual (or a group) who can use that information to adjust and improve current and future actions and behaviours.”
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Feedback
“helpful information or criticism about prior action or behaviour from an individual, communicated to the individual (or a group) who can use that information to adjust and improve current and future actions and behaviours.”
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Feedback
“helpful information or criticism about prior action or behaviour from an individual, communicated to the individual (or a group) who can use that information to adjust and improve current and future actions and behaviours.”
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Evaluation“the making of a judgement about the amount, number, or value of something”
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• Terminology
• Effective feedback
• Difficult conversations
Feedback conversations
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When did you last receive feedback about your performance?
What did you want from feedback?
What did you need to make it meaningful?
4 minutes
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And?
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A short exercise
• Think of someone difficult to give feedback to• Think of an example of their behaviour• Think of their personality which makes it
difficult to give feedback• Think of a place where it would be difficult to
give them feedback
2 minutes
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how to draw a persons' attention to their less satisfactory aspects while maintaining or
even increasing their desire to learn, improve, and seek further evaluation
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open blind
hidden unknown
Known to self Unknown to self
Known to others
Unknown toothers
Self disclosure
Feedback
Johari Window
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Think about an occasion which did not go as well as you hoped when you gave feedback
• What contributed?5 minutes
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Why didn’t it land well?SCARF model of behaviour. David Rock. 2008• Status relative importance to others• Certainty the ability to predict future• Autonomy sense of control over events• Relatedness the sense of safety with others• Fairness the perception of fair exchanges
• Potential outcome? Denial and defense
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• Terminology
• Effective feedback
• Difficult conversations
Feedback conversations
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• What kinds of conversations do you find most difficult?
• What makes them seem difficult?
2 minutes
Difficult conversations
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Workplace Conflict
Task related
• Cognitive in nature• Perception of disagreement
about content of decisions• Differences in viewpoints,
ideas and opinions
‘improve group performance in specific situations, such as in the evaluation of potential problems in non-routine tasks’
Relationship related
• Emotional in nature• Perception of inter-personal
incompatibility• Includes tension, annoyance
and animosity
‘has profoundly negative effects on both team performance and team member satisfaction’
Rogers et al 2011
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Think about the way in which you ‘break bad news’
– How do you manage these situations?
– What skills do you do use?
Difficult conversations
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Think about the way in which you ‘break bad news’
– How do you manage these situations?
– What skills do you do use?
Difficult Important conversations
One or two comments each
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StrategyChoose an authentic conversation you want to have with someone
Write your strategy and your 90 second opener
Practice with a partner, get feedback and refine
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Criticismdisapproval of someone based on perceived faults or mistakes
Criticalexpressing adverse comments or judgments
Critiquedetailed analysis and assessment of observations
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Difficult Important conversations
Manage self
Manage conversation
Manage relationship
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Manage Self
1. Define your issue & purpose for having the conversation2. Express your motivation to find a positive way forward
3. Describe behaviour observed, effect and change needed
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Manage Relationship
1. Be collaborative: invite a response2. Tone should be as ‘neutral’ as possible
3. Generate options and agree on next steps
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1. Time and place, don’t ambush2. Be clear about concern and objective
3. Let them tell their story4. Identify common ground
5. Manage emotions and provide emotional support
Manage the conversation
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Some techniques
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• A pause has a calming effect
• High support and high challenge
• Address defensiveness openly and sincerely
• Be fair and consistent
Principles
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• A pause has a calming effect
• High support and high challenge
• Address defensiveness openly and sincerely
• Be fair and consistent
Principles
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• A pause has a calming effect
• High support and high challenge
• Address defensiveness openly and sincerely
• Be fair and consistent
Principles
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high challenge
low challenge
low support high support
increase motivationexcitementincrease commitmentproblem sharing and solvingenhance resilience
stress and resistancelow moraleself-protectionopting outfear, cautionlow creativity/risk taking
poor motivationlittle chance of changelow sense of achievementsterile, safe debatecollusion
boredomno commitmentabsenteeismstagnationloss of self-respect
Challenge vs Support
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• A pause has a calming effect
• High support and high challenge
• Address defensiveness openly and sincerely
• Be fair and consistent
Principles
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Defensive reactions to feedback• Blaming and excuses "It's not my fault because...” • Denial "I can't see any problem with that" • Rationalisation "I've had a particularly bad week" "Doesn't everyone do this?"• Anger "I've had enough of this"
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Dealing with defensiveness• Name and explore resistance ‘You seem bothered by this. Help me understand why’
• Keep the focus positive ‘Let’s recap your strengths and see if we can build on any of these to help address this problem’
• Try to convince the trainee to own one part of the problem
‘So you would accept that on that occasion you did lose your temper’
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Dealing with defensiveness• Acknowledge emotions ‘Do you need some time to think about this?’
• Locus of responsibility ‘What will you do to address this?’
• If recipient is in denial Reiterate the factsDescribe the behaviour
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We can also be defensive…• Obligation "I'm duty-bound to tell you this" • Moral high ground "It's for your own good" • Burying and fudging Taking a long time to get to the point and covering many irrelevancies• Minimising "Don't worry, it's not such a big deal.” “Everyone does it at some time“• Colluding "You're probably right, perhaps I am overreacting"
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• A pause has a calming effect
• High support and high challenge
• Address defensiveness openly and sincerely
• Be fair and consistent
Principles
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• A pause has a calming effect
• High support and high challenge
• Address defensiveness openly and sincerely
• Be fair and consistent
Principles
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Next steps• Think about what we
have covered today
• Identify one or more changes to your current practice you are likely to test out
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When the challenge increases, so must the support
Emotional bank balance - withdrawals cannot be sustained without credits in place first
Honesty does not allow either party to downplay strengths or to duck difficult issues
Key principles
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Summary of Feedback conversations
• Terminology
• Effective feedback
• Difficult conversations
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Next steps• Three hour masterclass
– Drama triangle– Influencing behaviour– Longer group work to learn from colleagues
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Thank you
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Thank you
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Mot
ivat
ion
and
Effo
rt
Certain ImpossibleReaching your Goal
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BREAK
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What have we covered so far?
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Pressure/Stress curve
Low
High
Low High
PERFORMANCE
Rust out Burn
outThe Drone
ZoneSelf confident
In ControlHigh Morale
The Fatigue
Zone
Fight FlightFreeze
The Effectiveness Zone
PRESSURE
Tipping Point
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Introduction to the Drama Triangle
From Transactional analysis by Steve Karpman 1972
Victim
TheDramatriangle
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Poor you! Let me help.Reality – concern for the victimCharacteristics:Take over the thinking and problem solvingDo more than their shareDo things they don’t want to doOften Nurturing Parent
Poor me! Powerless, helpless, stuckAct as if they don’t have the resources to solve their problemDon’t think in an Adult way to solve their problem
It’s all your fault!Critical, blaming, controlling, superiorAct in own interestsPart of their goal is to punishOften Critical Parent
Victim
TheDramatriangle
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From the Drama Triangle to the Winner’s Triangle
Creator
TheWinner’sTriangle
Victim
TheDrama
Triangle
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Ask for what they wantSays no to what they don’t wantGives feedback and initiates negotiationMakes changes in order to get their needs metDo not punishSkills: assertion skills
Can problem solve and think in an Adult wayAware of their feelings and uses them as informationSkills: problem solving, self awareness
Do not do the thinkingDo not take over unless asked (and they want to)Do not do more than their shareDo not do things they don’t want toSkills: listening and self awareness
Creator
TheWinner’sTriangle
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Influencing behaviour
constructive
destructive
assertive responsive
aggressive passive
Trainer behaviour
Trainee behaviour
PUSH PULL
ArgumentativeInterrupting
DenyingIgnoring
ChallengeSuggestions
ReflectingQuestions
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Give it a go…
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Strategy
90 second start
Explore both stories
Identify individual and shared interests
Generate options
Agree on specific next steps
Grimsley (2010)
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Remember – SCARF Model?SCARF model of behaviour. David Rock. 2008• Status relative importance to others• Certainty the ability to predict future• Autonomy sense of control over events• Relatedness the sense of safety with others• Fairness the perception of fair exchanges
• Potential outcome? Denial and defense
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Remember - Perceptual positioningTriple position to see the world from different perspectives (and take emotion out of the equation). Gregory Bateson.
1. First position – your perception of events (Self)2. Second position – that of another person, e.g. patient
(Other)3. Third position – objective observer (Detached)
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An exercise to try it out• Work in pairs• Choose 2 of the 3 scenarios• Take turns to be supervisor and trainee• 7 mins per scenario with 3 mins debrief per scenario
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Case Scenario You have been asked by colleagues to have a
‘word’ with Dr P, a ST3: Appears clinically sound. Eportfolio entries are dominated by tutorials, courses and reading. Not a team player; appears manipulative and aloof. Very strategic in choosing MSF respondents. • How would approach this task?
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Case Scenario
• GP Registrar in GP training • Their performance is causing you (as
Trainer/ES) concern• Late for surgeries and tutorials, visits
delayed, referrals are overdue and in some cases forgotten, calls in sick at last moment
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Case Scenario
• Your Trainee turns up to another tutorial once again unprepared despite having a week to be ready for an agreed topic.
• Plan and deliver your strategy for an improved outcome.
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Influencing behaviour
constructive
destructive
assertive responsive
aggressive passive
Trainer behaviour
Trainee behaviour
PUSH PULL
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Effective Feedback & Having Difficult Conversations
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Handout for Effective Feedback and Difficult Conversations Properties of good feedback:
• Specific: It should contain specific information rather than generalisations • Accurate: It should be factual and clear • Objective: Feedback should be unbiased and unprejudiced • Timely: It should be given as soon as possible after completion of a task (however, at times it
might not be possible and may be delayed to a more appropriate time and place) • Usable: Relate the feedback to goals and strategies so the individual can improve
performance. (Consider both clinical and non-clinical) • Desired by the receiver: Feedback can still be effective even in those who don’t actively seek
it, however those who are seeking feedback will often be more motivated to improve performance
• Checked for understanding: Clarify understanding with the individual to ensure they are getting the most out of their feedback
Matua et al 2014; Rose & Best 2005
Feedback may be received badly if one of the following traits are threatened:
• Status – relative importance to others • Certainty – the ability to predict future • Autonomy – sense of control over events • Relatedness – the sense of safety with others • Fairness – the perception of fair exchanges
From SCARF model of behaviour. David Rock. 2008 Consider using perceptual positioning:
• First position – your perception of events (Self) • Second position – that of another person, e.g. patient (Other) • Third position – objective observer (Detatched)
Search for: Triple position to see the world from different perspectives (take emotion out of the equation). Gregory Bateson.
Possible feedback frameworks to try out:
• Pendleton (good-bad-good sandwich) • Advocacy Inquiry - I saw… this happened… it made me think… [Advocacy].
I’m interested in what you were thinking. Could you take me through it? [Inquiry] • SBI – Situation, Background, Impact • CEDAR – Context, Examples, Diagnosis, Action, Review • IDEA – Identify, Describe, Encourage, Action
Remember:
• Johari window – feedback is an opportunity to learn more about yourself that others know and you don’t (yet)
• Listen. Ask - don’t tell. • Change arises when there is a balance of support and challenge • Avoid Parent:Child relationships. Avoid arguments.
Useful phrases:
• “Tell me more”, “Go on…”, “can you expand on that?” “you seem bothered by…” • “next steps…”, “even better if...”