10 FYi • Feedback


LET’S BE M


No one likes to give or receive criticism, but failing to speak up can threaten patient safety. Senior risk adviser Liz Price offers advice


OST of us don’t like to be criticised or challenged about our performance or behaviours. Despite our best intentions, such encounters can quickly disintegrate into defensive and unhelpful interactions. While avoiding potentially awkward discussions with colleagues might seem like a good idea, failing to speak up can harm patient care.


Evidence suggests that in teams where regular positive and negative


feedback is given across the group: • difficult issues are addressed earlier


• individuals are more likely to disclose problems and receive swift help


• people are less afraid to challenge • effective relationships are built up more quickly.


These are important factors in delivering safer patient care. Doctors have a responsibility to raise concerns if patient safety is at risk. Whilst it can be difficult, most clinicians find the courage to challenge colleagues when there is an imminent clinical error. Behaviours that are most difficult to address are often those which are less immediate, but more pervasive in terms of their effect on you, the team, or patients. This article will explore how to plan your approach to maximise the chance of a successful outcome. It will also look at how best to deliver feedback as a junior doctor, including the tricky dynamic of raising issues with senior colleagues.


Assessing risk As a junior doctor, you will have received feedback about your performance, and perhaps been challenged about your behaviours: “you were too abrupt with that patient” or “you didn’t consent the patient properly and that wasted our time”. Consider how the feedback was given – was it valid? Just? Constructive? What were your emotional and cognitive responses – did it make you feel uncomfortable, or even angry? Did you leave the encounter understanding what was expected of you? It’s likely that not all of your feedback experiences will have been pleasant. To decide on whether or how to address issues, ask yourself these


questions: • How much do you want to tell the person about your concerns? Is the issue making you unhappy or causing you/others to underperform? If it is not important in relation to patient care, is it your responsibility to raise the issue? If it’s not, decide whether the risk of a negative response is worth taking.


• Is there a culture of providing feedback within the team or do individuals tend to avoid challenging each other, meaning your feedback is then more likely to cause surprise? Providing regular praise has been shown to make it easier to accept criticism.


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