Secretary’s Second Thoughts: “Good Job”

Good Job

Like many of us, I had a shift the other day that I was just happy to survive without causing any harm to anyone, including myself. At the end of the shift, I looked to my resident, who was able to weather the storm admirably, and I said, “Good job today!” I certainly meant what I said, but, upon second thought, was what I said useful? Was that “feedback” going to help reinforce the positive aspects of what my resident had done that shift? Was my resident able to pick up on the nuance in how I said “good job” to glean from it that the medical decision making was superior and that the patients all had been kept updated regularly? Was my resident able to extract from the “good job” phrase that, while the care of patients was fantastic, the flow could have been improved if the expected course of several patients had been anticipated earlier and more timely admissions made? I would like to think that all of that was conveyed and understood in my efficient and intuitive announcement of “good job.” Unfortunately, I know that it was not. I would also like to say that this is an aberration, and that I normally give well formatted feedback, but it is not.

Feedback is an integral part of not only the educational process, but also any leadership position. So, whether you work in a setting with or without residents you will need to deliver feedback. Yes, like it or not, you have a significant leadership role while you are working in the ED. Often, you might not perceive it as so, but others who work with you do. From clinical techs to senior nurses, many people look to you to set the tone. Having the mantle of leadership requires that you give feedback so that you can refine the efficiency of your department and improve everyone’s enjoyment of working. {Yes, your shift can be enjoyable!}

Yet, even knowing that constructive feedback is of vital importance to everyone, I continually fall woefully short of providing it. So, if you are in the same inadequate boat as I am in, please feel free to join me in an attempt to take simple steps toward improving my feedback skills. Certainly, there are many chapters and texts written on this subject, but I prefer to keep things as simple as possible (simple minds like simple things). So, here are a few points that I am going to personally focus on:

  • Put forth the effort:

Perfection will not be achieved initially, but often the simple effort will stand out in such stark contrast to what is typical that it will generate significant impact.

  • Be concise and objective:

Do not overwhelm people with feedback. Much like how useful educational points are gleaned from succinct and timely pearls and not hour-long dissertations, our feedback will be “heard” more completely if it is delivered in concise, objective points. This is one reason why the end-of-a-shift feedback doesn’t work as well (I often can’t remember anything to be concise about, so I speak in vague generalities). When a moment arises for you deliver constructive feedback, do not paint elaborate pictures and scenarios: be succinct: be objective. This will have greater impact and also respect everyone’s time more than protracted tutorials.

  • Be prompt:

Both praise and critiques are best received in association with an action, so we must be timely. When you witness something positive, state that it was noticed and should be repeated. When you witness something that needs correction, correct it and do not let it linger. This also allows you to be objective because the facts are apparent and not diminished with time. With regards to residents specifically, this is most easily achieved if you take the time to evaluate a patient alongside the resident. When you leave the patient’s room, you can now report what the fly on the wall would have seen and you are able to encourage the beneficial behaviors and reform the ones that are counterproductive.

 

  • Ask for self-assessment:

Within the feedback process you have a natural ally: the person to whom you are giving feedback. Many times the most critical assessment will come from the person giving self-assessment. This will make your job easier! To streamline the process, you can simply ask the person to critique the interaction (or the procedure, or the evaluation, etc) first. You can then point out one or two concise points that need to be either commended or adjusted. Then move on.

Yes, there are various methods for providing timely and meaningful feedback available in the literature. Traditional evaluation forms, feedback card, electronic feedback forms, and end of rotation evaluations all have some benefit; however, the most significant impact will be elicited in person at the moment an action is performed. What I have discussed above is merely my attempt to make myself more accountable for giving useful feedback and a simple method to do so. I hope that you can join me in putting forth the effort to deliver concise, objective points in a prompt fashion after eliciting self-assessment.

Reference: Wald, DA, Choo EK. Chapter 6: Providing feedback in the emergency department. In Practical Teaching in Emergency Medicine. Editor: Rogers, RL. Wiley-Blackwell, 2009; pp.60-71.

 

Leave a Reply

Your email address will not be published. Required fields are marked *