Giving staff feedback on their performance can sometimes feel like making people jump through hoops. But there is an art to it, says Jenny Rogers

One of the strangest phrases you health service folk use is "to performance manage". I never hear it used elsewhere. Setting aside that the term is a hideous abuse of grammar, when one of my NHS chief executive coaching clients tells me that he is performance managing two people in his team, I now understand perfectly the sinister significance this phrase has for the people concerned: they are Billy No Mates, on their way out.

The phrase is all the more peculiar for this doom-laden meaning. After all, managing performance is the essence of what you are all paid to do 100 per cent of your time.

Friends outside the NHS often ask me why it seems to promote people so eagerly and then apparently only a finger-snap later ousts them, reputations destroyed because they are labelled as bullies or hopeless with money. If they were so incompetent, why didn't someone spot this before? Why didn't all their previous bosses deal with it, instead of some poor strategic health authority chief having to performance manage them out of their high-profile careers in the glare of pompous newspaper comment?

How to give feedback is taught on more or less every management development programme. Yet I observe it to be something that only a talented and steely minority can and will do. When we conduct our in-depth version of 360-degree feedback through telephone interviews, one of the questions is: "How do you get to know what X (our client) thinks of your work?" This is better than asking: "How good is he or she at giving feedback?" The typical response is a long silence and: "Er, well I don't really have any idea. I just get a few hints..." Or the reply suggests a boss who barks out the occasional exasperated criticism without ever saying what is going right.

Deepest fears

Why is this? An article by Jay Jackman and Myra Strober in the Harvard Business Review suggested some possible answers, among them that asking for feedback awakens fears of childish dependency, or sparks the negative fantasy that we might actually be as bad as we suspect in our bleakest moments.

On the feedback-giver's side is a dread of the emotional response we could provoke, whether this is tears or rage. Even when we have overcome our reluctance, giving feedback is a high-level art that needs to be distinguished from criticising. Criticism is offered out of anger and for the benefit of the giver. Feedback is offered calmly and is intended as an act of generosity.

Such is the dread we humans have of feedback that we invent a system called appraisal to do it for us. Unfortunately, no human problem was ever solved by a system. A report published in December by YouGov for Investors in People showed that fewer than half of 3,000 employees surveyed found their appraisals helpful and a quarter believed it a meaningless box-ticking exercise. Scepticism was especially high in the public sector.

Many appraisal systems, far from improving performance, often seem to have the opposite effect. Recently I took an agitated call from a scientist in a global pharmaceutical company. He had furiously informed his boss she could no longer expect work that went beyond duty, such as emergency flights on a Saturday to sort out problems in a factory on the other side of the world. The reason was that she had ticked "good" rather than "outstanding" on his appraisal form. It really wasn't about money, my client assured me, and I believed him. It was about recognition. In this case it was also about a company containing wage drift with a particularly pointy bell curve in its bonus system. The short term solution of cost-capping leads directly to a longer term problem of demotivation.

An appraisal system is only as good as the culture in which it exists. Where there is a tradition of fear and blame, as my clients constantly tell me is true of the highly politicised, target-driven and jittery culture of the NHS, then managers will funnel decisions upwards, creating gruesomely clotted bottlenecks of responsibility at the top. Later, when the boss falls over, staff defensively deny how much they colluded in the alleged wrongdoing, for instance by neither offering the boss honest feedback nor by persistently challenging obvious stupidity.

Possible solution

Furthermore, where there is a dearth of attractive leadership role models - and that is most organisations, not just the NHS - it is likely that people have never experienced skilled performance management. So it is not surprising they do not know how to do it. The NHS may also be recycling its managers too readily, relying too much on restructuring to achieve change.

Here is one possible solution. Every baby-manager in the NHS should be drilled in how to ask for, receive and give feedback to seniors, peers and juniors and not released into the wild until he or she can prove competence. The emphasis should be on catching people doing something right every single day and should distinguish between appreciation and feedback. Appreciation is better than nothing - for example, "Thank you, you did that well". But feedback is better still because it spells out exactly what you did do well. When you get proper, positive feedback you are much more likely to repeat the same behaviour. For negative feedback there is another equally well-known protocol to follow.

Alas, all this is simple to understand but not so easy to do, so this is a problem that is not going to go away any time soon.