The communication of effective and constructive feedback has long been a thorny issue in many an organisation, and not least the NHS.
The understandable reluctance for individuals to expose themselves to the possibility of finding out some horrible home truth has presented quite a barrier, in spite of numerous models, initiatives, and methodologies.
The happy truth is that, by and large, where it has been effectively implemented, performance-related feedback has been found to be helpful, constructive, and revealing. In a new initiative, South Tees Foundation Trust has begun to implement a 360-degree feedback process for consultants, otherwise known as multi-source feedback (MSF).
Over the last three years a select team has been working at South Tees Foundation Trust, in consultation with Associate Professor Michael Greco who has joint appointments with the Peninsula Medical School (University of Exeter) and the School of Medicine, Griffith University in Queensland, Australia, to implement the system.
The notion behind this initiative has been to increase awareness in the consultant group of the impact they have on the full range of those with whom they work, and then by facilitated behaviour change, to improve effectiveness, patient-centeredness, and safety. The guiding principle is one of a full feedback spectrum; that is from self, others, and patients.
The process unfolds in three distinct parts: first, a self-assessment instrument, highlighting interpersonal skills; part 2, (CFET - Colleague Feedback Evaluation Tool), presented to a cross-section of each consultant’s colleague and peer group, and part 3 (DISQ - Doctor’s Interpersonal Skills Questionnaire) completed the picture with patients’ views.
Responders for part 2 (numbering 12 minimum per consultant) were chosen from a wide-ranging group including peers, nurses, junior doctors, and others as diverse as administration and cleaning staff. For part three, a cross-section of random patient feedback was solicited by clinic reception staff by means of a form issued as patients departed after completing an appointment; the patients responding to the process remained anonymous throughout.
The entire process is known as the Client-Focused Evaluations Programme: CFEP360.
The pilot consultant group at South Tees was drawn from the oncology department, who agreed to participate in the pilot after a series of introductory one-to-one meetings. The process was overseen by the then medical director, Mike Bramble, and service improvement lead and service improvement facilitator from the trust’s organisational development department (The Improvement Alliance).
“Prior to the GMC requirement that 360-degree feedback be a part of consultant revalidation, we experienced some initial reluctance and reserve,” says service improvement facilitator Margaret McQuade, “but by continued one-to-one meetings and facilitation we were able to establish a really good level of trust. Once that was in place, we could resort to email as a primary method of contact. The initial trust-building was key, however. Once we’d achieved that, the consultant group was happy to take full responsibility for both the execution and administration of the process. That was excellent.”
Some of the initial difficulties and barriers included deleting relevant email, and the creation of extra work for clinic reception staff, who were provided with an overall process explanation and information sheet. Once again, direct human contact and conversation overcame reluctance, and agreement was reached.
Ms McQuade continues, “I took personal responsibility for the passage of all the information that arose, and maintained a communication hub in order to ensure confidentiality. It was key that we maintained the level of trust we’d worked so hard to bring about.”
Overall, and after some initial scepticism, the benefits have been widespread, and can be summarised:
- Much greater engagement in professional development has been achieved, and participants are now keen to take responsibility for soliciting feedback on a spontaneous basis.
- Administration is sufficiently slick to allow the process clear passage.
- A revalidation board now exists within the trust, for which the medical director is accountable.
- An excellent relationship has built up between the Medical Director and the Organisational Development unit, as well as with the consultants themselves.
- With the Trust’s link to Professor Michael Greco and CFEP-UK Surveys, a constructive link to a high-quality external provider has been created.
The project is now gaining momentum, and is in demand: consultants themselves have now grasped the initiative, and requests for delivery are increasing from across the whole of the trust. To date 84 consultants have enrolled and 68 have received their feedback reports. The following chart demonstrates the numbers of consultants taking part according to the speciality they belong.
Susy Cook is service improvement lead and Margaret McQuade is a service improvement facilitator at South Tees Foundation Trust. Adrian Stabler, writer and business consultant, sMeridien Learning