This is one of the recommendations from the ‘departmental’ section of the RCOG/RCM undermining toolkit.
Introduce both positive and constructive feedback and debriefing
Within maternity services, the following issues have been reported:
- A lack of skill when giving constructive feedback
- Fear of criticism and causing upset
- A culture of avoiding receiving feedback
When the efforts of midwives and obstetricians are regularly and deservedly acknowledged with thanks and praise via cards and emails, the entire culture has reportedly been transformed.
At University Hospital Southampton (UHS), midwives and obstetricians identified via friends and family feedback are recognised every month. In addition, those who have given exceptional care are identified and acknowledged following a case review. UHS is also introducing a ‘team player of the month’ award – see the nomination form (PDF, 97 kb).
The East of England Deanery has developed an interactive workshop (PowerPoint, 500 kb), in conjunction with the University of Bedfordshire, on strategies for difficult conversations. This workshop is delivered to all groups of trainees and helps develop an understanding of how to avoid undermining when giving feedback.
Team briefs and team feedback following clinics and theatre sessions encourage everyone to take responsibility for shared learning and enhanced teamwork. At the end of every clinic or theatre session, the clinical leader should encourage everyone to share a list of 10 things that have gone well and two that could be improved upon. This ensures no single person is singled out and staff animosity and conflict is reduced.
Constructive feedback and debriefing
Trainers often express concern that, when they have to give critical feedback to a trainee, they will be perceived as undermining. This should not be the case if feedback is given appropriately, with specific examples in a private environment.
- The London Handbook for Debriefing offers absolute basic principles of what to cover when conducting a debriefing and giving feedback in clinical settings, as well as exemplar behaviours for the facilitator.
- All staff need to develop skills in how to give and receive feedback. This should be incorporated into unit education sessions and postgraduate training. The RCOG has video examples within StratOG. The basic rules of feedback should be adhered to.
UHS has instituted ‘hot debriefing’ and developed a proforma (Word document, 27 kb) based on work from Imperial College London. Hot debriefing should take place immediately after an event or by the end of the shift to capture the whole team. Despite the challenge of achieving the hot debrief with ongoing workload, an immediate debrief should lessen the fear of criticism.
In keeping with the concept of a positive culture, the debrief starts positively and remains factual. There are 3 phases:
- Start positively. What went well? (Green)
- What needs consideration/could be better? (Amber)
- What must be changed? (Red)
Critically, the facilitator is responsible for signposting stressed staff to appropriate support at the end of the debrief, if needed.
The Health Education Thames Valley School of O&G has published guidance on supporting staff after a serious incident or difficult outcome.
References and further reading
- Honey P. Improve your people skills (revised 2nd edition). London: Chartered Institute of Personal Development; 2001.
- Kirkham M, Stapleton H. Midwives’ support needs as childbirth changes. J Adv Nurs 2000;32:465–72.
- White C. ‘Effective team management. Expanding nursing and healthcare practice.’ In: Nichol E, Harmer S. Leadership and management. A 3-dimensional approach. Cheltenham: Nelson Thorn; 2006.