[2021-03-18] Feedback

Today felt like a repeat of Sunday: I was nauseated, to the point that I needed to take anti-nausea medication. I had little energy, napping in the morning and spending most of the day on the couch. I'm experiencing mouth sores, and have started rinsing with salt water throughout the day. All of these symptoms appear to be common side effects of Lynparza.

The upside to feeling down is that I have time to read, listen to and watch a variety of media. I often reread material I've written in the past, finding content that is relevant to my current circumstances or messages that I'd like to share again.

One blog post that I reread today was called "How to successfully give and take negative feedback." A key concept in that post—which was based on The Key to Giving and Receiving Negative Feedback by social scientist Joseph Grenny—was that if people feel safe, they are much more open to negative information. Grenny says: "You can say almost anything to someone if they feel safe. Likewise, you can hear almost anything, if you feel safe." However, if you feel unsafe, states Grenny, even the tiniest bit of disapproval can be crushing.

What does "safe" mean? For me, it has always meant that the person receiving feedback believes that the person providing feedback has their best interest at heart. Grenny points out that when people distrust the intent of the commenter, for example taking the criticism as a personal attack or an attempt by the giver to appear superior to the receiver, then they will not be open to the content of the feedback.

Recognizing the challenge of giving and receiving negative feedback, what can givers and receivers do to prepare for the conversation?

3 ways to help others feel safe before you provide feedback
  1. Make sure you're in the right frame of mind before providing feedback. Grenny distinguishes between feedback and blowback: "Feedback is information intended to help others learn. Blowback is information used to wound." If you've been disappointed by an employee's performance and are feeling resentful, first deal with your own emotions before attempting to speak to the employee. "When you feel a genuine concern for the growth and development of the other person, you’re ready to talk—and not a moment sooner," writes Grenny.
  2. Ask permission to provide feedback. Grenny recommends that you offer to provide input but wait until it's invited. For example, you could say to an employee: "When we meet tomorrow, I'd be happy to provide you feedback on your presentation if you'd like." This gives the employee time to mentally prepare for the conversation.
  3. Share your intent before your comment. Grenny insists that "People become defensive less because of what you’re saying than because of why they think you’re saying it." This may be why employees are more open to being critiqued by a mentor than their boss; they're less likely to assume ulterior motives on the part of a mentor than a manager. Also, forward-looking conversations make for more successful performance discussions than backward-looking ones. It's easier for me to point out to an aggressive employee that they should soften their approach if it's in the context of their inviting feedback on how to advance in their career than if it's in the context of looking back at the employee's past performance. One other way I've found to make employees feel safe and open to negative feedback is to provide, on an ongoing basis, lots of positive reinforcement that is genuine and specific. This helps employees trust that I have the best of intent, even when I point out an area in which they could improve.

3 ways to help yourself feel safe before you receive feedback
  1. Make sure you're in the right frame of mind before receiving feedback. Grenny advises: "Never invite feedback until you are ready for it." Ask yourself whether you are seeking information or approval, the truth or validation. Make sure you're ready to listen with curiosity rather than insecurity.
  2. Let others know if you're not ready for constructive criticism. Admit when you're feeling too vulnerable to receive feedback and then take responsibility to schedule a time by which you will be ready.
  3. Be curious. "The best inoculation against defensiveness is curiosity." So ask questions and request examples with the simple goal of learning. "Curiosity inhibits defensiveness because it keeps the focus off of your self worth and on the experience of others," says Grenny.

Though Grenny's article and my blog post focused on constructive feedback in the workplace, I believe that the concept of psychological safety applies in the healthcare sphere as well. If I feel that the healthcare professionals who are interacting with me have my best interests at heart, I will be more open to whatever they have to say. Now, I never doubt that they care about my well-being. However, some healthcare professionals are better than others at making me feel like I am seen and respected as an individual. Some are better at not only giving me the information I need but also ensuring that I leave feeling as good as I can under the circumstances. The best show they care by using my name, answering—not dismissing—my questions, and acknowledging the promising signs in addition to the challenges ahead.

But maybe there's more at play than I realize in discussions with patients. In relation to performance feedback, Grenny notes, "Our belief that these types of exchanges will carry a high probability of hurt makes us understandably reluctant to invite them." Perhaps healthcare professionals have encountered many patients who crumble under the weight of bad news, which, in turn, makes the professionals feel bad. And perhaps many patients seek information that healthcare professionals cannot provide, such as assurances about the future.

We can't always know the challenges that healthcare professionals face—and I do believe that they have a very difficult job, as they regularly interact with people at their most vulnerable. So the more we can do as patients to prepare ourselves for conversations with healthcare professionals, the better.

3 ways to prepare for conversations with healthcare professionals
  1. Read all materials and follow all instructions provided by your healthcare professionals. If you seek additional information, consult credible sources.
  2. Prepare notes and write down questions in advance of conversations with healthcare professionals to make sure you're ready for their questions (how are you doing, are you experiencing adverse reactions to drugs, medical devices or procedures, do you have concerns about future treatments) and to ensure that you don't forget to ask any of yours.
  3. Keep notes of conversations with healthcare professionals and have them with you for any follow-up discussions so that you can compare new directions with previous information. This is especially important when being cared for by a healthcare team.

The biggest advantage for me in keeping notes of my conversations with healthcare professionals is that I can review the record. I often fixate on the one negative thing they said and ignore some of the positive news they shared. Rereading my notes after an appointment helps me to put what I heard and what was said in perspective.

If you provide feedback—as a boss, a parent, or a healthcare professional—think of ways to help others feel safe before you offer suggestions of improvement or challenging news. If you're about to receive feedback, approach the conversation with curiosity and try to see the observations of the other person as a gift. If you're a patient, prepare for appointments with healthcare professionals by noting questions that can help draw out good information, such as, "What positive signs do you see in my results?"

Grenny suggests in his article: "Feedback doesn’t have to hurt. In fact, under the right conditions, there is nothing we want more than to know the 'truth' as others see it." He adds, "Pain is not an essential byproduct of feedback—it is the result of an absence of safety." So strive to create a feeling of safety in others when providing feedback, and work to create a feeling of safety in yourself when receiving feedback.