Feedback Dr Simon Hall Introduction to self Introduction to each other Key challenges for group

Johari Window Disclosure/Feedback model of awareness known as the Johari Window, named after Joseph Luft and Harry Ingham. It was first used in an information session at the Western Training Laboratory in Group Development in 1955. Some Theory…

Johari Window Known to Self Unknown to Self Known to Others Open Blind Unknown to Others Hidden Unknown Highlight the border between Open and Blind. Open: The open area is that part of our conscious self - our attitudes, behaviour, motivation, values, way of life - of which we are aware and which is known to others. We move within this area with freedom. We are "open books". Blind: There are things about ourselves which we do not know, but that others can see more clearly; or things we imagine to be true of ourselves for a variety of reasons but that others do not see at all.  When others say what they see (feedback), in a supportive, responsible way, and we are able to hear it; in that way we are able to test the reality of who we are and are able to grow. Hidden: Our hidden area cannot be known to others unless we disclose it. There is that which we freely keep within ourselves, and that which we retain out of fear. The degree to which we share ourselves with others (disclosure) is the degree to which we can be known. Unknown:  We are more rich and complex than that which we and others know, but from time to time something happens – is felt, read, heard, dreamed - something from our unconscious is revealed.  Then we "know" what we have never "known" before. So If we ask for feedback then our blind spots are revealed to us.

Johari Window Open: The open area is that part of our conscious self - our attitudes, behaviour, motivation, values, way of life - of which we are aware and which is known to others. We move within this area with freedom. We are "open books".

Johari Window Hidden: Our hidden area cannot be known to others unless we disclose it. There is that which we freely keep within ourselves, and that which we retain out of fear. The degree to which we share ourselves with others (disclosure) is the degree to which we can be known.

Johari Window Blind: There are things about ourselves which we do not know, but that others can see more clearly; or things we imagine to be true of ourselves for a variety of reasons but that others do not see at all.  When others say what they see (feedback), in a supportive, responsible way, and we are able to hear it; in that way we are able to test the reality of who we are and are able to grow.

Johari Window Unknown: We are more rich and complex than that which we and others know, but from time to time something happens – is felt, read, heard, dreamed - something from our unconscious is revealed.  Then we "know" what we have never "known" before.

Examples Positive and Negative? Feelings and Thoughts? Insight and Reflection? Learning and Planning? Facilitate Change? Think back to a situation when we received feedback. Ask for someone to volunteer their experience. What happened? How did you feel? What did you think? So was it positive or negative? Did you gain a new insight? Did you reflect, Learn and Plan? Did anything change?

Skills Active Listening Response to Cues Open Questions Challenge Summarising Reflection A Consultation? Can we agree the meaning of the following terms? Active Listening- encouraging the participants contribution Response to Cues- to respond appropriately to important, significant (in terms of what emerges afterwards) cues Open Questions- (opposite of closed), “tell me more, describe the situation…” Challenge- who, what, where, when, how questions. Summarising- “So if I understand you…” Reflection- The learning cycle- To do, think, learn and plan… “Unconditional Positive Regard”

Pendleton Clarify any points of information/fact Ask the learner what s/he did well – ensure that they identify the strengths of the performance and do not stray into weaknesses. Discuss what went well, adding your own observations Ask the learner to say what went less well and what they would do differently next time. Discuss what went less well, adding your own observations and recommendations Pendleton, Schofield, Tate and Havelock (1984) Clarify the facts What went well? What went less well and what will be done differently next time?

SET-GO Group members to base their feedback on: 1. What I Saw descriptive, specific, non - judgmental Facilitator to prompt if necessary with either or both of: 2. What Else did you see what happened next in descriptive terms 3. What do you Think John? reflecting back to the doctor on the video who is then given an opportunity to acknowledge and problem solve himself Facilitator then to get the whole group to problem solve 1. Can we clarify what Goal we would like to achieve outcome-based approach 2. Any Offers of how we should get there suggestions, alternatives to be rehearsed if possible From: Kurtz SM, Silverman JD, Draper J (1998) Teaching and learning Communication skills in Medicine. Radcliffe Medical Press (Oxford) Silverman JD, Kurtz SM, Draper J (1998) Skills for Communicating with Patients. Radcliffe Medical Press (Oxford) Describe specifically Think about the problem Identify the Goal Think about the solution

Do Give it with Care Let the recipient invite it Encourage self-criticism Be specific Outline the positive Avoid evaluative judgements Make the feedback actionable Balance the positive and negative Balance the timing of the positives and negatives Choose the right time and place To be useful, feedback requires the giver to want to help, not hurt the other person Feedback is most effective when the receiver has invited the comments. Doing so indicates that the receiver is ready to hear the feedback and give that person an opportunity to specify areas of interest/concern People are willing to accept the criticism when they have recognised their own strengths and weaknesses. Start by encouraging them to appraise themselves and then build on their own insights Good feedback deals with particular incidents and behaviour. Making vague or woolly statements is of little value. The most helpful feedback is concrete and covers the area of interest specified by the receiver. By making feedback constructive you will be helping the receiver to find out what needs to be done rather than just telling them what they are doing wrong. Always look for areas of improvement rather than what went wrong. The most useful feedback describes behaviours without value labels such as ’irresponsible’, ‘unprofessional’, or even ‘good’ or ‘bad’ If the recipient asks you for a judgement, be sure to state that this is your opinion. To be most useful, feedback should concern behaviour that can be changed by the receiver. Feedback concerning matters outside the control of the receiver is less useful and often causes resentment. Positive feedback on its own allows no room for improvement and negative feedback alone is discouraging . Always begin and end with a positive, for each point you are making. Avoid giving all the positive points at the beginning or end of the whole feedback session. This allows the receiver to hear a more balanced view. The most useful feedback is given at a time and place that make it easy for the receiver to hear it e.g. away from other people and distractions. It should be given sufficiently close to the particular event being discussed for it to be fresh in mind. Enough time should be allocated to explore any issues raised.

Don’t Deny the other persons feelings Be vague Accuse Take for granted the person has understood Bring in third parties Be negative Be destructive Be judgemental Bring up behaviours that the person cannot help Be overly impressed Be aggressive

A Mnemonic Approach Balance Change Description Exact Sensitive to the person and their learning agenda Balance Of positives and negatives as per Pendleton. Credits to exceed Withdrawals to avoid an “Emotional Overdraft” Change To facilitate Change by Active Listening, responding to Cues to and providing Challenge. To identify their problem and, through skill rehearsal, to work on their solution. As per SET GO Description Feedback based on fact and not on opinion throughout. Exact Feedback focusing on specific areas throughout. Be sensitive (Unconditional Positive Regard) Be balanced (vs an Emotional Overdraft) Through Cues and Challenge to facilitate Change. Be descriptive (vs Value Judgements) Be specific Rehearsing their solution to their problem