Blogs and writing
|Posted on March 15, 2021 at 3:55 PM||comments (0)|
The current model of anonymous feedback should be scrapped
BMJ October 9, 2020
These days if I want some positive feedback, I look on eBay; I rarely get any at work. But as a hospital consultant I am responsible for giving feedback to colleagues, trainee doctors, and medical students on a regular basis. Quite rightly, I am encouraged to do this properly, so I am expected to receive training to achieve this. I learn that feedback should be timely, focusing on the positive and on behaviours that can be changed, not personality traits. It must be for the benefit of the recipient, not the giver, so I need to be sensitive to the impact of my message and encourage reflection.
Hospital consultants need to complete a multi-source feedback as part of their cycle of appraisal and revalidation. Patients, consultant colleagues, junior doctors, nurses, managers, secretaries and housekeeping staff can complete these forms. They invite feedback on a wide range of topics from probity to prescribing. You are then encouraged to reflect on the results with the help of a trusted colleague.
I have recently gone through this process in preparation for revalidation. The feedback I received from patients was consistently excellent, but I was surprised that my feedback from colleagues included a single “poor” score in nine of the nineteen domains including the one for “probity/honesty/trustworthiness”. I am unable to determine if these poor scores are from one colleague with a grudge or a number of different responders, since their identity is not disclosed. There is nothing in the free text section to give me any clue as to what the concerns might be. I reported myself to the survey director and asked them to investigate. My concerns were dismissed and I was told to be reassured by the overall very positive feedback. They refused to ask the responder(s) to justify their scores as this would breach the promise of anonymity they were given before completing the survey. But how can I possibly reflect on the “poor” scores without knowing what the issues are? How can I reassure the General Medical Council that my standards of probity, honesty, or trustworthiness are satisfactory when one of my colleagues has clearly posted a concern?
And what is the point of all these endless cycles of feedback? There is scant evidence that they result in any positive outcomes.  On the contrary, I have seen colleagues distraught by some of the negative comments they have received, which rarely have context, are almost always unattributed, and frequently breach all of the rules for giving good feedback. We have created a feedback system that allows people to make negative comments about their colleagues, concealed behind a cloak of anonymity and with no accountability. It is a worthless endeavour both in terms of rooting out bad practice and encouraging good practice. Would anyone be satisfied that a pilot was fit to fly a jumbo jet on the basis of positive feedback from the cabin crew?
But there is an alternative…coaching.  You choose your coach; it is someone you trust who has expertise in your field of work. Their sole aim is to make you as good as you can be in your line of work. They can help you to fix faults that you cannot see for yourself. I have found coaching a robust method of self-improvement. I do not give feedback anonymously and in my opinion; no one should be allowed to do so. The current model of anonymous feedback should be scrapped.
John Dean, Consultant cardiologist, Royal Devon & Exeter NHS trust
Competing interests: None declared
The feedback fallacy https://hbr.org/2019/03/the-feedback-fallacy
|Posted on November 1, 2019 at 10:30 AM||comments (0)|
Western Morning News December 2018
The snowflake generation
The crisis in mental health is all too real, says Dr John Dean
Each successive generation introduces new words to their vocabulary, often making the language they speak impenetrable to their parents. So let’s begin with a vocabulary test to see how ‘woke’ you are. If you are ‘woke’, you will also almost certainly understand the meaning of the word ‘snowflake’. This term is used to describe oversensitive young adults who are more prone to taking offense and less resilient than adults in previous generations, or are too emotionally vulnerable to cope with views that challenge their own. In order to protect vulnerable ‘snowflake’ students, some universities have created safe spaces on campus where they can escape to avoid emotional upset. And lecturers are encouraged to warn students about potentially disturbing content in their course, allowing the students to skip that bit in case it may ‘trigger’ an unpleasant emotional response. Invited speakers with contrarian views have been greeted by (sometimes violent) demonstrations by students whipped up into a state of moral panic. Even Dame Jenni Murray, presenter of the BBC’s Woman’s Hour has recently been ‘deplatformed’ by Oxford University students because of her views on transgender issues. If you make a seemingly innocent comment with no intention to insult, such as asking a person of colour ‘where are you from?’ you are guilty of ‘micro aggression’ by implying that they are not truly British
So it is tempting to conclude that the reported rise in mental health issues in young people is simply a consequence of their emotional fragility or a modern manifestation of the age-old problem of teenage angst. Doing so ignores the wealth of data highlighting the rise in young peoples mental heath problems. Eating disorders (such as anorexia), anxiety, depression, and self-harm are all on the rise. An article in Psychological Medicine in September showed that between 1995 to 2014 there was a tenfold increase in long-standing mental health conditions in 16-24 year-olds. According to The Mental Health Foundation 10% of children and young people aged between 5-16 have a clinically diagnosable mental health condition yet 70% of those will not have received appropriate, timely treatment. In its latest annual report, The Children’s Society found that self-harming behaviour is at alarming levels with 22% of 14 year-old girls deliberately injuring themselves. Almost half of children who are attracted to the same or both genders self-harm. Although some of these figures may represent an increased readiness to talk about mental health issues, this would not explain how the number of students taking their own lives has increased by over one fifth in the last decade.
It seems clear that the crisis in young peoples’ mental health is very real. And it is not that difficult to see why this is happening. Pressured from an early age by schools forced to focus on relentlessly testing rather than educating. Overprotected and indulged by parents unwilling to expose their children to any risk, raising them to believe they are entitled to whatever they want, whenever and however they want it. Increasing exposure to social media that paradoxically leads to increased social isolation – they may have hundreds of virtual friends in cyberspace but interact with none of them in real life. Confusion and peer pressure about conforming to gender stereotypes. A university education that leaves students facing the prospect of a lifetime of debt. And now the opportunity to move freely to live, love and work across 28 European countries is being snatched away by a Brexit that the overwhelming majority do not want. As with all health related issues there is an economic gradient: poverty being the key predictor of poor mental health. A decade of austerity has led to increasing numbers of children and young adults living in poverty. We are witnessing the inevitable decline in their physical and mental health.
But is it fair to label our young people as the snowflake generation? In a recent poll by YouGov/Prospect in the UK, two out of three respondents agreed with the statement: “Too many people are easily offended these days over the language that others use.” choosing this option rather than: “People need to be more careful about the language they use to avoid offending people with different backgrounds.” There was remarkably little variation by age, and the youngest age group of 18 to 24-year-olds was slightly less ‘politically correct’ than the population as a whole. A parallel study in the USA found similar results. So there appears to be little generational variation in ‘snow-flakiness’. Perhaps the perceived rise is simply due to increased media coverage. Just because you feel vulnerable and sensitive, it does not necessarily follow that you are not prepared to make a lot of noise about it. But the evidence that there is an increasing problem with mental health issues in children and young people is overwhelming. Yet the services they desperately need are in pitifully short supply and have been hit very hard by cutbacks in public spending. You do not need to be very ‘woke’ to appreciate that.
Dr John Dean is a consultant cardiologist at the Royal Devon and Exeter Hospital. The views expressed are his own