During residency new doctors are faced with several assessments. The 360-degree feedback is just one of them.
It involves the evaluation of performance on various tasks by, firstly, peers with knowledge of a similar scope of practice, secondly, co-workers from allied health professions and, thirdly, patients. Or: ‘letting future behaviour be guided by a systematic and critical analysis of past actions and their consequences’.
How the 360-degree feedback is put into practice differs with were they work. The most often heard complaint by residents about these 360-degree feedback is: “how can a secretary judge me”. Well the secretary is not there to judge nor to give feedback on medical competence but to give feedback on other competences such as communicating, administrative functioning etc.
Studies showed that 360-degree feedback improved the performance of consultants receiving the feedback. But which factors promote or block implementation of the suggestions received by consultants during a 360-degree feedback?
Of 23 consultants only 11 made concrete steps towards performance improvement.
an internist who forced himself to wait for 5 minutes before beginning to speak in multidisciplinary sessions in order to give other people the opportunity to think and speak
Overall, 360-feedback can work if skilled facilitators are available to encourage reflection, concrete goals are set and follow-up interviews are planned. The main obstruction to the good use of 360-degree feedback is an existing lack of openness in hospitals, departments, or consultant groups. The other important factor is absence of constructive feedback.
That brings us to the subject of giving good feedback:
- Be clear about what you want to say.
- Start by emphasizing the positive
- Be specific. Avoid general comments and clarify pronouns such as “it,” “that,” etc.
- Focus on behavior that you have seen or observed rather than the person.
- Refer to behavior that can be changed.
- Be descriptive rather than evaluative. Avoid qualifications
- Own the feedback. Use ‘I’ statements.
- Generalizations have to be avoided, be specific with observed examples
- If possible let them work out an advice to improve performance
These are just a few suggestions.
How was this research done?
a qualitative study using semi-structured interviews with 23 of these consultants, purposively sampled based on gender, hospital, work experience, specialty and views expressed in a previous questionnaire.
Limitations
Participants were all volunteers, this doesn’t exclude selection bias. Participants were working in a Dutch non academic hospital setting which limits generalization.
Is it a good thing the 360-degree feedback? I don’t know. It’s dependent on a lot of factors such as those found in this study. Especially changing a culture with lack of openness seems a tough cookie to me. What do you think?
Overeem, K., Wollersheim, H., Driessen, E., Lombarts, K., van de Ven, G., Grol, R., & Arah, O. (2009). Doctors’ perceptions of why 360-degree feedback does (not) work: a qualitative study Medical Education, 43 (9), 874-882 DOI: 10.1111/j.1365-2923.2009.03439.x
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I’ve had similar experiences with residents rejecting the concept of 360. I think it has a lot to do with their experience of assessment=punishment/reward rather than thinking of it as part of learning.
I’m a strong advocate of 360 as part of the formative process because it looks at medicine holistically not just mechanically.
There are many excellent guides to both guides to running a 360 degree feedback exercise on our web site which apply in both industry and the health sector. I’d particularly recommend ’360 Degree Feedback Best Practice’ in this case.
A significant part of my executive coaching practice involves coaching Sr-level physicians. While they often shun the idea of 360-degree feedback, they soon find it extremely valuable, as 360 points out the non-clinical side of performance, particularly when it comes to healthcare professionals that lead others. I will not begin a coaching engagement without it.