Last week we looked at lessons you can learn from fitness to practice proceedings. This week we are going to think about learning from feedback received in clinic.
It’s really important to use positive and negative feedback for your personal development. If you simply ignore feedback and try to hide away from it you will find that it can have a negative impact on your professional development.
Duty of Candour
In this series on complaints it is appropriate to just remind you of the Duty of Candour – D3 of the standards. Since 2014 all healthcare regulators signed a joint commitment to the Duty of Candour that requires healthcare providers to be open and honest with patients when things go wrong.
In an osteopathic context this may apply to an adverse event or injury from treatment such as a rib fracture. There is a duty to inform the patient, apologise and offer an appropriate remedy. This must be carried out under the advice of your insurers. You should be aware that this is your responsibility to be open and honest with patients.
When you receive positive feedback you want to use it to help you and your colleagues to reproduce that positive situation where possible. Patients may compliment you on your exercise information or on the way you interact with them. If you are trying to work in a particular way feedback from patient’s can confirm that you are achieving your goals. Last week a patient said to me ‘I don’t think it was anything you did with your hands but the conversation we had that made all the difference’. For me this is a great success because I focus a lot on education and for my patients with long-term pain I don’t want them to rely on me but to have increased self-efficacy.
Sharing positive feedback can be an effective marketing strategy (make sure you have patient permission). It can also help to boost team morale and inspire better practice.
When patients express concerns or complaints we’ve discussed in the previous articles the importance of identifying these early, and handling them well with good communication. Negative feedback should then not just be swept under the carpet but used for development of yourself and your colleagues.
There are some big risks of negative feedback and negative experiences having a negative impact on your practice.
When patient’s with low back pain associate their pain with starting after sitting on a certain chair they develop associated fears and beliefs. They believe that chair gives them back pain. They avoid sitting on chairs like that chair. They avoid situations where they might have to sit down for long periods. They end up with fixed beliefs about certain chairs and fear of sitting situations and this can lead to significant impact on their every day living. This will not be an unfamiliar story. Education about the lack of correlation between chairs and back pain and understanding other factors which may contribute to back pain will be important. Helping the patient to gain confidence to be able to sit on any chair without fear of pain will improve their quality of life.
That may seem an abstract story for this subject but I’m going to show how a similar experience can occur in clinic. Patient experiences can lead you to develop fears and beliefs that cause you to adapt practice – possibly subconsciously. If I ask you to think about some negative feedback you received I’m sure something will soon come to mind or possibly a few situations. No-one in practice does a perfect job with every patient every time.
As an example, imagine a patient with radicular low back pain makes a complaint of worsening symptoms and tingling and numbness after you had done an HVT to the lumbar spine. This may cause you to lose confidence in your skills treating low back pain, you may start to avoid doing HVT techniques, you may start to avoid patients with low back pain. How could you avoid this situation? Working through this case and understanding other contributing factors would be helpful. Identifying if there were areas that could have been improved in this case that were not your usual practice e.g. communication about expectations from treatment, making sure the technique was within the patient’s expectations, understanding the patient’s fears relating to their pain. It can helpful to work through this with a colleague bringing an independent view. Together you can identify key learning points for your development. Maybe you would benefit from a course to improve your confidence. Perhaps you could reflect on ‘successful’ cases to learn from your best practice.
When learning from negative feedback I would urge you to avoid criticising the patient. If the patient had negative feelings you need to question why not question the patient’s feelings – just as you would with their clinical presentation.
Significant Event Analysis
There are template processes that you can use to guide your thoughts through negative feedback such as Significant Event Analysis, or reflective models. A Significant Event Analysis can be used for positive or negative experiences administrative and clinical. The model considers what went well, what could have gone better, what could be done differently and identifies learning needs. You can reflect on all sorts of situations to improve your practice.
I would suggest if there is a situation that causes you to ruminate it would be worth reflecting to identify learning needs. I personally have improved administrative processes, improved communication skills, been on a suicide prevention course, and got systems in place for providing patient information all as a result of reflecting on both positive and negative incidents. I’m sure there will be many more opportunities to continue professional development.
How you respond to both positive and negative feedback can truly shape how you develop professionally.