Let me tell you a little story.

I have a friend who works for an NGO doing incredibly hard and very important altruistic work. She recently shared a feedback experience that has negatively impacted her ability to function in her role ever since.

My friend was told by her manager during an annual review that her experience and contributions were invaluable in making progress on multiple important projects within the organization. But, he said, she was not an effective communicator.

My friend was crushed. Her manager hadn’t named any specific examples, nor had he given her an idea of which resources and support were available for her to work on this perceived deficit. All she was left with after the annual review was the sense of having failed at an important aspect of her role, which left her feeling apprehensive, ashamed and unclear on how to move forward.

Since receiving this feedback, she has felt anxious about contributing her thoughts and suggestions during meetings because she now sees herself as an ineffective communicator. As a result, she speaks up less and less, even on topics in which she has the most experience. You see where I’m going with this. She has most certainly now become an ineffective communicator.

The thing about feedback

Feedback is like that. When done well, it creates opportunities for growth. It signals that you see your team members as the unique individuals they are and support them in their efforts to maximize their contribution. When executed poorly, however, it can create a cycle of dejection and withdrawal.

As I mentioned in my article Five Things To Do When Starting a New Position, I’m a big believer in soliciting feedback. Still, my experience with feedback in the hospital has been a mixed bag. And the mix has not always been particularly tasty. More like a bag of jellybeans that could have been delicious until someone decided to add buttered popcorn, jalapeno and draft beer flavor. (Really, JellyBelly? Why?).

Too much, too little, and juuuust right

During my US residency training, we received feedback after every single rotation. Rotations in one of the residency programs I trained at were two weeks long. So, for three years, residents were receiving feedback from attendings, senior residents and co-residents every two weeks. That is not feedback. That’s an avalanche. Anything potentially useful tended to disappear under the sheer mass of commentary and quickly lost its significance. And in a fast-paced clinical setting, almost no one had the resources to provide genuinely thoughtful, individually tailored feedback to so many different entities that frequently.  

In Germany, by contrast, feedback for residents was basically non-existent. There was the yearly evaluation with a supervising physician who had to sign off on core competencies for board certification. More often than not, that was the literal extent of the evaluation: a signature on a piece of paper. (Yes, physical paper. Made from trees? You may be familiar with it if you were born before the year 2000 or work in the German healthcare system. But that is a topic for another post.) As a resident in Germany, I was not once on the receiving end of a planned feedback conversation. The message this sent was fairly clear: You’re on your own. Figure it out.

So, my first feedback takeaway is this: The amount of feedback matters. Just like in Goldilocks, there is such a thing as too much, too little, and juuuust right. How much is just right will vary based on the specifics of your institution, who is providing the feedback, duration, context, etc. It may be once a month, or quarterly, or twice a year. It should not be constantly; it should not be never.

The quality of your feedback sandwich

Even more important than the amount, is, of course, the quality of the feedback.

Early on in residency, we were taught the sandwich method of delivering feedback. Sounds good, right? Who doesn’t love a sandwich? For those of you that don’t know this method, it consists of placing your negative feedback in between two positive statements in the hope that it will taste better.

One of the problems with this approach is that if your negative feedback or ‘constructive criticism’ is unhelpful, then no amount of layering will make it appealing. If you tuck a moldy piece of cheddar between two slices of freshly baked brioche, I’m still not gonna eat it.  

Useful feedback vs value judgements

So, what is useful feedback?

In order to be helpful, feedback needs to be clear, specific and actionable. Anything else is more likely to be a value judgement.

A word about those. Women, in particular, are often subject to value judgements rather than actual feedback. We should speak up more, or act less assertive. We should change the pitch of our voice to be taken more seriously. Stop apologizing. But be consistently agreeable. Smile more. Or smile less. (Any men reading this, show of hands please: How many of you have ever received feedback about your smile frequency?) These are assumptions about how women are meant to operate in society rather than assessments of potential growth areas.

If you are reading this thinking I’m exaggerating, I assure you I am not. I have been on the receiving end of some of the above statements. And I have sat with many female colleagues as they digested similar bits of ‘advice’.

Delivering constructive feedback requires examining our own assumptions and priorities and getting curious about those of the person we are evaluating. We need to be careful that the feedback we provide isn’t simply an outward projection of our inner story. If I feel undermined, insecure, or unsupported, it’s easy to interpret the actions of my team in that light. Good feedback requires honesty: with ourselves and with the person we are providing it to.

Format Matters

And this leads me to takeaway number three: Format matters. An anonymous written system- as was the case during my training- lacks another essential component of constructive feedback: trust.

The fact is, both giving and receiving honest feedback are inherently vulnerable, and making yourself vulnerable requires trust in your counterpart. Trust that the feedback we receive is not a way to vent pent up frustrations, of which there are naturally many in the pressure cooker that is a hospital. Trust that any negative feedback is not an indictment of our character. Trust that the other person sees us in our full humanity and not just as a means to an end.

Anonymous feedback is a bit like breaking up with someone via text message. We deserve better.

An investment opportunity

If all of this sounds like a bit much, it probably is. Giving good feedback is an investment, and like all sound investments it requires thoughtful planning and a commitment to getting it right. There will be times when it feels deeply uncomfortable. We will not always agree. It may reveal gaps in communication, or the need to work on building trust.  

Nevertheless, feedback provides us with a precious opportunity to cultivate relationships within our team and to lift each other up so we can collectively rise to our fullest potential. Let’s not squander it.

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How has feedback you received had a positive or negative impact? Anything you feel strongly one should or should not do when giving feedback? Please share!