Saturday, February 13, 2010

Reflecting on midwifery feedback from women

Midwives in New Zealand are expected to give feedback forms to all the women they care for. The forms are returned to the midwife so she can reflect on the care she has given women. This reflection becomes part of the midwife's Review process - the midwife is also expected to submit the forms to the Review Committee so the committee can comment.

My feedback for 2006
I received five feedback forms in 2006. Most of the feedback was excellent. My favorite was this comment:
"Brilliant. 2nd time with this midwife who I trust immensely"

However, one woman did have a few problems with the way I communicated with her. Whilst she felt my care when she was in labour was good, she felt I didn't always listen to or understand her, nor did I adequately individualize her care.

How to respond to feedback
Receiving feedback as a midwife can be difficult at times because it is so personal. On the whole I do a very good job but every now and again, things do not go as well as I would like. Sometimes it is difficult to tease out what feedback one should act on, and what is a personality clash. So what I look for in feedback is themes - if a comment keeps cropping up, then I know this is something I must respond to.

When a woman says I have not communicated appropriately, this is something I must pay attention to. I do not believe this is a theme in my practice and my feedback reflects this. However, appropriate communication is a key element of midwifery practice so it is important I remain vigilant to ensure my standards do not drop.

If you are a health professional, how do you gather feedback from the people you care for? As a health consumer, how do you give feedback to your doctor/nurse/midwife?


John Coxon said...

Can I offer some thoughts of a general nature on receiving and responding to feedback.

There are two key aspects to any feedback recieved, (1) all feedback is emotionally charged and (2) all feedback is an interpretation of events.

When someone is providing feedback it is because they have observed a particular behaviour. From their observations they have formed a perception and they have formed their own interpretation of the event. They will express their feedback as their interpretation. This means they are expressing their feelings more than what they actually observed and their feelings are influenced by emotions.

If you are recieving the feedback, what can you do? Firstly take a step back and create space to reflect. Consider writing down the feedback as it was voiced to you. Or reading through written feedback. Ask yourself what words were used? Can you seperate interpretation from factual observation?

You cannot respond to emotionally laden interpretations. Those are just one person's perspective. You can only respond to the fact - events as they were observed. If you do not understand the fact, the specific behaviour observed or heard then you should ask questions to seek clarification.

When you do understand the actual observed behaviour you can respond, should you choose to. When you respond, you should, firstly acknowledge and accept responsibility for the observed behaviour. This demonstrates you accept ownership and responsibility for changing how you behave. Focus on your behaviour, not on your interpretations or the other person's perspective. Avoid making excuses, no matter how logical or relevant, for your behaviour.

Just accept the feedback graciously, take time to reflect, ensure you understand the facts and take responsibility for changing how you do things.

It's easy isn't it? Yeah right! It's not easy, we are human beings, we are ruled by our emotions. So first off all, understand how you are feeling and why - before you seek any ongoing discussion.

John Coxon
Management Coach

Sarah Stewart said...

Hi John, thank you so much for this fabulous reply to my post about feedback - very wise words of wisdom. I have always liked the idea of feedback...when it's good :) It's not so easy to deal with it when it appears to be "negative".

As you say, one must look at facts - this is not easy to do when facts are not stated...the comments are more of a personal opinion. But in this context, I take the view that a woman's opinion must be respected as what it is then for me to reflect and decide if my behavior needs to change or if the comments are "one-off" and stored for further contemplation.

InfoMidwife said...

Hi Sarah, i am responding to john's comment... I enjoyed his thoughts on feedback and never really looked at feedback from that point of view...should have but never thought of it as an emotionally charged which of course it can be... i always seem to respond negativatly to personal I know it is emotionally charged.... thank you for a different point of view...I will in future take a step backwards first...

willie campbell said...

I am appreiacaive of John's comments on feedback and have been very conscious of these aspects for some time. The difficulty in"anaonymous+ therefore have a freedom to say honest things" model is that we can't have a reference to a situation or a person.
So- we step back, but we may also being less than digilent in contiuous improvement model.

Sarah Stewart said...

Thank you, Infomidwife and Willie for your comments.

I too have been very conscious of the 'facts' approach to giving and receiving feedback for some time, especially in my role as educator. The problem with the context I have been describing in this blog post is that women are not given any support or advice to give feedback in this way. They have just had a baby...feeling vulnerable and tired...and may feel dis-empowered. They may feel unable to give any 'facts' for fear that it may identify them, which may be problematic if they had a poor midwifery outcome.

As midwives, we have a lot of 'power' over women - this anonymous, non-specific feedback may be the only way a woman feels confident enough to give feedback to her midwife. At the same time, I do not feel it is particularly useful for the midwife's learning.

Sarah Stewart said...

I receieved this comment by email:
Yes, we need to know that our communication methods are working and whether we need a different approach for different individuals. The question therefore is, ‘Is feedback only summative or should we be looking for some form of pre-emptive formative feedback?’ And if so, what form should this monitoring take? Some early intervention on the basis of earlier feedback might be the answer. In any form of teaching or client service we need to know that we are communicating effectively and, for that matter, that the information that we are presenting is acceptable to them. Perhaps we should take more care in understanding the client’s initial perceptions/beliefs etc?