How To Facilitate A Feedback Session - NGHA 19

HOW TO FACILITATE A FEEDBACK
SESSION
Confidential & Proprietary - Do not use without express permission of Pascal Metrics Inc. © Pascal Metrics 2015
THE WHY’S & HOW’S OF
CONDUCTING A FEEDBACK
SESSION
TOPICS:
• Framework for understanding & improving culture
• Preparation: what to do before facilitating a feedback session
• Action: what to do during the feedback session
• Best practices and tips for planning and facilitating
• Follow-up Action: what to do after the feedback session
A FRAMEWORK FOR
UNDERSTANDING & IMPROVING
CULTURE
WHAT IS CULTURE
Artefacts (Visible part of culture)
- Behaviors, common language,
traditions, stories, etc…
What we say
we believe &
Adopted values do
- Spoken values, beliefs, shared
thinking
- Not directly visible, but be
extracted by what people say
What we
Underlying Assumptions actually
- True values, unconscious beliefs believe & do
Based on Schein (1985)

CULTURE IMPROVEMENT PROCESS
Communicate Session
Results to:
Work Settings
Manager
Work Setting Manager and
staff prioritize issues,
develop and implement
improvement initiative for
top priority issues in their
work area
Evaluate success of
Conduct Feedback Monitor & track
Survey Leader improvement
Sessions initiative progress
initiative
Survey Leader collates all
feedback session results,
shares themes with
leadership team who
identify and implement
strategic improvement
initiatives
WHAT IS A FEEDBACK SESSION?
• A facilitated meeting during which the most recent culture survey data is shared
with staff, the data is ‘debriefed’, and items or issues of concern are identified
• Feedback sessions ideally take place within a month or two of the release of new
survey data
• Survey data in conjunction with information obtained from the feedback session
determine what improvement initiatives should implemented
REASONS TO HAVE A FEEDBACK SESSION
Feedback sessions with staff…
• Close the loop with staff on the survey
• Demonstrate to frontline staff that their opinions and perspectives are valued
• Helps determine root cause of cultural inefficiencies
• Validates concerns expressed in survey comments are shared amongst all staff
• Commonly uncovers:
– Staff misunderstanding and misperceptions about policies and procedures
– Lapses in communication
– Unsafe workarounds
– Unknown deficits in equipment/supplies
– Ideas and suggestions of changes
– Staff observations about the state of patient care and patient satisfaction
THE IMPACT OF ACTING ON SAFETY CULTURE DATA
ICUs that DEBRIEFED ICUs that did not DEBRIEF
Reflected on culture scores and took Did not reflect on SAQ scores nor
action take action
1. >15% culture score increase in 5/7 1. 5% culture score drop in 5/7
domains domains
2. >10% BSI reduction 2. No reduction in BSIs
3. >15% VAP reduction 3. 5% increase in VAPs
* * *
* *
Attribution: M. Vigorito-
Cornell et al. Improving
safety culture results in
Rhode Island ICUs: lessons
learned from the
development of action-
oriented plans. Jt Comm J
Qual Patient Saf. 2011
Nov;37(11):509-14
PREPARING FOR FEEDBACK
SESSIONS
LOGISTICS
Key Decision: Who will facilitate the feedback sessions?
• Recommend a neutral facilitator
• Why use a neutral facilitator?
– Staff may be more comfortable speaking up, especially regarding issues of
leadership and psychology safety
– A neutral facilitator is more likely to drill down on issues than someone
familiar with the work setting
• Helps get to the root of the issue
– It can be difficult for work setting managers to get out of “problem solving”
mode and just listen to staff
• Neutral facilitators can be:
– Quality, Safety, Risk, HR, OD, and Nursing Education staff
– A manager from another work setting
LOGISTICS
Key Decision: Where will the sessions be conducted?
• A quiet place, close to the work setting so it is convenient for staff to attend
• Ideally a room with computer access and a projector in case facilitators want to
display a presentation of the survey results
Key Decision: Who should attend the sessions?

• Aim for at least 50% of staff, regardless of whether they completed the survey
• Staff representation from all shifts
– Option: One session per shift
– Option: Schedule session when shifts overlap
– Option: Schedule session during regularly scheduled all staff meetings
• Staff representation from all role types
LOGISTICAL BEST PRACTICE
Additional Helpful Tips
• If you have a large facility, have a centralized person/team responsible for
scheduling all sessions
• Be sure to communicate the feedback session plan with the work setting manager
and work them to find best times for holding the sessions
• If there are multiple role types that work in the setting, try to conduct a session per
role (e.g., all nurses together)
• Ideally, plan for sessions to last approximately one hour
FACILITATOR PREPARATION – TASK #1
Review work setting data
• Work setting dashboard
• Current year report (or culture change report if there are > 1 year of data)
– By position type if there are multiple position types
– Bar Charts may be a helpful visualization if you don’t have good position type data
• Qualitative comments (if they were collected)
• Focus on:
– High/low domains
– High/low item scores
– Differences in scores by position type
– Counterintuitive results
– Qualitative comments
• Helpful Resource: Understanding data webinar and slide deck - “Things to Think
About” slides
Make a list of topics, questions, specific results to ask the staff
about during the feedback session
• General topics to cover could include domain topics or something someone wrote in
a comment
– Example: If the teamwork domain is low develop a general question to start the
conversation such “Give me some examples of good/bad teamwork in this work
setting?”
– Example: “Someone wrote in a comment that staff morale is low, how would
you characterize the morale in this work setting?”
• Note low scoring items you want to probe into further with staff
• Note items that elicited different responses between role types
• Can also check with work setting manager to see if there are specific
topics/questions they would like addressed during the session
Identify what results you want to share with the group and create
a results package
• Don’t feel like you need to share all results with staff
– The majority of time should be a conversation with staff, not you presenting the
results
• Show the domain scores (either from the dashboard or one-page report)
• Pull out item scores you want to ask staff about
• Best result package formats

– Powerpoint slides to project during the session
– Printed copies for staff to review during the session
FACILITATOR PREPARATION
What To Take With You To The Session
• Note taking material
– Notebook or flipchart paper
• If possible use flipchart paper, staff can see exactly what you write and helps to put
staff at ease about notes being taken
– Pens/markers
• The list of topics and questions you prepared
• Survey results package you prepared
FACILITATING A FEEDBACK
SESSION
SETTING THE STAGE
How to begin
• Arrange the room in a circle if possible (a friendlier setting)
• Introduce yourself and state the purpose of the session
– To share results
– To gain additional insight from the team
• Ensure psychological safety
• Explain anonymity of any comments shared with manager (if led by neutral
facilitator) and survey leader
• Explain the next steps will be action planning
• Take notes!
SHARING DATA
Starting the conversation
• Start by asking participants to describe a typical day in the area
• Share data of interest from the survey
– Ask open ended questions based on your review of the data
– Share both high and low scoring items of interest
– You can refer to the “Things to think about” for each domain for help with
questions
• Answer any questions they have about the survey
• While you will start with the data, the session will most likely develop out of the
data to the topics identified in the conversation
• Ask additional questions to clarify responses
• If only one person answers a question, draw others out and ask if they agree or
disagree
TIPS FOR SUCCESS
Keeping the conversation going
• Be interested and curious about what staff are saying
– Don’t try to problem solve during the session, but continue to ask questions
• When staff use words like “Sometimes” or “occasionally”, ask questions to further
clarify amounts
• Summarize what you have heard to stimulate continued conversation
• Draw out quiet participants
• Watch for body language
• If you have a flip chart, be sure to write down comments of interest to stimulate
conversation
TAKING NOTES
Capturing the Information
• Time and date of session
• # of attendees and role types represented
• General mood/impressions of the group
– “Staff seemed engaged…”
– “Staff were hesitant…”
• Unanimity or dissent over topics
• Any comments of particular interest
– De-identified
• In follow up notes, use neutral statements: “perceived”, “stated”, “said”
AFTER THE SESSION
FACILITATOR
Writing up notes
• Immediately following the session, review your notes
– If you were not able to capture all comments and thoughts of interest, be sure to
do so now
• Collect and compile notes from all sessions for the work setting (if there are
multiple)
• Prior to sending your notes to the unit manager and survey leader, you may want to
categorize quotes and examples by:
– Survey Domain
– Theme (i.e. Relationship with physicians, equipment/supply issues, staffing
concerns)
– Or a combination
QUESTIONS
CULTURE IMPROVEMENT PROCESS
Communicate Session
Results to:
Work Settings
Manager
Work Setting Manager and
staff prioritize issues,
develop and implement
improvement initiative for
top priority issues in their
work area
Evaluate success of
Conduct Feedback Monitor & track
Survey Leader improvement
Sessions initiative progress
initiative
Survey Leader collates all
feedback session results,
shares themes with
leadership team who
identify and implement
strategic improvement
initiatives
WORK SETTING MANAGER
What next?
• Review the notes from the feedback sessions
– It may be helpful to mentally group the topics from the notes in categories:
• Items you can address on your own (i.e. clarifying
misunderstandings/misperceptions; minor equipment/environment issues)
• Items you can work together with the work setting team to identify improvement
opportunities/action items
• Meet with your staff to review and plan actions
• Keep the improvement process moving forward
– Keep your list of action items visible
– Check in with the team, and continue to monitor improvement
SURVEY LEADER
What next?
• Review Feedback session notes from all sessions and identify themes and
information that should be reported back to leadership. Examples:
– Facility-wide equipment issues
– Facility-wide process issues
– Local management issues
– Human resources concerns and issues
– Senior leadership issues
• Ensure Feedback Session notes from each session are provided to the appropriate
work setting manager
• Review action and improvement progress with the work setting managers
periodically

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HOW TO FACILITATE A FEEDBACK

Based on Schein (1985)

Key Decision: Who should attend the sessions?

• Best result package formats

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