Module 5: Celebration
Action Plan
Background
- Appreciation/positive feedback is under-represented in most forms of institutional feedback to individuals, including case review
- Historical focus has been on errors, gaps in performance, negative outliers compared to standards/expectations
- Most common “positive” feedback is reframing negative feedback with positive language (”opportunity for improvement” - i.e., this is bad/below standard but we will talk about it as an “opportunity” rather than a deficit) or non-specific kudos (”nice job” or ”thanks for good/hard work”).
- Science from education to coaching to safety supports that learning, motivation, performance, and culture benefit from increased positive feedback and appreciation at individual and team level.
- While offering appreciation for outcomes can highlight what excellence looks like, behavior change is most impacted by providing specific, timely, positive feedback on behaviors that support the outcome (not only negative feedback on what not to do).
- Optimal ratio of positive to negative/constructive feedback is 3-5 (+) to 1 (-) to maximize learning, performance, and morale.
- Appreciation formula is more effective than improvising or relying on positive platitudes like ”nice job“ or “keep up the good work.”
- Formula = “Thank you (name of person or group) for (behavior that positively impacted me/the DxEx program), because (here’s how it made a difference to me/the DxEx program).”
- Relying on randomly encountered opportunities to provide appreciation/positive feedback is less powerful than designing authentic, deliberate, regular (predictable and spontaneous) mechanisms for appreciation.
- Individual appreciation alone misses opportunity to amplify positive emotions for the whole group AND increase social consensus around desired behaviors - so group appreciation practices and structures are vital to accelerate change and program success.
- Science supports that mirror neurons allow people other than the one(s) receiving appreciation to benefit from similar neurobiological effects: the person giving appreciation has similar neuro-chemistry response to the one(s) receiving appreciation; groups seeing a member validated/appreciated similarly experience a similar benefit.
- To amplify appreciation beyond individuals:
- Make individual appreciation visible to the group and ensure the visibility includes the appreciation formula, so that specific behaviors and outcomes are highlighted in addition to individuals recognized.
- Build in public appreciations/positive feedback into standard group activities (meetings, case review, case conference, etc.).
- Create appreciation symbols that are physical items, can be given to a group for a time, can be augmented by each recipient group (e.g., the group can add flare or take photos), and are regularly rotated to other groups on a cadence (and thus become an abundant resource rather than a scarce resource like annual or lifetime awards that go to 1 group when many might be worthy of recognition).
- Traditional patient safety efforts focus on errors, deviations from standards, outlier cases, and search for deficits in behaviors, processes, and/or outcomes related to care.
- Safety II broadens focus to what is going right, not only what is going wrong.
- Safety II places an emphasis on appreciative inquiry: not only noting positive performance or positive outliers but uncovering the causative conditions and mechanisms, so teams and organizations can learn from these and make them more likely to occur.
- Practicing Safety II as it applies to Diagnostic Excellence requires capturing and highlighting examples of diagnosis done well at the individual, team, and organization level.
Pro Tips
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