Chapter 8
Step 6: Give Feedback That Matters
Feedback is the Breakfast of Champions.
Most managers would acknowledge that information is an important factor in employee performance. But very few managers understand just how critical a role information plays. The wise, useful, and timely dissemination of information is what transforms a system from a series of dysfunctional work units into an effective organization.
Too many managers look at information solely from their perspective—such as the process of passing on instructions or work details to workers—when it's only one small element of the information that is critical to good performance within the organization. And when organizations have considered how to use information in a businesslike way, it has often been simplistically. One focus has been on technology—as if upgrading or networking computers was an information strategy. Another focus, on knowledge management, has tended to be mostly about data warehousing or piling up reams of data without changing the culture and mindset necessary to really transform how the organization treats information.
When people walk in the door, they want to know: What do you expect out of me? What's in this deal for me? What do I have to do to get ahead? Where do I go in this organization to get justice if I'm not treated appropriately? They want to know how they're doing. They want some feedback. And they want to know that what they are doing is important.
Information, especially feedback on performance, is a key element of all organizations. Even if there is no intentional feedback, employees will look for signs that what they are doing is correct. For instance, if a particular task doesn't draw any criticism from managers, employees will tend to assume that this means what they're doing is right—when it may actually be a case of poor attention by the managers. Part of the reason that there are no magic bullets for organizations is that they are complex systems that usually require action on several levels to produce intentional, sustainable changes. And effective information dissemination in organizations is correspondingly complex.
Information Issues: The Greatest Cause of Performance Gaps
Information covers many potential performance issues, including
• What priority management places on a particular task
• Details about how much discretion there is with a specific piece of work
• Feedback to employees about their work
• Job clarity—how well the work has been explained or laid out to the employee
• The ability to get questions answered (or the perception that questions are welcome)
• The degree of openness within the organization—how many “undiscussable” topics there are, and the implications for work culture and rumors
• Context and big picture explanations (so people see how their work fits into the extended enterprise)
• Customer reaction and feedback (both complaints and direction about what customers prefer)
• Logistical or operational details (when critical meetings are happening or how to reach a specific team).
These are just a few of the many types of information issues that have the potential to significantly influence employees' performance. Therefore, it's probably no surprise that information issues are the primary cause of low performance in organizations.
For instance, the Conference Board published a report called “Closing the Human Performance Gap,” which found that of a number of different explanations for inadequate performance on the job, “poor or insufficient performance feedback” came in at 60 percent. Compensation came in at only 8 percent.
And this isn't the only research to demonstrate the impact of information on performance. The Harless Performance Guild looked at 200 diagnostic analyses (that is, performance analysis to determine what was causing performance gaps). In these 200 analyses, the guild found a wide range of causes, including:
• lack of skills
• poor compensation
• inadequate tools
• work was punishing
• no feedback
• turnover
• inequitable treatment
• dangerous conditions
• work was poorly designed
• employees lacked the physical ability to do the work
• standards were unachievable
• insufficient time
• internal conflicts in directions or rules.
The Harless Performance Guild found that most common cause of the 200 performance gaps that it examined was the lack of adequate feedback. Clearly, information deficiencies play a critical role in performance problems. In fact, you can easily see that many of the causes listed above are directly or indirectly related to a lack of feedback.
Why Is So Much Feedback Missing Something?
It is difficult for people to stay absorbed in any activity unless they get timely, online information about how well they are doing.
It's remarkable how different employees' and managers' perceptions are about feedback. Managers tend to perceive that the feedback they provide is sufficient. Yet according to survey data for a wide variety of organizations and levels of responsibility, performers (including managers) believe that the feedback they receive is insufficient. This is especially unfortunate, because useful feedback closes the performance loop by providing a check or perspective on the work—a feedback loop.
The feedback loop is a crucial element in performance. When employees are doing well, feedback to that extent builds confidence, whereas an absence of feedback will generally lead to self-doubt, slower performance, and experimentation (as workers test other ways of doing something in hopes that they will generate a favorable response). This point is a critical one for managers to internalize. Employees may be performing well yet seek a sign that the performance is good. When that sign (or feedback) isn't forthcoming, the good performers will often change how they're doing the work in search of generating some kind of positive response. Operant conditioning research and behavior shaping with dogs easily shows how the search for approval will result in someone cycling through various behavior to get the right response (Killion 2007).
In other words, failure to let people know that they should keep doing what they're doing may often lead them to stop what they're doing or shift. And when the work is being done poorly, feedback is a critical way for both making it clear that things need to change and targeting where and how to improve.
Generally speaking, feedback can be categorized into two types: encouragement or advice (Tosti 2007):
• Encouragement is intended to be motivating and inspiring. It lets people know that they've done well and acknowledges them for having done so. The idea behind encouragement is to get employees to keep doing what they're doing or to build their confidence in what they're doing, so they'll do it with more vigor.
• Advice focuses on improvement—how to get better. Specifically, good advice covers what needs to be improved and how to improve it.
A common mistake made by managers is to combine encouragement and advice (“I liked how you handled that complaint, but you need to follow up with the customer afterward and you didn't”). Especially when the feedback is given poorly, it's easy for the employee to see the encouragement as insincere (“Jim, you're doing a good job—a really good job—but I need you to work faster and make fewer mistakes”).
Some, however, argue that it's good to combine encouragement and advice. The best argument for combining them is that it's possible to appear more balanced by saying some positive about the employee as well as negative. However, if either the encouragement or the advice—or both—is handled poorly (with the encouragement coming off as cheerleading, or the advice being too general), the employee can easily reject all the feedback. Or the employee may focus solely on the encouragement (“Gee—my manager thinks I'm doing a great job!”) and miss the advice for improvement. Or the employee may hear only the words after “but” and completely miss the encouragement.
Another reason that encouragement and advice are usually combined is that it's easier for the person delivering the feedback. The manager can then check off the list “Give feedback to Janet.” The problem with this approach is that the purpose of the feedback isn't so the manager can check it off a to-do list. Its purpose is to improve the employee's performance. And to improve the employee's performance, feedback needs to be provided at a time and place when he or she is capable of focusing on it and using it. Even if the employee needs both encouragement in some areas and advice in others, the reality is that the best time to give the encouragement may be different from the best time to give the corrective advice.
Finally, the concept of “positive” or “negative” feedback frames the manager's comments in a manner that makes them too personal and subjective (“My manager doesn't like me”). Instead, the primary purpose of feedback is objective—to focus on the work at hand: to improve performance by letting the employee know what things to keep doing and what things to change. Although guidance for things to change or the advice may involve criticism that might be perceived as personal, it could just as easily be a circumstance of a change in the overarching work situation.
For instance, if the nature of the task calls for a change in procedures, this isn't personal criticism; it's simply direction about what the employee needs to do differently to accomplish the task or how the process needs to change. Thus, a manager might say: Earlier, you were working on the travel schedules. Now I need you to shift your focus to the meeting agendas. It's not that you were doing the wrong thing before, it's that the priorities have changed. My feedback in this case is neither positive or negative. It's an update on the work priorities.
The Art of Giving Feedback
There are many reasons why most employees feel they don't get good or enough feedback. And many managers admit they aren't very good at giving feedback. Two key principles are at the heart of this problem of poor or insufficient feedback. First, people need to make the time and effort to provide feedback. For too many organizations, feedback is something that happens officially during the annual performance appraisal and is otherwise rare.
Second, managers need to stop treating feedback as if merely delivering it is sufficient—that once the words have been said, the purpose has been fulfilled. Feedback is an act aimed at producing a particular accomplishment (faster production, an employee who's clear on priorities, staff members who are aware that management values them—these are just some possible intended outputs from feedback). Specifically, there is a tendency for people to feel that if they said it (that is, delivered the message), then feedback took place. But if someone provides information at a time, place, or circumstances that makes it difficult for the recipient to focus on or retain the data, then the effort at feedback failed. And if the message is delivered in a way that makes it difficult for the employee to perceive it as credible, then the feedback failed.
Feedback is not like a subpoena—it isn't sufficient to deliver it and then consider your job done. Again, the purpose of feedback isn't to be able to check a “done” off the to-do list; it's purpose is to improve performance. If the message is delivered in a way that makes it unlikely to improve performance, then feedback didn't happen.
Encourage for Results
Improving the information used by workers raises their measured performance substantially—never less than a 20 percent improvement, sometimes as high as 600 percent.
Encouragement is often mishandled because it is either insincere or is not delivered with a performance perspective in mind. Too many managers confuse being encouraging with being a cheerleader or motivational speaker. Spouting generalities about “keep up the good work” or “you're doing a great job” rarely inspires and usually fails to build credibility.
Also, this cheerleading approach doesn't target specific actions or performance and tends to operate from the philosophy that “if my staff hear me say something positive about them, then they'll work harder.” Because the purpose of encouragement is either to let people know that they should continue doing what they're doing or to let workers know they're doing it right (so any hesitation or self-doubt disappears), then the focus shouldn't be on cheerleading or giving positive strokes. Instead, the focus should be on the results of the employee's work—on performance.
You're doing a heck of a job, Brownie.
Too many managers mishandle encouragement because they view it solely as a motivational issue and thus think their role is to say something positive. This mindset has some problems. Saying positive things or providing general praise often doesn't specifically indicate what it is that the employee is doing right or needs to keep doing. It is often based on the assumption that “if I say something nice to someone, they'll work harder.” This assumption doesn't acknowledge that a greater performance barrier is that workers often don't know if what they're doing is something they should keep doing or if it's being done right.
Thus, the right way to encourage is not to cheerlead but to let people know specifically what is right about their work and to remove uncertainty and doubt (therefore improving the speed and ease with which they can work). This focus on performance prevents the praise from being seen as patronizing or cheerleading; if it's seen that way, it's often discounted, which not only defeats the purpose of the encouragement but also reduces the credibility of the person offering it.
Good Advice Has Fit, Focus, and Timing
The consultant Don Tosti (2007) has done extensive research on feedback and performance. He has found that there are three major characteristics of good advice:
• fit
• focus
• timing.
Fit. Fit involves adapting advice so that it is appropriate for the experience of the employee/performer as well as the circumstances. The feedback needs to be usable, so the level of detail needs to be adapted to fit the performer's experience.
Focus. Focus means feedback that looks specifically at the employee's behavior and avoids extraneous topics. For instance, good feedback should avoid putdowns and be specific rather than general. Focus also involves directing feedback at individuals rather than a group. It means saying “Karen, I want to talk with you about the accuracy of your cost overrun tracking,” rather than “Karen, we need to talk about how you Gen Xers track cost overruns.”
Another aspect of focus is referring to the performance rather than the performer. It means saying “Jamil, we need to decrease the rework in your section at least 8 percent” rather than “Jamil, you and your team are too sloppy and aren't paying attention to detail—your reworking numbers are 8 percent higher than any other section!”
Finally, focus requires providing feedback at a time and level that work for the performer. The purpose of the feedback to produce a particular result. Bad timing or poor circumstances that make it difficult for the worker to focus on and internalize the feedback produce failure by the manager. This requires getting feedback on the feedback: Is the performer ready for feedback? Is it understood?
Obviously, there may never be a perfect time to talk with an employee—some job circumstances are just too chaotic or fast moving to provide a great setting for an information exchange. But managers need to move past the focus on feedback as an action (and checking it off their list) versus feedback as a method to produce a particular result.
Timing. The third characteristic of good advice is timing. This means that advice needs to be given frequently. It's not appropriate for the manager to figure “I've said it once, so I'm done.” Again, the focus shouldn't be on the manager being able to put a check in the box next to “Gave feedback.” Instead, it should be on improving performance. A manager who says “I did tell them that they needed to pay attention to the safety regs” might be covered legally, but if the manager spends most of the time focusing on nonsafety issues, the result is to deemphasize the importance of safety, regardless of the single instance pushing safety compliance.
Another aspect of timing involves the question of when to give advice—a judgment issue. Sometimes employees benefit from advice shortly after or during the performance being evaluated, so they can use it directly (or so issues such as accurate recall are minimized). Other times, it's important (especially after bad performance) to let people cool down and collect their thoughts before addressing mistakes. In any case, advice needs to be given at a time when it's usable, and usability will vary with the situation.
Avoid the Forced-Rankings Pitfall
As organizations seek ways to get better results, they focus more on performance management initiatives within the company. The vast majority of managers and employees would probably say that their experiences with performance appraisals have been generally uncomfortable and that they felt as if they were jumping through hoops instead of generating real insights to improve performance. But one particular fad deserves to be singled out in considering feedback and how to improve performance: the technique of forced rankings.
A number of organizations use forced rankings, which require managers to divide the workforce into groups. The specifics vary with each organization, but the general approach usually involves quartiles, with the top quartile being ranked superior and the bottom quartile considered poor performers. Generally speaking, employees who end up in the bottom quartile, or are rated grade C—either at the end of the year or for two consecutive quarters—are dismissed (see figure 8–1).
Forced rankings have been seen by some organizations as a quick answer to ferreting out poor performers, showing that the organization doesn't tolerate suboptimal work and allowing the best to stand out. In short, these rankings are viewed by many proponents as a magic bullet for improving workplace performance. Some have claimed that this approach generates outstanding results—former GE CEO Jack Welch is one of those people. They're wrong.
The forced-rankings approach is based upon a couple of assumptions. One critical assumption is that a workforce consists of a bell curve distribution. In other words, in all companies, there is a consistently distributed pool of consistently poor performers. This assumption is wrong. Work and research with a number of organizations shows that most—or even all—organizations don't have typical bell curve distributions for work performance. Some organizations (especially elite groups) do a phenomenal job acquiring talent and growing it. To argue that 20 percent (or even 2 percent) of their members are consistently weak performers is contradicted by their performance records.
Figure 8–1. Bell Curve Supposedly Representing the Typical Workforce
Meanwhile, in some workforces the number of poor performers clearly exceeds more than one-quarter of employees and again bears no resemblance to a bell curve distribution. Furthermore, workforce performance often doesn't follow a stereotypical bell curve model—there can be multimodal distribution. The forced-rankings approach insists that a certain number of employees will be ranked as poor performers during each period. This is a quota system, and quota systems ignore individual realities.
It is much easier to measure job performance directly than it is to rate such presumed correlatives (as behaviors).
Another critical assumption behind forced rankings is that managers are capable of accurately identifying poor performers—that an organization can distinguish what constitutes bad work. Because most businesses tend to focus on behavior, attitudes, or knowledge rather than actual accomplishments, this assumption is often wrong. So forcing managers to rank some performers as poor thus can become an exercise in random probability. In fact, some organizations with forced rankings have discovered that managers rotate who gets the “poor” and who gets the “superior” rankings within the unit staff.
For every research source arguing that forced rankings are a means of boosting performance, there are even more demonstrating that forced rankings are not a quick way to generate better results. For instance, “a survey of more than 200 human resource professionals from companies employing more than 2,500 people from the Novations Group found that even though more than half of the companies used forced rankings, the respondents reported that forced rankings resulted in lower productivity, inequity and skepticism, negative effects on employee engagement, reduced collaboration and damage to moral and mistrust in leadership” (Pfeffer and Sutton 2006, 107).
Ultimately, a forced-rankings approach—even if it does result in the accurate identification and dismissal of poor performers—doesn't help an organization improve performance. Until management knows why people are performing badly, there's no sure way of improving performance. As Booz Allen Hamilton (2002) noted, “Systems that force managers to cut a certain percentage of their people often don't reveal the root causes of problems, often do not elevate performance and can ultimately be counterproductive.”
Some organizations have encountered legal issues with forced rankings and have considered other options such as comparative rankings or using customer input (for example, 450-degree evaluations; see chapter 1). People can argue for one approach over another, but the critical lesson is that none of these performance management approaches is the solution that will boost performance. The problem of poor performance isn't easily solved overnight, and the search for quick fixes ignores this reality. Performance management systems will fail to have much if any of an impact on worker productivity until the business can do a better job of measuring accomplishments and identifying truly good and bad performance. And so far, very few businesses have been able to do this.
Finally, forced rankings are an attempt to push managers to confront how employees perform. But the single biggest reason that managers shy away from dealing with this issue of performance is that appraisals are so subjective in most organizations. And that's because evaluations tend to focus on behavior or tasks rather than actual performance—accomplishments and outcomes. The more evaluations focus on accomplishments, the easier it is for managers to both appraise work objectively and give employees constructive feedback about their performance.
Pay Attention to the Dynamics of Information
In large organizations the dilution of information as it passes up and down the hierarchy, and horizontally across departments, can undermine the effort to focus on common goals.
Along with the process of information exchange among individuals, there are organizational dynamics that influence how events are perceived and what insight people gain. More specifically, the nature of each organization affects how people communicate, what information they share, and how they perceive reality. These dynamics have a tremendous impact on managers' ability to analyze performance issues and generate solutions that improve results.
Power of Mental Models and Need for Double-Loop Learning
Mental models are a way of explaining how people make sense out of what they see or hear. These models show the internal logic of a particular individual that indicates what information is important or explains how events happen. All individuals have mental models, and these models make people oblivious to some information and place great emphasis on other details.
For instance, a simplistic mental model that says “people are basically lazy” means that a manager with such a mindset perceives information differently than a manager with a mental model of “without clear and continuous direction, things break down.” These two managers could walk into a work setting, see a number of employees standing around, and reach two very different conclusions. The first manager would believe that the workers were inactive because they were lazy and needed to be threatened to stay busy. But the second manager would assume that the supervisor was at fault because if directions and priorities had been clearer, the employees wouldn't be waiting to be told what to do. These two managers—confronted with the same events, yet perceiving two different realities—illustrate the power of mental models.
Mental models are not inherently a bad thing; nor can they be eliminated. Mentals models help us make sense out of what we see—they tell us what is important and what to discard or ignore. The problem is that too many professionals are unaware of how their mental models shape what they perceive and how they interpret it (Argyris 1980). Wise professionals escape their perceptual limits through what Chris Argyris (1990) refers to as “double-loop learning,” which involves gaining an awareness of one's mental model and its limitations (see figure 8–2). Put another way, it's about knowing the limits of your perception and what assumptions you're making—and then testing them to see how important they may be.
The ability of working professionals to pay attention to their mental models is critical to their success in both doing their work and then analyzing and correcting performance problems. And though they can pursue double-loop learning, they also need to recognize their limitations. As researchers have expressed it, “The underlying theory, supported by years of empirical research, is that the reasoning processes employed by individuals in organizations inhibit the exchange of relevant information in ways that make double-loop learning difficult and all but impossible in situations in which much is at stake. This creates a dilemma as these are the very organizational situations in which double-loop learning is most needed” (Edmondson and Moingeon 1999).
Remembering Perceptual Limitations
People see only what they are prepared to see.
Perceptual limitations can result in professionals who are unable to accurately analyze what is really going on, let alone how to fix it. Furthermore, it's possible for organizations to develop mindsets that shape the collective perception of those working within the business. This can lead to organizations that are oblivious to obvious warning signings or collectively discount information that is inconsistent with the prevailing beliefs in the firm's mental model. Thus, there can be tremendous organizational buy-in for performance improvement strategies that are wrongheaded or doomed to fail because of perceptual limitations and collective blind spots.
As the world becomes more interconnected, work becomes more global. One result of a more global marketplace is an increasing reliance on virtual work and technologically driven interaction. This also has significant implications for information sharing within the business. It is incorrect to see virtual interaction as being primarily about technology. The dynamics of virtual interaction or teaming vary dramatically in a number of ways from traditional face-to-face environments (Willmore 2003). Interaction among teams changes significantly. For instance, some evidence indicates that virtual teams develop trust faster and do so using different criteria than do face-to-face teams (Jarvenpaa and Leidner 1999). The differences between face-to-face and virtual environments complicate performance analysis, because the work dynamics are different. And the degree of openness and trust varies between the settings, which has implications for feedback and information sharing.
Figure 8–2. Argyris's Model of Single-Loop versus Double-Loop Learning
Make Decisions Using Real Evidence, Not Masses of Data: The Importance of Evidence-Based Management
The plural of Anecdote is not Data.
Organizations collect lots of data. But much of the data isn't especially useful. More important, most decisions aren't based on convincing evidence. Management may sometimes cite examples as justification, but this is usually a case of making a decision and then searching for evidence to support it or using one or two anecdotes as a substitute for real data.
Take the example of business mergers. Practically any management team has financial data to justify why the specific merger they're about to undertake makes financial sense for a business. Yet the evidence indicates the contrary. According to Pfeffer and Sutton (2006, 4), “The list of failed mergers is long and provides fodder for much media attention. Study after study shows that most mergers—some estimates are 70 percent or more—fail to deliver their intended benefits and destroy economic value in the process. A recent analysis of 93 studies covering more than 200,000 mergers published in peer-reviewed journals showed that, on average, the negative effects of a merger on shareholder value become evident less than a month after a merger is announced and persist thereafter.”
The point of this example is not that mergers are bad. But mergers are a superb example of management culling self-serving examples or relying on anecdotes to justify an action—the merger—rather than objectively weighing information. It's important for organizations to understand that the evidence shows that most mergers fail and that it requires some specific and unique circumstances as well as a very systemic approach to implementation for a merger to be successful.
It's natural that there is some skepticism about the idea of evidence-based management. Many organizations insist that they now do use evidence, although these are mostly cases of selective data used to justify a bias or belief. And what would be the opposite of evidence-based management? In some ways, the term “evidence-based management” is a misnomer (coming from the concept of evidence-based medicine, which calls on doctors to consult data rather than operate on the basis of their individual interpretations). What evidence-based management calls for is a commitment to objectivity and to step away from hunches, ideology, and fads.
Help yourself see more by looking past your beliefs.
An organization must meet at least six prerequisites if it is to operate using evidence-based management:
1. A focus on solving a specific problem, not on a particular solution. When management finds a fad, it's always possible to discover evidence to justify the new initiative (usually evidence based on a best-selling book or the success of another company touting the idea). But focusing on the problem (without a preconceived solution or bias toward a particular direction) is more likely to produce objective analysis. In addition, too many initiatives are driven in organizations by political factors. For example, the human resources staff may focus on developing a new appraisal process because the CEO has told the VP of human resources that a new performance management approach is essential if she wants a bonus at the end of the year. In this example, the VP of human resources is motivated to show new initiative to get a bonus. There is no serious buy-in; nor is there a commitment to solving the problem. In fact, if the VP of human resources were honest, she might define the problem as “What can I do that will get me a bonus?”
2. The identification of data that matters—the organization needs to know what kind of evidence matters. This is especially true in terms of accomplishments—instead of behavior or traits or knowledge. Organizations generate great amounts of data that says very little. For instance, many internal training departments track the average Likert score for the average corporate training course, but this is something that rarely has any value for corporate decision makers.
3. A willingness to walk away from sacred cows and conventional wisdom. Most organizations have a traditional or prevailing ideology on a range of issues. Getting evidence does little good if it's for the purpose of buttressing an existing belief or the new CEO's pet project. Executives often insist that they are objective and open to all data. But the reality is that most decision makers operate from mental models that limit their ability to objectively evaluate data.
4. The ability to measure what matters. The organization needs to actually collect the kind of evidence that will lead to an informed decision. This will almost always involve some kind of root cause analysis to be sure why the gap really exists, rather than just generating opinions and theories (see chapters 5 and 6), as well as measuring performance by looking at accomplishments rather than behavior.
5. Patience—a willingness to do something right the first time rather than spend the next ten years throwing fixes at a problem. It's not that evidence-based decision making requires lots of time. But organizations in a hurry are quick to insist that there is no time to wait or that the fit of the solution is so obvious that it's a waste to ask for evidence. Without patience, a commitment to evidence-based management is only a paper commitment.
6. A culture in which the messenger is not blamed or even fired. The vast majority of organizations don't tolerate people with news that management doesn't want to hear or evidence counter to the CEO's pet project. This means that evidence, to the extent it is considered, is selective and usually only seen in support of the prevailing wisdom. Managers can insist that they operate on evidence, but unless the bearer of bad news is welcome, decision making won't be based on the evidence but on anecdote and ideology.
Performance Solution Notebook
Part of the reason that health care organizations have failed to act effectively is that they have not measured the right things when it comes to assessing health-care-acquired infections (HAIs). For instance, a report on HAIs from the Association of Professionals in Infection Control and Epidemiology found that “HAIs are often reported using rates. If an organization's rate is 5.1/1000 patient days and our competitor's rate is 5.4/1000 patient days, this may appear acceptable. Also, communicating rates does not define how many people are being injured and possibly killed by HAIs. No infection is acceptable despite the fact that, in hospitals, all infections are not preventable” (Murphy, Whiting, and Hollenbeak 2007). What health care organizations choose to measure determines the information they have, and thus their ability to identify if they have an HAI problem and how to solve it.
There is a tendency for organizations to collect HAI data that doesn't help solve infection problems. There is a difference between just collecting quarterly information on infection rates versus information that allows timely interventions to correct problems and improve care when it can make a difference for those infected. In addition, there is frequently a lack of information sharing across organizational units concerning HAI issues. Informational flow on HAI issues has often been unidirectional, with HAI programs being generated by the managers and imposed on the staff with little or no allowance for input from the staff on what the initiative should look like.
Internal feedback within health care organizations is invaluable in the effort to reduce HAIs. Feedback not only serves as a reality check for providers but also offers direction on priorities. As Terri Gingerich of VHA has noted, “By giving them feedback on their performance, and the data, they will tell you what needs to be done. Once they have that accountability and that empowerment, they make the changes, they're the drivers, they're the protectors of their patients” (quoted by Beaver 2007). Successful efforts to promote hand hygiene in facilities involve a large dose of feedback on performance (Gawande 2007).
Hitting the Mark
As managers consider and offer feedback, this chapter offers several important insights:
• Information and feedback are critical for good performance. Workers don't consistently accomplish what they're supposed to without effective, useful feedback. Information issues are the single biggest cause of human performance problems on the job.
• Managers need to base analysis of work as well as make decisions based on data, not beliefs or anecdotes. The concept of “evidence-based management” is one to which people pay lip service but rarely implement.
• Managers need to be willing to challenge their mental models and perceptions. Failure to do this results in tunnel vision, which produces ineffective interventions and wastes resources.
Information sharing and dissemination—especially in the form of careful, performance-oriented feedback—is one of the traits that distinguish an effective organization from a bunch of unrelated, uncoordinated groups. The quality, frequency, delivery means, and process for providing feedback are all critical elements in shaping performance. It is ironic that in an age when the means of sharing information seem to proliferate, the act of providing feedback is still problematic. By providing timely information and good feedback, managers can enable effective performance. By relying on data rather than beliefs and anecdotes, they can make better decisions. Ultimately, information positions the organization to analyze its performance issues and make the right changes. The next chapter looks at how to use your analysis to change things so you can produce better results.