Beyond Judgments: Transforming Physician Feedback Through Specific Behaviors and FeedForward

Photo by Igor Omilaev on Unsplash

Dr. Sarah Martinez had always prided herself on her clinical excellence. As a cardiothoracic surgeon, she demanded precision—from herself and everyone around her. So when HR called her into a meeting about "staff concerns regarding communication style," she was genuinely puzzled. The feedback was frustratingly vague: "condescending," "intimidating," "abrupt." Sarah left the meeting more confused than enlightened, wondering who had complained and what she had supposedly done wrong.*

*Dr. Martinez is a fictional character created to illustrate common patterns observed in healthcare communication challenges.

This scenario plays out in healthcare organizations daily, highlighting a critical gap in how we handle physician feedback. The current system of complaint management, while well-intentioned, often fails both the complainant and the physician by focusing on judgmental labels rather than actionable behaviors.

The Problem with Judgment-Based Feedback

Traditional complaint systems suffer from several fundamental flaws. When staff members or patients describe a physician as "condescending" or "intimidating," they're offering interpretations rather than observations. These judgments tell us how someone felt but provide no roadmap for change. How does a physician stop being "condescending"? The label offers no concrete guidance.

Consider Dr. Martinez's situation. If instead of hearing she was "intimidating," she learned that she "stands within arm's length when giving instructions" or "explains basic nursing procedures to experienced nurses," she would have specific behaviors to modify. The difference is transformative: one creates defensiveness and confusion, the other creates a clear path forward.

Our current reporting systems compound this problem by encouraging indirect communication and delayed feedback. Complaints often surface weeks or months after incidents, when context has faded and memories have dimmed. The accused physician is left to guess not only what they did wrong but when they did it and with whom.

The Power of Behavioral Specificity

Effective feedback requires behavioral specificity. Instead of "Dr. Smith is abrupt," feedback should detail: "Dr. Smith interrupts nurses mid-sentence during patient handoffs" or "Dr. Smith walks away while staff members are still speaking." These observations provide clear, actionable information that physicians can understand and address.

The challenge lies in training both complainants and those who receive complaints to think behaviorally. HR departments and managers need tools to probe beyond initial judgments. When someone says a physician is "condescending," the follow-up questions should be: "What specifically did they say or do?" "Can you give me an example?" "What would you have preferred they do instead?"

Real-Time Feedback and Power Differentials

The hierarchical nature of healthcare creates unique challenges for feedback delivery. Nurses, technicians, and even patients may feel uncomfortable providing direct feedback to physicians, particularly specialists who hold significant authority. This power differential often drives the preference for anonymous, indirect complaint systems—but these approaches create more problems than they solve.

Real-time feedback, delivered respectfully and constructively, is far more effective than delayed complaints channeled through intermediaries. When feedback is immediate, context is preserved, emotions are less likely to escalate, and opportunities for clarification exist. However, enabling this requires addressing the inherent power dynamics that make direct feedback feel risky for many healthcare workers.

FeedForward: A Solution for Hierarchical Challenges

Marshall Goldsmith's concept of FeedForward, detailed in his book "What Got You Here Won't Get You There," offers a powerful alternative approach particularly suited to healthcare's hierarchical environment. Unlike traditional feedback, which focuses on past behavior and can trigger defensiveness, FeedForward emphasizes future improvement and collaborative problem-solving.

The FeedForward process involves the receiver (in this case, the physician) asking for specific suggestions about future behavior rather than defending past actions. For example, Dr. Martinez might ask her nursing colleagues: "How can I better communicate my expectations during patient handoffs?" or "What would help you feel more comfortable bringing concerns to me directly?"

Several aspects of FeedForward make it particularly effective when power differentials exist:

Future Focus: By asking for suggestions about future behavior rather than criticism of past actions, FeedForward reduces the threat level for both parties. Staff members feel safer offering constructive ideas rather than pointing out failures.

Request-Based: When physicians actively solicit feedback, it removes the burden from staff to initiate difficult conversations. The power dynamic shifts from subordinate challenging superior to subordinate helping superior improve.

Solution-Oriented: Rather than dwelling on problems, FeedForward immediately moves toward solutions, making the conversation more productive and less emotional.

No Defense Required: Traditional feedback often provokes explanations and justifications. FeedForward's future focus eliminates the need for physicians to defend their past actions, reducing defensiveness.

Overcoming Physician Resistance Through Patient Safety

Many physicians initially resist FeedForward approaches due to perceived vulnerability. The medical culture often equates asking for feedback with admitting weakness or incompetence. However, reframing feedback as a patient safety issue often resonates powerfully with physicians who entered medicine to help others.

Research consistently demonstrates that communication failures contribute to medical errors and adverse events. When physicians are approachable and open to feedback, staff members are more likely to speak up about potential problems, near misses, and safety concerns. This creates a crucial safety net that benefits everyone—especially patients.

For Dr. Martinez, understanding this connection proved pivotal. When she realized that her communication style might prevent nurses from sharing critical patient information or voicing concerns about care plans, she became motivated to change. Patient safety provided the compelling "why" that made vulnerability worthwhile.

Implementing Change: Practical Steps

Transforming physician feedback culture requires systematic change across multiple levels:

For HR and Management: Develop training programs focused on behavioral feedback collection. Create interview protocols that probe for specific examples rather than accepting judgmental labels. Encourage real-time feedback systems and direct communication whenever possible.

For Physicians: Embrace FeedForward as a professional development tool. Regularly ask colleagues and staff for specific suggestions about communication and collaboration. View feedback-seeking as a sign of leadership and commitment to excellence rather than weakness.

For Healthcare Teams: Foster psychological safety that encourages respectful, direct communication. Provide training on giving behavioral feedback and using FeedForward techniques with colleagues across hierarchy levels.

The Perfectionist Paradox

Interestingly, physicians who receive the most complaints often care deeply about patient care and maintain exceptionally high standards. Their perfectionism, while driving clinical excellence, can create interpersonal challenges when they unconsciously expect others to meet their exacting standards without clear communication about expectations or context.

These high-achieving physicians respond well to FeedForward because it aligns with their improvement mindset. Rather than being told they're "difficult," they can channel their perfectionist tendencies into systematically improving their communication and leadership skills.

Moving Forward

The goal isn't to eliminate all complaints or feedback about physician behavior—it's to make that feedback constructive, timely, and actionable. By shifting from judgment-based complaints to behavior-specific feedback and embracing FeedForward techniques, healthcare organizations can create environments where communication issues are addressed proactively rather than reactively.

Dr. Martinez's story doesn't end with that frustrating HR meeting. Six months later, after implementing regular FeedForward sessions with her team and focusing on specific behavioral changes, she received different feedback: "Dr. Martinez has become much more collaborative," backed up with specific examples of asking for input, acknowledging others' expertise, and creating space for questions.

The transformation required vulnerability, but it strengthened both her relationships and, ultimately, patient care. In healthcare's high-stakes environment, that's a outcome worth pursuing.