Getting Feedback ‘Write’
November 30, 2022
Quality assurance and quality improvement hinge on feedback—but not just any feedback. The art of effective feedback depends upon three things: a quality case review that adheres to current performance standards and protocol rules; an engaging Q who truly wants emergency dispatchers to learn, grow, and improve; and carefully crafted word choices in both written and in-person feedback.
While nothing replaces the value of in-person feedback and dialogue, the pragmatic view is that until staffing levels at PSAPs are dramatically improved, most Q’s will continue to be challenged to convey more feedback in written form rather than face-to-face. To get the most bang for our buck, we need to pause and consider the important role of effectively constructed written feedback.
In the sea of never-ending case reviews, Q's often lose sight of the important role of words and how, like a well-intended text message, their selection, usage, context, and expected interpretation is often a frustrating challenge that can lead to unintended heartache.
While there’s no surefire way we can guarantee our written communication will be interpreted as intended, as Q’s we can be more thoughtful about our word choices and utilize the strengths-based feedback method to deliver written feedback.
What is strengths-based feedback?
We hear a lot about strengths-based feedback and its critical role in quality improvement. Feedback seeks to change future behavior. Telling emergency dispatchers what they did incorrectly is not helpful because they are unable to go back and fix their mistakes. That’s why strengths-based feedback intentionally focuses on equipping emergency dispatchers with the knowledge and reason to do things correctly in the future—where they do have the agency and control to do so. Because strengths-based feedback focuses on what emergency dispatchers do well, it makes it more likely that they will repeat the behavior in the future and be more open to feedback for improvement when it needs to be given.
Following this model, Q’s identify
a character strength or behavior demonstrated by the emergency dispatcher during the call being reviewed and communicate this to the emergency dispatcher through feedback, helping them identify and use their strength/behavior in the future. But strengths-based feedback isn’t used only when things go well; it’s also a good way to construct feedback when the call leaves room for improvement. Strengths-based feedback has three formulas so it can be used for every call reviewed.
1. Performance recognition: scenario (what happened), strength demonstrated(compassion, persistence, etc.), action (what they did), outcome
2. Performance improvement: future-forward intro (in the future, next time, etc.), scenario (what happened), use a strength (patience, etc.), corrective action to take, education (reason they need to do that)
3. Performance maintenance: less = more (e.g., Keep doing it just like that!)
Many Q’s still have lots of questions and challenges deploying this proven model to its fullest. From PSAP to PSAP and Q to Q, there is substantial variation in written feedback in the Incident Performance Reports (IPRs). Too much variance creates inconsistency and sows seeds of doubt among emergency dispatchers about the accuracy and intent of quality assurance reviews and those entrusted with this awesome responsibility.
First, like the essence of the Protocol system itself, words and the ways they are stitched together have precise meanings and connotations whether we think about them or not: “Tell me EXACTLY what happened,” “I need to get the suspect’s description,” “Is anyone trapped or in immediate danger?” The Protocol system leverages the power of precision in a scientifically proven way.
Second, the receiver of the feedback gets to interpret the meaning and connotations of those words and how they are stitched together, often differently than the writer intended. In all communication, word choice, meaning, tone, and emotion significantly impact the message and how well it will be received and put to use if the intent is behavior modification. Inevitably, emergency dispatchers may overanalyze and misconstrue the Q’s meaning and intent. This can create layers of mistrust, fear, anxiety, and strong anti-Q feelings in any quality assurance program.
If we as Q’s don’t consider the impacts of our word choices in written explanations, we can quickly lose the value of the message no matter how well intended it is. This is important to realize because we want to use Q as a vehicle to propel performance and morale forward.
Let’s look at an example that came across my email from a seasoned EFD-Q™. While a quick glance might lead you to believe that this feedback fits the basic paradigm for strengths-based feedback, the short answer is, it doesn’t. We’ll get into why.
“Caller was very excited and stated there was heavy smoke coming from his furnace room. Great job verifying the address and phone. You didn’t use the ECHO fast track, and this caused a delay in getting an early dispatch point in EFD. You also selected the wrong building type—the caller was calling from apartment B9, so clearly this is residential multiple and not residential single. You were graded on the path taken. In the future be sure to use the ECHO fast track any time the caller has a fire inside and be sure you select the right building type so we don’t cause an issue with the fire department. Your tone was good, and you gave PDIs at a clear rate.”
The primary issue with this feedback is that it focuses on past mistakes rather than actions that can be taken in the future to correctly handle a call of this nature. As mentioned earlier, strengths-based feedback provides the knowledge and reason behind actions to take in the future in order to handle an incident correctly.
Other issues with this feedback include word choices. In this example, use of the word “you” is almost always going to be construed as accusatory. Using “you” to describe something negative to a person almost immediately puts that person on full-zone defense and makes them feel targeted and incompetent. Avoid using the word “you” when referring to something not compliant so you don’t turn off the receiver and pollute the message. Be aware that the opposite is typically true when “you” describes positive or congratulatory behaviors. Similarly, use of the word “clearly” in this context not only implies incompetence but is laden with a demeaning or sarcastic tone. We may as well say, “How dare you not know that an apartment is a residential multiple! What’s wrong with you?” And then there’s the word “grade.” Words such as “grade,” “ding,” and
“score” should be stricken from our collective Q vocabulary since these words tend to produce universally negative connotations (think back to primary and secondary schooling), and it is that negative feeling that matters to the person whose performance we are trying to improve. We do not grade, score, or ding; we review, assess, and evaluate. It’s not just a matter of word choice, but rather the philosophy of being conscious of what we seek to accomplish as a Q and how our words will help or hinder us.
Education leads to performance improvement
One of the important pieces in the performance improvement feedback formula is education—providing the why. Emergency dispatchers are always looking for the why. They need Q’s to connect the dots and explain how something done (or not done) impacted their case and, more than that, how it could impact future cases of a similar context. Instead of focusing on what wasn’t done and what consequence it caused, we get more bang if we focus on the opportunities of “next time” or “in the future” by linking this future “next case” with the behavior we are expecting now that the dispatcher is aware of a better way. A more compliant way. A more effective way.
Let’s apply the education piece to the feedback example. The behavior of not utilizing the ECHO fast track for structure fire is a serious performance deviation, but the explanation would be more effective if cause and impact were linked to opportunity. Moreover, employing less accusatory connotated words will buffer the negative feelings that the emergency dispatcher could initially feel while reading how his or her actions created deviation and risk.
Finally, the part of the original feedback that starts with “In the future be sure to use the ECHO fast track …” suggests that the only reason the emergency dispatcher should have used the ECHO fast track is to prevent some sort of complaint from the fire department, when in fact it’s much more than that.
Following the performance improvement formula will ensure that the feedback is structured in a way that can be heard by the emergency dispatcher without a negative reaction. This involves connecting the behavior to a sound reason, in this case linking the ECHO fast track to response plans and speed and accuracy of the initial dispatch. Creating these links is paramount so that we don’t lose the effectiveness and positive impact of our message in what can sometimes be interpreted as a sea of criticism as emergency dispatchers read between the lines of what they didn’t do.
The feedback challenge is that we want to explain how protocol Rules, Axioms, performance standards, and solid caller management techniques are linked to behaviors and how those behaviors are expectations for the way we want the next similar incident to be managed. Just as successful emergency dispatchers leverage unscripted protocol enhancements, we in the world of Q must focus on the artfulness of effective word choice and explanations that connect the dots in a way that creates a safe space for mistakes to be springboards for a better way “next time.”
As a quality assurance professional, we must be ever mindful that our words, the way we use them in our written messages, and the way we write or say them are interpreted by the receiver. Our shared mission is to inform, coach, and inspire. Let’s use words and construct them in a way that helps us!
Strengths-based feedback in action
Utilizing the performance improvement formula [future forward intro, scenario, strength, corrective action, education], here are three feedback examples that offer an educational piece—the why—while focusing on what actions can be taken in the future to handle a similar incident.
1. In the future, when a caller reports heavy smoke coming from his furnace, selecting the ECHO fast track for structure fire will be a faster sequence to the SEND point, which is a zero-question SEND point. This helps get response started sooner.
2. Next time you encounter an excited caller, remember that it is OK to slow down enough to ensure your inputs to CAD and ProQA® are accurate so that the system works as designed. It is important to send the correct response to the scene so the caller gets the right help.
3. Remember for next time that an apartment building is categorized as a residential multiple when choosing building type. Selecting the correct building type helps responders know which type of building fire they are responding to and helps determine the correct response—in this case, an additional engine and ladder based on the ProQA Determinant Code and location.
Let’s also turn our attention to two feedback examples that focus on strengths as building blocks for using the performance recognition feedback formula: scenario, strength, action, outcome.
1. You were skilled at reassuring the excited caller that help would be forthcoming and that the “important information for the responders” you needed to “quickly gather” would ensure he got the help he needed. He calmed down and was able to provide the information you needed to send help.
2. I especially liked the way you reassured and explained what was happening to the caller’s wife after the caller passed the phone to her so he could get their dogs outside. She listened when you instructed her to get out of the house and close the door behind her. This may have saved her life and helped slow the fire by starving it of oxygen.
By providing strengths-based feedback, we capitalize on many behaviors that were done well and explain the opportunity that can happen next time if the suggested course of action is followed.
Taking the time to not only explain what could be done next time and WHY—in a manner that is both positive and constructive—is a skill that is sometimes hard to implement initially because we are so used to the old model of the antiquated and ineffective “feedback sandwich” (tell them something they did well, tell them what they did wrong, end on a positive note).
A Q who challenges herself/himself to be more effective in written feedback by practicing more thoughtful and precise word choice (and word avoidance) and focusing more on strengths and opportunities rather than deviations and risks, will soon master the craft.
Confidence comes with repetition, experience, and feedback from those on the floor. Change the way you write feedback and ask your emergency dispatchers for feedback on your feedback—you may be surprised what you hear. Choosing the best words and writing strengths-based feedback will make a world of difference to the emergency dispatcher reading the review. Take the time to “get it write.”
If you’re looking for more information on strengths-based feedback, check out the Dispatch in Depth “Play to Your Strengths With Kim Rigden” podcast episode.