The “feedback gap” – an important quality improvement concept


The original concept of LfE was to create a system for positive feedback for excellence in healthcare.  The excellence was not defined a priori: i.e. we assumed that people know excellence when they see it, and they can define it subjectively.  That did indeed turn out to be the case, and thousands of reports have been submitted since we started the initiative back in 2014.  Over the years, it has started to become clear that there are certain themes in the reports, most of which focus on non-technical skills, many of which are not described in the published non-technical skills frameworks.  Examples include, generosity, compassion, perseverance, positivity and my personal favourite: kindness.  There is also a significant theme of reports around technical excellence (e.g. diagnostic and clinical acumen).

After LfE had been in place for a year or so, we wanted to know if there was a measurable impact on the behaviour of professionals.  i.e. we wanted to know if people “learn” from positive feedback, by changing how they go about their business.  That was the idea behind the PRAISe project, in which we showed that “everyday” behaviours could be enhanced through simple positive reinforcement.  i.e. if you show people what they are doing well, they will do more of it.

We named this approach LfEQI, and last year we delivered bespoke training for a number of teams around the NHS and Ireland to help them develop their own LfEQI projects.  We’ve written a guide on how to do this, and the PRAISe project describes the impact we were able to measure.  Several of the posters at LfE3 also illustrated study designs using this approach. We are now adopting this approach in several QI projects in my place of work.  Slowly it is embedding as a valid and legitimate approach to QI.

So, I thought it would be helpful to share a vital insight into this approach:  LfEQI relies on changing behaviour through the provision of positive feedback for successful work.  This work is usually simple, everyday work – i.e. “people just doing the right thing”.

And here’s the key to this approach:  this work is not usually associated with positive feedback.  So much everyday work is simply accepted as “doing one’s job”, and there is no recognition of success.  This is the “feedback gap”.  Applying positive feedback to a chosen area of everyday success will increase the rate of success.  It’s very simple and it really does work.  There is no need to make a song and dance about it, there is no need for celebration.  A simple acknowledgement that the work was successful is all that is required, and over time, it will improve.


2 thoughts on “The “feedback gap” – an important quality improvement concept

  1. These are some of the key principles that we have built the peninsula PAFTAs upon. The “feedback gap” is definitely real, and we have expanded the PAFTAs from something that was initially very trainee focussed to something that now encompasses the entire MDT because we noticed such a vacuum.
    Our website has some phenomenal examples of what you mention above, and kindness & compassion are hugely influential with your team.

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