Intended for healthcare professionals

Views & Reviews From the Frontline

A penny for your thoughts

BMJ 2009; 338 doi: https://doi.org/10.1136/bmj.b552 (Published 11 February 2009) Cite this as: BMJ 2009;338:b552
  1. Des Spence, general practitioner, Glasgow
  1. destwo{at}yahoo.co.uk

    “How was the food?” My cranial nerve IX fired. “Lovely, thank you.” I pushed lettuce over the uneaten food. “Could we have the bill please?” my wife asked sweetly. On the street we fell into each other laughing and headed for a drink. We didn’t complain but enjoyed the story with friends. The restaurant passed away, but we still had our fond memories of the pretentious, overpriced nonsense of it all. Perhaps the business might have been saved by using a satisfaction questionnaire, but surely they should have realised that their food was disgusting.

    Feedback questionnaires now litter every organisational landscape. Smart marketing types expound pseudoscientific sociology jargon: “It’s like fundamental to business planning.” So on our holiday flights or in the bank queue we are offered the chance to win a corporate cuddly toy for our feedback. At university the students fill in feedback questionnaires on the teachers, we fill out questionnaires on the students, then the departments give feedback on the feedback. Ten pages of “validated” questionnaires use numerical scales to compare us with the national average, all in the name of “quality and improvement.”

    The problem is not that all this is an utter waste of resources but that the mindless process is actually eroding quality and holding back improvement. One reason is that those who want to give feedback often do not represent the happy majority. Furthermore, positive feedback may be warming but offers false reassurance and encourages complacency. But it is negative feedback that is the real problem. It may represent 1% of the comments but occupies 99% of our attention. With feedback now increasingly anonymous, the process is unshackled from accountability or responsibility. Of course, then we are asked (in a “non-threatening learning manner”) to account for this negative feedback, which undermines the confidence of the sensitive types, while the others carry on regardless. So now, fearful of the inquisition of negative feedback, we steer clear of anything that might be considered offensive or challenging. Thus education and medicine are reduced to the lowest and blandest common denominator, stifling innovation and free thought. I demand the right to be upset, challenged, and offended, for this is the oil of change and innovation.

    So let us boycott fake and crude feedback questionnaires, deface them, tear them up, make them into airplanes. Real feedback is timeless: a certain look, a quiet word, the slamming door, the good reference, and, of course, the word of mouth.

    Notes

    Cite this as: BMJ 2009;338:b552