Does the ‘compliment sandwich’ give better feedback?

Most physicians, ophthalmologists included, are required to serve in leadership roles. We can’t avoid it.

Whether it is running a clinic and directing the efforts of technicians and other staff, performing a day of surgery and coordinating the efforts of operating room nurses and others, or managing a group practice and dealing with all the inevitable personnel issues, those around us look to the physician for leadership that will make things work well for patients and employees.

One challenge is that medical school, unlike business school, places little or no emphasis on training students in the leadership arts. Most physicians learn to (or not) be effective leaders through on-the-job training.

As residents, fellows, and young practitioners, we observe and may emulate the habits (good and bad) of professors and senior partners. We may make it a point to read practice management articles in publications like this. We might take courses in management and leadership, and some physicians go so far as to attend business school and get formally trained. Whatever the route, as intelligent and motivated professionals, we hopefully master most of the skills required of us.

Giving honest feedback

One area where many physicians get poor grades is in giving honest and direct feedback to members of their teams. Many physicians have told me they find this hard to do because criticism can make people angry, defensive, upset, tearful, or likely to leave.

In many instances, the experience for the physician leader is bad enough that he/she simply doesn’t do it. So an employee who is not performing up to standards does not get that message and does not get the chance to improve. Not wanting to upset the people we lead, we instead let them down by abdicating an important duty.

One approach that is sometimes recommended to give honest feedback is to deliver it between two positive comments. This is known as the “compliment sandwich.” While some advocates of this approach still assert its value, it is largely out of favor and is often ridiculed.^1-3

Employees, not being dumb, see the approach for what it is-the boss hides the “real” reason for the meeting between two superfluous comments. Or the serious issue gets lost. Or the employee registers the criticism but isn’t sure what to do to correct things.

Other approaches

There are ways to become good at honest and constructive evaluation and guidance of our employees. One is to speak up when an issue is identified and not wait for an annual review. Another is to replace the sandwich with a statement of the observed behavior that is of concern and an immediate helpful suggestion: “I noticed you have difficulty with xxx. What do you think about trying to do yyy instead? Do you think that would make things go better?”

The message behind this approach is that “I, your physician leader, want you to be successful. So I am making sure you are aware of the issue and, having given the matter careful thought, I offer you some of my best ideas for you to consider as ways to help you be more successful in the future.”

Does there exist a perfect and pain-free method (sandwich or otherwise) to deliver necessary constructive criticism? Probably not. But is it vitally important that we provide employees with performance assessments? Absolutely!

And you, dear reader? Are you the deliverer of honest feedback you think you should be?

References

1. https://youtu.be/ewIT_KAQQlU

2. https://youtu.be/etAOPds3G-0

3. https://youtu.be/chqpTQlDmaI