I’ve just been reading a post from an ambulance driver (woops, they don’t like that title).
It is a privilege, because I might not otherwise have the chance to observe the nuances of their job, and even if I did, to learn the same might take hours of interviews and hours of rewriting.
So we are lucky to have this blog. It also teaches lessons for the general practice of job design – which it did today.
Briefly, feedback is a key idea in job design. Yet, it gets forgotten for procedures and targets.
This is what is critical. For every task anyone does, they must get feedback on how well they have done before they begin that task again.
Experts often get feedback as they move from one part of a large task to another. That’s what makes them expert. The ability to detect feedback that will mean nothing to anyone else.
But at some point a task is handed over to someone else. When and how do they get feedback on how well their work fitted into the next process down the line?
If they don’t get feedback, what sense are the supposed to make of their work? What sense will they make of their work? And what of evidence-based practice, if the people doing the work do not get ‘knowledge of results’ before they start the same task again?
This is the story
The ambulance man and his colleague raced a severely dehydrated child to hospital rather than attempt to re-hydrate the child themselves. They drop off the child, but hear nothing more about what happened next.
There appears to be no mechanism to tell them if their decision was correct and whether equally trained people would have made the same decision.
The blog post talks about the decision points in the job. It is worth reading in the original for the pattern of thinking that is typical in skilled people. We are constantly on the look out for this thinking to inform our understanding of the information that experts use and need. And indeed, who is an expert and who is not.
You will also see the confusion and overload that’s caused by not getting feedback quickly.
So what can the organization do to provide adequate feedback?
I don’t know what the NHS does. I’ve never worked with the NHS in a professional capacity and I don’t know any work psychologist who has.
What I would expect to be happening is a regular psychological audit of each and every job to look out for situations like this.
We want to know that in each and every situation, a skilled and experienced worker is able to set a goal, lay out a plan, and obtain feedback before they begin that task again.
Why might that feedback not be available?
1. The task is handed over, and for some reason, the feedback loop is not in place. It might have gone AWOL (in which case alert the line managers and check that they put it back). It might never have existed (in which case which psychologist slipped up). The job might have drifted (in which case re-analyse it and adjust the feedback system).
2. There is one other scenario that is more tricky. Managers have been known to hijack feedback because making people wait for information makes them feel powerful (and sometimes allows them to distort what is said). An organization has to come down on such practices like the proverbial ‘ton of bricks.’ Withholding information causes stress and overload, delays learning, and potentially causes accidents, which in an organization, like the NHS, may lead to loss of life. If managers are intercepting feedback, that has to be reversed. In a hierarchical organization, usually we have one meeting with the manager concerned, and if that does not produce immediate redress, we have an urgent meeting with his or her manager.
Who guards the guards, so to speak?
The system does not stop with psychologists keeping jobs properly balanced. The file on the job (not the person – the job) should have the internal auditor’s signature on it confirming they have checked that the psychological audits are taking place and are being conducted properly.
And there should be another file with copies of the report that the internal auditors routinely send to the Chief Psychologist to report on the quality of the psychological audits.
A lot of work?
Organizations are a lot of work. That’s why we have to consider whether we want one at all. But once we have one, we have to run them properly and ‘prevent rather than cure’. Good systems reduce crises, problems and accidents.
I don’t know what the NHS does exactly but as the largest employer in the world, I imagine they have sophisticated management systems in place. Feedback failures are one of the many things that ‘staff managers’ count, monitor and resolve.
Does anyone know how the NHS, or other large British employers, manage their feedback systems?
For further reading on the 3 tier system of