This topic is a veritable smorgasbord of content. The three key components are learning, conversations, and feedback. I could muse forever about the virtues of these individual components but prefer to consider how synergistic they are. However, as great as feedback can be, feedforward can be an even more excellent tool for individual and team success and knowledge-building.

The Influence of Experiential Learning

We are all learning enthusiasts and acutely aware of the 70/20/10 model of learning and development (Lombardo et al., 1996) – in fact, it is etched forever in many of our minds. Of particular relevance for this article is the 70%, known as experiential learning – life is rarely linear, but logically, the better the experience, the richer the learning. When you consider the length of a professional life, 70% is a significant amount of time in which a person can influence and be influenced by their experiences. Experiential learning can be evident, planned or even subliminal, but very few of us work solitarily – we are all subject to the influence of others, both positive and negative. When you consider the number of daily conversations, there are so many opportunities to influence and be influenced – imagine what could be achieved through mindful packaging to maximise positive learning outcomes.

Healthier Alternatives to Feedback Sandwiches

The ‘’feedback sandwich’’ has now become superseded by so many more effective ways of giving feedback for learning. Indeed, some attempts at providing constructive feedback have historically been limited by too much ‘bread’ or insufficient filling, confusing the messaging. We have all been both protagonists and victims of these feedback conversations, which are often a point in time instead of on a continuum, so how can we cater for the gluten-free by removing the bread from the menu?

Feedback or Feedforward?

We should consider turning the feedback sandwich into a series of omnipresent feedforward conversations. The culture where the Manager berates staff for getting things wrong and dishing out punishment should no longer exist but has been replaced with a culture where the Leader promotes vulnerability, trust, and continuous feedforward, fostering a culture of physical and emotional safety. What is linear is that safety equates to learning – safety takes time, and creating a safe environment takes skill and planning.

Conversations are also an opportunity to learn about other people, as well as about yourself. In any workplace, multiple conversations are occurring at any given time, and I have a few tips to make your learning conversations count – be mindful that what you say and what people hear may be entirely different – logically, that means that you may hear things differently to how they are spoken. Stewart & Thomas (1995) describe this ability to listen through conversation as dialogic’ listening.

What Lies Beneath the Surface?

Dialogic listeners are aware that below the surface of every behaviour you see or hear is a series of values, thoughts and beliefs – seek to learn about people through asking questions and listening to answers. Be emotionally intelligent and invested, using different conversational strategies and word choices, priming, framing, and even triangulating conversations to maximise the effect. Feedforward frequently, empathetically and at the right time, focusing on positive and constructive feedback for improvement.

Learning Conversation Frameworks

Planning learning, or feedforward conversations, can be easier if you plan, rehearse and use a framework to guide your intent. Frameworks may focus on reflective conversations (York-Barr et al., 2016), framed reflections focused on goal setting and reflection (Costa & Garmston, 2015), calibrating conversations focused on the reflection on stakeholder feedback, framed directions, focused on replicating known successes (Sternin, 1991) or prescriptive conversations, focused on the establishment and communication of clear criteria for change (Anderson, 1994). The context will dictate whether you use a framework for more reflective discussion or something more prescriptive. Either way, planning, implementing and evaluating learning conversations as a ‘’team norm’’ can remove the fear of feedback and replace it with embracing a feedforward culture.

Benefits of Learning Conversations

Importantly, the potential benefits of continuous learning conversations are holistic. Healthcare team members can become more aware of what type of conversation and who motivates them the most. They can reflect on the actual learnings and the actual process of learning, enabling a more transparent view of what the 30% of ‘more formal’ learning may or may not be. Learning can become a series of building blocks of conversations over time rather than a defined period with real or imagined pressure to achieve learning outcomes.

For healthcare leaders, the challenge is to let go of the metaphorical learning reins – releasing this control will require an appreciation of andragogic principles and self-awareness. Potential outcomes include greater team engagement, boosting productivity and reducing errors and unplanned absences. This may create the space for innovation and improve essential metrics such as retention and recruitment.

We can all agree that life is far from perfect; therefore, no ideal conversations or learning consequences exist. In healthcare, errors are more likely to originate from the system rather than human flaws – the feedback sandwich can only be directed at humans and is, therefore, redundant. Learning conversations are real-time and future-focused and, when done well, can lead to greater engagement and productivity. When the fear of feedback is removed, a ‘learning mindset’ can dominate, enabling reflection and innovation. Only then can humans flourish and be more innovative, liberated by permission to learn through discourse.

References

Andelson, S. J. (1994). The FRISK documentation materials. Available at https://cindymiller.wordpress.com/2008/07/08/114/.

Costa, A. L., & Garmston, R. J. (2015). Cognitive Coaching: Developing self-directed leaders and learners (3rd ed.). Lanham, MD: Rowman & Littlefield.

Lombardo, M., & Eichinger, R. (1996). The Career Architect Development Planner (1st ed.). Minneapolis: Lominger, p. iv.

Stewart, J., & Thomas, M. (1995). Dialogic Listening: Sculpting Mutual Meanings. McGraw-Hill, pp. 184–201; retrieved 2024-23-12.

Sternin, J. (1991). What is positive deviance? Positive Deviance Initiative. Available at https://www.positivedeviance.org/.

York-Barr, J., Sommers, W., Ghere, G., & Montie, J. (2016). Reflective Practice for Renewing Schools (3rd ed.). Thousand Oaks, CA: Corwin.

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