"Health Conflicts, Episode I" - or the Feedback Culture as a Threat

Miday morning in Feedikon Hospital, Canton Backwil. Senior managers are sitting in the meeting room: Mr. A. D. Müller, CEO, MBA HSG; Head of Nursing Ms. Brändli, Msc; Senior Physician Dr. HoffmannFeckenstedt; Professor Langholz, Chief Physician; Mr. Quehl, Quality Manager (QM). The hospital managers sit in front of their tablets. The night before, rankings were published on the online platform "Kunuparis". "Kunuparis" links satisfaction data from healthcare guests and employees (both permanent and leased) and uses this to create a health business rate score for institutions in the Swiss healthcare system.

While competing providers such as "SkypingDoctors" and the "EBikingNurses" were once again able to record rising share price gains, the share price of Feedikon Hospital, Canton of Backwil, collapsed once again and has now been in the bottom third of the ranking for a few hours. - "A disaster! We urgently need to do something!" CEO Müller energetically opened the meeting.

"Well, I just can't explain these values, when we do so much for our employees and have invested so much in the expansion of our private ward" chants Dr. Hoffmann-Feckenstedt in her own North German focused way - "It used to be a disaster when I came to the ward in the morning and we suspected an outbreak of the Noro virus overnight. Today, it's a disaster when our poll numbers plummet overnight," Professor Langholz notes with consternation.

"Mr. Quehl, you know best about surveys and measurements, do you have an idea what we can do?" PDL Ms Brändli directs her gaze at QM Quehl. Her pragmatic, solution-oriented manner does her good once again. Of course Mr Quehl has an idea. Quehl: "I think we should take a closer look at our feedback culture. Maybe we have some blind spots that we don't notice, and good feedback would be the key."

"Feedback culture?
What exactly do you mean by that, Mr. Quehl?" "A good question, Dr. Hoffmann-Feckenstedt. It's a broad topic: it's about feedback from our healthcare guests, feedback from and among staff, and what family members, referring physicians, post-acute care providers, and outpatient services think of and say about us."

Prof. Langholz: "That seems to me to be a complex matter." "Very true," confirms QM Quehl, "this culture understands itself like Scrabble: once you start, one topic gives rise to the next. That quickly brings us to trust, open communication culture, learning organization, error culture and transparency."

"Mr. Quehl, how exactly can we approach our feedback culture?" asks CEO Müller. "There is a new device from the company "HappyInHealth". A feedback tomograph (FBT for short). It's supposed to give clear results, it includes good resolution and hardly any old-fashioned artifacts. The accompanying app includes a microsensor and is easily downloaded to all mobile devices and PCs. It's also possible to install on all medical equipment, on operating room lights and coffee machines." - "What do you think?", Mr. Müller turns to the round.

Dr. Hoffmann-Feckenstedt has just had to examine a cut in the emergency ward via tablet. Professor Langholz wonders whether the app would also access his research data? Ms. Brändli's eyes, on the other hand, light up. CEO Müller decides: "Good, then we'll test the device. We'll start on the surgical ward and in the operating room next week."

Neon pink signals Monday:
In the operating room. Change of plans at short notice: instead of a meniscus, a fracture of the neck of the femur has to be operated on as an emergency. The senior physician steps in front of the anaesthetised patient's knee. The assistant asks uncertainly: "I thought this was the emergency - neck of femur? Attending: "Oh, you always know better, don't you? You must have been one of those who always sat in the front row in the lecture?!" The operating room light flickers neon pink! Everyone flinches, a soft female computer voice sounds from the FBT: "Feedback rule number one: Supervisors underestimate the intimidating effect of their offhand remarks. The correct answer would be "THANK YOU". STATEMENT 1: Giving up clear feedback could be a strategy to secure influence."

Tuesday: In the station office.
Two nurses are taking a coffee break. "Now the ward manager has scheduled me for duty for another whole weekend. She knows I don't have anyone to take care of my kids on the weekends." - "She told me yesterday that I have to put my summer vacation in by the end of this week. At the same time, I can't even plan now because I don't know when my husband will be able to take a vacation." - "That's typical of our ward manager again. She only has her career in mind, she only lives for the hospital. She doesn't give a damn that we also have family at home!"

It promptly flashes neon pink on the coffee machine. A voice from the FBT is heard. "Feedback Rule #2: Blasphemy is not a good way to relieve pressure. Conflicts should be resolved directly with each other. STATEMENT 2: Avoid assumptions and interpretations. Please leave out negative assumptions about others; instead, assume POSITIVE INTENTIONS or MISTAKES!".

Wednesday:
A flying visit from Prof. Langholz in the patient's room. "Well, Mr. Pueblo, how's the pain?". Mr. Pueblo: "Much better. Something is annoying, however. This is the second time I have been given the wrong lunch!". The professor brusquely: "Well, that is annoying, unfortunately I have nothing to do with it. Perhaps they will inform the nursing staff or the hotel staff again. I'm sure there's someone there to take care of our health guests' complaints." The senior doctor leaves the room. Neon pink flashes appear on the business tablet. "Feedback Rule #3: Customers give important feedback, which must be taken seriously right away. STATEMENT 3: Justifications or GUILTY ASSIGNMENTS are out of place. The point is not to always look good, but to learn, to develop the organization!"

Mr. Pueblo (alone): "And anyway, why do they always talk about health guests here? I'm a patient after all...maybe I should share that. But to whom and how?"

Thursday:
Surgical ward, medicine cabinet. The healthcare assistant has accidentally provided the wrong dose of blood pressure medication for a patient. Fortunately, the nurse in charge notices, changes it - but says nothing and mumbles to himself: "Today's young people only have their mobile phones in their heads, and at work they are as absent-minded as dandelions. Typical Generation Z." Suddenly it lights up above the air conditioning, the FBT voice sounds: "Feedback Rule #4: Giving feedback is a leadership task. Without feedback, today's mistake is tomorrow's standard. STATEMENT 4: The "F -alliteration" applies here: Celebrate mistakes, don't cover them up! Only by acknowledging mistakes do we develop. By the way, praise should be verbalized more often. UNDER STATEMENT 1: Missed praise = missed opportunity!"

Friday:
In the office of CEO A. D. Müller. On the phone Mrs. Müller-Hoffenheim: "Hello darling, please remember, tonight we are invited to the neighbors'." - "Oh, I'd forgotten all about that. Tonight I have the meeting with the board of directors." - "Again? When are you going to start adding private appointments to your agenda? Friends should be important to us too." - "Now don't get all testy again! You know very well that I have to keep my work and my private life separate!" Mr. Müller's screen glows neon pink. "Feedback Rule #5: Don't feel attacked when someone gives you feedback.

STATEMENT 5: UNDERSTATEMENT 2: You should at least reflect on time allocations and your goals to effect mutual change."

Conclusions (first FBT protocol)
It is uncertain whether the feedback tomograph (FBT) will be approved in the Swiss healthcare system by 2026 and whether it can be used across the board. However, it would be nice if such "feedback" were used as a matter of course in the healthcare system to open up blind spots, to optimise processes and outcomes, and ultimately to put employees and patients - in short: people - at the centre.

Many good approaches such as surveys of patients, employees and referring physicians already exist. It is important to coordinate these approaches correctly, to adapt them technically to the state of the art and, above all, to treat the results transparently and securely. Because feedback culture only works as a cycle: Those who provide feedback want to bring about or perceive changes. Of course, it is not enough to simply distribute questionnaires. Openness, transparency, and ultimately setting an example - at all hierarchical levels, in all professions, in everyday professional life as well as in training - are the be-all and end-all.