Providing Meaningful Feedback for the Telephone Triage Nurse
FEEDBACK IS ESSENTIAL
Successful telephone triage requires the simultaneous application of interviewing, listening, critical thinking, and decision-making skills, in addition to customer service and technology skills. Adding to the practice complexity is the relatively autonomous environment in which the triage nurse operates. Receiving regular feedback and coaching on call performance is essential to mastery of the telephone triage role.
In the call center, feedback may come from many different sources including managers, peers, or customers. It is paramount for nurses to understand the primary intent of feedback is to advance learning. Emphasis on learning starts in orientation and continues throughout the triage role. Learning is growing!
In telephone triage, the goal is to provide safe, high-quality care. To know if nurses are achieving this goal, we generally look at benchmark standards. Several standards are assessed by using the key quality improvement (QI) processes described below: (Source: STCC User’s Guide).
Review new nurse call documentation until competency is established.
At regular intervals, review call documentation for all other nurses to assess ongoing performance: selection of appropriate guideline, appropriate disposition and accurate documentation.
If call concerns are identified, also review call audio.
COACHING FOR LEARNING AND DEVELOPMENT
Many of us are encouraged to provide peer feedback on the quality of triage calls using audit tools specific to audio or computer documentation. Review of call audio and computer documentation helps nurses gain valuable insight into the call flow and assessment processes, as well as the clinical decision-making process. STCC strongly supports the idea of all triage nurses participating in these QI measures. Both new and seasoned nurses can benefit from QI participation and discussion.
When providing call feedback, here are some coaching tips for success:
Give feedback in a timely manner on a consistent basis.
Base feedback on facts and established benchmark standards, not personal opinion. Objective feedback is better received when it is data-driven.
Speak to what went well and celebrate success. Recognize the difficulty of completing a “perfect” call.
Provide specific details on the behavior or skill being addressed. If needed, include the impact on others (e.g., patient, colleagues). With newer colleagues, focus on the skills necessary to become proficient rather than what is deficient.
Determine the most appropriate communication style to use based on practice level and triage experience. A novice nurse may benefit from more directive approach, while a proficient nurse may prefer a less directive, more conversational approach.
Consider personality types and how to deliver feedback appropriately to their “type”. For example, a “director” type of personality likes feedback to be delivered to them factually and briefly. A “socializer” may want more conversational feedback. A “thinker” may desire more data and time to carefully review the data.
When providing conversational feedback, here are several additional recommendations:
Engage colleagues in dialogue rather than debate. In debates, it is all about winning, one right answer, and finding flaws in other’s points. In dialogue, it’s more about learning and working together to find solutions. A sense of collaboration prevails. Minds are open and willing to consider different perspectives.
Recognize if the conversation begins to shift into debate and redirect it back to dialogue. Staying alert to non-verbal cues, body language and tone of voice can help keep the conversation non-threatening and productive.
Ask questions. It is an ideal time to invite input, especially if providing performance-related feedback. The more a nurse reflects on their understanding of the situation and considers alternate decision making, the more ownership they take for changing their performance going forward.
BE INSPIRED TO GIVE AND RECEIVE FEEDBACK … AS A GIFT
Many of us become uneasy when we hear the word feedback. In our heads we understand the need for feedback; yet our hearts may or may not be ready to hear it. Perhaps memories of negative or dismissive feedback contribute to the restlessness. Let’s change the mindset!
We have a professional obligation to foster a learning culture which endorses patient safety and promotes best practice. Be inspired by the concept to give and receive feedback as a gift. In principle, effective and constructive feedback is a good thing, a caring gesture. It shines light on our performance, things we may not have been able to see or learn on our own.
By integrating effective coaching and feedback techniques into performance management and QI programs, we can improve individual and team performance. Whether addressing strengths and successes or performance deficiencies, a change in our approach can make the difference. May your team be energized to recognize the countless opportunities they have to give and receive feedback as a gift!
Authors
Lisa Swerczek MSHI, RNC-TNP
Pediatric Clinical Coordinator
Schmitt-Thompson Clinical Content
Kelli Massaro RN CPN
Pediatric Clinical Content Manager
Schmitt-Thompson Clinical Content