Strategic 360s

Making feedback matter

The Wisdom of Uncertainty

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I read a book titled, “How Doctors Think” by Jerome Groopman after seeing a short review of it in Time magazine a few years ago. (See also a review by Michael Crichton in the New York Times Book Review dated April 1, 2007). The book asks the question, why do doctors misdiagnose so frequently? And how can we (as consumers) protect ourselves from being a victim of misdiagnosis and improper (or nonexistent) treatment, sometimes with fatal consequences.  The author, who is a physician, had himself been a victim of misdiagnosis.

All of us are in the business of diagnosis in one form or another as we perform problem solving and make decisions based on our analysis of a situation.  In the context of 360 feedback, the analysis and interpretation of the feedback report is a major (and sometimes only) step in the diagnosis that hopefully leads to some decisions regarding developmental action plans, and maybe some other decisions as well.

Dr. Groopman  interviewed many other doctors regarding their diagnostic practices. He was particularly interested in knowing about cases where doctors had misdiagnosed a patient and how that had come to happen.  His major conclusion was that physicians are often guilty of arriving at a diagnosis too early. They are also more likely to arrive as diagnoses that are consistent with their area of specialty, i.e., their “comfort zone” and/or most experience. The problem is compounded in the training of residents, creating whole communities of misdiagnosticians (now I am inventing words;, heck, Shakespeare did it).

The quote that has stuck with me, and that I have often shared with others, is,

“Sometimes the key to success is uncertainty.”

How many times have we heard a 360 participant say, “Oh, I know exactly why I got those results.” And often they are probably right. But they really don’t know, and they are also often wrong. Coaches can often also fall into that trap by not encouraging the participant to check their assumptions. Even worse, some coaches have their own pet developmental suggestions and, coincidentally, a tool kit to fit the bill. (I will address the topic of, “When Coaches Go Too Far” at a later date.)

As I have noted in earlier writings, 360 is an artificial form of communication where respondents have to use multiple choice items to send a message to the participant. Despite our best efforts at writing the perfect items, the fact is that we can’t be sure of how the rater is reading the item and what meaning they might attach to it. The participant (and coach/manager) may also attach their own interpretation to an item that is also different.  There are also differences in how raters use the rating scale, for example.

One way to reduce uncertainty is to encourage (or require) participants to follow up with their raters and to seek clarification. One constructive role the coach/manager can play is to help the leader prepare for such follow-up, including practices to reduce the likelihood that the feedback providers will feel that their anonymity is being compromised. There are many other benefits to these follow up meetings, and I will also go more deeply into that subject at a future date.

As human beings, uncertainty is usually our enemy, and we will do whatever we can to reduce it. Sometimes those things are not rational.  We should linger in our uncertain state a little longer than we might like if it helps us consider alternatives to our first instincts. And, by the way, encourage your physician to do the same.

©2010 David W. Bracken

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Written by David Bracken

September 20, 2010 at 8:18 pm

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