Dr Jenner is a senior practicing GP and a respected leader with past roles in Clinical Commissioning Groups and as a Primary Care Network clinical lead.
We recently interviewed Dr Jenner on his experience with patient and colleague feedback and here he generously shares his insight and advice.
CFEP: Please tell us a little bit about yourself, your background and your career as a doctor.
Dr Jenner: Hi, I’m Dr David Jenner. I’m a GP down in Cullompton, which is in the southwest of UK and semi-rural practice. I’ve been a GP there now for 30 years. Just beginning to wind down a little bit now go part time. But I’ve loved working there all my life.
I’ve always held about a portfolio career. And I got heavily involved in medical management, being lead GP in primary care groups, primary care trust, Clinical Commissioning Groups, over the years. And even took a few years on the road just delivering talks to my colleagues about various things from improving the patient experience, to clinical topics like CPD.
But my real vocation and heart lies in general practice.
CFEP: Can you recall your first thoughts when introduced to the concept of patient feedback?
Dr Jenner: Oh, wow. Yeah, well, I remember this very clearly. It’s one of those sort of punctuation marks in your life you’ll never forget. And that was at a time when CFEP looking for trial sites in the UK, to try their new questionnaire. And we were approached as a practice to do that. To be honest, I wasn’t really frightened of it at the time because I think with a sort of sense of professional arrogance, I thought I would be good. But when I got the results, it was a bit of a wakeup call. And I think it’s fair to say that I went through a full-fledged grief reaction with the five stages in there.
And the truth with me and my feedback was, I was pretty good men but I was really crap with women in the consultation room. And so that stuck, and really then motivated me to do something about it.
CFEP: Did you continue the process of with CFEP Surveys after that initial experience?
Dr Jenner: Absolutely. Been doing it every few years since. I mean, really the most important one, though, is the first one after your initial score if you get a score you’re uncomfortable with like me. I did that after about another year. But after learning some very simple skills, that was really heartening to see a major improvement. The improvement has gone on over the years but then it sort of flattens out a bit. I think in the first five to 10 years there was ongoing improvement. Probably, I’ve done nearly 20 years’ worth now. And the latest results are pretty consistent.
But the really important thing for me is, if you get consultation and communication skills better, you enjoy your job more.
CFEP: Is there anything that you particularly value or appreciate about the process?
Dr Jenner: Several things so… I find myself like Michelangelo, I never stop learning. So it’s great to have a stimulus to learn more, and to get some honest feedback about your performance is what it is, isn’t it. But also giving you the opportunity to get things better. And that’s what CFEP did, because, I mean, it was a little bit of individual coaching outside of the questionnaire process.
I remember I was told, patients don’t care how much you know until they know how much you care. And I sort of have that written across my brain because when I went to medical school, it was all about how much you knew and getting the diagnosis right, rather than getting the consultation right. I think that’s changed completely now. So, it gives you feedback.
Also, with colleagues, it gives them a chance to let you know what things they really appreciate. And perhaps more importantly, what things you do that irritate them. And of course, they’re asked what are the most important things in the feedback that this person could do to change their behaviour? So the feedback is a mixture of the raw scores and then some sort of supporting narrative or comment. And to be honest, you probably get more of that from colleagues than you do from patients.
CFEP: Is it true that your first instinct as a diagnostician was to go to the negative feedback? – And if so, how do you work through that?
Dr Jenner: I think you’ve got to understand most people who are doctors have probably performed pretty well in life to get into medical school. And then to get through that and live in an environment where the vast majority of the feedback they get from everyone is positive. Certainly, at school, at university and everything. So you’re used to living in an environment where people think you’re great and tell you you’re great and doing well. And I think it’s called stroke economy theory, that if you live in an environment where nine times out of 10 you get a positive feedback, then if eight times out of 10 you get positive feedback, you feel really bad about it. Whereas someone else might think that’s a really good score.
I think it’s also because we desperately care about getting it right. And we all hate as doctors getting it wrong with a patient, getting a diagnosis right is the thing. And I think we’re all motivated and taught all the way through to learn, reflect on what you do, and try and improve. And I think nowadays, medical schools get that better than they did in my day. But it doesn’t mean that you want to hear the negative feedback when you get it.
And it also means you’re probably like the to interpret feedback that’s meant to help you improve as negative. When in fact, people might be trying to help you. So that’s something about your personality. And I think it’s good just it’s again, important before you do the feedback to think about why you’re doing it, what you want to get out of it. And if you are actually going to use it to improve, you’re probably going to get something that tells you, you’re not God’s gift to man and women.
CFEP: What can you tell us about the structured format of the process?
Dr Jenner: Most people, I think, go straight to the overall score. But I can understand that. But then you’ve really got to look behind that. Because the feedback you get specifically for patients will break it down as to the age of the patient, the gender of the patient, and whether you’re seeing that patient for the first time or not. With colleague feedback, you get it from what profession they are.
So, it gives you the chance to reflect on that. And look, I think in business terms they call it market segmentation, to see that there’s some areas where you need to improve. But perhaps some areas, you’re doing it right. And as a doctor, what that’s taught me is there’s no one approach for all patients. You have to think about the person in front of you, and adapt to that. And the structured patient feedback can give you that.
With colleague feedback, it helps you learn if you tend to treat people, maybe who are subordinate to you in a different way to colleagues, or people who are clinicians or non-clinicians. And again, that just stops and makes you think if there is a particular difference between those.
The structured feedback also gives you a great chance to discuss it with a Supportive Medical Colleague, or indeed as we do in in the UK, with your appraiser every year. And the structured feedback the CFEP give gives you prompts, as to what you can write down having reflected on it; which is just meat and drink to the appraisers. They love that. They love reflection and the comment and so that feedback report, as you get it is great in all of those ways. So getting right to the particular issues and then helping you focus about what are you going to do about it.
CFEP: What would you describe as the most rewarding part of this patient and colleague feedback process?
Dr Jenner: The most rewarding part of the whole process is enjoying your job more. Of that there’s no doubt. However, one really rewarding bit came up in one of my colleague feedbacks from one of my colleagues. I don’t know who it is said, ‘Dave realised that he could be a bit sharp with patients and not so strong on emotions, has recognised this really tried to do something about it, and is now a better doctor as a result’. Ah, that’s lovely.
And also, the patients. The patients tell you not always in verbal ways but they tell you in nonverbal ways, like the way they look at you or want to shake your hand at the end of the consultation or something like that.
So, it’s fair to say for me, it has changed my practice considerably. And so much for the better, and its great people around me can see that.
CFEP: Have you seen or had experience with other providers of patient or colleague feedback services?
Dr Jenner: So I’ve never actually conducted a 360 feedback with another provider. But because I got interested in this and you know, I’ve told my story from time to time in front of people, I’ve seen some of the other products. And I mean, a lot of them are validated. I think what makes CFEP different from the others is the back end of it, as I call it. It’s the way the feedback is presented and the support that comes in afterwards.
From my own experience, I think I’ve told how the importance of being helped through the whole process. Thinking about how you do it, looking at the result and getting it broken down into a group feedback, and then with prompts for reflection, to discuss with your appraiser really adds so much value to what on the face of it could be seen as quite a simple product.
CFEP: Do you have any advice for doctors or other healthcare professionals who are undertaking this process for the first time?
Dr Jenner: Okay, so I think, be prepared, and see it as an educational experience, as if you’re going on a course. And keep an open mind. But it’s important to know that the feedback you get, it may be absolutely great. And to be honest with doctors, it normally is. But there may be some things in there which you might feel uncomfortable about.
So make sure you’ve got somebody, a Supporting Medical Colleague, or your Appraiser – and time it if needs to be for that to happen around you, to help support you in that process. And I would say the Supporting Medical Colleague should never be someone in a line management position to you. They should be a friend and not someone who’s going to judge you on the results. That’s really important. Because I think, if you thought you were going into a line management situation, with these, it might be totally appropriate to do that – but might be good just to have someone you could touch base on before you do that. So you’ve had time to reflect and they can help guide you through the process.
The other thought is, just go into it with a completely open mind and don’t have preconceptions about what the results will show. Because you do get surprises. And I think if you’re aware that you might get surprises, is easier to deal with them if you do. But get someone to support you is the important bit, particularly with colleague feedback.
CFEP: Thank you to Dr David Jenner for sharing his experience of more than 30 years in practice and his journey with patient and colleague feedback over the last 20 years.