5:1 feedback improves medical care Published April 20, 2018 By Shireen Bedi Air Force Surgeon General Public Affairs FALLS CHURCH, Va. -- The 5:1 Feedback ratio is an effective Trusted Care tool aimed at ensuring respectful teamwork among healthcare providers, and plays a key role in ensuring patient safety. (U.S. Air Force graphic by Josh Mahler) Photo Details / Download Hi-Res Criticism can be a bitter but necessary pill to swallow for medical Airmen. Because patient safety is top priority, Air Force medical groups use a 5:1 feedback ratio. The 5:1 feedback ratio is an important Trusted Care tool, emphasizing respectful teamwork among healthcare providers. Through this approach, medical personnel provide five positive comments for every one criticism given. “Our use of 5:1 feedback has been crucial in establishing ‘respect for people’ in our Trusted Care culture,” said Lt. Col. Christian Lyons, special assistant to the Air Force Surgeon General for Trusted Care. “Direct recognition of our Airmen’s great value to the mission and to the team is critical to earning acceptance and fostering teamwork when providing constructive feedback.” This method communicates and reinforces performance expectations in a clear and respectful manner. And for a medical clinic, this means patient safety. “We want to reinforce foundational behavior when it comes to our ability to deliver safe, quality care,” said Col. Jeannine Ryder, commander of the 81st Medical Group, Keesler Air Force Base, Mississippi. “If we want to change behavior, it is more effective to concentrate on what someone is doing right.” This balance is effective in communicating expectations, while showing Airmen how leadership respects and values them. Ryder stressed that it is important for leadership to communicate when something is done right. To that end, she praises the daily efforts of her medics. “Recently, we recognized an Airman who prevented a potential medical safety hazard,” said Ryder. “The following week we celebrated her and her eye for detail. She is an [airman first class] just starting out and we want to reinforce that kind of behavior at every level. Focusing on the positive helps good behavior become repetitive.” This feedback method has had a significant impact on the health of the organization and on patient care. Since implementation, Ryder has seen a decrease in safety events. “Here at the 81st Medical Group we have very robust team meetings where we go through examples of how we are using 5:1 feedback, examine instances when it wasn’t used, and the outcomes of those interactions,” said Ryder. “We have seen a huge culture change here as a result, and that makes a big difference in the delivery of safe, quality care to our patients.” Recognizing good performance is now a regular part of the hospital. Because of this, Ryder has noticed improved team communication and trust. “We talk about ways to ‘stop the line’ when something is not working while also respecting each other,” said Ryder. “At every level we can use 5:1 feedback to ensure we are building that trust and ability to speak up. It is not only good for the team, but so important for the patient.” Medical Airmen have many stressors. This feedback approach builds up Airmen’s skills to ensure world-class patient care and safety. “We are not here to break our medical Airmen down,” said Ryder. “No amount of training ever fully prepares someone for the challenges of working in medicine. People learn by doing. So, finding those opportunities to give praise and positive feedback is going to make for a better organization for our staff and our patients.”