The Feedback Process Model (FPM) was introduced as an explanatory model of cognitive mediators of the effect of feedback on an individual’s performance within an organization by Ilgen, Fisher and Taylor in 1979.140 The model was validated as a predictive model of cognitive responses to performance feedback in a modified form by Kinicki et al. in 2004.147 FPM was originally created to organize findings from an extensive review of the feedback literature (Figure 8). FPM models an individual’s response to performance feedback as being moderated first by perceptions of the feedback message or complex feedback stimulus and by the source of the feedback. Next, the effect of a feedback message can be mediated by the following sequence of cognitive variables: perceived feedback, acceptance of feedback, desire to respond to feedback, and intended response (goals). Each variable in the sequence is capable of attenuating the effect of feedback on performance, contingent on the effect of the preceding variable. Each variable in the sequence is also presumed to be influenced by individual difference characteristics such as personality, ability, and motivation. Finally, the recipient’s actual response is recognized to be influenced by external constraints that represent any possible external influence on an individual’s performance. Ilgen et al.’s review discusses each cognitive construct in terms of the feedback source, message, and recipient.
Figure 8: A cognitive model of feedback processing from Ilgen, Taylor and Fisher, 1979.
The source of the feedback is recognized to influence an individual, with the associ-ated construct of source credibility playing a significant role in the effectiveness of feedback.
Source credibility refers to the perceived expertise and trustworthiness of the source of the feedback message. For feedback delivered by a clinical supervisor, source credibility repre-sents a recipient’s belief that the supervisor understands his tasks and work environment.
If a healthcare provider perceives that his supervisor has a poor understanding of the re-quired competencies of the work, or that the supervisor is not genuinely concerned about performance improvement, the feedback message is likely to be rejected. Source credibility may also be compromised by lack of trust in the data sources of the feedback message. For example, if a provider perceives that the quality of EMR data used to generate the feedback is poor, he may reject the feedback message.
The feedback message is described as information about past behavior. The properties of the feedback message include its information value as a measure of increase in knowledge or reduction in uncertainty about competing explanations for behavior. The message may also motivate future effort as an indicator of future rewards, or serve in as a kind of reward or punishment on its own to reinforce a behavior.
Perceived feedback primarily concerns how accurately the recipient perceives the
mes-sage that the source intended to provide. For example, a clinical supervisor who provides feedback may raise self-presentational concerns within a recipient that distracts him from accurately perceiving the feedback message. Peers who provide feedback on the other hand, and who may be more similar to the recipient, may provide feedback messages that are more accurately perceived. Ilgen and colleagues suggest that credibility of the source and power dynamics may influence the accuracy with which feedback is perceived. The authors also note that attributes of the message, including the sign and timing of the feedback, and the characteristics of the individual might influence how accurately the recipient perceives the intended message.
Acceptance of feedback is the degree to which the feedback message is accepted as an accurate and valid representation of her performance. This variable includes the perceived errors, fairness, and any negative affective reactions (e.g. discouragement, anxiety) to the feedback message that may cause it to be rejected. Both Kinicki et al. and Ilgen et al.
claimed that negative messages are most likely to be misperceived and not accepted.
Next, desire to respond refers to motivational factors including external incentives and the recipient’s intrinsic motivation. Desire to respond is determined by a) the ability to judge one’s personal performance and b) locus of control, or the degree to which one believes she can freely choose to take action when performing tasks. Desire to respond follows acceptance because it is capable of reducing the impact of the message even if is accurately perceived and accepted. For example, even if a feedback message had a high perceived accuracy, for a healthcare provider who has devolved into learned helplessness, the condition under which one believes that locus of control is entirely external, he or she would not be motivated to respond to feedback.
The final moderating factor is intended response, which refers to the level of effort the recipient intends to dedicate to the task addressed by the feedback, relative to effort com-mitted to other tasks competing for limited attention. The intended response is capable of moderating the effect of feedback in spite of a high desire to respond in cases where compe-tition from other tasks of equal or higher importance cause a recipient to reduce the level of effort to the task addressed by the feedback.140,147
There are several aspects of the FPM that are relevant to AF in health care at a
fun-damental level. Relative to FSC theories, FPM models the mechanisms that may influence an individual’s approach to eliminating the FSC gap. For example, instead of increasing effort as a result of perceiving a feedback-standard gap, one might abandon the standard because of problems with source credibility or perceived accuracy of the feedback message.
Changing or abandoning the standard could also occur when the perceived accuracy is ad-equate, but the recipient’s desire to respond or intended response is low. Increasing effort, and resulting improved performance, follows an increased desire to respond and increased intended response. Therefore, FPM offers explanation for the decisions behind the resulting approaches to feedback-standard gap elimination that FSC theories describe.
Furthermore, FPM describes the rationale behind responses to feedback outlined by FSC theories, but specifically within the context of a workplace feedback intervention. One area of potential incompatibility between FPM and FSC theories is in Ilgen et al.’s assertions that negative feedback is likely to be misperceived and rejected. On the contrary, FSC theories require negative feedback as essential for understanding the feedback-standard gap.
This discrepancy could be explained in part because of the broad scope of FSC theories, including specific and dissimilar tasks such as driving a car, team-based monitoring of radar screens, and playing tennis, where negative feedback can simply refer to any state other than the goal state. On the other hand FPM has been developed for the narrower scope of workplace performance feedback, where negative feedback represents a potential threat to the recipient’s self-concept, and may refer to a summary of all performance, rather than performance for a specific task. Belief in the ineffectiveness of negative feedback in workplace feedback appears to be common within the field of industrial and organizational psychology, although some have argued for its use and effectiveness.108,148
FPM may serve as a useful conceptual model to guide research about factors affecting the impact of feedback on performance in clinical settings. In applying FPM to clinical AF approaches, the theory emphasizes the importance of credibility of the feedback source, the perceived accuracy of the feedback, and, particularly relevant for AF in low-resource settings, the recognition that motivation to respond to feedback can be attenuated by intent to respond, due to competing priorities and limitations in the workplace. FPM is unique in providing a process model that emphasizes the impact of individual differences in feedback
recipients and their situations as moderators of the effect of feedback on performance. FPM aligns with the scenarios presented to illustrate COM-B, indicating that individual barriers to behavior change can differ, and that supervisors tailor feedback to accommodate such differences. Although FPM was developed as an explanatory model, it provides a potentially useful organizing framework for predicting the effect of feedback, as Kinicki et al. have demonstrated.147Therefore FPM could potentially be used to guide the tailoring of feedback messages according to observable differences in the cognitive variables it describes, and known individual and situational differences that influence each variable.