One theme of the management classic In Search of Excellence: Lessons From America's Best-Run Companies by Tom Peters and Robert Waterman Jr. is that a successful business leader should manage by walking around. Of course, time
spent observing and interacting is only useful if the work patterns—and workers—causing problems get addressed. In the pattern
of Pavlovian behavior modification, the patterns needed to be corrected and dealt with in a timely manner: this minute, this
day, this week, this month—not this year. Other guiding principles of the daily preview include:
Do not complain until you train. When an issue pops up, first take it as a training moment. Look for patterns of personal behavior and work performance, and
address these when a negative pattern has been identified. Feedback, nurturing and behavior adjustment need to become a way
of life—the more instant and daily the training, the quicker the learning.
Ask your staff daily for improvement ideas. Look for comments like, "We should revisit how we're supposed to seal endotracheal tubes." Some staff members may be uncomfortable
discussing an issue in person, so provide another vehicle, such as anonymous notes for staff members to bring issues to light
rather than letting them fester. Employees can type notes and seal envelopes to deliver more sensitive issues.
Be hard on the issue and soft on the people. Neuter discussions of improvement to make them generic. Be clear about what you want; say, "I would like (insert issue of
concern) to be completed in this manner, fashion or style." Staff members will usually think they know the practice's policies
and protocols, but these often change with stressors applied, and what a staff member may think is correct has undergone a
metamorphosis in his or her mind. Expect that the staff members most needing to hear an issue and make adjustments are the
ones who will not believe the issue involves them, so be prepared to discuss the issue with them privately at first.
Do not discuss pay in daily previews. Salary and benefits should not be included in the review process. Make the only issue on the table the item of discussion
and specifically link the deed to how it affects patient care. My favorite way to keep the discussion on track is to say,
"If this were you, or your pet, would you be happy with (insert the issue)? (Pause.) Then this is how we will improve care
in the future."
- Keep employee files current when using daily previews. Make it a habit to record succinct messages about individual performance and issues on telephone pads or 3-x-5 cards and
file them in the secured employee files. However, always be sure to post the training issue—which does not discuss individual
performance—for all to see.