CPOM Module 7, Section 2: Conducting Reviews, Coaching, and Constructive Feedback
MODULE 7: Performance Management & Staff Development

Section 2: Conducting Reviews, Coaching, and Constructive Feedback

A masterclass on moving beyond the annual review to a model of continuous coaching, including practical frameworks for delivering both positive and constructive feedback effectively.

SECTION 7.2

Conducting Reviews, Coaching, and Constructive Feedback

From Annual Verdict to Continuous Dialogue: The Leader’s Role as Coach.

7.2.1 The “Why”: The Annual Review is Leadership Malpractice

Imagine you are managing a patient on a complex vancomycin regimen. Would you draw a single random trough level once a year, use that solitary data point to judge the entire year’s therapy, and then tell the patient everything you think they did wrong for the past 12 months? Of course not. It would be clinically absurd and professionally negligent. Effective therapy requires frequent monitoring, real-time data, and small, continuous adjustments to keep the patient in the therapeutic range. A once-a-year trough level is a useless, lagging indicator of a single moment in time.

Yet, for decades, organizations have run on the leadership equivalent of this flawed model: the traditional annual performance review. It is a system built on the same clinically bankrupt principles: infrequent monitoring (once a year), a focus on lagging indicators (past mistakes), and a high-stress, low-value conversation that both manager and employee dread. Storing up a year’s worth of feedback—both positive and negative—and delivering it in a single, high-stakes meeting is not just ineffective; it is a profound failure of leadership. It guarantees that feedback is delivered too late to be useful, fosters anxiety and distrust, and is plagued by recency bias, where a full year of work is judged only by what the manager can remember from the last month.

This section is about fundamentally reframing performance management. We will dismantle the archaic annual review and replace it with a dynamic, clinically sound model of continuous coaching. This is a philosophical shift from being a “judge” who delivers a verdict to being a “coach” who is actively on the field with their players every single day. The goal is no longer to rate past performance, but to actively improve future performance through an ongoing, supportive, and data-driven dialogue.

Pharmacist Analogy: Home BP Monitoring vs. the Annual Physical

The traditional annual review is like a patient with chronic hypertension who only gets their blood pressure checked once a year at their annual physical. That single reading on that specific day is a stressful, high-stakes event that tells you almost nothing about their actual blood pressure control over the entire year. It’s a snapshot in time, not a trend line.

Continuous coaching is the leadership equivalent of giving that patient a home blood pressure cuff and teaching them how to use it. You supplement this with frequent, low-stress check-ins.

  • Daily Home Readings: This is your informal, in-the-moment feedback. Quick, frequent data points on what’s happening right now.
  • Weekly Log Review / Pharmacist Check-in Call: This is your structured one-on-one meeting. A regular time to review the data, identify trends, solve problems, and make small adjustments to the care plan (the coaching).
  • The Annual Physical: This still happens, but its purpose changes. It’s no longer a day of judgment. It’s a high-level summary of the year’s progress, a time to review the overall trend line, and a chance to plan long-term health goals. The blood pressure reading on that day is just one data point among hundreds you’ve already collected. There are no surprises.

As a leader, your goal is to stop relying on the “annual physical” and instead build a system of continuous monitoring and adjustment. This approach lowers stress, improves outcomes, and builds a trusting partnership between you and your team member.

7.2.2 The Architecture of a Coaching Culture: A Three-Tiered Framework

Shifting from a “review” mindset to a “coaching” mindset requires a new operational structure. A robust culture of continuous performance management is not random; it is built on a predictable cadence of different types of conversations. Each type of conversation serves a distinct purpose, and together they create a powerful system for developing talent and driving results. Think of it as a pyramid: the broad base of frequent, informal interactions supports the less frequent, more structured conversations at the top.

The Performance Dialogue Pyramid

The Formal Review

Frequency: Annually

Purpose: A retrospective summary of the year’s performance against goals, career aspiration planning, and formal discussion of compensation and ratings. There should be no new feedback here.

The Structured 1-on-1 Check-in

Frequency: Monthly or Bi-weekly

Purpose: A forward-looking, employee-led conversation to review progress on goals, identify and remove roadblocks, align priorities, and provide structured coaching. This is the engine of performance development.

In-the-Moment Feedback

Frequency: Daily or Weekly

Purpose: Immediate, specific, and informal recognition of positive behaviors or course-correction of negative behaviors. This is the foundation of the coaching culture, building trust and psychological safety.

7.2.3 Masterclass on In-the-Moment Feedback: The 2-Minute Intervention

The base of the pyramid—and the most important element of a coaching culture—is the practice of giving frequent, informal feedback. This is your equivalent of the daily home blood pressure check. These are not scheduled meetings; they are brief, immediate interactions designed to reinforce what you want to see more of and gently course-correct what you want to see less of. The goal is a high frequency of low-stakes conversations, which builds a bank of trust and makes more formal feedback feel less intimidating.

The key is to make it specific and immediate. General praise like “Good job today” is nice, but it’s not feedback because it’s not specific enough to be reinforced. Effective in-the-moment feedback links a specific behavior to its positive impact.

Playbook: The Positive Reinforcement Formula

When you see a behavior you want to encourage, use this simple two-part formula immediately. This should take less than 60 seconds.

Formula: [Describe the Specific Behavior] + [Explain its Positive Impact]

  • Scenario: A technician calmly handles a difficult call from a frustrated nurse about a missing medication.
    Your Feedback: “Hey Sarah, I just overheard that call with the nurse from 5 West. The way you stayed calm, validated her frustration by saying ‘I understand this is urgent,’ and then clearly explained the steps you were taking to locate the med was perfect. That de-escalated the situation and made our whole department look professional and responsive. Excellent work.”
  • Scenario: A new pharmacist catches a potential drug interaction during order verification.
    Your Feedback: “John, great catch on that Bactrim for the patient on warfarin. Pausing verification to call the physician with a specific recommendation for an alternative was exactly the right clinical move. That prevented a potentially serious adverse event. That’s the kind of ownership we need on this team.”
Playbook: The Gentle Course-Correction Formula

When you see a minor error or a behavior that needs to change, address it immediately and privately. The goal is not to shame, but to teach. The tone should be helpful and supportive.

Formula: [Quickly State the Observation] + [Provide the Correct Way/Expectation] + [Confirm and Move On]

  • Scenario: You see a technician draw up a medication without swabbing the vial.
    Your Feedback (privately): “Hey Mark, quick second. I noticed you didn’t swab the top of that vial before you drew up the dose. The expectation is that we swab every vial, every time, to maintain sterility. Just make sure you’re hitting that going forward, okay? Thanks.”
  • Scenario: A pharmacist gives a curt, one-word answer to a nurse’s question over the phone.
    Your Feedback (after the call, privately): “Susan, can I give you a quick piece of coaching? On that last call, your answer to the nurse was very brief. When we’re talking with nursing, even when we’re busy, we need to ensure our tone is collaborative and helpful. Something as simple as ‘Let me check on that for you’ can make a big difference in our relationship with them. Just something to keep in mind.”

7.2.4 Masterclass on the Structured 1-on-1 Check-in: The Engine of Growth

The structured, recurring one-on-one meeting is the heart of a continuous coaching model. This is your dedicated, protected time to move beyond the day-to-day tasks and focus on the employee’s progress, challenges, and development. This is not a status update for the manager; it is a dedicated coaching session for the employee. A well-run one-on-one is the single most effective tool a leader has to build trust, improve performance, and retain top talent.

The Cadence and The Cardinal Rule

Cadence: The ideal frequency is 30 minutes every other week or 60 minutes once a month. Anything less frequent loses momentum. Anything more frequent can feel like micromanagement.

The Cardinal Rule: Never cancel a one-on-one. Reschedule it if you absolutely must, but never cancel. Canceling a one-on-one sends a clear message to the employee: “My other priorities are more important than you.” It is the fastest way to destroy the psychological safety and trust you are trying to build. This is the most sacred meeting on your calendar.

The One-on-One Agenda: A Playbook for High-Impact Conversations

The key to a great one-on-one is that it is the employee’s meeting, not yours. They should own the agenda and do 80% of the talking. Your role is to listen, ask powerful coaching questions, and help remove barriers. Use a shared document (like a Google Doc or a OneNote page) to track the conversation and action items from week to week.

Standard Agenda Template:
  1. The Check-in (5 minutes): Start with a personal connection. “How was your weekend?” “How are things going outside of work?” This builds rapport and acknowledges them as a whole person.
  2. Their Agenda (15-20 minutes): Progress & Problems

    This is the core of the meeting. The employee drives this section. Your job is to listen and ask coaching questions.

    • Progress on SMART Objectives: “Let’s look at your goals. What progress have you made since we last talked? What wins can you celebrate?”
    • Priorities for the Coming Weeks: “What are your top 1-3 priorities between now and our next meeting? How do they align with your goals?”
    • Problems & Roadblocks: This is the most important part. “Where are you stuck? What’s getting in your way? What challenges are you facing?”
  3. Your Agenda (5-10 minutes): Alignment & Feedback

    This is your chance to share important departmental updates or provide structured feedback that requires more time than a 2-minute intervention.

    • Department Updates: “I wanted to give you a heads-up about the upcoming Joint Commission visit…”
    • Feedback & Recognition: “I want to share some feedback I received from the ICU charge nurse about your work on the vancomycin protocol…” or “Let’s talk about the situation with the medication delivery delay last Tuesday.”
  4. The Look Ahead (5 minutes): Development & Support

    End the meeting on a forward-looking, supportive note.

    • Career & Development: “What skills are you thinking about developing? Are there any projects you’d like to get involved in?”
    • How Can I Help?: Always end with this question. “What do you need from me? What can I do more of or less of to better support you?”
Stop Solving, Start Coaching: The Power of Questions

As a pharmacist, your instinct is to solve problems. When a technician says, “I’m having trouble with the new compounder software,” your brain immediately jumps to giving them the solution. You must fight this urge. A manager who solves every problem creates a dependent team. A coach who asks questions creates a team that can solve problems for themselves.

Instead of giving the answer, ask a powerful question:

Employee Problem Manager-as-Solver Response (Weak) Manager-as-Coach Question (Powerful)
“I can’t get Dr. Smith to call me back about a critical clarification.” “Okay, I’ll call him for you.” “That sounds frustrating. What have you tried so far? What’s another approach you could take?”
“The new techs aren’t pulling their weight, and I’m having to pick up the slack.” “I’ll talk to them.” “I appreciate you bringing this to me. Before I step in, what have you done to provide them with feedback directly? How could you help them succeed?”
“I’m overwhelmed with this project. I don’t know where to start.” “Here’s what you should do first…” “It’s a big project, for sure. If we were to break it down into just three small, manageable first steps, what would those be?”

7.2.5 The Art of Delivering Constructive Feedback: A Clinical Approach

Despite a culture of frequent feedback, there will be times when you need to have a more formal conversation about a significant performance gap or a problematic behavior. These are the conversations that most managers fear and avoid. However, avoiding them is a dereliction of duty. Your job as a leader is to help your people see a blind spot they cannot see themselves. When delivered with skill, care, and a positive intent, constructive feedback is one of the most valuable gifts you can give a member of your team.

The key is to have a structured, evidence-based model that removes emotion and judgment, and focuses on objective facts. Just as you follow a precise protocol for sterile compounding, you must follow a precise protocol for delivering feedback.

The SBI Model: Situation-Behavior-Impact

The most effective model for delivering feedback is the Situation-Behavior-Impact (SBI) model. It is a simple, powerful tool that forces you to be objective and non-judgmental. It separates the person from the behavior and focuses on the tangible consequences of their actions.

  • Situation: You start by grounding the feedback in a specific time and place. This provides context and prevents the feedback from feeling like a vague, generalized attack. (e.g., “Yesterday morning, during the 8 AM leadership huddle…”)
  • Behavior: You describe the person’s behavior in factual, observable terms. This is the hardest part. You must describe what you saw or heard, like a video camera would. You cannot use judgmental words, interpretations, or assumptions about their intent. (e.g., “You stated that the pharmacy was ‘too understaffed to help’ with the new discharge project.” NOT “You had a really negative attitude.”)
  • Impact: You explain the actual, tangible result of the behavior. This is what makes the feedback resonate. You connect their action to its consequence on you, the team, the department, or the patient. (e.g., “The impact of that statement was that the Chief Nursing Officer questioned our department’s commitment to the project, and I had to spend time after the meeting reassuring her.”)
Abandon the “Feedback Sandwich” Forever

For years, managers were taught the “feedback sandwich” (or “praise sandwich”): start with a positive, deliver the negative, and end with a positive. This is a deeply flawed and manipulative technique that you must eliminate from your leadership toolkit.

Why is it so bad?

  • It Erodes Trust: Employees quickly learn that praise is just a setup for criticism. They start to distrust all of your positive feedback, waiting for the “but…”
  • It Obscures the Message: The real message (the criticism) gets buried in the fluff. The employee often only hears the praise and misses the point of the conversation entirely.
  • It Feels Inauthentic: It’s a formulaic, unnatural way to talk, and it comes across as cowardly, as if you don’t have the courage to address the issue directly.

Keep positive and constructive feedback separate. Give praise freely and often (using the formula we discussed earlier). When you need to give constructive feedback, address it directly, kindly, and professionally using a model like SBI.

Masterclass Table: The Constructive Feedback Playbook in Action
Common Pharmacy Scenario “Bad Feedback” Example (Vague, Judgmental) “Good Feedback” Script Using SBI
A skilled but cynical senior pharmacist consistently makes negative, dismissive comments about new hospital initiatives during team meetings. “Dave, you need to fix your attitude. You’re always so negative, and you’re bringing the team down. You have to be more of a team player.”

Manager: “Dave, can I share some feedback with you?” (Wait for “Yes”).

(S) “In our team meeting this morning when we were discussing the new Meds-to-Beds program…”

(B) “…I observed that you said, ‘This is just the flavor of the month, it will never work,’ and you sighed loudly when the timeline was presented.”

(I) “The impact of those comments was that two of the newer pharmacists on the team who were initially excited about the project became silent and disengaged. It also undermines my ability to get the team aligned on a key hospital priority.”

(Pause. Let him respond.)

(Shift to Coaching): “Can you walk me through your concerns about the program?”
A technician is frequently 5-10 minutes late for their shift, delaying the morning workflow. “Listen, your tardiness is becoming a real problem. You’re disrespecting the team. You need to start showing up on time.”

Manager: “Hi Jen. I need to talk to you about your start times. Can we chat for a moment?”

(S) “I’ve reviewed the time clock reports for the last two weeks…”

(B) “…and I see that you have clocked in after your scheduled 7:00 AM start time on six of your last ten shifts.”

(I) “The impact is that the morning ADC fill run is delayed, which caused three calls from the ED about missing meds last week. It also creates a fairness issue for the rest of the team who are here on time.”

(Pause.)

(Shift to Coaching): “Is there anything going on that’s making it difficult for you to get here on time?”

7.2.6 Repurposing the Annual Review: A Summary, Not a Surprise

If you have built a culture of continuous coaching with frequent, high-quality conversations, the formal annual review transforms from a dreaded event into a non-event. Its purpose is no longer to deliver feedback or pass judgment. Instead, it becomes a streamlined, high-level summary and planning session. There should be absolutely no new information or surprises in an annual review. If there are, it is a sign that you have failed as a coach over the preceding 12 months.

The Three Modern Functions of an Annual Review

  • A Holistic “Look Back”: The review serves as a formal, written summary of everything you’ve already discussed in your one-on-ones. It synthesizes the year’s performance against the SMART objectives that you set together 12 months prior. It’s the final, cumulative lab report based on a year of frequent monitoring.
  • A Strategic “Look Forward”: It’s a dedicated space to zoom out from the month-to-month and discuss long-term career aspirations. “Where do you see yourself in 3-5 years?” “What skills do you need to develop to get there?” “What experiences can I help you gain?” It’s the transition point from evaluating the last year to planning the next.
  • The Formal HR & Compensation Discussion: This is the official forum for the administrative side of management. It’s where you formally document the employee’s performance rating for HR and have the separate, dedicated conversation about their salary increase, bonus, or other compensation changes. By decoupling the money conversation from the day-to-day coaching conversations, you keep your ongoing dialogue focused on development, not on justification for a raise.
A Modern Annual Review Agenda

A well-run annual review meeting should feel like a celebration of progress and a strategic planning session, not a trial.

  1. Employee Self-Assessment Review (30% of time): The employee walks you through their self-assessment, highlighting their biggest accomplishments and challenges of the year in relation to their goals.
  2. Manager Summary (20% of time): You provide your summary, reinforcing their accomplishments and adding your perspective. Again, no surprises. Reference specific examples you’ve discussed throughout the year.
  3. Career & Development Planning (40% of time): The bulk of the conversation is forward-looking. Discuss their long-term goals and brainstorm potential SMART objectives for the upcoming year.
  4. Ratings & Compensation (10% of time): The final, brief part of the conversation. “Based on the great performance we’ve just discussed, your official rating for this year is ‘Exceeds Expectations.’ In line with that, your merit increase for the coming year will be X%.”