Border control Psychological boundaries need to be protected even stronger and more sensitively than territorial boundaries. After all, a person whose psychic territory is constantly invaded by uninvited guests has to deal with extremely unpleasant consequences of such visits. Him

Lack of Control Lack of control over the circumstances of your life can be a powerful source of stress. Jessie feels like her co-workers think poorly of her and she has no way of influencing their thoughts. She would also like to take a vacation, but believes that

Control When you feel a situation is getting out of control, your brain may perceive it as a threat, activating an appropriate stress response (as we saw with rats in Chapter 9). Cultivate independence and independence in your subordinates

A person takes best care of himself when others take care of him too.

George Savile

to whom: owners, top managers, executives

“Control - how much is in this word...”, or is it worth “pressing the control pedal” in all cases?

Control - how much this word contains for the Russian heart! How much echoed in him... We have a national tradition: going to extremes. As a result, companies either have no control at all, or managers try to solve most of the problems that arise by strengthening control.

Indeed, in some cases it is difficult to do without increased control. But in many others, this measure is as effective as putting out a fire with gasoline.

What awaits a manager who indiscriminately “presses the control pedal” when faced with problems in the work of his subordinates? A special position “controller” appears in the company (or division), and then “controller of the controller”, “controller of the controller of the controller”, etc.

After some time it suddenly turns out that the control consumes an excessive amount of time both the boss and his subordinates and, worst of all, the quality of work still remains mediocre. As a result, the manager develops two misconceptions: " it's easier to do everything yourself" And " I'm surrounded by slackers and mediocrities".

Does this mean that control is harmful? Of course not, because without control, things will simply be left to chance and it is easy to predict what disastrous result this will lead to.

So, I have come to the goal of this article: to show how to build a control system in a company, properly control your subordinates, and in which cases control is appropriate and in which it is extremely harmful.

Consequences of overcontrol

• Demotivation of employees. Why should we strain ourselves and do high-quality work right away if the manager monitors and corrects everything for us? Consequence: degradation of employees’ professional competencies and quality of work.
• Manager demotivation. The time spent monitoring and correcting defects begins to exceed the time required to complete the work itself. Consequence: degradation of the manager’s managerial competencies and the quality of the work performed.
• Low efficiency of both the company as a whole and in departments in particular. The manager spends excessive time on control instead of developing the unit, while employees spend too much time on participating in control activities instead of producing results.

Of course, there are other consequences: for example, high staff turnover, degradation of company processes.

Is it possible to replace control with anything?

Control- one of the basic competencies of a leader. It is impossible to do without it, because... The manager is responsible for the work of all his subordinates (within the hierarchy, projects, functional projects and tasks). You can hardly be held responsible for something that is not under your control.

What is the meaning of control? Make sure that the results of the work (both intermediate and final) and the process of achieving the result comply with the specified parameters, requirements and standards.

The worse a manager knows how to plan and delegate, the more he is forced to control. Many managers follow a seemingly simpler path: instead of developing their “Planning” and “Delegation” competencies, they begin to use the “Control” competency at 1000%. Which becomes one of the most common causes of excessive control in an organization. Other reasons and ways to overcome them will be discussed below.

Causes of overcontrol

I would like to convey the idea once again that I think the main problem is not so much the lack of control (we’ll talk about this a little later), but its excessiveness.

In this case, one gets the impression that everything is serious and competent, but in essence it turns out to be “rotten at the core,” because instead of developing processes and obtaining results, efforts are focused on controlling “every sneeze.”

1. Employees do NOT comply with agreements

It would be appropriate to ask the question here: “ For what reason may employees not comply with agreements?" Before placing the blame on careless subordinates, I propose to consider one of the most common, but few people take into account, reasons.

1.1. The manager does not comply with agreements

For many, this comes as a revelation, but... Often, employees comply with agreements exactly as much as the manager himself adheres to agreements with his subordinates. Of course, I am not considering pathological lazy people and slackers here. We are talking about conscientious workers.

Therefore, when a manager constantly “forgets” and “forgets,” he must be ready to “receive return.”

How can we make agreements more likely to be observed?

Eliminate the “moral right” not to comply with an agreement by an employee:

1. If an employee believes that you (his manager) are not complying with the agreement, let him give feedback (in the form of status/opinion, but not complaints).
2. Record and analyze the feedback received, use it to develop your professional and managerial skills. If you really broke the agreement, make it a teaching example for others. And, of course, if possible, correct the consequences.
3. If you consider it necessary to revise previously agreed upon agreements, inform the employee in advance. It will be useful to voice your motives (why you are reconsidering).

1.2. Low culture of compliance with agreements in the company

Yes, a lot depends on the corporate culture and whether the rule works there “ If you can’t fulfill the agreement, let me know”, and whether any measures are taken against those who violate it.

It sounds simple enough, but this is one case where enormous effort and scale are required to solve the problem. Those. “wonderful mantras” for employees from the category “ keeping your word is good“If they act, it will be temporary and not for everyone. And all because in our (Russian) culture it is not very common to observe agreements.

1.3. Sabotage, disruptive actions

In this case, you need to follow these steps:

1. First, it is necessary to identify the “opponents,” “disruptors,” “anti-leaders,” and “freeloaders.” The article “” will help you with this.
2. Show the employee the “right path” and the consequences of deviations from it.
3. If the dynamics are negative, say goodbye.

2. Low professional qualifications of employees

Let's return to the reasons for excessive control. One of them is the low qualifications of employees. Indeed, “students” and “newbies” need to be controlled at every step. As soon as you turn away, there is already “an armful of broken firewood” in front of you.

A typical mistake is to hire unqualified employees and replace the proper level of their professionalism through excessive control by the manager. Is it possible to? Yes, if “forget” to count the time, which the boss will spend on excessive control. As a rule, it costs more than the money saved on staff salaries.

The solution to the problem will be either upgrading the employee’s qualifications, or, if this is not possible, transferring him to another position or dismissing him.

In some cases, it is possible to build a technology for performing work so that the task is performed correctly even by a low-skilled employee.

3. Low managerial competencies of the manager

With poor development of the “Planning” and “Delegation” competencies, the manager is forced to overuse the “Control” competency.

This alignment is appropriate only in one case: the manager is rapidly and purposefully developing his “Planning” and “Delegation” competencies. If this does not happen, a leader with “excessive control” does much more harm than good (see above “Consequences of excessive control”)

How to identify such leaders? When the mistakes of his subordinates are revealed, you hear the famous phrase: “ I can't control everything!".

What to do with such leaders? The same as with subordinates who need to be constantly monitored because of their low qualifications: train them or say goodbye to them.

Careful study and practice of the following articles will help you improve your “Delegation” competence:

• Article No. 1: “”.
• Article No. 2: “”.

• Article No. 1: “”.
• Article No. 2: “”.
• Article No. 3: “”.

4. Poor employee planning

It is the manager's job to ensure that employees use the necessary technologies, including scheduling. A typical mistake (and it’s simply easier for some “soft” managers) is to think in the spirit of “ let everyone use the technology they like, as long as there is a result" But what often happens in the end? There is either no result, or it is very different from the required one.

Therefore, the manager must introduce general planning technologies for all employees (they may differ depending on the type of work: planning for office employees and production workers will be different).

Where appropriate, involve employees in the development of planning technology and its further improvement. But, as I have said more than once, agreements must be observed 100% before new ones are concluded (this means that proposals are welcomed, but amateur activity without authority is punished).

To solve the problem of planning on the part of subordinates, I recommend turning to the same list of articles as for managers (given above).

5. Pathological distrust of subordinates on the part of the manager

It appears when employees do not fulfill their agreements (we discussed this option above), as well as in the absence of skills and knowledge on the part of the manager (the “low qualifications” option).

There are, of course, “clinical cases” when a leader sincerely considers himself the “navel of the earth”, and everyone else is obviously stupider, more clueless, lazier, more resourceful. The only problem is that such a leader’s employees actually become stupider, more clueless, lazier, and more resourceful.

No magic, just business. After all, the way a boss perceives his subordinates is reflected in their actual behavior. You can’t trust a slacker with an important task, and someone who doesn’t do important tasks becomes a slacker. The circle is closed. I sincerely hope that this is not about you as a leader. But if you suddenly recognize yourself in this description, it is better to change your views and behavior later than never.

Key principles of management control

The causes and consequences of excessive control have been discussed, in my opinion, in sufficient detail. Now I propose to delve into the study of the process of building effective and non-redundant control.

1. Monitor compliance with agreements by employees

Your company should follow the following rule: “ if something is agreed upon, it must be carried out" If someone leaves the agreements or wants to change them, they must inform the other party.

To ensure that things don’t work out differently, monitor compliance with agreements. Set control points and be sure to respond to deviations (without reaction, control becomes meaningless).

2. Plan control tasks in advance

If you assign a task to an employee and want to control its result and other parameters (including deadlines, final document, etc.), immediately set yourself a separate task for control.

For component tasks, projects and processes, identify and record the most critical stages (the points of no return or the highest risks, when if something goes wrong, it will cause serious losses) and pre-plan intermediate controls before they occur.

Select control points based on the individual's performance trends and their area of ​​immediate development.

3. Classify control every time, analyze and draw conclusions

Write down a list of one-time and regular tasks that you now need to control.

Determine whether this item is redundant control or integral? If it is redundant, put the appropriate reason from the ones I discussed above.

Ask yourself questions:

• Has this situation already been repeated with a similar task/employee?
• What needs to be done to solve the same problem with less control (change the technology for solving the problem, replace the performer, etc.)?
• How feasible is it to perform these activities (resources, time, cost, etc.)?
• Is it possible to delegate control to another employee?

Based on the responses received, plan corrective actions based on the identified problem.

Example #1: The need to monitor (listen to) every negotiation between a sales manager and a potential client indicates the employee’s low professional qualifications. So, the first thing you need to do is plan his training.

Example #2: Monitoring daily employee reports can be divided into two main segments of work.

1) Work related to the formal side:

• do the tasks have results?
• are they formatted correctly?
• Are work reports recorded in the system?

2) Work related to the evaluation of the result:

• Does the quality of the result meet the specified parameters?
• Is the optimal amount of time spent on the task?

In example No. 2, control of work from segment No. 1 can be delegated to an employee with a low level of qualifications, while work from segment No. 2 can be performed either by a manager or an expert in the performer’s professional field.

4. Delegate and automate control

One of the surest ways to reduce the time spent on control by a manager is: 1) delegate most of it to subordinates. 2) come up with and implement technology into the work so that the control function is performed during the work process (automate).

4.1. With the help of checklists, employees will be able to monitor the correctness of their work themselves.

For repetitive tasks, it is necessary to organize the process of performing the work so that the employee can check the result for errors/deviations himself (i.e., actually control himself).

Checklists for performing sequential tasks will help with this. One of the options for such checklists is tables with the following columns:

• Name of the checklist item(for example: for the “Write an article” task, one of the checklist items will be “Upload pictures for the article to a specially designated folder on the server”).
• Status “Done / NOT Done”. When an employee completes an item, he sets the status to “Completed.”
• Link to regulations. As a rule, this is a link to the necessary section of the regulations on how to perform the work. The link is necessary because for one process (checklist) there may be several regulations, each of which describes only a certain stage of the process. For the task “Prepare and post an article on the website” the following regulations are used: 1) Requirements for the article and images; 2) Content manager algorithm; 3) How to prepare an email newsletter.

A checklist is a kind of “super-regulation” that lists all the actions necessary to complete a task or process. The employee goes through the checklist and marks the completed items.

Bonus for attentive readers: example of a checklist

Would you like to get a sample of a working checklist based on the example of the “Preparing and posting an article on a website as part of content marketing” process, which you can use as a template for creating your own checklists?

Follow 2 simple steps:

1) Leave a comment to the article at the very bottom, as in the screenshot at the link: https://yadi.sk/i/QHQ2_R4oiWjkV (Write briefly your experience in supervising employees: the difficulties you encountered and how you managed to overcome them).
2) Send a request to receive an example of a verification checklist through my personal accounts on social networks (via private message) + attach a link to this article:

4.2. The work submitted for control must be completed 100%

Often subordinates provide results with the expectation that the manager will find and correct all errors and inaccuracies. That's why they don't try too hard. On the other hand, the work can be so important that it needs to be checked in any case, and the employee knows about it.

How to make sure that a subordinate does not rely on control, leaving a gap in the quality of the work performed? Brief principles:

• Require that work be submitted for inspection if it is considered 100% completed.
• If an employee has any questions, he must voice them before the start of the control.
• All deviations not specified when transferring work to control are assessed as errors or misconduct. Based on them, the manager draws conclusions about the employee’s professional qualifications and its dynamics.

4.3. Control at intermediate stages of processes by employees

The dream of any manager: for employees to control each other when transferring intermediate results. In some business processes this is more than justified.

For example, a construction team receives materials from a warehouse to build a house. In this case (where possible), they must check the completeness and quality of the materials upon receipt.

A widespread problem is that employees from adjacent departments cover for each other, guided by the principle “my house is on the edge” and “today I covered you, and tomorrow you cover me.” How to deal with this? Exhortations are useless, but motivation will be effective. Options that can be used both together and separately:

• If the team arrives at the construction site with a shortage, delivery will be organized at their expense.
• Both participants are punished (both the one who made the marriage and the one who missed and accepted the marriage). An option is possible when costs are divided in half between warehouse workers and builders or in some percentage.

5. Organize the possibility of delayed control

It is not always possible for a manager to physically control the results of work immediately after its completion by subordinates. But what to do in cases where control is necessary? Often, a manager is forced to rearrange his work schedule.

Yes, in some cases immediate control is necessary, especially when the further stage of the task cannot be completed until the previous one is controlled.

In other cases, the manager should have the opportunity to apply deferred control. To do this, it is necessary to organize the work of subordinates so that:

• All intermediate results were recorded (example: in the “Selection of a new employee” process, the results of negotiations with each applicant were recorded).
• The history of comments and discussions was saved (if employees discussed or commented on a document, it should be possible to view “closed” comments + links to brief summaries of the discussion and tasks associated with them, they can be added in a separate tab for tables, in the project log, at the very bottom of the regulations ).
• The history of document editing was saved (seeing what contribution a particular employee made to a document and when, as well as how the time spent on a task is compared with this contribution is priceless).
• All tasks completed during the day and the time spent on them were recorded (this is solved using a formalized task setting system).

Errors when using the “Control” competency

Some of the typical errors were listed and discussed above in the article, where it was appropriate in the context. The rest have been collected by me here.

Mistake #1. Punish employees with control

There are managers who believe that if you make control unpleasant for an employee, he will strive to do the work so well that control is not needed. However, in fact, it turns out that the employee begins to avoid control, while quality does not increase.

Therefore, if you, as a manager, are forced to strengthen control, you must:

• Explain the reasons for increasing control to the subordinate, clearly convey your position based on the results of the analysis of a particular case. If the reason is the employee, determine the time to correct the trend and explain the purpose of strengthening control. In this way, motivate him to do the work in such a way that it requires less control (as a result, the manager’s managerial time).
• During control and discussion of its results with a subordinate, concentrate on the goal (high-quality performance of work), and not on the control process.
• Use the results of control to develop the subordinate’s professional skills and his area of ​​immediate development.

Mistake #2. “You can do without any control at all”

Based on the results of the control, the employee receives feedback. If there is no control, then the employee is unlikely to develop (mistakes will be repeated and accumulated).

In the absence of control, only top-class specialists and fans of their craft can work efficiently. But they can sometimes “go in the wrong direction” and, for example, spend resources on an interesting, but useless project for the company.

Mistake #3. Favor sudden control

In some companies, employees and the manager play a sort of catch/don't-catch game. The leader controls suddenly, swoops in like a kite.

But... abuse of sudden control indicates a low culture of compliance with agreements. If employees do not fulfill agreements, then, alas, no sudden control will help. Yes, sudden control is needed (to keep employees on their toes), but, in my opinion, its share should not exceed 10% of the total number of control tasks.

Please note that selective control differs from sudden control in that the employee knows about the manager’s plans to control the work of his subordinates, but the control itself is carried out selectively.

For example, as part of selective control, a manager reviews several employee work reports per month, and not every day. Sudden control is when the manager does not check the reports at all, and then suddenly does it once a year. Even for sudden control, 1 year is too long a period.

The bottom line: the vast majority of control tasks should be planned in advance, and your subordinates should be informed about them.

“Golden Key”, or Which employees are most valuable to a manager

The time spent on control is one of the most important indicators of an employee’s effectiveness. If you have an expert working for you, but you have to control his every sneeze, you need to part with him. But in any case, first the manager needs to ask himself the question “ Do I have any input into why this employee requires excessive supervision?”.

Therefore, I tell my subordinates in plain text: “ Colleagues, we need to organize our work so that the minimum possible control is required on my part. If the time I spend on monitoring your work is too much, then it turns out that it’s easier for me to entrust the task to someone else, do it myself, or abandon it altogether. I also evaluate the level of your qualifications and prospects in the company by the time it takes to supervise you”.

The relevance of diagnosis and treatment of arterial hypertension (AH) continues to increase. Despite the large range of antihypertensive drugs available, it is not possible to achieve the necessary control of blood pressure (BP) due to many reasons: frequent dosing, side effects, inadequate dosage, etc. The review presents an attempt to create an algorithm for selecting antihypertensive therapy with the basic drug valsartan and its combinations with insufficient control and varying degrees of blood pressure increase, taking into account the risk of cardiovascular diseases and target organ damage. The basis was taken from clinical studies conducted on the Russian patient population: VICTORY - a study of valsartan and its combination with hydrochlorothiazide and a Russian observational study of the combination of valsartan and amlodipine. It has been shown that dose titration of valsartan from 80 to 320 mg/day and its combination with hydrochlorothiazide promotes successful blood pressure control in 91.0% of patients, provides a good and very good therapeutic effect in 96.9% of patients and shows a high subjective assessment of quality improvement life. The combination of valsartan with amlodipine is highly effective in grades II and III hypertension and high cardiovascular risk. In particular, initially higher figures for the average level of systolic and diastolic blood pressure were 167.5 ± 16.2 and 100.1 ± 9.2 mm Hg. Art. – decreased to target values ​​in 80% of patients. Thus, an algorithm for the treatment of hypertension with valsartan and its combination with hydrochlorothiazide or amlodipine as basic antihypertensive drugs was created. At the same time, it was possible to achieve blood pressure control in 80–91% of patients with hypertension of varying degrees.

Keywords: arterial hypertension, insufficient control, blood pressure, combination therapy, antihypertensive therapy algorithm.

For quotation: Zagidullin N.Sh., Sukhareva N.N. Possibilities of antihypertensive therapy in case of insufficient control of arterial hypertension // Breast Cancer. Medical Review. 2017. No. 11. pp. 780-785

Possibilities of antihypertensive therapy in inadequate blood pressure control
Zagidullin N.Sh., Sukhareva N.N.

Bashkir State Medical University, Ufa

The importance of diagnostics and treatment of arterial hypertension is only increasing with the time. Despite the existing number of antihypertensive medicines, the adequate blood pressure control is not achieved because of the variety of reasons: frequency of administration, side effects, inadequate dosages, etc. In this review an attempt was made to create an algorithm for antihypertensive therapy based on valsartan in patients who do not control blood pressure at different degrees of hypertension, taking into account risks and target organ damages. The algorithm is also based on the clinical studies conducted in the Russian population such as VICTORY study with valsartan and its combination with hydrochlorothiazide and the Russian observational study with combination valsartan and amlodipine. It has been shown that the titration of valsartan from 80 to 320 mg/day and its combination with hydrochlorothiazide contributes to the successful control of blood pressure in 91.0% of patients, leads to a good and very good therapeutic effect in 96.9 % of patients and has a high subjective assessment of the treatment. A combination of valsartan with amlodipine is effective at severe stages of hypertension and in patients with high cardiovascular risk. In particular, initial blood pressure 167.5±16.2/100.1±9.2 mm Hg can be decreased to target level in 80% of patients. Thus, the algorithm for the treatment of arterial hypertension was developed using valsartan and its combination with hydrochlorothiazide or amlodipine as the basic antihypertensive medicines to achieve blood pressure control in 80–91% of patients at different degrees of arterial hypertension.

Key words: arterial hypertension, inadequate control, blood pressure, combined therapy, algorithm for hypertension treatment.
For citation: Zagidullin N.Sh., Sukhareva N.N. Possibilities of antihypertensive therapy in inadequate blood pressure control // RMJ. 2017. No. 11. P. 780–785.

The article is devoted to the possibilities of antihypertensive therapy in case of insufficient control of arterial hypertension

Arterial hypertension (AH) is a very common pathological condition, and its prevalence in the Russian Federation reaches 45%. A number of clinical studies have shown that lowering blood pressure (BP) to recommended values, including in patients at high risk of cardiovascular disease (CVD), leads to a significant reduction in mortality. Achieving target blood pressure levels with the help of antihypertensive drugs can reduce mortality from cerebral stroke by 35–40% and coronary heart disease (CHD) by 20–25%. When taking antihypertensive drugs, you should first of all strive to strictly control blood pressure and achieve its optimal values. If the degree of blood pressure reduction is insufficient, adjustment and selection of the most effective treatment regimen is required. The attending outpatient physician, with limited time to communicate with the patient, needs disease treatment algorithms developed on the basis of available scientific evidence. It is important to take into account recommendations for the selection of therapy, its safety, and concomitant diseases. The frequency of dosing is also important: the latest recommendations give preference to a single daily dose, which significantly increases patient compliance. Therefore, a modern antihypertensive drug should have a wide range of dosages for easy titration. Considering that 70–80% of patients require combination therapy, fixed combinations with different dosages are advisable, which would make the process of drug titration more convenient and allow choosing therapy for any degree of hypertension.
Currently, for most of the most commonly used antihypertensive drugs, an extensive evidence base has been created, based on randomized clinical trials and meta-analyses. At the same time, given the high prevalence of cardiovascular drugs in Russia, data from studies conducted in our country are of particular value.

Choosing a class of antihypertensive drug

Algorithm for selecting therapy for insufficient control of hypertension

Conclusion

Literature

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