Doctors are increasingly seen as ‘managers’, people who manage. But why are a few much more effective than the rests? Research indicates it is energy and focus which separates 90% of managers from the top 10%, who are more purposeful and employ useful habits.

The bottom 90%

Do you recognise yourself in this? The ‘distracted’ doctor represents 40% of the workforce; they’re highly motivated, full of energy but switch between activities without much sense of purpose and are not good leaders.

Then there’s the ‘procrastinators’, who make up 30%. Experience has taught them that whatever they do, it won’t make a difference so they’re not good motivators.

The next 20% are the ‘disengaged’, who are focused but unexcited by work; lack energy to deal with problems or drive things forward; and get absorbed by routine and fire fighting, with little time for reflection, planning or creative thinking.

The top 10%

These guys maintain their energy, staying focused despite distractions and deciding for themselves what they need to achieve. They manage their work environment and those around them, to achieve their goals. Think about how you could be effective. Where would you start?

Improving effectiveness

Let’s agree ‘purpose’ is a good thing. Often we find our workshop delegates are more concerned to do a job perfectly than to question whether they should be doing it at all. Perfection has its place in medical training but elsewhere it should not blind you to the need to examine routine critically and regularly. Here are two ideas:

1. The Pareto Principle (being selective): the peculiar relationships of any 80% with any 20%, for example we may say that 20% of what we do each day accounts for 80% of the results we achieve. How can this help? It reminds us to be selective, to focus on the few things that matter while doing our best not to get involved with the many trivial things which take up valuable time.

2 Parkinson’s Law (being motivated): as the old adage goes, work expands so as to fill the time available for its completion. This leads to work taking longer than it should because more people get involved and unnecessary tasks are introduced. This damages motivation. Having a sense of purpose leads to doing the right things (being effective). It’s more important than doing things right (being efficient). Look first at where you’re wasting time (Time Log) then plan tasks better.

Useful habits to adopt regarding time

1. Know your time: we all perform better at different times in the day so if we know when this is, we should try to do the most difficult or demanding tasks at that time.

2. Do the worst first: or choose to do these as early as possible and get them out of the way. There’s a sense of relief and a morale boost too.

3. Take breaks: don’t be too busy to take (short) breaks. Those who are refreshed work, think and react better than those who are tired.

4. Impose deadlines: set a timer for 30 minutes to see how many boring admin tasks can be completed before it rings.

5. Plan the day: either do it the night before (preferable) or that morning. If in the morning, you focus on what’s urgent rather than what’s important.

6. Clear for action: whatever you do or wherever you work, it saves energy if you know where you can lay hands on the tools of your trade quickly.

This is Bob Mathers’ final article in this three-part series on time management. Read the first and second parts.

Bob provides non-clinical communications training for health professionals. Email him on bobmathers@btinternet.com or call 07816 230 213.

In the second part of this series, we look at how a doctor has to establish their priorities in order to manage their time effectively. Personal goals are the reference points for most of our decision-making about what to do and when. They are the criteria against which we plan and measure achievements. Self-discipline is also an important element in that planning.

Tasks, objectives and priorities

The question ‘where am I going?’ is more useful than ‘what are my trust’s goals?’ Objectives are even more specific. They are the intermediate steps on the way to achieving goals. Don’t confuse objectives with priorities. Objectives involve the routine tasks relevant to our key responsibilities. Tasks only become priorities in answer to the question: ‘What do I need to do first, now, next?’

Setting priorities

Setting priorities takes practice. Our difficulties with setting them stem from three factors:

1. Too many items on the list.  

2. Not having clear criteria to help us choose.

3. Occasional conflicts of interest.

It pays to be flexible as priorities can change hourly, daily and monthly. Using a diary approach is essential. It’s obvious that activities that will significantly help patients or improve unit performance are often near the top, for example, medical emergencies.

Focus on the important things

The ability to keep a clear focus on important things regardless of what else is happening is a skill worth developing. Start by taking on fewer commitments but trying to deliver them on time.

Ask ‘How urgent or important is it?’ This helps you to focus. We can lessen the potential impact of a task becoming urgent for the wrong reasons by:

1. Reserving time in the diary to do it and protecting that time.

2. Starting the job at the time it falls due even though you are busy.

It is easier said than done, but once you fall behind schedule, you are in trouble.  It often happens because you are sidetracked into other, less important activities. Be ruthless by:   

1. Recognising potential time-wasting activities before committing to them.

2. Say ‘No’ to as many requests for your time as can justifiably be refused.

3. Once you have made the judgement be assertive about it.

Raising expectations

Note that some activities become priorities because of expectations we raise, for example, if we make promises and fail to deliver on time they become urgent.

Difficult though that may be, consider lowering others’ expectations. If ‘urgent’ is what we have to do within the next two hours, ‘manageable’ might be whatever we can comfortably do within the next few days. So keep any priority list short.

Using a diary

In our multi-tasking world the diary, electronic or paper, is still our best friend. Use it to:

1. Assemble the chosen priorities (meetings, activities, etc).

2. Provide flexible time cover for when it might be needed.

3. Produce a daily ‘to do’ list (priorities) of no more than a dozen items.

4. Include only simple tasks that could each be done within three to five minutes, for example dictating a letter, making a phone call (with a message ready to leave in case the person is not available).

This is Bob Mathers’ second article in this three-part series on time managemant. Read the first part.

Bob provides non-clinical communications training for health professionals. Email him on bobmathers@btinternet.com or call 07816 230 213.

Our time doesn’t just depend on us. In a doctor’s day-to-day life, fatigue, stress, interruptions and real life keep intervening.

Managing handovers, planning work then re-planning it, all have to be done in the context of:

1. The random nature of work - identifying real emergencies; taking opportunities to do several things at a time safely; disruption of our focus.

2. Other people - communicating purposefully; confronting difficult personalities and behaviour; handling disagreements positively.

3. Our behaviour and attitudes - how we feel on the day; immediate past experiences; strengths and weaknesses, and previous successes and failures.

Shared learning on time management

Doctors need to look on time management as learning a ‘personal specialty’. Invest enough time to learn how to plan the process. Unless you do you will never be truly effective. Try to learn with your medical peers. If only one person in the group is trying to improve their effectiveness it is difficult to make an impact. Don’t just try to do something faster. Concentrate instead on developing useful habits.

Keeping a time log

Consultants need to find out how they are currently using their time. Until you do, you can never identify unproductive periods, far less eliminate them. Log activities under selected headings (no more than ten) and record daily for around a month or until a rough pattern emerges.

Examples of time log headings

Key                        Main activity                        Including:

I                            Inspection                           Ward rounds, patient visits

E                           Education                            Study periods, conferences

M                           Meetings                             Committees, handovers

A                           Administration                       Patient notes, forms, emails

Doctors then have to analyse the data it produces. Look for the unnecessary demands, recurring interruptions, outside influences which ‘steal’ your time. Aim to take action. Examples of typical time stealers include:

1. Procrastination/indecision/lack of planning/unfocussed activity

2. Unpunctuality/forgetfulness/too easy personal access

3. Unclear personal objectives/untidy workplace/lost paperwork

4. Fear of failure/perfectionism/poor attitudes/cynicism/negativity

The impact of work practices

It’s not only personality traits that steal time. Poor work practices can also have a massive impact on our success in managing time. Examples of poor work practices stealing our time include:

1. Inadequate or poor communications/untrained staff and colleagues

2. Bureaucracy/ disorganised managers/low work standards tolerated

3. Information overload/missing or incorrect information

It is easy to ignore the importance of organising our own work correctly. But unless the big tasks are being completed as priorities, no amount of skirmishing with time will solve our problems. We should look at our own attitudes and working inclinations to ensure we build useful habits rather than poor ones. Consultants have to determine what’s important to them rather than just ‘urgent’.

Useful habits

1. Articulate - explain clearly to those involved what you’re doing.

2. Delegate - don’t do it all yourself; train others, they’ll take responsibility.

3. Start - if you start a planned task on time, the chances are you’ll finish it.

4. Finish - forget perfection, doing your best will be good enough if it’s on time.

5. Say ‘No’- limit people’s access to you; encourage them to think for themselves, rather than dump on you.

This is the first article in a three-part series.

Bob Mathers provides non-clinical communications training for health professionals. Email Bob on bobmathers@btinternet.com or call 07816 230 213.