Time management
Senior Clinical Teaching Fellow, Warwick University, UK
Institute of Clinical leadership, West Midlands Workforce Deanery, UK
E-mail: veronicawilkie{at}doctors.org.uk
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Abstract |
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 TOP Abstract IntroductionBenefits of time managementIdentifying what needs to...Prioritizing what needs to...DelegationWhy do people fail...Other benefits of good...References |
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Veronica Wilkie is editor and Robert Cragg is an author in the forthcoming book ‘Management for New GPs’ due to be published by the RCGP later this year.
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Introduction |
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TOPAbstractIntroductionBenefits of time managementIdentifying what needs to...Prioritizing what needs to...DelegationWhy do people fail...Other benefits of good...References |
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‘Don’t say you don’t have enough time. You have exactly the same number of hours per day that were given to Helen Keller, Pasteur, Michelangelo, Mother Teresa, Leonardo da Vinci, Thomas Jefferson, and Albert Einstein’ H. Jackson Brown (1991)
Good management makes for better patient safety and happier NHS professionals. The RCGP curriculum includes management as part of curriculum statement 4.1 to help new GPs and Associates in training see how working as a GP depends on the smooth running of the system in which they work also contributes to good patient care. This article looks to give a few hints and tips on managing time for Associates in training.
NHS GPs face a number of conflicting challenges balancing the quality of care against the quantity of patients, prioritizing between elective and emergency caseloads, juggling administration and medical responsibilities. On top of these staff shortages, inefficient systems and interruptions can add to workloads further.
These workload demands are not periodic or predictable but are dynamic and constantly changing. In order to survive, all of us need to develop our own coping strategies to manage their time effectively (Maitland, 1995).
Time management is a discipline comprising of tools and techniques that once introduced into your working life can enable you to be more productive at work, while enabling you to maximize free time. As with any discipline, time management requires focus and initially requires both effort and concentration to overcome old habits and attitudes, hopefully leading to new, more effective working practices.
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Benefits of time management |
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The benefits of time management are self-evident. Being in control of time enables a clear focus to be retained on objectives and sense of purpose, the knock-on of which leads to increased productivity and or a more organized working day. Prioritizing workload in the absence of external pressures is more likely to lead to correct decision making about how time is managed.
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Identifying what needs to be done |
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The irony of time management strategies is ‘they take time to perform’—it is necessary to invest time, to save time.
A good habit to get into is taking a quiet 10 minutes, at the start of a working day, to think through what needs to be achieved. An age-old time management mantra is
- ‘STOP’
- ‘Stop, Think, Operationalize, Perform’.
During this time, it helps to do a realistic ‘to-do list’. Recording activities in this way focuses attention on the job in hand and ensures that key jobs are not forgotten. During a ‘normal working day’ your to-do list might accept the normal, surgery, administration, visits, surgery format, also including a note to make time to speak to the District Nurses, or phone a colleague, about a particular patient. Imagine you arrive at work, looking forward to seeing your children in a school play that evening, only to find that of your three doctors teaching practice, one of your colleagues has called in sick, another is on holiday and the registrar is away doing his exams....
It would pay you to spend a few moments to think about what can be done, obviously discussing the situation with the receptionists and/or practice manager. Some of the things you might list might be (and this list will also include items you might do everyday) the following.
- Asking the Practice manager to call the locum agency to see if support is available tomorrow or if help can be provided this afternoon.
- Making sure that the receptionists know how many appointment slots are available and to look to reduce appointments that are routine and non urgent.
- Reduce demand by triaging patients on the phone to see if they still need their appointment and identifying if any patients would be willing to surgery tomorrow, instead of today. Who is best to do this?
- Start your surgery on time.
- Signing routine referral letters from yesterday's surgery.
- Contact the district nurse team to see if the home patients known to them can be triaged by the community nursing time and have their visit delayed.
- Go through mounting pile of non-patient-related post and circulars.
- Get the Administration team to look for exceptional asterisked results that require action, filing all routines and bringing urgencies to your attention.
- Determine if the practice nurse has any capacity to see specific patients in addition to her existing list.
- Complete insurance forms.
A typical GP to-do list should focus on the aims of the day which are to get patients seen both in the practice and in the community and act on abnormal results. Allocating a time to each task will enable you to keep a check on progress as you progress through your work.
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Prioritizing what needs to be done |
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The way to-do lists are prioritized (and many GPs probably have a mental rather than a written list on a day-to-day basis) is critical to making the most of a working day. Covey helped develop the theory of prioritization developing the belief that all tasks can be analyzed over two axes of importance and urgency. Each activity therefore has a value of importance and urgency unique to that task, which Covey believes can be mapped out onto a 2 x 2 matrix. Each person's perspective of urgency and importance will differ, as all individuals are unique in the way that issues are prioritized based on individual value base or working preference (Covey, 1999). So your most urgent need might be that urgent visit, but it is still important to make sure the rest of the patients are seen appropriately.
‘Urgency’ in this context is usually defined or dictated by the needs of others, for example patient's need or an organization's deadlines, whereas ‘importance’ relates to individual needs, for example developmental activities. Covey suggests that we should spend our time performing just important activities, working in a way that prevents urgent work materializing. This can be difficult to achieve in today's NHS but underlies the preventative side of medicine, which underlies much of modern day general practice. Covey believes that we ensure we perform working tasks that are ‘not urgent but important’ where we have the time and concentration to do a job well (Covey, 1999).
So using this scheme your emerging scenario might also include a request from a patient for a form to do with insurance or benefits claim. You would obviously reduce that request to a lower level of importance but be sure to make time to do this once your medical staffing is back to normal, that is when delegated a task from others, it is vital to assess workload before accepting the task. ‘Only accepting the task if it is possible given other commitments’. This balance is particularly difficult for doctors in training who must balance appearing approachable without being a ‘pushover’, must balance the needs of training with the service needs.
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Delegation |
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Once tasks have been prioritized decisions on which tasks can be delegated and to whom must be made.
Good delegation can reap many rewards for those who do this well, saving valuable personal time, and done well can encourage others to invest both in their own development and their standing in the organization. If applied correctly, delegating tasks to others can be motivational. Conversely poor delegation baffles, aggravates, induces stress and leads to potential failure of achieving the task.
Delegation is more than a simple instruction, telling someone else what to do; delegation of tasks must be done in such a way that the person receiving the task is ‘empowered’ and may directly or indirectly receive an incentive, be it developmental, including a feeling of satisfaction in getting the team through a difficult patch (Maitland, 1995).
Delegation is often mistaken as an all or nothing process, with the individual delegated the task having to assume full responsibility for the task in question. This approach to delegation can be too restrictive, narrowing the range of individuals upon which the dealer can call upon. A more effective way is to visualize delegation is as a ‘scale of accumulative responsibility’ that can be given to an individual.
The critical step is to ensure the ‘freedom allocated within the task matches the competence and reliability of the person being delegated to’. Good delegation can build relationships, confidence and trust between team members.
Like setting objectives, delegated tasks must follow key guidelines:
- setting explicit jobs under mutual consent
- these ‘jobs are quantifiable, pragmatic, time specific, appropriate and documented.
So when looking at the ‘nightmare day’ described above, any tasks delegated need to be done well, with appropriate back up, and to the right people when allocating some of the tasks, for instance:
- telephone triage of appointments made for later today to see if the appointment is appropriate the patient to postpone
- looking forward at the rest of the weeks’ appointments to free up spaces
- identifying experienced clinical staff in the practice to share the burden of some of the more urgent clinical needs
- appointing an individual to identify abnormal results to bring to the attention of a GP, leaving those marked as normal by the laboratory for review later on in the day
- identify members of the wider team to see if they are able to assist with any of the home visits or checking if some visits can be done at another time.
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Why do people fail to delegate? |
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Doctors who are stressed often have problems delegating tasks to others. The reasons underlying such difficulties are varied but may include
- desire for perfectionism
- doubting the ability of peers
- failure to relinquish control
- failure to develop trust or take the time to invest in peer relations sufficient to ask for help and support
- dysfunctional team dynamics
- poor communication.
All of these will lead to reduced team functioning, the reduced ability of the team to perform when unforeseen circumstances occur and therefore a reduction in patient safety.
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Other benefits of good time management |
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Other things to consider besides prioritization and delegation when looking at good time management are as follows.
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Administration
Not taking the time to manage your in tray and personal administration can lead to disorganization. Hoarding needless administration and untidiness leads to loss or delay in finding, compiling and sending key correspondence. It is worth reflecting on what you write, over long letters are rarely read by the recipients and are probably disliked by the secretarial staff who type them.
Taking on too much
Doctors are enthusiasts and can run the risk of delegating well but still taking on too much. Even worse is the individual who fails to delegate and still takes on too much. Good time management would mean that the individual thinks or even talks through with his peers and colleagues when he does extra things, no one wants to cause others to become burnt out, and we need to make sure that outside commitments are done in such a way that the clinical need at the practice is covered, and not just by our colleagues working ever harder! Team members who fail to resolve productivity issues in their peers are at risk of becoming less effective at their own jobs as they try to compensate for their colleagues ‘for the good of their team’.
Not making time to save time
In today's target-driven service, it can be difficult to take time out from seeing the ever increasing pressure of patient and service demand to discuss developments and improvement ideas. However taking a half-day once in a while can soon pay dividends through enhanced efficiency in the medium to long term, by planning workload against need, investing in research to widen the clinical team and how it is used and to look at training and development needs of the whole practice.
Turning a blind eye
System failings can be allowed to persist if time is not taken out to correct poor or struggling performance. Productivity problems in one person will impact on the wider team. Therefore, it falls to peers and managers alike to address performance issues. Historically addressing inadequacies in colleagues has been erratic; however, the culture is gradually changing with appraisal and redevelopment becoming the norm, as the NHS nears revalidation and recertification of doctors at every level of service. The best thing is to stop the problem ever surfacing in the first place.
Time drift
‘For tyme y-lost may not recovered be’. Geoffrey Chaucer (c. 1340–1400).
There are days in any career in which drive and motivation are lost and when procrastination can take hold (McGee-Cooper, 1994). Such dawdling is normal on an occasional basis but if not controlled can all too soon edge its way into daily practice and bad habits take hold. A few top tips to keep on track include the follows.
- Avoid unnecessary interruptions and perhaps allow all urgent calls to a nominated duty doctor, who has time allocated to deal with them
- Do not delay surgery start time through idle chatter—the time can be difficult to make up once surgery has started
- Avoid getting embroiled with practice or NHS politics if there are other people who are better placed to intervene
- If you cannot fit in everything to your day, make time to discuss it with your colleagues and managers to look at solutions early before problems develop
- Where possible work on an ‘empty’ desk principle. Keep up to date with referrals and paperwork and avoid leaving an ever increasing in tray, something important at the bottom may never be reached.
- Make good use of tea breaks; breaks to refresh the mind and concentration are essential but avoid unnecessarily prolonged or frequent ones.
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Delay can be positive
Occasionally delaying action can be the correct thing to do (Maitland, 1995). An example of this might be when an individual is tired. When you are tired or unwell, tackling jobs that require tact and sensitivity, and that are not urgent, might lead to greater calls on your time or that of another member of the team later when ‘the pieces’ need to be ‘picked up’ so ideally saving actions for when there is space to do this properly, and in a timely manner, and when your mind is fully engaged can save ‘time’ in the long run.
Some aspects of modern communications can help as well as hinder time management, for instance:
- e-mails and electronic task lists can be put aside (and out of mind), until there is a suitable space to do them properly
- e-mails can become an addictive problem giving the impression of immediate replies required and giving such tasks an unnecessary priority
- having a mobile phone turned on and the number available to all your colleagues can help in making yourself available at all times but
- it can also lead to frequent distractions during surgeries or home visits thus prolonging the consultation and creating a risk of missing vital information from the patients.
Key points
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References |
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TOPAbstractIntroductionBenefits of time managementIdentifying what needs to...Prioritizing what needs to...DelegationWhy do people fail...Other benefits of good...References |
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Covey S. First things first ((1999)) New edition. New York: Simon & Schuster Ltd.
Edward Young. Night thoughts. Night i. Line 39. In: Night thoughts: or, the complaint and the consolation ((1742 and 1745)) New edition. Mineola New York: William Blake Dover Publications. (August 20, 1996).
Geoffrey Chaucer. Troilus and Criseyde Penguin classics ((c. 1340–1400)) Reissue edition. (April 30, 1971).
Jackson Brown H. Life's little instruction book. ((1991)) Nashville: Thomas Nelson.
Maitland I. Managing your time. Management Shaper series. Wolverhampton: Chartered Institute of Personnel and Development.
McGee-Cooper A. Time management for unmanageable people ((1994)) London: Bantam Doubleday Dell Publishing Group.
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