TIME MANAGEMENT

1
TIME MANAGEMENT
Society for Academic Emergency Medicine CHIEF
RESIDENTS FORUM May 30, 2008 Washington, DC
Thomas Cook, MD Program Director Palmetto Health
Richland Columbia, South Carolina
2
Welcome to Administration
The beatings will continue until the morale
improves.
3
Three Currencies of Physicians

• Power
• Money
• Time
• The most crucial element to the resident
• Potential for significant differences between
  individual residents

4
What is Time Management?

• BUSINESS MODEL
• Five Resources to Manage
• Capital
• Physical
• Human
• Information
• Time

5
What is Time Management?

• BUSINESS MODEL
• Time is UNIQUE
• Only so much of it
• You can not get more
• Clock can not be speeded up or slowed down
• Must be spent at fixed rate

6
What is Time Management?

• Time Management is a Misnomer
• We can only manage ourselves in relation to time.
• We cannot control how much time we have
• We cannot choose whether to spend it, only how.

7
TIME WASTERS
Twenty Things to Think About
8
1 - Management by Crisis

• EVERYTHING should not be a crisis
• Plan for when things will go wrong
• Establish contingency plans
• Rule of 10s

9
1 - Management by Crisis

• The Killers
• Resident leaves program for any reason
• RC leaves program
• PD leaves program
• The other chief leaves program

10
1 - Management by Crisis

• The Killers (continued)
• DISRUPTIVE RESIDENT
• Resident vs. nursing staff
• Resident vs. patients (ED rage)
• Resident vs. attendings
• Resident vs. office staff
• Resident vs. you (usually about scheduling)

11
1 - Management by Crisis

• The Killers (continued)
• You have an unexpected pregnancy (whoops!)
• You get sued
• Other personal or family crisis

12
1 - Management by Crisis

• The stuff you should have planned for
• Short-term Resident illness
• Resident pregnancies (someone elses)
• Conference lecturer does not show up
• Completing your own assignments

13
2 - Telephone Interruptions

• How much time do you spend on the phone NOT doing
  things that are important?
• Average phone call is SIX minutes
• Check your cell phone log

14
2 - Telephone Interruptions

• NEVER answer the phone at the nurses station or
  office
• Its actually someone elses job
• Do NOT let nurses push you into doing it
• Ask colleagues to send you e-mails
• Never take scheduling requests by voice

15
3 - Inadequate Planning

• Design check lists
• Weekly
• One or two major objectives
• Monthly
• Schedules, schedules, schedules
• Annual
• Graduation, application season

16
3 - Inadequate Planning

• Check lists
• This should be standardized for your job
• Handed down from generation to generation of
  chief residents

17
4 - Attempting Too Much

• Will lend itself to living from crisis to
  crisis
• In the end, nothing is done well
• Including having fun and spending time with family

18
4 - Attempting Too Much

• Causes and Solutions
• Need to achieve
• Insecurity (we have to prove ourselves)
• Failure to delegate authority
• Unrealistic time estimates
• Not knowing when to say no (intense desire to
  please)
• Lack of personal organizational skills
• Perfectionism

19
4 - Attempting Too Much

• Causes and Solutions (How to fix it)
• Learn to delegate
• Learn to say no to the boss
• Learn to estimate time better
• (Learn to plan better)

20
5 - Drop-In Visitors

• Hey, got a minute?
• Its NEVER one minute!
• How do you provide access to you by your
  subordinates?
• Must learn to tactfully encourage time
  efficient communication

21
5 - Drop-In Visitors

• The danger of the open door?
• Find efficient communication systems
• Text messaging
• E-mail, e-mail, e-mail

22
6 - Ineffective Delegation

• Do you have the authority to delegate?
• Cant find anyone to take on responsibility?
• Or is it you?
• Fear of losing control
• Desire for perfection
• Lack of confidence in others
• False sense of efficiency

23
6 - Ineffective Delegation

• Every time you start an activity, ask yourself
  Can someone else do this?
• Residency coordinator
• Other residents
• Office staff

24
6 - Ineffective Delegation

• Steps in effective delegation
• Choose the right person
• Give clear instructions
• Give commensurate authority
• Follow up
• Support and coach as needed
• Resist upward delegation
• Dont do your team members work for them

25
6 - Ineffective Delegation

• Final thought . . . .
• Take care of the people who take care of you
• Incentivise others

26
7 - Personal Disorganization

• Chronically disorganized people are a serious
  liability to their organization
• A loaded desk does not equal a very busy and
  important person
• It only means that you are disorganized

27
7 - Personal Disorganization

• Get a personal digital assistant
• Personal schedules
• Professional schedules
• Contact lists
• Weekly, monthly, and long term goals
• Dont have one?
• You are already behind get with it!

28
8 - Lack of Self-Discipline

• Do not let your new job overwhelm you
• Do not ignore
• Your health
• Your family
• Your personal professional responsibilities
• i.e. scholarly project, procedure logs, etc

29
8 - Lack of Self-Discipline

• Develop a Vision Mission statement
• Stick to it
• Include items for your personal physical, mental,
  and spiritual health
• Develop the habit of self-discipline
• Habits are the chains that set you free

30
9 - Inability to Say NO

• It reminds me of the story of the idiot who hits
  himself in the head with a hammer . . . . .

31
9 - Inability to Say NO

• FOUR steps to saying no
• Listen
• Say no
• Give reasons
• Offer alternatives

32
10 - Procrastination

• Why do people procrastinate?
• Fear of failure
• Lack of interest
• Passive-aggressive behavior

33
10 - Procrastination

• Do not give in to rationalization
• I work best under pressure.
• Set deadlines for important projects
• Set up time to work exclusively on those projects
• Find a quiet space to work (it may not be your
  office)

34
11 - Meetings

• How many of you are responsible for running
  weekly conference?
• If yes, you are charged with managing as many as
  250 hours of meetings per year

35
11 - Meetings

• Steps for success . . . .
• Prepare the agenda (or schedule)
• Make sure all participants know time and place
• Start on time and stick to the schedule
• Sometimes hard to do with guest lecturers
• Be clear UP FRONT about start and stop time

36
12 - Paperwork

• Move towards a paperless environment
• Vacation requests
• Program databases
• Performance evaluations
• Peers, medical students, conference lectures, etc
• Application reviews

37
13 - Leaving Tasks Unfinished

• Missing project deadlines
• Most commonly schedules
• Also scholarly project
• The most common Monkey on your back in
  residency training
• Find quiet time to sit down and focus
• Do not leave until you reach pre-determined
  stopping point

38
14 - Inadequate Staff or Resources

• You need adequate resources for the job
• RC and office staff
• Computers
• Internet access and tools
• Cell phones w/ text messaging
• If you need it, ask for it!
• It may not help you, but may help those that
  follow

These can make up for lack of adequate human
resources
39
15 - Socializing

• Can take up large amounts of time
• Weigh social time against other uses
• Time with family
• Time for self (work out, hobbies)
• Time for study
• Dont overdo it
• You need to be accessible to your subordinates

40
15 - Socializing

• Strategies
• Screen calls
• Request e-mails
• Evaluate the physical set up of your office
• Develop strategies to end social time
• Dont give in to persistent talkers
• Learn how to deal with the boss (PD or Chair)

41
16 - Confused Responsibility or Authority

• Where does the buck stop?
• Know the extent of your authority
• Do not let it be undermined
• By other residents
• By the PD
• Develop SOPs
• Stick to your guns

42
17 - Poor Communication

• Telephone
• Terrible in terms of efficiency
• E-mail
• Best way to disperse general information
• Schedules, meetings, agendas, memos
• Text messaging
• Great for urgent information

43
17 - Poor Communication

• When giving or receiving instructions
• Make sure instructions are clear and concise the
  first time
• Repeat what is to be expected
• Ask questions before you start on something

44
17 - Poor Communication

• A word about e-mail . . . . .
• Good way to hang yourself
• Never write in a moment of anger
• Careful about sending out missiles
• They often create a lot of collateral damage

45
17 - Poor Communication

• A word about e-mail . . . . .
• Never discipline or criticize by e-mail
• MUST be done face-to-face
• Better if done in your office in quiet safe
  environment
• Copy yourself on important messages

46
18 - Inadequate Controls Progress Reports

• Utilize DEADLINES for projects
• Graduation
• Important meetings
• Your scholarly project
• Reminder e-mails are helpful
• Without controls . . .
  you will manage by crisis

47
19 - Incomplete Information

• For each task . . . . .
• Understand objectives
• Understand your level of authority
• Understand all instructions
• Know who you report to
• Estimate what can go wrong

48
20 Automate Repetitive Duties

• Many repetitive duties can be automated with
  computer technologies
• Rotator Orientation
• Medical Student Orientation
• Medical Student Evaluations
• Scheduling requests

49
SUMMARY
If nothing else, do this!
50
SUMMARY

• Adequate Computer Resources
• Notebook computer is preferred
• Group e-mail communication
• Duty Checklists
• Monthly and annual at a minimum
• Scheduling SOP
• Database skill set a must

51
Questions?