The Challenges of Time Management Physicians are swamped: heavy patient loads, mountains of administrative demands, endless team and departmental meetings, and the list goes on. The result? Patients are kept waiting. Work becomes less enjoyable. Stress builds; and "expendable" activities, such as exercise, family time, and sleep, are jettisoned. Part of the problem, experts say, is that most people, including physicians, aren't trained to manage their time. While time management is an integral part of many corporate management training programs, medical training is about "triaging emergencies," says Dr Craig Gordon, a nephrologist and assistant professor of medicine at Boston University Medical Center. "We are trained how to be busy, so we don't stop to ask questions like, 'Is this the best way?' and, 'How do I want to spend my time?'" How do you address the problem? Here's some advice designed specifically for doctors. 1. Develop self-awareness. "Medicine is full of type A personalities," says Dr Gordon. For many, introspection isn't a frequent activity. To improve your time management skills, you really need to know your personal strengths, weaknesses, habits, and goals. When are you at your best? Are you a morning person or a night owl? What makes you drag your feet? For Dr Gordon, waiting for big blocks of uninterrupted time to tackle large projects "is just another form of procrastination." Instead, he breaks big projects into more manageable pieces. What's more, he's figured out that he can get far more accomplished on those projects during a couple of hours in a coffee shop over the weekend than he can in his office during the week. 2. Huddle with your team. In a practice situation, Elizabeth Woodcock, an Atlanta -based consultant and author of Mastering Patient Flow: Using Lean Thinking to Improve Your Practice Operations, recommends starting each day with a staff huddle. It's a chance to identify time-saving opportunities. For example, you can identify the best times to work in patients if you know which patients on your schedule are likely to be no-shows. Similarly, "if your nurse knows that Mr Jones has trouble walking and takes 20 minutes to get from his car to the office, you can head that off by making plans at the morning huddle to meet him with a wheelchair,"she says. "It's great customer service, and it helps you stay on time." 3. Start on time. Woodcock advises practices to prepare examination rooms the evening before. If office hours start at 8 am, the first patient should be scheduled for 7:45 to allow time for greeting, registration, and clinical intake. That way, the physician can begin promptly. The same rule applies for the first appointment after lunch. 4. Work with your scheduler. If every patient visit runs 5 minutes longer than scheduled, despite your best and repeated attempts to be on time, then talk to your scheduler about strategies for adjusting your workload. Can the scheduler increase the amount of time he or she allocates for patient visits or work a 15-minute break into your midmorning schedule to give you a chance to get back on track? Yes, such strategies are a productivity ding, but they'll reduce your stress and, by improving your on-time performance, may boost your patient satisfaction scores. "This has to be a team effort," says Ken Hertz, a principal with MGMA Health Care Consulting Group. Steps That Help Create More Time 5. Look for role models. "Practices will always have someone who does a really good job figuring out how to use the electronic health record (EHR) or how to work with their staff," says Hertz. "Look to those people and identify best practices." 6. Create protocols to limit interruptions. "The electronic environment makes it easy to pass the buck," Woodcock says. Practices need to ensure that every staff member is working to their practice level and that everyone on the team is engaged in patient care so they are not simply forwarding messages to the physician's task queue. That means investing time in establishing protocols for everything from message taking to how refills are handled. 7. Establish a strategy for dealing with messages. There's no one-size-fits-all solution here, Woodcock says. Some doctors can tackle a few quick messages between appointments. For others, that's a recipe for falling behind. Those doctors may find it best to create pockets of time every hour or two to respond to nonurgent messages. But don't wait too long, Woodcock cautions. "If you wait until the 3-hour mark to respond, you are going to start getting call-backs from patients." Waiting until the end of the day is even worse, she says. Not only will you have redundant messages from frustrated patients, there won't be anyone left in the office to whom you can delegate the work. 8. Hire a scribe. Scribes can be costly, but for doctors who can't type and are struggling with their practice's EHR, they can be a godsend. Woodcock says that scribes aren't a long-term solution, and doctors coming out of training today won't need them, but for some established physicians, "they can fill in a very important gap in functionality." She advises practices to hire a true medical scribe—not just a typist. "Figure out what you want from a scribe and hire to those qualifications." 9. Set the agenda. When patients raise questions about new and unrelated problems and concerns at the end of the visit, it can throw a wrench into your schedule. Try to head off those moments at the outset by setting an agenda for the visit, Woodcock says. Have your nurse find out the patient's priorities for the appointment as part of the rooming process. After listening to the patient's complaint, at the outset of the visit, recap what he or she said, agree that that's what you'll be focusing on, and ask if there is anything else that needs to be discussed. That initial time investment keeps the encounter focused and prevents last-minute diversions. 10. Optimize your EHR. Your EHR can be the best thing that ever happened to your productivity—or the worst. It depends on the system's functionality and user-friendliness and the quality and frequency of training physicians and staff receive. Optimizing your system requires a huge up-front commitment of time and energy, Woodcock says, but it pays off in the long run. 11. Use gadgets and tools. Everyone understands the importance of Health Insurance Portability and Accountability Act (HIPAA) confidentiality and the reason why idle computers log staff members off. "But how many times a day do you log into your system?" Woodcock asks. "Thirty? Forty? It's crazy." Biometric screening can minimize log-in time. Fully equipped workstations on wheels can save you a trip down the hall to the printer, and a good old fashioned clock will keep you mindful of your time, she says."No one wears watches anymore, so no one knows what time it is. Put clocks in exam rooms and nurses' stations." 12. See the big picture. Congratulations! You've been asked to write a paper, speak at a conference, sit on a committee, or join a board. It may be an honor, but deciding whether or not you should commit to the new responsibility depends in part on understanding your long- and short-term goals, says Dr Gordon, who published a paper on physicians and time management in the May 2014 issue of thePostgraduate Medical Journal[1] and has led numerous time-management seminars for physicians. Time management is about much more than maintaining efficiency and punctuality in the clinical arena. It is a critical skill if physicians are to maintain work/life balance, avoid burnout, manage additional nonclinical responsibilities, and achieve their personal and professional goals. Whether they're conducting research, serving on committees, or writing papers, "almost everybody has additional roles these days," he says. Before taking on new responsibilities, physicians need to consider how the new tasks will advance their career goals and how they will allocate their time. Considering these questions at the outset enables physicians not only to identify and focus on the most meaningful tasks but to devise realistic time-management strategies for accomplishing them. Source
