The time management guide A practical handbook for physicians by physicians Hema Patel Derek Puddester The time management guide A practical handbook for physicians by physicians Hema Patel | Derek Puddester The time management guide A practical handbook for physicians by physicians © 2012 The Royal College of Physicians and Surgeons of Canada All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage or retrieval system, without permission in writing from the publisher. Permissions may be sought directly from the CanMEDS and Faculty Development Unit at the Royal College of Physicians and Surgeons of Canada at [email protected] Printed in Ottawa, Ontario, Canada. First printing. Cover photo: Shutterstock ISBN: 978-1-926588-16-2 How to reference this document: Patel H, Puddester D. The time management guide: A practical handbook for physicians by physicians. Ottawa: Royal College of Physicians and Surgeons; 2012. Contents About the authors iv Foreword v Introduction | 1 Part 1: Basic concepts in time management 1 Time management: the surface and the core | 7 2 Where does the time go? | 13 3 Time-keeping and goal-keeping | 25 4 Models and frameworks | 37 Part 2: Getting organized: practical tools for time management 5 Owning your schedule | 41 6 Making your workspace work for you | 59 7 Time-efficient communication | 69 8 Recycling, multi-tasking, batching, and using small bits of time | 83 9 Are your papers in order? | 93 10 Making it practical | 96 Part 3: Interpersonal skills for effective time management 11 Effective teamwork | 109 12 Meetings | 118 13 Managing interruptions | 130 14 Delegating and outsourcing | 137 Part 4: Investing in yourself 15 Overcoming procrastination | 147 16 Building time for yourself | 154 17 Managing transitions | 167 Serendipity | 175 Appendix A: A time diary template 177 Appendix B: Time management tips for in special contexts 179 Index 183 The time management guide iv © 2012 Royal College of Physicians and Surgeons of Canada About the authors Hema Patel Dr. Patel, MD, FRCPC, MSc (Clin Epi), is a mother of two, wife, daughter, sister, friend, colleague, teacher, and learner. She is an associate professor of Pediatrics with the McGill University Health Centre, with specific training in Clinical Epidemiology (University of Toronto) and Academic Ambulatory Pediatrics (The Hospital for Sick Kids, Toronto). Her undergraduate studies at McMaster University were followed by medical school at the University of Western Ontario and residency in Pediatrics at Dalhousie University. She is active in teaching, advocacy, and clinical research. Her work focuses on the comprehensive care of children with complex needs, and she has a particular interest in advocacy for vulnerable pediatric populations. Her educational activities include an emphasis on the CanMEDS Manager training objectives. Currently she supervises the Academic General Pediatric Fellowship, McGill University, and is program head of the Complex Care Service at the Montreal Children’s Hospital, McGill University Health Centre. She has won awards for teaching, advocacy, program innovation, research, and snorkeling. She is a firm believer in beginning with the end in mind. Derek Puddester Dr. Puddester, BA, B Med Sc, MD, MEd, FRCPC, completed his undergraduate training in English and Russian Studies and in Medicine at Memorial University of Newfoundland. He completed a residency in Psychiatry at McMaster University and a fellowship in Child Psychiatry at the University of Ottawa. He is the medical leader of the Behavioural Neurosciences and Consultation-Liaison Team at the Children’s Hospital of Eastern Ontario (CHEO), a service that strives to meet the mental health needs of children and youth with severe physical and mental illnesses. Dr. Puddester is also the director of Continuing Medical Education and Professional Development for the Department of Psychiatry at CHEO. Dr. Puddester is an associate professor of Medicine at the University of Ottawa, where he also served as director of the Faculty Wellness Program. Dr. Puddester’s educational and research work focuses on physician health, healthy work environments, e-learning, disruptive physician behaviour and professionalism, and curriculum theory and development. He is a proud Newfoundlander, parent, and son. Ask him about geocaching, the value of play, and the power of actualized ideas. v © 2012 Royal College of Physicians and Surgeons of Canada Foreword Jason R. Frank, MD, MA(Ed), FRCPC how me a physician with time to spare and I’ll pinch you to stop you from dreaming. In 21st-century medical prac- tice, there is no such thing as quiet professional contemplation or a relaxing chat in the hospital lounge. Those days are long gone, having been replaced by a frenetic push for maximum productivity: how many cases can you take care of while main- taining quality, avoiding error, escaping burnout, remaining human, ensuring income, and keeping everyone satisfied? Although physicians may have contemplated the most effective methods of organizing their practice for as long as there has been medicine, only in recent years has our profes- sion formally incorporated expertise in personal effectiveness and time management into the required competencies of the physician’s role. Fellows of the Royal College have articulated the essential abilities of the competent 21st-century physician in the CanMEDS Roles Framework. Included in its seven do- mains are competencies in the effective management of one’s practice, career, and self, primarily in the Manager Role. The authors of the CanMEDS Manager domain never envisioned that all physicians would need to pursue an MBA; rather, they felt that the evidence called for a set of essential abilities that all physicians need for an effective and satisfying professional life. These are articulated in four core competencies within the CanMEDS Manager Role. Clearly, effective time management is crucial to each of these: • To participate in activities that contribute to the effectiveness of their health care organizations and systems; • To manage their practice and career effectively; • To allocate finite health care resources appropriately; • To serve in administration and leadership roles, as appropriate. S The time management guide vi © 2012 Royal College of Physicians and Surgeons of Canada Do you need this book? Ask yourself the following: • Are you among the majority of physicians who reported in the 2010 National Physician Survey that they worked over 50 hours a week and at least 30 extra hours on call? • Are you part of the 40 percent of other specialists who reported in the 2010 National Physician Survey an increase in their weekly work hours during the past two years? • Have you ever been hours behind in a clinical day? • Does your stack of long-ignored journals that you should be reading now replace your bedside furniture? • Do you believe that time management is only for “type A” personalities? • Are you always late for meetings? • Do you want to carve out more time for your family? • Is your medical work never-ending? • Are you looking for ways to plan your work week better? • Do you secretly stroll through the self-help section of your local bookstore hoping to find a book that will reveal the “secret” to making your many demands “work”? • Do you have trouble “getting it all done”? • Do you feel stressed just contemplating what you need to do today or tomorrow? If you answered yes to any of these questions, this book is for you. The Time Management Guide is a timely and important resource for the enhancement of physician capabilities. The authors have assembled an accessible, practical guide to essen- tial abilities we all need for 21st-century practice. Read on, and the benefits will flow to you, your work, your loved ones, and your patients. Office of Education Royal College of Physicians and Surgeons of Canada 1 © 2012 Royal College of Physicians and Surgeons of Canada Introduction • Time management is about behaviours, not time. • It is about matching your behaviours with your true priorities and goals. • Like any skill, it takes time to master. t is probably safe to assume that if you are thinking about reading this book it is because you wish you had more time in your day to get things done. But the secret of time manage- ment lies in understanding that it is all about behaviours, not having more minutes or hours in a day. The modus operandi of many physicians faced with an increasing workload is to work harder and longer to get things done. This strategy got most of us through medical school and our residency years. In his in- fluential book The 7 Habits of Highly Effective People,* Stephen R. Covey recounts the old tale of a woodcutter attempting, with great effort, to saw down a tree. Someone approaches the woodcutter and asks him why he does not sharpen his saw. The woodcutter replies that he is too busy sawing to stop and sharpen the blade. The average physician might find it upsetting to realize that his or her work strategies are no more logical from a time- management perspective than the woodcutter’s. Nonetheless, physicians frequently sacrifice time with family and friends, and the time they need to look after their own health and to pursue personal interests, in an effort to meet seemingly end- less work commitments. There comes a time to realize that simply throwing more effort at a situation is just not working. It’s time to stop, take stock, and sharpen the saw. * Covey SR. The 7 habits of highly effective people. New York: Free Press; 1989. p 287. I The time management guide 2 © 2012 Royal College of Physicians and Surgeons of Canada Time and priorities Time is a limited resource: as much as we’d like to, we can- not add more hours to a day. The only solution to not having “enough” time is to make better use of the time we do have. This involves making choices, and those choices need to be based on a clear understanding of how we do, and do not, want to use our time. In other words, we need to be clear about our priorities. After spending years following the direction of others in medical school and residency, controlling our own use of time might not come easily. However, by reflecting on our values and mapping out our goals, we can begin to make de- cisions about how best to allocate our time. If we choose to “just work harder” without considering what tasks are truly meaningful to us, other people’s priorities are likely to start edging out our own. Sometimes when we present the material in this book in workshops for physicians, participants tell us they don’t want to live by lists or to have every minute of their day tightly orga- nized. We understand the need for a healthy balance between organizational efficiency and creativity. Most physicians need both —but, usually, the more they have of the former, the more time there is for the latter. To never take time to think about one’s behaviours and attitudes with respect to time reflects a pas- sive stance that can only lead, as pressures mount, to reactive and often unconstructive behaviours—and, eventually, to burn- out. A smarter approach is to make a proactive investment in planning how we will spend our time. What to expect from this book This book is intended to help physicians match their behav- iours with their authentic priorities, values, and goals. It melds big-picture concerns with day-to-day tools and strategies. In Part 1, we reflect on general concepts and models for time management, with an emphasis on values and goals. Reading through these chapters provides a way of “checking in” with Introduction 3 © 2012 Royal College of Physicians and Surgeons of Canada yourself, and builds a foundation for the practical techniques offered in the other chapters. In Part 2, we describe practical techniques and tools for tak- ing control of your schedule, making your workspace more efficient, using technologies for communication and infor- mation management in a way that is both time-effective and collegial, and adopting time-efficient habits such as “recycling,” “batching,” and taking advantage of small windows of time. In Part 3, we examine interpersonal skills that will help you run your professional life more smoothly. We look at the in- gredients for time-efficient teamwork and meetings, how to manage interruptions, and how to delegate. Finally, Part 4 encourages you to invest in yourself. We look at ways to overcome procrastination, to build in time to look after your own health and fitness, and to protect time for your family and friends. Although the focus of this book is time management for physicians, we realize that time efficiency at work and at home are inextricably linked. Throughout the book we offer tips on how to apply good habits of time management on the home front. Whatever the specialty or environment, work abounds in health care. It’s easy to be busy every moment of the day and yet fail to make satisfying progress toward the things that really matter to us. If this sounds like you, reading this book is a first step to taking control of your time. You may find that some of the strategies we suggest can be absorbed effortlessly into your work habits and daily routine; others will take more time to become reflexive. The most important thing, though, is to start. Like any worthwhile skill, effective time manage- ment takes practice, and a measure of patience with oneself, to master.