Abstract
When I was a young child, I remember being taken to our general practitioner in the small industrial town in North India where I was born. His surgery/clinic and pharmacy were downstairs and very prominently placed was a framed embroidered wall hanging that read: ‘We kill time and time kills us’. Since then, I have been aware of how limited time we have and why it is important not to waste it because lost time is never going to return. It is lost forever.
In clinical medicine, in particular, managing time is an important skill because whether we are clinicians, teachers, researchers or involved in medical politics or any other activities, often limited time faces unlimited demands that can put any of us under extreme pressure leading to burnout and compassion fatigue, as discussed in earlier letters.
Different personality styles will have different approaches to managing time. Some of these are inherent styles whereas we can learn to manage time before time starts to manage us. Sandford 1 proposes that different personality styles influence both attitudes to time management as well as practicalities of prioritisation and management. Her observation is that individuals who are judging and sensing according to the Myers–Briggs Type Indicator are better at time management. That is reflected in their inability to relax and judging preferences, which can make them stressed. Sensing/perceiving types may show flexibility whereas intuitive/feeling types are the sensitive ones and will give time freely to others and find it hard to say no. This is likely to add further pressure on their time and, consequently, on them. Intuitive/thinking types see time as a concept but not necessary to take actions. It is worth learning about your own personal style and strengths and weaknesses so that your individual approaches to time management can be developed through appropriate strategies.
The key step in managing time is to be clear about work/life balance. This will allow your personal priorities to emerge. Knowing one's own strengths and weaknesses can help us understand the pressures we will be put under, how we manage them according to outcomes we want, linking these with what we see as our goals and purpose of life. This understanding can form the core of our professional and personal functioning. Suitable approaches and strategies can thus be developed according to the needs, pressures and preferred outcomes.
The first step is to explore how we use time. A good starting point is keeping a diary for a couple of weeks using half-hour slots. This can give us an overview of what we do during the day, including working time, but also when we relax. The log or diary need not be complex but by simply noting down each activity (in half-hour slots) and checking whether this was imposed upon us or planned can give us an idea of how to further set priorities. Keeping a time diary can be fun but it is important to be honest about it. Imposed activities can be emergenciesor interruptions when colleagues drop in for chat/advice/coffee. If your job takes you to multiple sites, then it is important to note down travel times too. Inevitably, in certain cases work will spill into home and it may be very difficult to keep clear boundaries between the two. Try and avoid keeping your diary during your holidays!
After keeping the time diary or time logbook for at least a couple of weeks, look at it carefully and note if any clear patterns emerge. It will allow you to consider the possibility of interruptions whether these were avoidable or not. If you are constantly interrupted, the question to explore is whether these were necessary or casual interruptions. If the latter, is it because you have an open-door policy that can be extremely helpful, but it also means that if your door is closed, people know not to disturb you. It is helpful to know from your time diary about who the disruptors are and how you manage them. A key responsibility of the team leader in many settings is to delegate tasks to the most suitably skilled, qualified and appropriate individual and not because you do not like them. Other options are either dealing with the matter yourself or ditching it. When you look at the time diary, does it tell you whether you are spending inappropriate time on certain tasks rather than on others that may need to be prioritised or delegated?
Identifying, prioritising and allocating tasks can be an extremely helpful way of getting tasks done within the allocated time. Inevitably, clinical matters will take priority, and depending upon your job, various approaches can be used. For example, looking carefully at your time diary will help you to set priorities. In some settings, it may be worth your while to spend time before the formal start of the day to look at your diary and plan your day, focusing on deciding how much time you will spend on certain activities. Some individuals tend to carry out this task the day before so that they are prepared. This may, of course, change or be knocked out completely by urgent and unexpected demands.
Covey 2 proposed a quadrant of urgent–non-urgent and important–non-important matters. For example, clinical matters and emergencies are both urgent and important though other activities related to clinical services such as prevention or strategy development may be important but not urgent. Non-important and non-urgent activities may be interruptions, which can take inordinate time and contribute to stress.
Doctors need to organise and plan work activities but need to remember that unexpected emergencies may knock their schedules out. But planning and using information can help keep better records and reduce stress. Efforts can be made to have other colleagues cover the emergencies if you are busy dealing with other urgent and important acts. Doctors must be aware of effects of change, both nationally and locally and how these will influence any time management practices. Furthermore, it may help if you recognise how your body clock works. For example, if you are a morning person then having morning meetings can be more productive.
Managing time is about prioritising what is urgent and important, urgent and not important, and important but not urgent. We have become so dependent upon emails and electronic media that we appear to be focusing incessantly on them. It may be worth thinking about setting a limit on how often you check them. Twice a day, perhaps once in the morning and once before leaving for home, should suffice although it is for you to decide how often you do that so that everyone knows when to expect a response. In the days of snail mail no one expected an immediate response (if that was needed, then people would use telephones). It is helpful to see emails as one form of communication to respond appropriately. There is nothing more annoying than responding to all 300 people copied in the original email thus wasting other people's time.
A key part of time management in medicine is also managing teams in an appropriate manner. Motivating team members through training and support can enable individuals to take on more suitable work thereby freeing you to focus on urgent and important things. It is worth recognising that once you have delegated the task, do monitor the progress by all means but do not keep badgering the person as to whether they have carried out the task. Be available to support and advise but do not interfere unnecessarily.
Using a framework of mastery, Nielsen 3 challenges different myths we have about time. In this framework, he argues that your experience (relating to strengths and weaknesses) influences the importance of the task, its design (to address it), the inspiration behind it and the celebration of its completion. Nielsen argues that the framework helps deal with common time management challenges and frustrations.
As a young doctor, you need to get your work–life balance and priorities right. In leadership roles, you may need to be more inspirational and influential, as well as both a leader and a manager. A key skill to achieve all this is managing time effectively. The key to time management is not measuring seconds, minutes or hours but focusing on the full spectrum of work–life balance, bearing in mind the capabilities you have of bringing about sustained change in the world.