Expert Interview

Time management begins with activity management

Susan R. Johnson

Time management expert Susan R. Johnson, MD, MS, is professor of obstetrics and gynecology in the Carver College of Medicine and ombudsperson at the University of Iowa. Through her work in administrative positions and as a clinician, Johnson honed her long-standing interest in time management and recently founded her own company, Thriving Amidst Chaos, to offer coaching, workshops and articles on the topic.

Johnson spoke with Endocrine Today and offered several tips for health care providers to better manage their time.

What was the motivating factor for you to learn about time management and then educate others?

Johnson: I have had an interest in time management since I was in junior high when I first experienced problems with procrastination and knowing how to juggle multiple tasks. I wasn’t very neat either! Like a lot of people, I managed to get by as long as I was in a situation, like school and residency training, where the expectations were clear. Moving to a faculty position, with its multiple missions and the need to make my own decisions about what to do was more challenging, but I muddled through. My moment of truth came, when in addition to my faculty role in research, teaching and clinical care, I accepted a position as a collegiate administrator. Now there were even more choices, along with a huge increase of things to do. I returned to the books I had been collecting over the years, and I discovered techniques that got me back on track. People around me noticed the difference and invited me to speak locally, and that morphed into invitations to other medical schools and to professional societies.

How does time management affect your life?

Johnson: I’m not perfect — my tendency is still to want to put things off — but now I know how to respond when it happens. My work space is organized so that I can focus, and I don’t waste time looking for information, I don’t miss deadlines or forget things, and I use my time more effectively. I save time by using efficient processes, such as for managing email. I’ve also learned not to take on too much at one time, and to finish things before I take on something new. All of this has allowed me to be more productive, and at the same time more relaxed and less stressed.

Why is time management important for health care professionals?

Johnson: It’s tough practicing right now. The pressure to see more patients or earn more RVUs, coupled with time-consuming documentation requirements and other administrative requirements can be overwhelming. As an example, Sinsky and colleagues (Ann Intern Med. 2016;doi:10.7326/M16-0961) studied time use among physicians in four specialties. They found that 2 hours were spent on documentation and desk work for every hour spent seeing patients, and that up to 2 hours was spent after work on medical records. Additional time is needed to keep up with new medical knowledge and practice guidelines and address the increasing expectations from payors.

This is not a sustainable model. A 2013 national survey (Shanafelt et al. Arch Intern Med. 2012;doi:10.1001/archinternmed.2012.3199) found that nearly half of all physicians reported at least one symptom of burnout.

Although there are clearly many systems improvements needed, individuals can make personal changes that will help.

What recommendations would you give to physicians regarding time management?

Johnson: First and foremost, health care professionals need to place a top priority on self-care. While this is heresy to those of us trained to be selfless and put our patients first, the truth is we can’t take care of others if we don’t take care of ourselves.

Here are a couple suggestions. First, take breaks. This includes vacations, weekend time off, and ideally one weeknight free of work. Also, build in short breaks during the day. Even 5 minutes every few hours can make a difference. Try to take time for lunch without doing work. There is evidence that working intensively through an entire day is not as effective as working in shorter spurts.

Another strategy is to use centering technique to help stay in the moment. If we focus just on what we’re currently doing, we work more efficiently and effectively, and with less stress. The simplest technique is to stop and take a deep intentional breath. For another simple method, try Martin Boroson’s one moment meditation technique, which is used in medical centers across the country (www.onemomentmeditation.com).

Finally, there are the things we recommend to our patients, but don’t always find time to do ourselves: exercise, eat right, get enough sleep and nurture relationships. Spending some time alone is not a bad idea either.

What are your strategies for implementing these recommendations?

Johnson: I have one for how to make changes, and another for creating a better balance between work and personal time.

To make a change, first assess what in your life is not going as well as it could be. Then, plan small incremental changes and see if you can move in the right direction. Specifically, pick one thing to work on, and find a change you want to make. Try that for a few days, then evaluate how it went. Tweak and try again if needed. Repeat this cycle until you have something that works. When you are ready, work on something else.

To get more work–life balance, spend a little time at the beginning of the week deciding when you will and when you won’t work, and make some plans for your free time. Even if you end up not being able to keep these boundaries exactly (which may be the norm), by thinking about this in advance you’re more likely to take time to refresh, relax and attend to relationships.

What are some other strategies that will help physicians in their practice?

Johnson: These ideas are more tactical, addressing how to do your work better.

The first strategy is to not “work out of your head.” Memory involves remembering what we did, but there is another kind of memory, prospective memory, which refers to things that we plan to do in the future. A lot of people manage their prospective memory by trying to remember all the tasks they need to do, a job your brain was not designed for. It’s better to record future tasks, whether on a to-do list or a calendar. If you commit to this approach fully, you will be amazed at the reduction in your stress level — and you will get more done, on time.

Physicians are notoriously perfectionistic. That is part of why we are good at our jobs, but dysfunctional perfectionism can get in the way. One manifestation of perfectionism is a reluctance to delegate, with the rationale “I’m faster.” That may be true, but it’s not a good use of your time if the task is part of someone else’s job description. Another downside of perfectionism is spending excessive time trying to create the “perfect note.” This can be tough to overcome, but comparing your notes with those of more efficient respected colleagues can help you start to develop a better sense of what a good, but shorter, note can be.

Third, when we switch frequently between different kinds of work, for example from an email to a seeing a patient, there is a cognitive load associated with the switch that affects the time it takes to settle into the new task. One solution is to work on tasks that require a similar mindset in batches. For physicians, batches can work for email, phone calls and medical documentation.

The fourth suggestion has to do with your own internal time clock. People work at different speeds, and physicians with slow internal speeds face challenges, especially in the clinic. One technique that can help is to use a timer. When you set a timer, your brain responds by speeding up to meet the “deadline.” You can use a timer to do administrative work faster, and you can also use one if you have trouble going over time on patient visits. I have one client who put a timer in her pocket that set to vibrate when she had 10 minutes left in the scheduled time. She found that 10 minutes was a sufficient warning for her to wrap up the visit, and she made dramatic strides in keeping on schedule

A final suggestion is about documentation. Make the time to learn how to use the technology. The more tech fluent you are, the faster you’ll be able to work. I have also found that physicians tend not to use their colleagues as a resource. Your whole group might benefit from spending some time sharing best practices for your EMR.

What misconceptions might health care providers have about time management?

Johnson: Most everyone has misconceptions about this topic! Part of that is the term “time management.” You can’t manage time but you can work on managing your activities to fit the time you have. The managing involves three steps: deciding what you will do, when you will do it, and learning to do work as efficiently and effectively as possible.

Another misconception is that time management is about scheduling every minute to pack in as much as possible. In fact, good time management can lead to more free time. – by Cassie Homer

Disclosure: Johnson reports no relevant financial disclosures.

Susan R. Johnson

Time management expert Susan R. Johnson, MD, MS, is professor of obstetrics and gynecology in the Carver College of Medicine and ombudsperson at the University of Iowa. Through her work in administrative positions and as a clinician, Johnson honed her long-standing interest in time management and recently founded her own company, Thriving Amidst Chaos, to offer coaching, workshops and articles on the topic.

Johnson spoke with Endocrine Today and offered several tips for health care providers to better manage their time.

What was the motivating factor for you to learn about time management and then educate others?

Johnson: I have had an interest in time management since I was in junior high when I first experienced problems with procrastination and knowing how to juggle multiple tasks. I wasn’t very neat either! Like a lot of people, I managed to get by as long as I was in a situation, like school and residency training, where the expectations were clear. Moving to a faculty position, with its multiple missions and the need to make my own decisions about what to do was more challenging, but I muddled through. My moment of truth came, when in addition to my faculty role in research, teaching and clinical care, I accepted a position as a collegiate administrator. Now there were even more choices, along with a huge increase of things to do. I returned to the books I had been collecting over the years, and I discovered techniques that got me back on track. People around me noticed the difference and invited me to speak locally, and that morphed into invitations to other medical schools and to professional societies.

How does time management affect your life?

Johnson: I’m not perfect — my tendency is still to want to put things off — but now I know how to respond when it happens. My work space is organized so that I can focus, and I don’t waste time looking for information, I don’t miss deadlines or forget things, and I use my time more effectively. I save time by using efficient processes, such as for managing email. I’ve also learned not to take on too much at one time, and to finish things before I take on something new. All of this has allowed me to be more productive, and at the same time more relaxed and less stressed.

PAGE BREAK

Why is time management important for health care professionals?

Johnson: It’s tough practicing right now. The pressure to see more patients or earn more RVUs, coupled with time-consuming documentation requirements and other administrative requirements can be overwhelming. As an example, Sinsky and colleagues (Ann Intern Med. 2016;doi:10.7326/M16-0961) studied time use among physicians in four specialties. They found that 2 hours were spent on documentation and desk work for every hour spent seeing patients, and that up to 2 hours was spent after work on medical records. Additional time is needed to keep up with new medical knowledge and practice guidelines and address the increasing expectations from payors.

This is not a sustainable model. A 2013 national survey (Shanafelt et al. Arch Intern Med. 2012;doi:10.1001/archinternmed.2012.3199) found that nearly half of all physicians reported at least one symptom of burnout.

Although there are clearly many systems improvements needed, individuals can make personal changes that will help.

What recommendations would you give to physicians regarding time management?

Johnson: First and foremost, health care professionals need to place a top priority on self-care. While this is heresy to those of us trained to be selfless and put our patients first, the truth is we can’t take care of others if we don’t take care of ourselves.

Here are a couple suggestions. First, take breaks. This includes vacations, weekend time off, and ideally one weeknight free of work. Also, build in short breaks during the day. Even 5 minutes every few hours can make a difference. Try to take time for lunch without doing work. There is evidence that working intensively through an entire day is not as effective as working in shorter spurts.

Another strategy is to use centering technique to help stay in the moment. If we focus just on what we’re currently doing, we work more efficiently and effectively, and with less stress. The simplest technique is to stop and take a deep intentional breath. For another simple method, try Martin Boroson’s one moment meditation technique, which is used in medical centers across the country (www.onemomentmeditation.com).

Finally, there are the things we recommend to our patients, but don’t always find time to do ourselves: exercise, eat right, get enough sleep and nurture relationships. Spending some time alone is not a bad idea either.

What are your strategies for implementing these recommendations?

Johnson: I have one for how to make changes, and another for creating a better balance between work and personal time.

To make a change, first assess what in your life is not going as well as it could be. Then, plan small incremental changes and see if you can move in the right direction. Specifically, pick one thing to work on, and find a change you want to make. Try that for a few days, then evaluate how it went. Tweak and try again if needed. Repeat this cycle until you have something that works. When you are ready, work on something else.

PAGE BREAK

To get more work–life balance, spend a little time at the beginning of the week deciding when you will and when you won’t work, and make some plans for your free time. Even if you end up not being able to keep these boundaries exactly (which may be the norm), by thinking about this in advance you’re more likely to take time to refresh, relax and attend to relationships.

What are some other strategies that will help physicians in their practice?

Johnson: These ideas are more tactical, addressing how to do your work better.

The first strategy is to not “work out of your head.” Memory involves remembering what we did, but there is another kind of memory, prospective memory, which refers to things that we plan to do in the future. A lot of people manage their prospective memory by trying to remember all the tasks they need to do, a job your brain was not designed for. It’s better to record future tasks, whether on a to-do list or a calendar. If you commit to this approach fully, you will be amazed at the reduction in your stress level — and you will get more done, on time.

Physicians are notoriously perfectionistic. That is part of why we are good at our jobs, but dysfunctional perfectionism can get in the way. One manifestation of perfectionism is a reluctance to delegate, with the rationale “I’m faster.” That may be true, but it’s not a good use of your time if the task is part of someone else’s job description. Another downside of perfectionism is spending excessive time trying to create the “perfect note.” This can be tough to overcome, but comparing your notes with those of more efficient respected colleagues can help you start to develop a better sense of what a good, but shorter, note can be.

Third, when we switch frequently between different kinds of work, for example from an email to a seeing a patient, there is a cognitive load associated with the switch that affects the time it takes to settle into the new task. One solution is to work on tasks that require a similar mindset in batches. For physicians, batches can work for email, phone calls and medical documentation.

The fourth suggestion has to do with your own internal time clock. People work at different speeds, and physicians with slow internal speeds face challenges, especially in the clinic. One technique that can help is to use a timer. When you set a timer, your brain responds by speeding up to meet the “deadline.” You can use a timer to do administrative work faster, and you can also use one if you have trouble going over time on patient visits. I have one client who put a timer in her pocket that set to vibrate when she had 10 minutes left in the scheduled time. She found that 10 minutes was a sufficient warning for her to wrap up the visit, and she made dramatic strides in keeping on schedule

PAGE BREAK

A final suggestion is about documentation. Make the time to learn how to use the technology. The more tech fluent you are, the faster you’ll be able to work. I have also found that physicians tend not to use their colleagues as a resource. Your whole group might benefit from spending some time sharing best practices for your EMR.

What misconceptions might health care providers have about time management?

Johnson: Most everyone has misconceptions about this topic! Part of that is the term “time management.” You can’t manage time but you can work on managing your activities to fit the time you have. The managing involves three steps: deciding what you will do, when you will do it, and learning to do work as efficiently and effectively as possible.

Another misconception is that time management is about scheduling every minute to pack in as much as possible. In fact, good time management can lead to more free time. – by Cassie Homer

Disclosure: Johnson reports no relevant financial disclosures.