Article

Managing time: a doctor-CEO’s guide

When every hour counts.

Time: It is the most precious, yet elusive, commodity. Aristotle called time “the most unknown of all unknown things.”1 Peter F. Drucker, management consultant and writer, once wrote, “Time is the scarcest resource and unless it is managed nothing else can be managed.”2 As it relates to the physician CEO, nothing could be truer: time management constitutes an essential part of increasing efficiency and productivity. Well, that’s easy to say!

Every Sunday, starting at the stroke of midnight, we are each afforded 168 hours of time, to do with as we wish, for the week. It is vital we use those hours effectively. The problem of course is that at least 49 of those hours are already allotted for sleep.

Because most of us don’t simply spend our time counting the hours we have left, it is imperative that we strive to manage them efficiently. As physicians, we juggle myriad activities and interests in our daily lives, and trying to fulfill our responsibilities may become a challenge.

Often we are fooled into thinking that what needs to be balanced are those activities in our personal life juxtaposed with our work-related ones. In reality, this is a misconception because the majority of us enjoy what we do in work, and it certainly has become part of who we are in toto. A better way of looking at this dilemma is to consider balancing our “life” as a whole, by allocating time to the “six buckets of life” (see page 21):

  1. Work: Aim at working no more than 50 hours per week.
  2. Family and friends: Maintain positive relationships with family and friends.
  3. Health: Strive to maintain a proper lifestyle with good sleeping, nutrition and exercise routines and habits.
  4. Spirituality: Reflect, reflect and reflect. Take time to think.
  5. Entertainment: Life has to be fun, too.
  6. Social responsibility: It is our duty to balance the profits we generate with activities that benefit society as a whole.

While these six points may seem like lots to tackle, the reality is that we need to, in some way, combine them. For example, one of my favorite activities is swimming early in the morning. This is a healthy physical activity that also allows me to reflect on the day to come. Traveling to do charity work abroad with your spouse and children combines family time, social responsibility, work and spirituality. This is what “life balance” is about.

Yet, one problem still remains regarding balance: precisely defining the components that we need or want to balance. People who have not taken the time to decide what is important, in essence, who have not been self-reflective, find it difficult to decide priorities.

To summarize these concepts, I am sharing the following four points that I have found helpful in managing time:

  1. Take time for you: Reflect on what “makes you tick”: define your values, your purpose and the things that are important in your life. Take time to exercise and stay healthy, to foster relationships and work on what you love to do. In addition, take time to give of yourself, to others.
  2. Take time from you: Delegate tasks that don’t excite or that take you away from what you enjoy. A recent study from the University of British Columbia and Harvard Business School disproves the myth that “money can’t buy you happiness” and suggests that in fact, paying for the delegation of tasks may be linked to enhanced satisfaction in life.3,4 Master the use of digital technology to your advantage. An important suggestion in this context is the avoidance of “to do” lists. Rather, immediately “delegate” such activities to your calendar, thus effectively “removing” them from your mind until the scheduled date.
  3. Take time to do: Prioritize. Define what is important, whether nonurgent or urgent, and what is not important. Our medical profession is one of service. Take time to serve your patients and consider it the core of what you do. Staying fit and healthy improves your productivity and performance in clinic and the operating room. Practicing self-reflection allows you to better manage your office, providing an improved patient experience. While multitasking (or “polychronicity” or “multifocality”) may seem highly efficient, in reality practicing “monochronicity,” whereby the individual focuses on a specific activity before moving on to the next one, may be a better approach. Embrace determination to complete a project.
  4. Take time not to do: Say “no.” Learn to identify those things that are not important or enjoyable to you. Graciously decline, do not feel guilty and move forward. One cannot be all things to all people: choosing what you are best at, and doing it well, is a better approach.

In practical terms, I recommend outlining on a sheet of paper a general schedule plan that can be adjusted every few months. Then, maximize the use and synchronization of digital calendars, having your team, staff or even family members send you calendar requests to minimize confusion. On the digital entries, one can easily add attachments such as agenda items or even electronic tickets, thus eliminating the waste of time that ensues when looking for these files. In addition, several available project management programs may prove useful depending on the type of practice or activities. The ultimate goal of any technological support is to prevent any pending items from hovering in one’s mind.

The six buckets of life

  1. WORK: Aim at working no more than 50 hours per week. The Royal College of Physicians and Surgeons of Canada, in an effort to define the qualities of a balanced physician, has developed the CanMEDS Roles.5 This constitutes a framework that “identifies and describes the abilities physicians require to effectively meet the health care needs of the people they serve.” It is expected that a competent physician will devote time to seamlessly integrate these six activities to become a “medical expert”: a professional, communicator, collaborator, leader, health advocate and scholar.
  2. FAMILY AND FRIENDS: There is ample evidence that maintaining positive relationships with family and friends leads to enhanced health and happiness in our lives.6,7
  3. HEALTH: Mens sana in corpore sano (Roman poet Juvenal). Strive to maintain a proper lifestyle of good sleeping, nutrition and exercise habits and routines. Technology allows for the development of some of these, from monitoring sleep patterns and sleep apnea management, to proper food balance and physical activity tracking. These in essence create a type of self or small group “competition” that motivates us to improve: Citius, Altius, Fortius. Another easy reminder to stay healthy is to schedule annual physical check-ups around one’s birthday.
  4. SPIRITUALITY: Reflect, reflect and reflect. Whether early in the day, or after a hard day at work, take time to think. Consider what you could have done better in the day, the challenges you faced, and what you can do better tomorrow. The power of self-reflection is one of the most efficient uses of our weekly hours. There are many meditation apps for the novice (i.e., Headspace), with the benefit of training and allowing the mind to focus, flow or be still, achieving the ultimate goal of becoming more productive.
  5. ENTERTAINMENT: You get to decide on your preferred art genre, sporting event or hobby.
  6. SOCIAL RESPONSIBILITY: As physicians and/or managers, we are in a privileged position. It is our duty to balance the profits we generate with activities that benefit society as a whole.8

That sounds simple enough. However, the reality is that we as physicians do not work in a production line. Our days can be fraught with unpredictability and, often, excitement. For many of us, this adrenaline rush of the unexpected is what makes us tick on a daily basis. To avoid burnout and stress, not only internally but also in the office or surgical environment we lead, we must develop an ability to manage time and prioritize. Remember, keep calm, because calm spreads.

In closing, one must not forget the eternal question of why we do what we do. Why do we even have to manage time? Why not bask in the sun until its departure every day? David Viscott (1938-1996), an American psychiatrist, provided what I consider to be an excellent depiction of our purpose in life: “The purpose of life is to discover your gift; the work of life is to develop it; the meaning of life is to give your gift away.”9

Working on our life balance encourages us to develop our gift — whether it’s giving sight to others, educating future generations or raising a family with values, we have a responsibility to nurture that gift. Giving our time, or receiving time from others, is one of the most precious gifts of all. Do not waste it. OM

Acknowledgement: Harry M. Jansen Kraemer Jr, clinical professor of Strategy at Northwestern University’s Kellogg School of Management, for his insights and manuscript comments on outline.

REFERENCES

  1. Aristotle’s philosophy quotes. http://www.philosophyinquotes.com/Aristotle.html . 2010. Accessed Nov. 29, 2017.
  2. Peter Drucker Quotes. https://www.brainyquote.com/quotes/peter_drucker_122188 . 2017. Accessed Nov. 29, 2017.
  3. University of British Columbia. Using money to buy time linked to increased happiness. ScienceDaily. From www.sciencedaily.com/releases/2017/07/170724161258.htm (2017, July 24). Retrieved Sept. 17, 2017.
  4. Whillans AV, Dunn EW, Smeets P, Bekkers R, Norton MI. Buying time promotes happiness. PNAS, 2017 DOI: 10.1073/pnas.1706541114. Accessed Nov. 29, 2017.
  5. The Royal College of Physicians and Surgeons of Canada. http://www.royalcollege.ca/rcsite/canmeds/canmeds-framework-e . Accessed Nov. 29, 2017.
  6. TIME Guide to Happiness. http://www.time.com/collection/guide-to-happiness/4809325/friends-friendship-health-family/ . 2017. Accessed Nov. 29, 2017.
  7. Chopik, WJ. Associations among relational values, support, health and well-being across the adult lifespan. Personal Relationships. 2017;24:408-422.
  8. Investopedia: Social Responsibility. http://www.investopedia.com/terms/s/socialresponsibility.asp . 2017. Accessed Nov.29, 2017.
  9. Quote Investigator. https://quoteinvestigator.com/2014/06/16/purpose-gift . Accessed Nov. 29, 2017.

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