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SECTION 1: PLANNING AND TIME MANAGEMENT
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Time management is an issue for many people who work in health care today, with too much work and not enough time being a common complaint. People respond differently to the pressures of time. Some like Minna in scenario 1, stay later at work, getting progressively more tired and then finding it more difficult to make decisions, thus finding that work is taking even longer. This is a vicious cycle and can lead to others thinking we are less able or efficient than we are.
We cannot alter the time we have; there are still only 24 hours in a day. We should focus on managing ourselves, our behaviours and how we choose to use the time we have.
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Reflection 1 of 2: Where in a day do you ‘lose’ time? Think through a typical week at work and identify where you might engage in something that is not necessarily time efficient. Maybe it is technological – checking emails too regularly or waiting for the computer to load. Maybe you are engaged in some conversations that are taking you away from the work you must do. Try to see where you might ‘lose’ time in your day. Another way to look at this is to consider where you are ‘giving away’ time to people or tasks that aren’t aligned with your goals. This can be done individually or in small groups. If in small groups, please share thoughts. |
You might like to try a ‘time audit’ for a little while to analyse where your time actually goes. Here are some resources to help you get started:
https://www.mindtools.com/pages/article/newHTE_03.htm
http://www.babblingengineer.com/productivity/time-log-and-time-management/
Time savers:
- Planning
- Delegating
- Saying 'no'
- Procrastination
Do be aware of that favourite phrase of many grandmothers: “More haste, less speed!” In today’s fast paced world, we are often guilty of rushing through something which seems to take less time, only to find that the thing we rushed comes back to us to be done again. If we had taken more time initially, we might have saved time in the long term.
CLICK ON THE TABS BELOW TO REVEAL MORE INFORMATION ABOUT THE TIME SAVERS:
Planning our work time is not just something for those who manage others or plan the rota; we can all benefit from planning at every level of our career. The goals at the start of this module will have given you an idea of what is important to you in both your personal and professional life and so in order to be effective in these areas, you are advised to plan in accordance with these goals.
Many of us only have a vague idea of where we are heading, or where we want to end up, but we do know the values that make us who we are. Using those values, we can develop a greater awareness of which aspects of our future personal and professional lives we do and do not want to develop.
This clip from You Tube https://www.youtube.com/watch?v=MURgliJjbH4 (22 mins) provides an overview of personal and professional effectiveness, some of which repeats elements of this module. It also provides a very useful summary of the extremely popular book on effectiveness by Stephen Covey, ‘The 7 Habits of highly effective people’. If you prefer to read, then the following summary is also very useful: https://blog.hubspot.com/sales/habits-of-highly-effective-people-summary
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In his bestselling book (25 million copies), The 7 Habits of Highly Effective People (1989), Stephen Covey identifies the following habits:
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Notice how many of these habits relate to planning and having a clear idea of the ‘bigger picture.’ Planning helps us to contain our own and others’ expectations of us, thereby managing some of our work stress. Try this exercise to see if it helps to clarify your thoughts.
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Activity 1 of 2: Think of something you would like to do at work. This could be a project, a change in practice, or something relatively small, but still not necessarily easily achieved. Using the SMART acronym answer the following questions: Specific: What do I want to do, and why? How could I go about doing it, in simple steps? Measurable: how can I measure the success of it? If I cannot measure it, maybe it isn't worth doing? Achievable: who can I get to help to do this? What is my time frame? Do I need other support or backing? How can I get that? Relevant: how is this relevant to what we do in my context? How will it improve or enhance what we do here? Timely: how long will this take? Set final and interim timings.
This can be done individually or in small groups. If in small groups, please share thoughts. We can use this acronym to clarify our goal setting around the things we wish to achieve. Try it if you are feeling overwhelmed and need to exert some greater control over your work. |
How many of us with time management issues can truly say that there is nothing in our work that cannot be shared with or handed over to someone else? Look at your workload and consider where some of it might be shared. Many of us in healthcare work with students, trainees and mentees. We often think that taking the time to explain things to them is time wasting, but it can often be time saving once first outlined. Not only can this help your time management, but it greatly enhances their learning experience.
Here are some guidelines for using effective delegation:
- Choose the best person for the task
- Ensure they know specifically what is asked of them and what a good outcome looks like
- Make sure they have the relevant training for the task
- Give them the authority to act on the task
- Give them a relevant and appropriate time frame
- Give clear and supportive feedback on their work
- Retain control and contact
- Agree how often you will check in and give them a way to say ‘get out of my way’ to prevent micro-managing!
Supporting resource: A helpful overview of delegation and a planning form from the NHS London Leadership Academy can be found here:
https://www.londonleadershipacademy.nhs.uk/sites/default/files/Delegating_a_task-LAL1.pdf
Several scenarios in this module involve people who found it difficult to say no, or to share their feelings with their colleagues. This is a common problem in healthcare where professionals feel they must give their all, and never say no. Stop and ask yourself, who knows best about the work you must do? Why, you do, of course. So, you are best placed to decide whether you can take on more of it. People tend to struggle with saying no because they do not know how to say no. Feeling pressured, we often resort to being aggressive, sarcastic, martyr like or avoiding the ‘no’ word altogether and then feeling even more pressured.
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Notice the positive start to Eve’s reply, which followed by a statement of fact about the extra time she is giving above her allocated hours. She acknowledges that she is not complaining about those hours, but that this is a line she is drawing – she cannot take on another commitment. She finishes with an alternative suggestion, with a timescale attached. Because Eve said what she meant, was firm but positive and offered an alternative solution, it is hoped that her saying no would be accepted.
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Activity 2 of 2 Have a go at saying no to the following requests:
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Structuring saying no
So, we might say to request number 1: “I can’t stay late tonight. I already have plans that cannot be changed. I do understand that we are short staffed and want to help so maybe I could do some extra hours tomorrow night?”
If we look at this, we see:
- A clear decision first (Response)
- A reason for that decision without apology or unnecessary detail (Explanation)
- An expression of understanding of the context of the request (Understanding of context)
- An alternative offer (Alternative).
In response to request number 2 we might say: “I understand that somebody has to do it but am not willing to do it alone. We all know it is going to be a difficult conversation, so I suggest two or three of us do it together. I would be willing to be part of a pair or a trio and would help with the preparation.”
Here we see the same factors are being used albeit in a slightly different order:
- Understanding of context
- Clear response
- Explanation
- Alternative
Sometimes we have to say no because a request is not within either our remit or our area of expertise. We can still use this approach. The reply to request number 3 might be: “I can’t do that. I have never done that before and am not able to do it without some training and/or preparation. If this is something you would like me to do in future, then we can discuss how best to equip me to do it.”
Here we see the response including:
- Clear response
- Explanation
- Context understanding
- Alternative
All too often we apologise for not being able to do something when it is not within our ability or resources to do it. Remember that if someone has a right to ask you to do something, you too have a right to say no if it is not within your role, expertise or experience.
Supporting resource: You can find more strategies for saying ‘no’ in the HEE Assertiveness E-learning Module: https://london.hee.nhs.uk/assertiveness-home
20% of people identify themselves as procrastinators. They believe they work better when under pressure and leave things to the last minute. Procrastination can adversely affect health and well-being. This is a learned behavior and therefore can be unlearned.
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Procrastinators tell themselves five lies:
(Marano 2003) |
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Reflection 2 of 2: If you recognise yourself as a procrastinator or find yourself procrastinating from time to time, think about a specific occasion, and consider what might be causing you to delay.
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Try these tips for overcoming procrastination, remembering it is not a condition you were born with, but behaviour you have learned:
- Set yourself a reward; when work is boring or unpleasant, a reward can help us to get it over and done with
- Break it down into smaller tasks if it is overwhelming as you achieve each one you will feel better
- Use planning strategies to allocate time
- Overestimate the time required and when you finish early it is a bonus
- Think about the consequences of not doing it – to others, to yourself
- Get help if you really do not think it is within your capabilities, but remember that procrastinators are often perfectionists too, and that it is likely within your capability to do a good job
- Mark things as urgent or important to prioritise them and deal with the most urgent first
- Imagine you will be incapacitated tomorrow or the next week and then the task will never be done. Better to do it today
- Think of what else you could be doing with your time if you were not wasting it procrastinating
Natural differences of pace.
People do naturally work at different paces – we all know the story of the hare and the tortoise. Some people work in fast bursts and then take time out, often referred to as ‘sprinters’ and others are ‘long distance runners’ preferring to pace themselves more slowly but to keep on going. We might be different in other contexts and our pace may change as we age. Some people claim that they work more slowly in the final years of their career but that their many years of experience can compensate for the slower pace as they need to be less experimental. We need to be aware of the ways in which we view different paces of work. This example illustrates this:
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Example from a professional: Jen told me about two people who work in her department. Person A who we will call ‘Andrew’ was popular, good looking and well dressed. He had a pleasant, friendly way with the patients and the other staff. Person B who we will call ‘Ben’ did the same job but was less well liked. He was less well dressed and sometimes a little short with people. Several colleagues had remarked that he seemed to take more coffee breaks than others, questioning his work rate and efficiency. During a larger audit of departmental work Jen noticed that Ben was actually doing more work than Andrew. He had a naturally faster pace because he did not stop to chat to everyone. He used his coffee breaks to process the patients he had seen, to organise himself, and his work. Ben was not unpopular or rude or unpleasant, he just was not as charming and extrovert as Andrew. Jen said she realised that perhaps there is space for both types of professionals in one department. She also wondered if conversations about work rates and personalities could be a beneficial use of staff development time, so that people were able to see the advantages of different rates and approaches to working. |
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Scenario 1: Minna’s outcome Minna’s educational supervisor could not work out what was going on with Minna and decided to ask her to attend a residential course with her, in the hope that the change of focus and scene would help. During the course they were asked to engage in a piece of reflective practice about a patient case that had not gone according to plan. Minna chose a case that had happened a few months earlier, at the start of her time in the department. However, in the course of the reflection, Minna found herself emotional, and the impact of the case came back to her. She told her supervisor that she felt that the adverse outcome the patient had suffered had been her fault. Her supervisor was astonished at this, and reassured Minna that this was not the case, but took her back though the case again to ascertain why she had come to that conclusion. Minna had been new to the department at that time, had done all that could be done for the patient, but had not sought any feedback or debrief around the case afterwards. The reflection in which she was engaged on the course was the first time that she had been able to voice her concerns and it was an emotional release. Thankfully Minna’s supervisor realised that the case had affected Minna more than she had currently recognised and asked her about her work since then. It transpired that the slower working, the increased diligence and the drop-in confidence were all consequences of Minna’s uncertainty over this case. A further conversation in private to work through the historic case and to address the confidence and time management issues resulted in Minna returning to her previous efficient practice, with some support in managing her time and workload. |
What can be learned from this scenario?
Time management can be an issue for all of us, especially in a pressured service. How we manage our time can make a difference to how we feel about our work and ourselves. A combination of strategies to prioritise what we can do, look for ways to seek help and support when we can, and to be clear headed about decisions, including about what we cannot always do, can be helpful. If we work in close teams it could be beneficial to discuss personal working styles and maximise individual strengths.
Minna’s story shows us that work can often result in an emotional reaction that finding an outlet for can be helpful. Minna could have sought out a trusted colleague to reflect on this case and seek a more experienced perspective which might have saved her from the months of worry she had. Please see the module on reflection at: https://london.hee.nhs.uk/reflective-writing-home
For some other ideas around time management, take a look at this article from the Guardian: Overwhelmed? 10 ways to feel less busy (Burkeman 2016).