1. Time Management: how hard can it really be? Carlos E. Araya, MD Pediatric Nephrology

3. Introduction Everyone has demands on their time It is commonly thought that: – Residents and Fellows are overworked and have little time left over – No time for personal lives – Can lead to job/life dissatisfaction This lecture will give some tips on how to manage your time

4. Inefficient Time Use Most time management literature is centered in the business area However, studies have shown the inefficiencies of trainees Lurie et al. found that most of the time in a clinical rotation was not spent in direct patient care (90 to 180 minutes in a 24hr call). If time could be spent more efficiently: – Direct patient care – Reading medical literature – Performing research

5. Pareto’s Principle and Time Wasters Pareto’s 80/20 principle: – 80% of the time is spent to do 20% of the work 3-4 times the amount of time is used to get the job done Due to Time Wasters: – Ill-defined goals – Procrastination – Priorities and deadlines associated with poor delegation of responsabilities Eliminating Time Wasters allows you to accomplish more work in less time.

6. Principles of Time Management Set Goals: – Knowing what the goal is before you start a task will direct energy and save time Short and long term goals: – Allows you to define a value and prioritize – Example: finish writing the book chapter by editor’s deadline (long term). Write draft of introduction (short term) – Short term goals may be broken down into daily goals for planning – Update goals and leave room for error

7. Set Priorities Do the important things first and allow them more time Sometimes we tackle the urgent over the important things (answering a friends call vs studying for the boards). The four quadrant method is helpful in prioritizing

8. Four Quadrant Method 1.Urgent and Important Crises Pressing problems Deadline driven projects (cardiac arrest, floor emergencies, book chapters, family responsibilities) 2. Not Urgent but Important Preparation Goal clarification Planning Crisis prevention (Research projects, CME, board certification, exercise) 3.Urgent but Not Important Interruptions (Phone calls, visits from friends or relatives, gossip) 4. Not Urgent and Not Important Busywork (shopping, watching TV, gourmet cooking, excesive sport activities)

9. Quadrant 1: Urgent and Important Quadrant 1 activities are easy to recognize Require immediate action and may lead to inefficiency, procrastination of other important projects However, it is important to prepare for time spent in Quadrant 1 (know ACLS, common floor/specialty problems, etc) The best way to avoid as much Quadrant 1 are activities in Quadrant 2 (Not Urgent but Important)

10. Quadrant 2: Not Urgent but Important Most important quadrant If quadrant 2 is neglected, quadrant 1 crises will cause more disruption Example: – I neglected to plan for writing the chapter (Quad 2) and spent free time watching football (Quad 4), now I am missing the deadline and are in crises (Quad 1) Too much time in Quadrant 1 = – Stress, stomachaches, marital problems, poor sleep Less time = – Less stress, increased life satisfaction, etc

11. Quadrant 3: Urgent but Not Important It is difficult to determine what falls in this category It is common to give these activities much more time than they deserve This may lead to trouble Example: I spent too much time with a friend yesterday and did not have time to read up on rapid sequence intubation prior to my first PICU call; I got called to a patient with respiratory distress, and now will struggle handling the crisis

12. Quadrant 4: Not Urgent and Not Important They cause the most trouble Are easy to define, but difficult if unmotivated to ignore Pleasant activities like sports, pleasure reading, etc are hard to ignore They are very important for emotional well being. However, if given excessive time will cause disruption

13. Communication, Delegation, Supervision Organize tasks and decide which should be performed by yourself and which by others Communicate assertively, not aggressively when giving instructions Delegating does not end by telling someone to do a job – Make sure resources are available to do the job, so that it can be done correctly – Follow up with the progress of the job, give guidance when needed and credit too Example: a patient needs a kidney biopsy. Have the fellow set up for the procedure, then call you when ready to begin.

14. Dictations and Chart Writing Writing H & Ps, progress, procedure notes,etc is very time consuming. Documentation methods other than handwriting are more efficient Words per minute – Write: 15 – Type: 20 to 60 – Dictate: 65 to 95

15. Getting Started Daily and weekly “To Do Lists” are helpful Smartphones or PDAs have applications that help people manage their professional/personal affairs more effectively Manage interruptions Avoid procrastination – Primary reason for professional failure – Four main reasons for procrastination

16. 1. Fear of Failure The most common and least rational cause Keep in mind that failure is rarely fatal Through failure we learn to succeed the next time Break large projects into smaller parts and schedule time to complete the smaller projects

17. 2. Perfection Paralysis Expecting to achieve perfection in everything When faced with this, ask yourself: – What does perfection really mean? – How much will it cost to achieve(energy, time, money)? – Is it worth the effort? A more realistic goal is to do thebest you can with what you have The process of your efforts and not the outcome is just if not more important

18. 3. Fear of Success Women: – Successful career at the expense of family life – Make more money than husband = husband feels threatened – Sabotage their own success Overcome it by learning to feel good about success Have a sense of purpose or mission in life to get beyond the fear

19. 4. Lack of Self-Discipline It is hard to do the most important and difficult task first Set up a reward system It is hard to change procrastination behaviors or old habits, but it is more enjoyable to accomplish the things you want to do

20. Conclusions Time management is how effectively time is spent Succesfull people manage their time very well Most people need some guidance Set goals Delegate when appropriate Avoid procrastination Focus your efforts Remember it is not time we are trying to manage… it is ourselves

21. Thanks for Listening! Questions or Comments?