Episode 74: Managing your Time in a System Which Sucks with Dr Ed Pooley
Are you using all the time management techniques you know yet still feel unproductive at work? Then maybe it’s time to change the system you’re working in.
No amount of personal time management techniques can save you from loss of time if you have an inefficient work environment. Personal time efficiency is essential but you must also look at the larger system.
Dr Ed Pooley joins us in this episode to share his take on time management techniques for busy individuals. He discusses the three types of competing demands and how to manage them. We also talk about being more comfortable holding difficult conversations about workplace issues – vital to help change the environment we work in.
Tune into this episode to discover how time management techniques and communication can help you get a calmer and more time-efficient workplace.
Here are three reasons why you should listen to the full episode:
- Discover how you can manage competing demands.
- Learn how to improve communication and handle difficult conversations in the workplace.
- Ed shares his top personal and professional time management techniques.
[04:30] About Ed
- Ed hasn’t always been a doctor
- Ed started with bachelor’s and master’s degrees in biomedical sciences.
- He was working on a PhD in psychiatry.
- To fund his studies, he was running his own business, working as a web designer.
- He reapplied for medical school and got accepted. He has now settled on being a GP because he liked that it was flexible.
[05:38] The Importance of Maturity and Exploration in Medicine
- Ed thinks that entering medicine later in life gives you more experience under your belt.
- You’re better able to understand workplace dynamics.
- Ed also thinks it’s important to explore different processes outside of medicine.
- He examines what processes work and applies these in his practice of medicine.
[10:33] How to Manage Competing Demands
- Ed advises us to reflect on three types of demands. These are value demands, internal failure demands, and external failure demands.
- Value demands are the tasks you want to spend all of your time on. These have a limited capacity, so you need to remove the unhelpful failure demands.
- Internal failure demands are the things that need are redone. By looking at these, you increase your ability to do the things you want to do effectively.
- External failure demands are the things done by other people that end up in your lap. For Ed, external failure demands are the most frustrating.
- Listen to the full episode to learn more about the three competing demands.
[18:11] Time Management Techniques on a System Level
- Personal time management techniques are essential, but it’s not enough. You also need to have a systems approach.
- You can get better results if you recognise the system you work in and make adjustments.
- Ed gives the analogy of having a Ferrari engine in a 1960s Mini. It will go really fast, but the other parts will limit it unless they have been tweaked accordingly.
[21:46] Quick Ways to Address Internal Failure Demands
- In the GP setting, an easy change is to move from siloed working to outcome-based working.
- To save time in meetings, do most of the work beforehand and use the meeting to discuss key points.
- Don’t use meetings as a proxy for team cohesion. If you want to build team cohesion, make time specifically for that.
[26:00] Time Management Techniques for the Workplace
- Allow yourself to rest from working during your free time.
- Know that your identity and worth are not dependent on the amount of work you do.
- Be open and honest with people about your boundaries.
- You can see what each person needs to make their day better in terms of time management. By doing so, you’re able to work in a happier environment.
[30:43] On Affecting Change as a Doctor
- Being in medicine becomes your identity. And so, when we struggle with things like time management, it becomes an identity threat.
- We feel like we should be able to cope with challenges. If we don’t, we feel like we’re not good enough.
- Instead of complaining about someone’s work, approach them and discuss the problem. Ask about the other person’s perspective.
- When having an honest yet difficult conversation with someone, focus on learning instead of blaming.
- Listen to the full episode to know the importance of proposing solutions to issues raised.
[35:05] Improving Workplace Communication
- Make SMART objectives SMARTER.
- The additional E stands for emotion. What are the drivers?
- The R stands for rationale and review. Look back on how things went after achieving your aim. Reflect on what you have done and what you can do better.
- Listen to the full episode to know more about how to improve your communication in the workplace.
[41:44] How to Voice Out Your Concerns
- Instead of criticising, ask exploratory questions.
- By doing so, you’ll find out more about the organisation and how the issue fits into the context.
- To know how you can apply this tip, tune in to the full episode.
[46:29] Ed’s Top 3 Time Management Techniques
- Think of the time first before thinking about the task.
- If you have a to-do list, write down how long each task would roughly take.
- If you’re struggling with completing tasks, break them down into four elements.
- These elements include task management, attention management, knowledge management, and system management.
- When looking at a task, remember that you have four options. You can do it, delegate it, defer it, or delete it.
7 Powerful Quotes from This Episode
[10:40, Ed] ‘If you look at a lot of the causes of burnout in doctors, it’s often because there are a lot of competing demands, and you’re often not able to do the things that emotionally nourishing or emotionally validate you, you know, defining a diagnosis or feeling good about making someone feel better.’
[17:51, Ed] ‘And that’s the key thing about time management, it’s recognising what is in your control and what you need to do about it even where that’s uncomfortable.’
[19:50, Ed] ‘But I think, you know, in all time management, I think one of the things that’s not been focused on has been that sort of ecosystem that we live in. And actually, if you’re able to recognise the system that you work in and tweak different bits, you get a better result.’
[26:53, Ed] ‘So I think from an individual level, the key thing is if you’re creating time, it’s okay to use the time that you create for yourself; it’s okay to use that time to do things that you wouldn’t otherwise have done.’
[27:54, Ed] ‘I think we need to move away from this culture of, you know, if you’re free, therefore, you must be doing something because someone else is. What we should be looking at is, well, how do we make this system feel better for everyone.’
[33:34, Ed] ‘And I just think it becomes almost easier to complain than it does to approach someone with a genuine authenticity and try and have a conversation where you both learn something about it. So what I teach people is that you’re trying to have a conversation that is about learning; it is not about blame.’
[40:04, Ed] ‘I think that having that more open culture in medicine before problems happen is much better.’
Dr Edward Pooley is a GP, GP trainer, and former speciality doctor in Emergency Medicine and Chronic Fatigue/Rehabilitation Medicine. Before practising medicine, Ed was a researcher in molecular biology and genetics of neuropathology and behaviour. To fund his training, he set up his own web development consultancy business.
Passionate about language, psychology, and medicine, Ed became a time management and communication skills educator. In 2020, he released Managing Time in Medicine: Developing Efficient Consulting in Primary Care. He continues to share his takes on time management for busy professionals across different platforms.
If you want to know more about Ed, connect with him on Linkedin or visit his Facebook page. If you’re a healthcare professional looking for an online community, you may also join his Facebook group.
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In today’s high-stress work environment, you may feel like a frog in boiling water. The pan has heated up so slowly that you didn’t notice the feeling of stress and overwhelm becoming the norm. You may feel that it is impossible to survive AND thrive in your work.
Frogs generally have only two options — stay and be boiled alive or jump out of the pan. Fortunately, you are not a frog. You have many more options, choices and control than you think.
Learn to master your destiny so that you can thrive even in the most difficult of situations. If you enjoyed today’s episode of You Are Not a Frog Podcast, then hit subscribe now!
Dr Rachel Morris: Do you ever get frustrated that the system you’re working in is so inefficient? Have you tried your best to manage your own time only to be scuppered at the last minute by something that should have been sorted out by someone else, until you feel able to raise the issues you can see without being judged or criticised for moaning?
In this episode, I’m joined by Dr Ed Pooley, GP and time management and communication skills educator who has an interesting take on time management for busy professionals. We talk about how making individual time efficiencies can only get you so far if you’re working in a system that is unwilling or unable to change and how better conversations are the only way to make constructive changes that count.
So listen, if you want to learn about the three types of demand and get some practical tips about how to identify and raise issues without raising hackles. And find out why some time management techniques, if used alone, can be a little bit like putting a Ferrari engine into a mini.
Welcome to You Are Not A Frog, life hacks for doctors and busy professionals who want to beat burnout and work happier. I’m Dr Rachel Morris. I’m a GP turned coach, speaker, and specialist in teaching resilience. And I’m interested in how we can wake up and be excited about going to work no matter what. I’ve had 20 years of experience working in the NHS, both on the frontline and teaching leadership and resilience. I know what it’s like to feel overwhelmed, worried about making a mistake, and one crisis away from not coping.
2021 promises to be a particularly challenging year. Even before the coronavirus crisis, we were facing unprecedented levels of burnout. We have been competitive frogs in a pan of slowly boiling water, working harder and longer. And the heat has been turned up so slowly that we hardly notice the extra-long days becoming the norm and have got used to the low-grade feelings of stress and exhaustion. Let’s face it, frogs generally only have two choices, stay in the pan and be boiled alive, or jump out of the pan and leave. But you are not a frog. And that’s where this podcast comes in. You have many more options than you think you do. It is possible to be master of your destiny and to craft your work and life so that you can thrive even in the most difficult of circumstances.
Through training as an executive and team coach, I discovered some hugely helpful resilience and productivity tools that transformed the way I approached my work. I’ve been teaching these principles over the last few years at the Shapes Toolkit Program because if you’re happier at work, you will simply do a better job. In this podcast, I’ll be inviting you inside the minds of friends, colleagues, and experts—all have an interesting take on this. So that together, we can take back control to thrive, not just survive, in our work and our lives and love what we do again.
I don’t know about you, but I’m exhausted at the moment, even though my job isn’t as physically demanding as it used to be. Staring at a screen all day and interacting mostly online is exhausting. But I’ve discovered some hacks that have drastically reduced my virtual fatigue. So I’ve created a virtual fatigue Buster toolkit, which shares these tips, techniques and resources, and useful links with you. And even includes a three-minute video in a short team-building activity that you can use with your team to beat virtual fatigue. It’s available completely free to listeners. So click the link in the show notes to get your free download. And while you’re at it, why don’t you get off your screen, get outside for a walk or move around in some way whilst you listen to this episode. So it’s fantastic to have with me on the podcast today, Dr Ed Pooley. Now Ed is a GP, but he’s also a communication and time management expert and trainer. So welcome, Ed.
Ed: Thank you for having me. It’s great to be here.
Rachel: Really good to have you. Now, I wanted to get you on the podcast for all sorts of reasons. You seem to have this wealth of knowledge about how to manage our time, how to have these really difficult conversations, and actually, how conversations in time actually are more closely linked than we would think they were. But first of all, tell me how you got into all of this because you haven’t always been a GP have you?
Ed: No, so I started off as a graduate student in medicine. I worked. I did a basic biomedical sciences degree, then a master’s, and was kind of going down the educational route and was working on a PhD in psychiatry. And to fund that, I was kind of working as a web developer, a web designer, running my own business. And I kind of always had this thought of wanting to go into medicine, and I didn’t quite get in there the first time around, so I went off and did something else. And then thought, actually, I’m going to regret it if I don’t reapply, so I reapplied and got in, and then went through my training. And I was kind of one of those people that are enthusiastic about everything, wants to be everything that you do as you go through each rotation. So I finally settled on GP as being kind of the most flexible option because it’s one of those where you can build in and change your career path very easily because you’re sort of a generalist.
Rachel: So lots of different routes. So you end up as a GP having done graduates, and how old were you when you eventually qualified?
Ed: I qualified just for my 30th birthday.
Rachel: Okay, so the reason I’m asking that is that I have noticed that I think there’s quite a difference between people that qualify as a graduate and people that—I know that when I qualified, I was young, I was only 23, and I felt very disempowered. I sort of just did everything that everybody asked me to do without sort of standing up. Whereas my colleague, I work very closely, he, again, was a graduate student and had another job, quite responsible for much before he went to medicine. And then, when he was working as a junior doctor, he felt much more able to have difficult conversations or sort of challenges, consultants, and things like that. So I just think it’s quite interesting. It’s not just the age you are when you qualify in medicine, but actually, the maturity that you have.
Ed: Yeah, I think it does give you a different perspective. I think that you’re entering medicine later in your life and your career. You’ve often done other stuff before. So you’ve got that other experience under your belt in terms of just understanding how workplaces work, understanding hierarchies and how things are, and you’re able to, rather than get caught up in it, you can sit back and you can see, ‘Well, why is that happening?’ Or ‘Oh, I like the way that’s happening.’ Or, ‘I can see why that’s…’ It gives you sort of mental headspace to stand back and analyse things, I guess, in a bit more detail. Because you’re not just trying to convey and learn medicine, you’re also trying to establish the rules of a working environment. And because I’ve already done that, it just becomes easier.
Rachel: Do you think that’s why? And we were talking earlier, it sounds like ‘you’re a real expert,’ but you went, ‘Oh, no, I’m not an expert.’ But for me, you’ve got a lot of wisdom, you’ve got a lot of knowledge about this. You think that’s because the approach that you took was you were not just looking at what you were doing, but it’s actually how you were doing it?
Ed: Yeah, I guess so. I think that for me, part of the thing that I enjoy about medicine is how everything fits together. So for me, as a GP, a lot of the focus is on diagnosis, managing uncertainty, and knowing what to do with patients. But actually, a bigger part of that is, ‘how do you manage all those competing demands? How do you communicate with people in their families?’ Because if you can get that right, and that saves you time and avoids you being caught up in a lot of drama that you’ve sort of unnecessarily created. So for me, it kind of all fits together. And I like to tweak different things and processes to see what works, what doesn’t work. And that sort of fits my style of medicine. And that’s kind of something I talk a lot about to other trainers and trainees about techniques that have worked for me, things that haven’t worked for me, and how we use tools outside of medicine—so things from psychology, from psychotherapy from business, rather than just thinking, ‘This is the mindset of medicine. This is how I’ve always done things, and this is what the experience of my medical elders has been.’ I like to kind of think, ‘Well, is there a different way? Have another group of people solve this problem that we can bring into medicine?’
Rachel: Because traditionally, I don’t think we’ve been very good at that in medicine, have we? Using the stuff from the business world, for example, to make things better for us?
Ed: No, I think that there’s often resistance to that. There’s almost a sense that business ways of doing things don’t apply, or you’ve got to think of the patient at the centre of it. And there’s often a degree of conflict or friction when you try to bring in business ideas. And what I quite like is the fact that I can do the business speak, and I can do the medical speak, and I think you need people who can navigate both of those areas. Because without that, you just end up with two people not understanding each other.
Rachel: Completely agree. I think that’s the same in the other sort of professions like law and accountancy and stuff like that. Yes, we do different things. We see patients; they have clients. They have people coming to them with slightly different problems, but still, they’re feeling overwhelmed. They’re still working with a lot of competing demands with people that are quite emotional sometimes, and we’ve been quite slow to look at the processes that are going to—well not only make our lives better but, if you nail your time management, you’re probably going to be a better doctor as well. Would you agree?
Ed: Yeah, if you look at a lot of the causes of burnout in doctors, it’s often because there are a lot of competing demands, and you’re often not able to do the things that emotionally nourish you or emotionally validate you—defining a diagnosis or feeling good about making someone feel better. If patient care becomes just another task to do, just something you’ve got to survive, then I think that creates burnout, and it creates conflict, and that doesn’t lead to a very happy environment to work in.
And as a basic exercise, what I think, is a really useful thing to do is to reflect on three aspects. And these are in the systems thinking world, where people analyse systems and structures. They talk about something called external failure demand, internal failure demand, and value demand.
So value demand is the stuff that you should be doing. So for me, as a GP, that would be seeing patients doing referrals, assessing investigation results. If you’re a lawyer, it might be reviewing clients, organising paperwork, communicating with different stakeholders. And that’s the stuff that you want to spend all of your time doing. And obviously, there is a finite amount of that that you can do if you have a limited capacity. But if you then get rid of the other two bits, which are the kind of unhelpful bits.
So internal failure demand is the stuff in your organisation that is just being reworked and is being redone. So, for me as a GP, that might be where I’ve not really captured all the information I need, so I’ve had to bring a patient back. And therefore, that’s used up another block of time. For a lawyer or an accountant, that might be that you haven’t really captured what the person wanted. And so therefore, there’s a complaint, or they’ve come back and said, ‘well, that’s not really what I wanted.’ And that’s just using up more time. By reducing that by being aware of, say, the top three things that cause internal failure demand, and that might be not having the right person seeing the client or the patient at the right time. Or it might be having a sub-optimal process for information capture. By looking at those things, you increase your ability to do the thing that you want to do and that you’re you’re good at and that only you can do.
External free demand is a bit more challenging. So this, in its bluntest terms, is the stuff that other people create that ends up in your lap. So for general practice, that is stuff that should have been done in a hospital care setting that’s kind of been dumped on you, that’s a huge source of stress or anything. I guess in accountancy or legal terms, it might be that other people in the process that you’re organising, haven’t done what they needed to do. And so you ended up working perhaps outside your competence just to get something done, or you’ve ended up having to go back to that person, and that just uses up more time because time is finite, and we can’t save it up. And we usually have to do stuff within that time. And that involves balancing priorities, and we want to spend the time that we have available doing the stuff that we are competent and capable of, rather than the stuff that somebody else should have done or where we’ve had to unnecessarily retread overall ground.
Rachel: But it seems really clear when you put it like that. I love those three concepts. Which one tends to be most frustrating? Is it the external failure demand in your experience?
Ed: I think they create different feelings, so I can only talk really from my viewpoint as a GP. The thing that makes me angry is external failure demand. So, when someone in secondary care hasn’t done their job, they’ve expected me to pick up the pieces. And often that anger and that frustration comes from the fact that there’s a patient caught in the middle who doesn’t understand that there is a delineation of primary and secondary care. Their concept of healthcare is that it’s one uniform system. So why can’t I do the thing that the hospital told me to do or requested of me? It makes me appear to be the one who is causing a problem. So that tends to create a feeling of frustration and anger.
Internal failure demand is interesting. Because perhaps of all of those three processes, that one requires the most skill in amending. It’s the one where you have to approach colleagues and discuss with them in a sensitive way. How do we do this better without that colleague feeling threatened? Because these are people you’re going to have to work with. It’s very easy to send a letter back to a hospital or a secondary care consultant because you’re not in the same building as them; you’re not going to have to sort of manage that relationship. I’m not saying that you should be rude, but it’s often a bit more difficult if you’re in the same room or the same building as someone who you’ve got to say something quite difficult to. How did this happen without that person feeling threatened or got at or frustrated or bullied? And I know a lot of the stuff that you’ve looked at before has been about organisational culture and bullying and things like that. And we’ve got to tread a very fine line. Because ultimately, you’re trying to make an organisational process more effective.
Rachel: Interesting. Say, it’s harder to cope with the internal failure demand, perhaps because it’s maybe closer to home. But I guess with the external failure demand, I started looking at from my viewpoint and I use— one of my Shapes that I use is the zone of power, so that’s the things that are in your control. So I guess with the external failure to mine, a lot of that—unless you are the head of the CCG or chief executive of the NHS Trust—a lot of that is actually outside of your control. You can’t do much about it apart from sending a stinky letter. It’s almost easier to just send the letter about but harder to change. The internal part is more uncomfortable to address, but some of that generally is within your control.
Ed: Absolutely. And that’s the key thing about time management; it’s recognising what is in your control and what you need to do about it, even where that’s uncomfortable.
Rachel: That I think is such a fascinating concept, because a lot of the stuff you know—I’ve been talking about with time management has been very personal. It’s the podcast for a reason, which talks about time. So what can you do to help you to reduce your distraction and all those sorts of things? But what you’re saying now is ‘Yes. You need the personal time management stuff. But it’s not enough. Is it? You need to go that step further. And look at it from more of a systems approach.’ You can get so far on an individual level.
Ed: Yeah. Because if you look at individual time management, you’re thinking about things like task management, attention management, and knowledge management. And those are things that you can do. But then you’ve got to look at the system around you. And that works in the work environment, in the home environment. What I find talking to different doctors from different specialities is that some are very good at managing time in certain roles. So some are very good at managing time in their work role, because often they’re permitted to say no to people, or they’re allowed to have a bit more organisational tweaking that they can do. Whereas at home, for instance, it might be that you’re trying to, say, carve out time to do something on a project that you want to do, and you’re trying to balance time with children, with partners. And often that conversation can be more difficult, and people can feel less empowered, and vice versa. But I think, in all time management, I think one of the things that has not been focused on is that sort of ecosystem that we live in.
And actually, if you’re able to recognise the system that you work in and tweak different bits, you get a better result. And the analogy I give is, it’s a bit like putting a Ferrari engine in a 1960s Mini. It will go really fast, but it will be limited by the fact that the gearbox doesn’t matter. So the wheels don’t have enough traction. And actually, you’d be better off putting in a less powerful engine, but improving the tires or the suspension or the gearbox, and tweaking everything to save 50% of its optimal rather than one thing to 100%. And I think a lot of the stuff that’s been written about time management has focused on the individual, which if you are doing all of the things you should be doing, but you are still not getting done what you need to get done. It can often lead to sort of negative psychology, psychological processes, like shame, and things like that will actually lead you to feel more stuck.
Rachel: Yeah, that’s a really good point. I remember as an auditor, I once audited my own surgeries and my time management within the surgery and came up with the conclusion that the only thing I could really change to make things any better was to actually turn on my computer ten minutes before my surgery, because I found five minutes was spent just waiting for things to load up and not check my phone in between patients. Although that, sometimes, just gave a little bit of a break or whatever. And not ever go to the loo. There wasn’t a lot actually in there. But there was an awful lot if I think about that, internal failure to mind—that would have absolutely helped that. So in your opinion, let’s start off with the low-hanging fruit: What are the quick wins you can do in these internal failure demands? But what have you seen that it’s quite easy to change that people forget about changing?
Ed: If we look at, for instance, the GP setting, one quite easy change is to move from siloed working to outcome-based working. So let’s say you have a patient who has diabetes, hypertension, heart problems that you’re going to want to call them in for a review. Rather than give them three appointments, why not just give them a longer one? So it’s less impact on that time. You’re capturing often the same information across all three of those clinical issues that’s required for you to collect and manage that person successfully. And then they follow up with a GP on the same day, you improve your compliance rate. You make it easier for the patient, and you make it easier for the practice.
The downside of that, and I suppose the caveat and the resistance comes in that, if you can’t get the patient in, then obviously you may have lost more time in one single go which can feel a bit frustrating. But certainly, when I’ve worked at surgeries that have moved to doing that, and reducing the need to keep bringing patients back or keep collecting the same data, it’s improved efficiency, patients have preferred it and sort of the complement rate has gone up because it’s just made it easier for for the majority of people.
And likewise, one of the things that comes up in general practice a lot is information requests. So let’s say a receptionist is taking a call and wants a bit of information or wants to let a GP know about something, they’ll often send a screen message. The problem with that is psychology creeps in. So they’ll often send the screen message to the person who is least likely to complain. And therefore is less likely to give them a hard time asking a question. And that person who starts off being nice ended up being used up because they’re the go to person for everything.
Or, let’s say meetings! Meetings are a huge source of internal failure demand in general practice because it’s the biggest single use of practice time outside of consulting. And it can be managed so much better, even just by doing a lot of work prior to the meeting, and then just using the meeting to discuss key points that are raised. And I think that applies across all industries. We often use meetings as a proxy for team cohesion, but it ends up being a less successful way of doing that. You may as well use the meeting, use it for less therefore to gain consensus of opinion and move something forward. And then, if you want to build team cohesion, make time specifically for that rather than try and do two things less successfully at the same time.
Rachel: Yeah, and I know that definitely applies not just for general practice, but for loads of other organisations that actually possibly even more meeting heavy than general practice, because actually their work is done in the meetings if they’re not directly client-facing or whatever. So that can be hard. I guess with all these said—and I can see how this would really help on a practice level. But I’m wondering, how would this help me individually? Because if I’ve got that patient going just with one appointment, that’s great.But what will happen is they’ll just slot more patients in with me, and I’ll just be just as busy as before. I can see how sorting out the meeting time would be good. And then information requests. Yeah, I can see that if you’re really nice, you’ll just get everyone asking you to do all the stuff than if you’re a really snappy person. So, what is there that an individual can do to affect change that’s actually going to make a difference to their day-to-day time management within their work?
Ed: I think it depends on where they’re struggling with time management. And people really only know that they’re struggling with time management when it hits a crisis point. And actually, they’ve ended up going home at 10 o’clock three weeks in a row where they should have been home at seven, or where there’s been a complaint, or there’s been specific feedback about something that’s gone wrong. I think one of the problems that we have in general practice is that, in some ways, it is seen as an unlimited service. And we know that it isn’t an unlimited service.
So I think from an individual level, the key thing is if you’re creating time, it’s okay to use the time that you create for yourself. It’s okay to use that time to do things that you would otherwise have done. But that requires having boundaries. And that requires being open and honest with people.
So I meet a lot of GPS, who will do things like they will come in very, very early, they will get through all of their tasks, and they’ll be out of the door, perhaps an hour early because they finished all their phone calls. And that works very well for them. But it can create stress within the team because other people think, ‘well, look at them, they’re not pulling their weight because they don’t see the effort going in.’ They’re only seeing what they’re there to observe.
Likewise, again, if you’re a very quick consulter, what can sometimes happen is that there’s almost a pressure on you to do more work because you’re freely available. I think we need to move away from this culture of ‘if you’re free, therefore, you must be doing something because someone else isn’t.’ What we should be looking at is, ‘well, how do we make this system feel better for everyone.’ Because actually, maybe that person needs that time to have lunch or to go on a walk or to rest. We know that how we process time from a neurobiological perspective is very tied up with a circadian rhythm clock. All those brainstem structures, dopamines, if we’re depressed or emotional or stressed or haven’t slept—our ability to process time goes out the window. And I think we’ve probably both experienced that state of heightened emotion when you’re on a crash call, or you say witnessed someone having bad news broken to them.Time slows down because it’s linked to those processes. And I think awareness of that is really helpful.
Rachel: Unless that point that this stuff only works, if you’re freeing up time to do what you either want to do or to have a bit of breaking your day or a little bit more spaciousness. This doesn’t work if all you’re doing is freeing up time for the organisation then to give you more work. And I think that is what that is the crux of it. And that’s the nub of it. And that is possibly where I think the next really important thing that I need lots of teaching that comes in and that is having these difficult conversations.
Ed: I think that the one of the advantages of, say, working in a general practice rather than a hospital. And likewise, if you’re in a legal firm, if we’re in an accountancy firm, or if you’re in a smaller organisation, your ability to affect change is less limited than if you’re in a bigger organisation. And you can try different things, you can experiment. You can see what each person within that organisation needs to make their day feel a little bit better in terms of time management. And if you do that, you will be working in a happier environment where you’re able to give the people that you do need to be seeing that valued demand, you’ll be doing your best effort for that rather than just seeing it as another task to be crossed off on your list. And I think that also impacts on things such as patient safety.Because we know that if you’re hungry, angry, late, tired, all of those things, you become less good at successfully managing patients and keeping their risk though.
Rachel: Yeah. So in your experience, where do we come a cropper with having these conversations? Is it that we don’t raise it in the first place, we just put our heads down and we suck it up? Is it that we raise it but then it just becomes a complaint and a grievance and a moan rather than actually affecting change? Or is it that people just generally don’t want to hear it?
Ed: I think it’s a combination of all three, which I’m aware is a really kind of politician type of… Let me just tease that part of it.
I think one of the issues that we have in medicine is our sense of identity. I think that if you take the majority of medics. Let’s say around five to six years of age, they suddenly announce to their parents, their guardians, they say something like ‘I want to be a doctor.’ And the world goes nuts. Everyone thinks, ‘well, you’re an amazing child, what a really a good thing to go for, you must be really clever.’ Then your teacher starts to say it and this whole environment contracts around you to make being a doctor or being a nurse or any other these sort of vocational jobs part of your identity. And so therefore, when we struggle, in terms of, say, time management, it’s an identity threat. And then it becomes a very difficult thing to discuss because we feel that we should be able to cope with more, we should be able to fit more in, we should be able to do just that one more thing. Because if we don’t somehow, we’re not good enough. And I think that’s a really toxic thing that can lead to a lot of problems in the healthcare world. So that would be the answer to the first one, I think we do just tend to suck things up and just do more. And I think there is almost a culture of reward for people who do that. It becomes about quantity rather than quality. And I think that’s a problem.
Part two is that it is very hard to talk to other people about things without them feeling better. And I think part of that reason is that we’re just not very practiced at doing it. And one of the things that I see, rather alarmingly, is that often it’s easier to put in a complaint about someone than it is to actually approach them and say what’s going. If you’re in any of the medical forums, you’ll see lots of commentary about a receptionist, he said this, or someone was really slow at doing this. And you’ll get someone halfway down the comments who will say something like finding a disciplinary, and you say, ‘Well, how did it go from a mistake to a disciplinary? Is there no intermediate step?’ And I just think it becomes almost easier to complain than it does to approach someone with a genuine authenticity and try and have a conversation where you both learn something about it.
So what I teach people is that you’re trying to have a conversation that is about learning; it is not about blame. So I tend to avoid words like feedback, because I think the moment we say, ‘Can I give you some feedback and alarm bells?’ It’s one of those words that we associate with something negative. And so I tend to get the other person’s perspective and say, ‘Well, what happened there? What was going on for you? How did that feel?’ And then I say, ‘Well, actually, what happened as a result of that is, when that person came to see me they were really angry and agitated, and that pushed me back.’ How can we look at making that process more effective, so you’re not feeling on the spot and I’m not feeling stressed? And then let you know. So you’re basically gaining an understanding of the other person, what it means for them. And how to move things forward is a sort of a shared negotiation. And that’s appropriate when you’re a colleague of an equal level, you know that there are sometimes performance issues that you need to take on board. But I don’t think that stops you from having an authentic conversation at all.
Rachel: What about if you feel safe, you are a salaried employee in an organisation, and there’s a process that’s really causing grief, and it’s not an individual that you can go feedback to, but it’s sort of the whole way people do things? And you feel concerned about even raising it that it’s just going to be seen as you moaning, are you not coping? How would you suggest people face this?
Because actually, the more you get used to what goes on, it just becomes the way we do things around here, doesn’t it? And actually, the people that are just joining and more genius often are the people that are spotting the problems. They can see things better, but they feel really unable to speak up because they haven’t proven themselves or they’re too junior and all those sorts of things.
Ed: Yeah, I think that is a really common thing. Because obviously, the longer you work in an organisation, the more indoctrinated you become in the way that organisation does stuff. And I think if you look at industry, they actually specifically focus on not becoming indoctrinated into ways of thinking. So I think if I was that junior, if I was that new recruit, I would note what I’m observing. I would send out perhaps an email or raise it in a meeting and say, ‘Look, I’ve noticed this, has anyone else noticed this, too?’ And if they haven’t, you can then think, ‘Is it literally just me who’s noticed this problem? Or do I need to gain more evidence of this?’ And then you can approach people either together with the other people who have noticed it and say, ‘Well, this is what we’ve noticed. This seems to be the impact it’s having on us, and it may be having an impact on the organisation. Perhaps if we look at doing it this way, or would you mind if I tried it this way, and see the outcome?’ Because what you’re doing is you’re noticing something and providing a solution. I think people get very defensive if you’re just noticing problems without providing solutions or saying, ‘Well, can we try it a different way?’
Rachel: I like that. And I can certainly think back to times when I’ve been very, very good at pointing out the problems, but not necessarily sat and gone, ‘actually, this would be something that we could do differently.’
Ed: And actually you may not know enough about that organisation to come up with a solution. But what you can say is, ‘well, this is what we’re feeling, or this is what I’m feeling. Perhaps this is having the following impact on the organisation. Maybe we all need to reframe things so that we all have to work less hard, because it might feel comfortable doing what we’re doing. But wouldn’t it be good if it felt better?’ So there is an element of kind of selling an alternative approach.
Rachel: Yeah, absolutely. It’s like that book ‘Getting to Yes.’ If anyone hasn’t read it, it’s really worth reading, and we teach this a lot in our Lead.Manage.Thrive! course.
First of all, getting the facts and figures in front of you, getting some evidence is quite helpful in depersonalising it. So, it’s not ‘you’ve done that to me,’ but it’s like, ‘here’s the issue.’ But the impact is so important because it digs down to what people’s interests and needs are, doesn’t it? Because the impact is that it’s causing lots and lots of appointments to be used up. Actually, that’s the financial impact for the practice. It’s a workload impact for the doctors; if the impact is that it’s affecting patient safety, things are falling through the cracks, that is a potential big problem. But you need to also know the people that you’re talking to who are able to affect change. You need to know what is going to influence them because not everybody is influenced by having a happy, engaged workforce. Some people might be influenced by having a very financially tight ship, or some people might be influenced by minimising all the complaints. I don’t know. That’s the sort of idea of different currencies.
Ed: Yeah, I think, certainly within general practice, and I have a feeling this might be true in law as well. There’s often people at the top who are very interested in maintaining how things are because they’re not going to experience the consequences if things don’t work or they’re not going to have to. They have been through lots of cycles of change, and there’s often a bit of change resistance, and a feeling that ‘Oh, well. We’ve tried that before. It didn’t work.’ And it’s unfortunate because I think that having a more open culture in medicine before problems happen is much better.
Because if you look at where things have gone horribly wrong, let’s say like the mid staff issue; it’s raised questions where we’ve had to look at things. Everyone goes, ‘I will, of course, yes.’ But very few people think, ‘well, how can we prevent something like that happening again? Or how can we make things more efficient and more effective from our baseline now?’
So this whole sort of idea of SMART objectives. What I like to do is to sort of extend that a little bit and say, ‘well, let’s make them smarter.’ Let’s add emotion in there: ‘What’s the driver? What’s the positive? And what’s the negative emotion? Are we doing something because we don’t want to feel bad? Or are we doing something because we want to feel happier or more validated?’ And then at the end of that, you might want to add a rationale and a review.
So, you know, once you’ve gone through that goal setting process and you’ve achieved your aim, or you’ve not achieved your aim, you can ask yourself, ‘Well, did I do it the best way? If I were to do it again, would I change what I did? Or did I need to do it in the first place?’ And I think those things just extend that model a little bit, and make it more interesting for people to go through that process. They connect people with the ability to reflect and they connect with an emotional state.
Rachel: So what would you say to someone who is working in an organisation where they’re not in charge, they feel that they don’t have very much power, but they can see hundreds of things that could be better that are causing issues? And let’s face it, in every organisation, there’s always something that could be better that could be run better? Where would you suggest that this person starts?
Ed: I would start by asking questions rather than criticisms. So I think I would start by saying, ‘I’ve noticed that this happens. Why does that happen? Is that something that traditionally always happened? Or was there a reason that this process developed?’
Because if something was just being done, for traditions sake alone, that’s normally not a great reason to continue doing it, unless there’s some other benefit to doing it. So I would start by asking sort of exploratory questions. I would start by then, moving on to, ‘what do you notice about the way that things are done? Causing a problem? And it’s not because maybe you don’t know enough about the organisation, so you might need to find out some more information. Or actually, do you know enough about the organisation and there is a problem that you identified?’ And sometimes we can do things off our own back, and then present them to people and say, ‘Look, I noticed a problem. I fixed it. And I found this, what do you think? Do you think this will apply to the whole organisation?’ And certainly, that’s a quite common thing in business where people have almost felt empowered to change the status quo and get credit for doing something.
I think one of the things that is perhaps more difficult in a general practice setting is that primarily with doctors, we’ve kind of fallen into the role of business managers very often because our training doesn’t always include effective strategies on how to run a business or leadership, or how to facilitate change or how to pull apart processes. Even to the point where—let’s say we develop a new system, almost all GP practices never document how that’s done. So, therefore, there’s no central repository for if you’ve got a patient who needs to be admitted to a palliative care ward, you can’t go and look at this document that tells you exactly what to do. You’ve normally got to find the one person in the practice who’s probably on annual leave that day, who knows what to do. And that just uses up a ridiculous amount of time.
Rachel: I’ve been there and they’ve always got an internet. There’s masses of documents. It’s like, which one has no idea where to go? And how to do this is quite a straightforward thing. And what do I do? I think that’s such a good point. I remember chatting to a practice manager or a group of practice managers that had been recruited from business into a very large group of general practice who was sort of all banding together. And actually, each practice ran really well that this chap came in. And I said to him, ‘Are there better efficiencies you can make people do things better?’ He almost fell off his chair. Like, ‘you have no idea.’ Everyone’s doing their best, but until someone’s actually properly listed, there is so much you can do to make this so much better. There is no reason why you have to be working like this. And it was really interesting just to get that perspective of an outsider.
So we’re nearly out of time. We’re gonna have to do another one, because I think I really like to talk a little bit more about speaking up and having these sorts of conversations. Because the biggest issue, I think—for people in work—is being able to speak up, to raise concerns. They give difficult feedback, although we’re not using the word feedback anymore—obviously, the word learning, talking about learning, or improvements. That is the single biggest thing I think people struggle with across the board, and it leads to… It causes, sometimes, poor psychological safety. And we had a podcast come out a few weeks ago about that, but also just leading to all sorts of issues just being perpetuated and continuing. So I’d love to get you back to talk about that. But we’re talking now about time management as it applies to me as an individual working in an organisation with the recognition that actually, there’s only so much you can get your Ferrari engine really good. But there’s only so much that can do. If it’s then in that Mini, what top tips would you give? Would you have for that individual?
So, I think the first one I would say comes from a kind of a task management basis. So I would say my first tip would be: think of the time first and the tasks second. So we often get into a habit of, say, writing a task list, and then we have a block of time, but that task will take too long. And you end up just not doing the task because the perfect opportunity never comes along. And that’s because we often see tasks as jigsaw pieces that we’re trying to slot into the right time. So I would say, ‘Think about how much time you’ve got. And if you’re writing a task list, write down roughly how long each task will take.’ So you can say, ‘I’ve got a 20-minute block now. Let me pick one of those 20-minute tasks and just get it done.’ So that would be my first tip.
The second one, if you’re struggling with completing tasks, break it down into the four elements of what that task requires for completion. So there’s task management, ‘Which is what needs to be done?’ There’s attention management which is, ‘Do you have a clear mental headspace or enough of a headspace to be able to do that task?’ Things like the Pomodoro Technique, and setting timers are really good for attention management. And then there’s knowledge management, ‘Do I have enough knowledge to do that task to a suitable degree?’ And the fourth one is, ‘Do I work in a system where I can do this effectively or effectively enough?’
I think the third thing I would look at—and the third tip is—when you’re looking at tasks, recognise that you have four options: you can do it, you can delegate it, you can defer it, or you can delete it. And really, deferring it is just doing it. So really, there are only three. But pick one, don’t leave it sitting there for ages. You normally know whether this is something that you do, whether you can’t do, or whether you need more information to do. And so that would be my three, sort of take home messages.
Rachel: Thank you. And I think for me what’s really come out of this is actually staying in your zone of power—what is it that you as an individual, what control do you have over the system. You might not have very much but you have control over those conversations that you have, how you feed stuff back, what you notice that you try out. And actually that’s a lot more than we normally do. Often, we notice there’s something wrong and we just sit and whinge about it, and we get stressed about it. Rather than bringing it up, using those really good sort of communication techniques of bringing it up in a non-threatening, non-arshole way. Because actually, most just bring stuff up in a real arsehole way and then it goes really bad because everyone’s amygdalas chin chips are triggered and everyone’s jumping all over the place and it doesn’t work. But yes, slightly psychopathic but you know, what else can I do in this? Pay attention to your time management—your attention exactly like you said, but don’t neglect the system stuff. And don’t be frightened of the system stuff. But you need to go about it right?
Ed: Yeah. Go with that.
Rachel: Great. So if people want to find out more about you or more about your work, how can they do that?
Ed: So if it’s specific things in relation to time management in, say, general practice, I’ve written a book, and you can put my name into Amazon, and you’ll get ‘Managing Time in Medicine’, which is the book that I wrote talking about time and task management from an individual level of my practice level. If you want more information about having difficult conversations, or challenging conversations with people, and you’re a healthcare professional—this group is really only up to health care professionals just because of the nature of the topics that we talk about—if you look for Difficult Conversations in Medicine, on Facebook, or if you search for Ten Minute Medicine on Facebook, you’ll find a link to it. Feel free to join. I do a session every week, where I look at a challenging aspect of medicine and health care and how we can have that conversation more effectively.
Rachel: Oh, fantastic. And we’ll put those links in the show notes so that people can get to them really easily. And presumably they can contact you through that Facebook group or LinkedIn?
Ed: Yes, I’m on LinkedIn as well. And if anyone is looking specifically for communication training or time management training, feel free to message me, and then we can have a conversation about what your needs are.
Rachel: Perfect. Thank you so much for being here today. It’s been a fascinating conversation, and we’ll get you back soon if that’s okay.
Ed: Absolutely fine. Thank you very much for having me.
Rachel: Thank you. Bye.
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