Working Less Can Make You More Productive

Gregory A. Hood, MD

Disclosures

August 01, 2017

In This Article

Time Management Versus Energy Management

Starting earlier, working later into the night, and working weekends are easy traps that have all been tapped to their full potential in society, and in the healthcare culture in particular. Working "more" does not satiate the demands of our calling.

However, what if "time management" is an illusion in the first place—a misconceived myth? If there were a way to manage energy more efficiently per unit of time, then this might be a promising way to maintain productivity and meet patient needs.

One key for getting more done may be to rethink how you prioritize your day—in particular, how we craft our to-do lists, such as the stack or list of patient labs and specialist reports to review. A study done in the 1980s divided undergraduates into two groups.[4] Some were advised to set out general monthly goals and study activities; others were told to plan activities and goals in much more detail, day by day. Although the researchers assumed that the well-structured daily plans would be most effective when it came to the execution of tasks, they were wrong: The detailed daily plans demotivated students.

Tim Harford, author of Messy: The Power of Disorder to Transform Our Lives, argues that inevitable distractions often render the daily to-do list ineffective, and that leaving room for improvisation in such a list can reap the best results.[5]

Any physician who has returned to his or her workstation after a day full of appointments and interruptions, and who has felt the fatigue and distaste for opening their task list, understands this point.

How to Manage Interruptions

The average working professional experiences 87 interruptions per day.[6] Interruptions make it difficult to remain efficient and on task throughout the workday. In a 2001 study, physicians were found to have different numbers of interruptions across specialties, but they also required different amounts of time to reconcile the varying nature of the interruptions.[6]

The study found that emergency physicians were interrupted an average of 9.7 times per hour compared with 3.9 times per hour for primary care physicians, for an average difference of 5.8 times per hour.[5] Primary care physicians spent an average of 11.4 minutes per hour performing simultaneous tasks, compared with 6.4 minutes per hour for emergency physicians (average difference, 5.0 minutes). Emergency physicians experienced more interruptions and managed more patients concurrently than the primary doctors. The primary doctors spent more time performing simultaneous tasks than the emergency physicians.

This "suggests there are important ergonomic differences between emergency medicine and office-based primary care work environments that may require different training approaches, design considerations, and coping strategies," the investigators concluded.[5] This study may be understood to mean that "time management" is too crude and inexact a concept by which to address the complex schedules and complex interruptions that are common to healthcare.

Sometimes reworking one's schedule can be very effective. Some physicians I know have found better productivity by using a "wave schedule."[7] Others have used scheduled or impromptu "power naps" to reinvigorate themselves. Each approach may keep certain patients waiting longer to be seen for a brief period.

Breaking up the structure of the day into smaller units can also be helpful. Achieving goals in each 45-minute segment can remind one of the adage of how one eats an elephant—one bite at a time. It also can make the day pass more quickly and with less of an energy drain than trying to conceptualize and approach a full workday as a single entity.

Physicians are already well-versed in being flexible. We never know what questions and issues the next patient visit will bring for us. We never know when the next emergency will come. We never know whether the next interruption is to be mundane or an emergency. However, we can harness this "reactive flexibility" into a proactive flexibility. As one professional found, "the key to maintaining focus and energy in shorter bursts was to apply flexibility to those segments—she could use some for exercise, some for meditation, some for work. Getting rest within her workday helped lower stress levels and therefore achieve better results within the allotted time for working."[3]

Given the complexity of today's patient and of the healthcare environment, maintaining one's energy, devoting time to meditation, and setting aside protected time for undistracted focus for deep thought on challenging clinical scenarios holds a clear benefit. This will hopefully inspire more creative, accurate, and productive solutions to the challenges of your day. I carve out time for this in my schedule each week, and in each quarter. It helps my schedule and my effectiveness to "breathe" flexibility into the demands of patient care.

Being unfocused is not being lazy; it can be useful.

How often has a previously unrealized solution to a clinical problem come into your mind from out of the blue, when you were thinking of something else, were thinking of nothing, or had been asleep? "Idleness is not just a vacation, an indulgence or a vice; it is as indispensable to the brain as vitamin D is to the body," wrote Tim Kreider in an essay titled "The 'Busy' Trap."[8] Idleness, Kreider believes, "is, paradoxically, necessary to getting any work done."

Srini Pillay, MD, assistant professor of psychiatry at Harvard Medical School and author of Tinker, Dabble, Doodle, Try: Unlock the Power of the Unfocused Mind, "believes this counterintuitive link between downtime and productivity may be due to the way our brains operate. When our brains toggle between being focused and unfocused on a task, they tend to be more efficient."[3]

"What people don't realize is that in order to complete these tasks, they need to use both the focus and unfocus circuits in their brain," says Dr Pillay.[3]

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