Time management chaos or science?

by TheEditor

Categories: Investigative

Health service work involves complex and competing demands on time. No one should be surprised by that. Psychiatrists are often given some time management strategies to work with in their basic and higher training. However, my experience over the last 20 years is that most of those strategies fail. The reasons are:

  1. Excessive workloads
  2. Increasing demands for quality based on a number of relevant standards (in the public domain).
  3. The frequent unexpected number of urgent and complex situations that turn up.[AC_PRO id=913]

Time management is about organisation and discipline. Strategies for time management require practice. There are ready-made strategies and tools. These are not ‘meant’ to work for anyone. It is the other way around i.e. ‘you’ are meant to work the tools and strategies. It is like any other ‘physical’ tool that is not used by a disciplined person; the outcome of which could be an exercise in futility.

Changing time demands

Increasing standards

The combination of the above is the result of employers demonstrating little awareness of how demanding standards are.  I will give one example and there are several I can think of. The assessment of capacity towards achieving consent for treatment, prior to 2005 was a seemingly simple matter. It involved 4 basic capacity tests. Around that time regulation of medical practice was much softer than it is today. An average jobbing doctor would not be under much pressure to document such an assessment or to give patients rich treatment information. As a matter of fact between 1990 and 2000, it was told by many senior colleagues, “You don’t need to discuss rare side-effects with patients. That might get them very worried and they would refuse treatment.” Then came the Mental Capacity Act 2005, which codified common law capacity criteria, thereby creating statutory duties. To cut a long story short, from 2005 the robust assessment of capacity required careful demonstration and documentation. Then came the NHS Constitution on 21st January 2009. This gave patients many more rights and for them to be treated as participants in their care. Patients were given rights written in black and white to complain if not satisfied. You don’t need to be a doctor to see that these matters of law and standards meant that doctors were obliged to spend quality time with patients. That meant more time demands.

The above is only one set of circumstances that led to increased time demands. I could go on to write about 10 other similar changes that meant greater time demands.

Employers tend to fall into a cognitive-attitudinal trap. They often know about complexities and demands. However, attitudinally systems remain slow to change. That’s my honest perception based on real observational evidence. Attitudes are more connected to habits and patterns of work-based expectations. The big problem for services is that many of their agreements made with other groups and organisations were locked in when demands were not complicated by complexities of law and regulatory standards.

Information technology problems

Around 2002 there was great hope that electronic systems would do away with paper and the world would become far more efficient. The switch to electronic health records (EHRs) and paperless was slow to happen. When IT took off, the problems of ‘paper’ did not go away. I think they got worse overall. In health services what seemed to happen was that the problems related to physical paper document production, storage and retrieval were replaced by more or less the same set of problems in using electronic documents and systems. I’ll explain.  Documents in the form of guidance, policies or even assessment forms seemed to become more demanding. Whilst theoretically it appeared easier to retrieve electronic records and documents, finding them remained a big issue impacting on time.

The transition from paper-based systems to electronic systems in various industries, including health services, has been accompanied by a set of challenges. While the initial expectation was that digitisation would streamline processes, reduce physical storage needs, and improve accessibility, the reality has often been more complex.

One of the primary issues encountered is information overload. The ease of creating, storing, and disseminating digital documents has led to an exponential increase in the volume of data. This has been observed across industries, not just in health services. For instance, in the corporate sector, the proliferation of emails, reports, and digital files often leads to a situation where critical information is lost in the sea of data.

Another challenge is the difficulty in locating specific documents or pieces of information. Despite advanced search capabilities, the sheer volume of digital data can make retrieval time-consuming and inefficient. This problem is exacerbated in industries like healthcare, where data is often stored in disparate systems due to privacy concerns and regulatory requirements. Documents became larger as the size of a paper document to be stapled or bound was no longer a limitation. Records were no longer limited by space and availability of paper. That meant more text in documentations, more to read from various sources, and make sense of.

Furthermore, the transition to electronic systems required significant changes in work processes and habits, which was difficult for employees to adapt to. This led to resistance and slowed down the adoption of new systems.

However, it is important to note that these challenges are not insurmountable. Solutions such as improved data management practices, better search algorithms, and user training can help mitigate these issues. Additionally, the use of artificial intelligence and machine learning can aid in managing and retrieving data more efficiently.

In conclusion, while the shift to electronic systems has brought about a new set of challenges, these are not unique to any one industry and can be addressed through technological advancements and improved practices. The benefits of digitisation, such as improved accessibility, reduced physical storage needs, and the potential for automation, still make it a worthwhile endeavour for most industries.

Key references:

  1. Industry 4.0 Challenges and solutions for the digital transformation and use of exponential technologies – Deloitte“: This study discusses the key challenges faced by manufacturing companies in achieving digital transformation and the benefits derived from it.
  2. Challenges of digitalisation process in different industries. Before and after – ResearchGate“: This publication investigates the challenges and needs of companies from different industries before and after the implementation of digitalisation.
  3. CHALLENGES OF DIGITAL TRANSFORMATION“: This research aims to find the challenges of digital transformation in the restaurant industry.
  4. Challenges with Organising for Digital Transformation in International Manufacturing Networks“: This paper provides a comprehensive understanding of challenges related to digital transformation and solutions on how to overcome them.
  5. Digital transformation challenges: strategies emerging from a multi-stakeholder approach“: This paper proposes strategies that companies, public administrators, and organisations in the education industry can undertake to address digital transformation challenges.
  6. The Challenges and Opportunities in the Digitalisation of Companies in a Post-COVID-19 World | Semantic Scholar“: This paper discusses the challenges and opportunities in the digitalisation of companies in a post-COVID-19 world.

Staff shortages

The next thing that was changing over the last 15 year was increasing shortages of staff. A Kings Fund report (Nov 2022) “NHS staffing shortages: Why do politicians struggle to give the NHS the staff it needs?” stated “The most recent statistics for England – from September 2022 – report a vacancy rate among doctors of more than 7 per cent and a vacancy rate among nurses of almost 12 per cent (NHS Digital 2022c). Just four months earlier, in May 2022, the same figures stood at less than 6 per cent and at 10 per cent respectively (NHS Digital 2022cOfficial figures).”

An increasing nursing staff shortage in mental health services, saw the NHS promoting up relatively inexperienced nurses in order to boost recruitment. There is no hard data on that phenomenon. It is something that I and my colleagues saw. I saw it across every Trust I worked at in the last 5 years and I did not have the luxury of time to gather data. The impact of that is not easily appreciated. It meant that the experience and expertise one would normally expect was not there. I spent more time explaining the very basics to those promoted up staff, in order to ‘get the job done’.

According to The Royal College of psychiatrists (October 2021) an approximate 10% shortfall of psychiatrists in the UK has caused  “…some patients to wait 18 weeks or longer for treatment…” The article did not disclose a median waiting time. It went on, “Consultant vacancy rates vary dramatically across England. The North West and Trent (East Midlands) have a vacancy rate of 15% – significantly higher than the national average of 10.68% – followed closely by the West Midlands and South West at 14%.

Pandemic

The pandemic had a serious after shock on staffing numbers and performance. By ‘staffing’ I mean both nurses, psychiatrists and other so-called ancillary staff. I won’t go into it here. See: Pandemic lash and Health Debt for deeper details.  The effect of the health debt meant that patients relatives and carers needed very careful attention and time. People were in much distress. It would have been cruel to move ‘at speed’ with them.

The pandemic and post-pandemic periods also saw teamwork taking a big hit. Mental health teams by force of circumstance during the pandemic, could not work closely together despite new technology for video conferencing. Over-reliance on email led to workers spending more time on computers. In the post-pandemic period teams are finding it difficult to re-group into real physical spaces for rich working together. The nature of that is complicated and the topic of perhaps a PhD thesis (not mine). But focus and think about what all that means for time and time-efficiency. In a nutshell, it is bad news.

The tools of TM

In this part I will focus on time management strategies and techniques for time management (TM). However, those were never tested scientifically and no one (I know or could find) has tested them in the post-pandemic period. Time management strategies are tools. The effectiveness of any tool depends on how well it is used.

Eisenhower Matrix

 See how the EM works from here: https://www.eisenhower.me/eisenhower-matrix/

Download a free Excel template from: https://www.vertex42.com/ExcelTemplates/eisenhower-matrix.html

Pomodoro technique

This is about managing the time spent on a task in various increments of time.

Read more about it: https://www.techtarget.com/whatis/definition/pomodoro-technique

Wider traditional strategy

Take away summary

This article highlights several factors that have increased time demands in health services and made traditional time management strategies difficult to work with.

  1. Changing time demands and increasing standards: The author cites the example of the Mental Capacity Act 2005 and the NHS Constitution 2009, which increased patient rights and required doctors to spend more quality time with patients.
  2. Information Technology problems: The transition from paper to electronic systems was expected to increase efficiency, but it has led to information overload and difficulties in locating specific documents or pieces of information. The author suggests that these challenges can be addressed through improved data management practices, better search algorithms, user training, and the use of artificial intelligence and machine learning.
  3. Staff Shortages: The article mentions increasing staff shortages in the NHS, with a particular focus on the mental health sector. The author notes that this has led to the promotion of relatively inexperienced nurses, which has increased the time demands on more experienced staff.
  4. Pandemic: The COVID-19 pandemic has had a significant impact on staffing numbers and performance, and has also affected teamwork. The author suggests that the health debt caused by the pandemic has increased the time demands on health service workers.

The article concludes with a brief mention of time management strategies and techniques, including the Eisenhower Matrix and the Pomodoro Technique. However, it is observed that these techniques have not been scientifically tested and their effectiveness can vary depending on how well they are used.


Other posts that may interest you...

Systemic disempowerment in care-delivery organisations

Today I explore the term ‘systemic disempowerment‘ (SD) as pertains to large health and social care services. Health services are without doubt inseparably intertwined with social care services. The concept ...

Read more

Off-label and off-licence prescribing

In the UK, the terms “off-label” and “off-licence” prescribing are often used interchangeably, but they refer to slightly different concepts. The General Medical Council uses the term ‘unlicenced prescribing’.  Typical ...

Read more

Documentation

All health service personnel who deliver or are involved in delivering frontline health services are required to document their work. This is unarguable. [AC_PRO id=913] What does documentation mean?  Documentation ...

Read more