PERSPECTIVE: Mastery of time: a challenge for physician leaders
Malcolm Ogborn, MBBS
Dealing with time demands is an ongoing challenge for physician leaders and a significant reason for the reluctance of physicians to accept leadership roles. Mastering time involves more than just maintaining a structured calendar; it requires understanding the bias our own perception places on time choices, understanding how we assign priority, and developing and maintaining good, consistent habits of time allocation. Time perception falls into five main frames: Past-Negative, Past-Positive, Present-Fatalistic, Present-Hedonistic, and Future. How we balance our focus between them has a significant influence on our time-allocation choices. Understanding urgency requires vigilance for decisions being driven by impatience. Understanding importance requires careful reflection on personal mission, values, and goals. Email is often cited as a unique challenge to effective use of time, but is really just a slightly special case of the consequences of not having a firm paradigm for making decisions about use of time. These concepts can be applied in concert through frameworks, such as the Eisenhower box. Effective time management is not a simple trick; it is the product of good habits of thought, appropriate organizational skill, and clear communication to those with whom we work. Commitment and practice in this area can be life changing.
KEY WORDS: time management, time perception, physician leadership, Eisenhower box
“How did it get so late so soon? It’s night before it’s afternoon. December is here before it’s June. My goodness how the time has flewn. How did it get so late so soon?” — Dr. Seuss
Better time management is an almost universal wish of physician leaders. Taking control of our time is essential for our own effectiveness and well-being. Also, one of the most common responses of potential leaders is, “I am not sure if I can find the time.” To attract other physicians to leadership, leaders must demonstrate, by example, that the demands of leadership can be managed within a reasonable lifestyle.
Mastery of time occurs in three steps: understanding our own individual perception of time; achieving insight into what is truly urgent and truly important; and applying those insights to allocate time.
Understanding perception of time
“You can’t have a better tomorrow if you are thinking about yesterday all the time.” — Charles F. Kettering
Nor can you effectively manage the challenges of today if your head is perpetually lost in the infinite possibilities of the future. Dr. Philip Zimbardo, over decades of research into how we perceive time, has identified five “temporal frames” that capture how we cluster our time perceptions.1 These are Past-Negative, which views past experience with negativity and pessimism; Past-Positive, which is the reverse; Present-Fatalistic, where we see ourselves at the mercy of current events; Present-Hedonistic, where we seek pleasure and gratification in the moment; and Future, where we plan and consider diverging possibilities. The tendency to use each of these frames can be measured by an online inventory tool.2
Based on accumulated data from this inventory and studies correlating it with other psychological measures, the researchers have proposed an ideal balance between frames — not just for time issues but for balancing affect.3 Predominant foci in Past-Negative, Present-Fatalistic, or Future have been associated with negative affect, whereas Past-Positive or Present-Hedonistic foci are correlated with positive affect. To be productive in the present and organized for the future, we must accept what is beyond our control in the present, while making room in the moment for our happiness, well-being, and celebration of achievement. We also need forward-thinking plans without being paralyzed by consideration of an infinity of possible outcomes. If we lean excessively to past or future, we risk not allocating enough time to present events.
Conversely, if we fill every minute of our formal schedule with present concerns, we set ourselves up to fail when we inevitably drift for some time into reminiscence or speculation. In balanced time perception, making allowance for time spent in past, present, and future is essential. Achieving this balance in perception is amenable to a range of coaching or self-change approaches, discussion of which is beyond the scope of this article.4 Without such balance, we may pay lip service to managing time in a logical way, but our preferred time focus will act to sabotage our best efforts by leading us away into past or future, or allowing to us to abdicate responsibility for our fate by wallowing in fatalism.
Deciding urgency and importance
“Your time is limited, so don’t waste it living someone else’s life.” — Steve Jobs
Urgency is an important influence in time-related decisions, and complex mathematical models compete to quantify its impact.5 But while we measure urgency, defining the source is much more elusive. Jon Elster, a political and social theorist working from a more philosophical viewpoint, hypothesizes that we tend to be “intolerant of inaction.”6 He then draws a distinction between two states that form that intolerance: impatience and urgency. In impatience, we are unable to defer gratification and will accept smaller gains for immediate reward. Urgency is more complicated; it leaves space for recalculation of the benefits of delay and the urge to act may be tempered by other concerns. Top
In both cases, our judgement is likely being influenced by how acting will reward us. How many of the things that hit your urgent list will have serious consequences for you and others if delayed, meaning they are truly urgent? Here the reward is achievement of a goal or avoidance of catastrophe. Alternatively, how many things on that list will have irritating consequences or require some effort to defer or refuse, but their delay will not contribute to the end of life as we know it? Here the reinforcement is often no more than avoiding or deferring something undesirable, or requiring more immediate effort to secure a longer-term gain. Such immediate gratifications can unfortunately still be powerful rewards. Top
Do you ever accept a task that is really a distraction, but it is easier to get it out of the way than deal with a nagging requester or have a learning conversation about whether the request is appropriate? Do you find yourself saying, “It’s just easier to do it myself”? If you answered “yes” to either question, you may be confusing impatience with urgency. We are busy people; as a result, many of our urgency rankings risk being relegated to Daniel Kahneman’s7 largely subconscious System 1 thinking, which supports quick decision based on unconsciously recognizing patterns of inputs. This instant decision-making, while economical of effort in the moment, creates the risk of being seduced into short-term expediency at long-term cost. Mastering time requires using Kahneman’s more objective, intentional, and reflective System 2 to make conscious decisions about what issues truly merit the designation urgent. Top
The issue of importance also has layers of nuance. To quote Stephen Covey,8 “If something is important, it contributes to your mission, your values and your high priority goals.” It follows logically that, to identify something as important, you must be able to identify your mission, articulate your values, and set your high-priority goals. Top
Mission may be something imposed by organizational practice or business, although often such statements lack the precision required to inform choices among individual scheduling demands. Leadership literature stresses the value of personal mission statements as the “how” of achieving our vision, which in turn is the “what,” a describable and achievable state of the future. Time aligned with mission is time spent in a role or behaviour that contributes to what we seek to achieve.
Values shape the choices we make in our mission. However, we often only become aware of our values when something arises that conflicts with them. More commonly, we must make a choice about best fit with our values, and this requires conscious reflection. The free online Barrett Personal Values Assessment (PVA) can help start this process.9 The PVA is useful for articulating values, but it also maps them onto psychological drives. Time aligned with values is time aligned with meeting the underlying needs those values support. Top
Goal setting — Many organizations have embraced the SMART goal concept: Specific, Measurable, Achievable, Realistic, Timely. However, in my experience, many people do not routinely use such goals much beyond annual performance evaluations, let alone in daily scheduling decisions. Even simple steps in this direction, such as maintaining an up-to-date “to do” list can be very helpful. Time aligned with goals results in completion of objectives and milestones that you have set for yourself.
It is worth noting what research says about how we perceive time well spent. Dr. Ilona Boniwell3 found that time well spent is associated with doing things we like, that serve balance in our lives, work well with our organizational systems, and do not leave us with a sense of time running away from us or out of our control. She describes a cycle, which might be seen to reward some choices and discourage others. It does hinge on the starting point of doing things we like, or things that give us satisfaction. Top
Dr. Kennon Sheldon10 found that events contributing to self-esteem, such as autonomy, relatedness, and competence, tended to be seen as the most satisfying and were consistently ahead of those contributing to self-actualization or meaning, physical thriving, and popularity. Events associated with the acquisition of money and luxury were seen as an even less satisfying use of time. The hierarchy that puts status and achievement ahead of well-being may well be relevant to the discussion of burnout among physicians and other high-achieving professionals. Even the concept that we find enhanced self-esteem more satisfying than self-actualization suggests a risk of making time choices to look good rather than pursuing personal goals. Top
Making accountable decisions about time allocation
“The key is in not spending time, but in investing it.” — Stephen R. Covey
The core issue in mastering time is having a clear decision-making paradigm about allocating time and a clear action pathway arising from that paradigm. A simple and effective model, described in detail under the third of Stephen Covey’s8 “seven habits of highly effective people,” is the Eisenhower box. This model was first described by President Eisenhower in a speech to the World Council of Churches in 1954. The box is a simple two by two grid with columns labeled “Urgent” and “Not urgent,” and rows labeled “Important” and “Not important” (Figure 1). The simplest application suggests that tasks in quadrant 1, urgent–important, be done immediately. Tasks in quadrant 2 (not urgent–important), while important, can be scheduled to a convenient time. Tasks in quadrant 3 (urgent–not important) may be urgent for someone other than you or, even if urgent, the penalty for not putting them ahead of other priorities may be acceptable. These may be deferred, delegated, or discarded. Tasks in the final not urgent–not important quadrant may be nice to do but not essential, or may often be tasks continued out of tradition or habit. These may be safely discarded. Top
Covey makes some further telling observations about the “highly effective” people he studied. First, they anticipate the demands of the urgent–important quadrant. They pre-emptively allocate time for these tasks, knowing they will happen, even if they do not know what they will be. This is analogous to an office medical practice reserving a couple of appointments each day for urgent patients. Second, and most striking, highly effective people simply do not do quadrant 3 and 4 tasks. In Covey’s view, highly effective people focus exclusively on what is important. It also follows that they must be skilled at turning down requests for their time. Top
Totally ignoring the tasks allocated to quadrant 3 may be a luxury not all can afford, but this area is prime for developing delegation skills.11 There is a trade-off here: in exchange for gaining back time that would otherwise be spent on the task, the leader must intentionally allocate a share of quadrant 2 time to provide clarity about the task to the delegate, make a commitment to follow up, provide thoughtful and constructive feedback, and celebrate success. By so doing, they convert a distracting task to a capacity-building exercise for members of their team, which will reduce their own workload in the long term. Delegation is also a valuable tool in deriving the most benefit from personal time.
A number of studies have shown that people who use their wealth to buy time for desired pursuits are happier than those who accumulate “stuff,”12 making this the exception to the old saw of money not buying happiness.
Time spent in maintaining social relationships, fitness, and health should clearly be quadrant 2 activities. If you are deferring these during your precious off time to cut grass or clean bathrooms, you might want to explore buying those services. Top
Email is not above the law
“Any email that contains the words ‘important’ or ‘urgent’ never are, and annoy me to the point of not replying out of principle.” — Markus Persson
Email gets a special mention, because it is frequently identified as one of the major time stresses in many environments. It is recognized as a driver in many workplace distraction scenarios and maladaptive behaviours. Some companies and European countries have gone as far as regulation and legislation to limit off-hours access to and use of work email as a workplace health and safety concern.13 Despite this imposition, these countries and companies seem to be doing fine, perhaps proving that there is life beyond email.
If you sit at your screen, waiting to pounce on and respond to messages at any time of the day and night, you are the one training people to send you those emails. Instead, you could set aside specific time for email processing in your schedule. It is possible to construct filters to align incoming messages with your urgent and important criteria. If you do so, you will find that people will pick up the phone if it really is urgent (it usually is not). They may conclude that, if there will not be an instant response, maybe the issue is not important enough to waste time typing. Email survival, detox, and rehab is a big topic that is well covered in The Hamster Revolution.14Top
To master time,
Understand how you perceive time and strive to develop a balanced perspective of past, present, and future.
Develop explicit criteria for what you can truly accept as urgent.
Develop and continuously update criteria for what is important. Intentionally weigh demands on your time against your mission, values, and goals. Do not forget those things that are important to your well-being and humanity.
Create and implement a decision-making paradigm to apply the axioms you adopt. Put the commitments involving your life balance and well-being into the calendar first. Apply the paradigm to everything, including email.
Practice ways to say no to demands outside your priorities. Look for opportunities to delegate while allowing adequate time to follow up and support the delegation.
Consider coaching to support you. This could be informal, working with friends, family, or colleagues who are striving to or have achieved similar results, or engagement with a professional coach.
There is no instant panacea for time management. Each of these steps requires reflection, development of a process that works for you, commitment to apply that process, and re-evaluation of your results. It involves discarding old habits and developing new ones, with all the neuropsychological complexity that we now understand comes with such changes. This is challenging work, but success, or even progress, can be life changing. Do you dare try?
“If we take care of the moments, the years will take care of themselves.” — Maria Edgeworth Top
13.Russell E. Dealing with work email: what are we doing and why are we doing it? In: Niven K, Lewis S, Kagan C (editors). Making a difference with psychology. London: Richard Benjamin Trust; 2017:202-9. https://tinyurl.com/tr77mpp
14.Song M, Halsey V, Burress T. The hamster revolution: how to manage your email before it manages you. San Francisco: Berrett-Koehler; 2008.
Malcolm Ogborn, MBBS, FRCPC, CCPE, COC, ACC, is a retired pediatric nephrologist and researcher who has worked across Canada. He is an International Coaching Federation certified professional coach who focuses on supporting health care leaders, particularly those new to leadership.
Affiliation/conflict of interest
Dr. Ogborn is a clinical professor, pediatrics, at the University of British Columbia and coaching lead with The Optimistic Doc, a division of Dr. M. Ogborn Medical, Inc. He derives income from offering health care leadership and consulting services to individuals and organizations. He has no commercial or other relationship with any authors whose work is mentioned in this article.