The Power of Priorities: How Hospital Leaders Can Regain Control of Their Time

Prioritization is one of the biggest challenges leaders face today. In fact, I hear about this issue all the time from leaders at all types of healthcare organizations, from huge multi-hospital systems to physician practices.

One question we ask as part of our Straight 'A' Leadership Assessment is, "What are the top three barriers or challenges you face that keep you from achieving results in your area of responsibility?" We've surveyed more than 34,000 leaders, and they most often identify three things as barriers:

They say 1) they have too much on their plate, 2) they don't have enough resources and 3) they have too many priorities.

A few months ago a new leader said to me, "Quint, one of my biggest issues is prioritization. I almost think I have Attention Deficit Disorder. When I come to work, I want to get something specific done. Then I go home and realize I did a whole bunch of tasks that day, except the one task I originally meant to check off the list! So many things interfere."

I believe many people are facing similar situations. But the harsh reality is every leader will always have a full plate. Every hospital manager, in the foreseeable future, will have to work with fewer resources — not more. And each leader will always have many priorities. This means constant efforts to be more effective and efficient are necessary for any leader in any department at any successful organization.  

My recommendation is this: Don't just make a to-do list — weight and prioritize it. Make this a ritual. Before you begin checking emails — before you even turn on your computer — first plan your day, prioritize your tasks and figure out the most efficient way to execute each item.

"A, B, C" ratings aren't enough
Agendas are nothing new to most healthcare leaders, from managers on up. Almost every one goes to work with a to-do list, many of which are lengthy. Many people use an A-B-C scale to evaluate tasks, but this can grow problematic. By the time we're done ranking, most things come out as "A" priorities. This doesn't help us know which things to do first, because all of a sudden we are looking at a long list of critical, high priorities.

It's hard to ignore what this can do to leaders' morale. It causes us focus on what we don't get done in a day, and that can be quite discouraging. It can make us feel like we've failed in some way, even though we are hardly alone in this challenge. Most people set out knowing they may not finish everything they'd like to.

This is why more deliberate prioritization is vital. It helps us more clearly focus on what we actually executed, and eases our worries that something important might slip through the cracks. Ultimately, a weighted to-do list leaves us feeling empowered and in control.

Leaders can also instill more meaning into their workdays by focusing on their accomplishments. When I was at Holy Cross Hospital in Chicago, I asked the leaders to ask themselves a specific question each day before they left: "What have I done today to make this organization better?" We found that after answering this, leaders walked away feeling better. They were focused on what they accomplished and on how that added value to their hospital.

A day in the life of leader: How to weight and prioritize
I've seen weighting and prioritizing work for many people. I recommend others try the following method; it helps us make sense of lengthy to-do-lists that can easily blend together to become one big, overwhelming, "high priority" task bundle.

It's important that leaders start their day by defining what 100 percent of their time is equal to. Whether that's eight hours, 10 hours or 12 hours, this number equals 100 percent of the time they have to give to work. Then, look at each item on the to-do list and prioritize and weight it based on how vital it is to execute that task within the time you've allotted yourself.

Let's say I'm a leader and this is my to-do list for the day:

1. Plan for the rollout of the employee engagement survey, which will begin next week.
2. Round on employees, particularly for feedback on the new software product that's been implemented in the past week.
3. Hand out reward and recognition tokens to a couple of employees who were specifically noted during my most recent rounding session.
4. Check up on an employee who has been out of work with a sick child.
5. Send a note to my boss about an employee so that person can be recognized with a thank-you card.
6. Make sure staff is flexed appropriately in light of financial pressures. Do I have the right labor hours based on patient volume?  
7. Get back to a physician about a question she asked me about a patient's admission.

These are all tasks I must complete in one day. Where do I start? First, I need to identify those that are most vital. Hopefully, I'll be able to determine this based on goals that have been set by my boss, which are weighted more heavily on my evaluation. (Objective, weighted leader evaluations are a cornerstone of any successful organization.)

Maybe I determine that out of the seven items, the most important are those related to staffing levels and the physician's question. I make a plan to get back to the physician immediately, and I also set aside time to review staffing and determine if we need to make any adjustments for the upcoming schedule. So let's say I give "get back to the physician" a weight of 25 and "review staffing" a weight of 25.

The next weight and priority might be spending some concentrated time reviewing and preparing for the rollout of the employee engagement survey. I have to devote enough time to this task to properly study the process and make sure I'm able to clearly communicate it at tomorrow's staff meeting. I also need to make sure I can connect the survey to our broader organizational goals in that meeting to maximize the response rate and staff input. So that gets a weight of 20.

Next, I'll prioritize rounding, which gets a weight of 20. I will plan what type of feedback I want to gain from my staff so my time is well utilized and I'm efficient while on the floor. I'll plan to ask specifically about the new software product that was implemented last week so I can make any changes needed. I can also use feedback from rounding in the staff meeting tomorrow to provide updates. Even more, I can prepare to reward and recognize staff who were managed up as I round, and during the round I'll connect with the employee who is back and check on her child.

Finally, the next priority would be to send the request for a thank you note to my boss so an employee I heard positive things about in my recent staff rounds is recognized. I'll give this a weight of 10.

Do the math and you'll see this all adds up to 100 percent. Of course, it may not really take 100 percent of my day, but that's fine. I can always spend excess time working on items from tomorrow's list.

I find this process works. Instead of looking at tasks from a surface level, I thought each one through — how it relates to one another and which tasks, when completed, help me more effectively complete future tasks, like my staff meeting tomorrow. I can also organize in a way that helps me multitask, like rounding while also checking up on an employee with a sick family member.

By connecting my behaviors and allotting a certain amount of time to each to-do list item, I can better understand what constitutes a "priority." This is an empowering piece of knowledge, as everything in healthcare can quickly become a "high priority" if we don't deliberately think it through.  

Finally, this routine lets me begin my day with a sense of certainty that vital tasks will get finished first. That evening, I won't leave my office thinking about the one vital thing I didn't do.

Another tactic: Hardwiring essential behaviors
Rituals are incredibly powerful for time management. Another way to organize tasks and make the most of your time is to hardwire certain behaviors and items from your to-do list into your routine. To many leaders, it makes sense to frame items as daily, monthly and quarterly tasks. Just as airplane pilots refer to a pre-flight checklist to hardwire safety, leaders can do the same. Here is an example of a checklist you can use to hardwire leadership behaviors.

Daily
1. Manage up myself, my colleagues and physicians.
2. Round for two hours each day with employees and patients.
3. Utilize rounding logs to follow up on issues, and reward and recognize employees.
4. Reward and recognize staff with the 3:1 compliment ratio.
5. Make pre- and post-discharge phone calls.

Weekly
1. Manage up one compliment to a senior leader to feed the employee thank-you note process.
2. Publicly reward and recognize a high performer while rounding or during staff meetings.
3. Recruit one high performer to coach one middle performer to help him or her achieve higher performance.
4. Encourage employees' bright ideas and innovation.
5. Update the communication board and post weekly patient satisfaction scores.
6. Solicit feedback from staff for suggested service and operational improvements.

Monthly
1. Hold monthly department meetings.
2. Meet monthly with your supervisor. Discuss identified opportunities for improvement and what you've learned from rounding.  
3. Reinforce behavioral standards, both for the organization and department.
4. Conduct 30- and 90-day with new hires and help answer their questions.

Quarterly
1. Review and update 90-day work plans and goals. Include initiatives, actions to be taken, timelines and rewards.
2. Attend leadership development sessions.  

I've found both weighting and prioritizing and breaking tasks into daily, weekly, monthly and quarterly checklists can help leaders regain control of their workday. No leader, department or hospital can wait for their external environment to calm down, as such a time will likely never arrive in healthcare. We can't change this reality — what we can change is how we live and work in the face of it.

More Articles From Quint Studer:

Building a Culture That Works: 5 Traits of High-Performing Healthcare Organizations
The Hospital CEO's Ultimate Dashboard: What to Check Daily, Quarterly and Yearly
10 Signs of Troubled Physician Alignment

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