28 June 2024

Do you mean soon, urgent, critical, important, emergency, pressing or now? The pressure of time prioritisation is relentless and often feels out of my control. This is the nature of healthcare and the unpredictability of illness.

We all attempt some form of time management, maybe classifying jobs on the important/ urgent grid. Perhaps that helps you, but the trouble is that nearly everything is important and urgent when you are dealing with people and their health. Many organisations use a red, amber, green (RAG) colour system to classify job urgency, but those systems tend to develop darker and darker shades of red as task prioritisation struggles to keep pace with urgency.

The NHS uses OPEL (Operational Pressures Escalation Levels) to monitor and manage pressure in health services. This replaced a system of colours of which black was the colour beyond red. Opals are those beautiful gemstones renowned for their remarkable optical properties, meaning nearly every colour can be seen in them, so a very clever choice of acronym.

Probably like most clinicians, my urgent is “now, immediately, Do Not Pass Go”. Those are the medical emergencies we get chased down for and need to run to. 

The problem we have is that there is a near infinite range of importance and urgency in between those two poles and we must decide how to manage this.

The unpredictability of illness

There are just no rules when it comes to side effects or complications. We might know on average how many people get ill after certain treatments. We might try to prevent tumour lysis, thrombocytopenia or sepsis, but whatever we do, they will keep on happening.

Blood results come through as you are walking down the corridor to go home. Phone calls about sick people arrive when you are trying to prescribe complex chemotherapy. Blood results appear when your daughter is texting you her exam results, and scan results are emailed as you are dealing with the routine.

I get overloaded with everyone wanting everything done NOW, it can’t wait, whatever you are doing, it has to stop and focus on the new problem. It reminds me of O level algebra and those pesky nested brackets – you have to do the problem in brackets first.

Which one do you do first in the following formula?

((x-2(y+z))3 + (93-b(a+d)))2

You begin one job and find yourself doing another one “inside” that first job, and before you know it, you have forgotten what the first job was. You forget or you make an error.

Every test, every scan, every deadline, every single bit of care is marked urgent for fear that if we don't, then it just will not get done.

Urgency – the unwanted gift

There are a whole host of time management tools. Instead, I hope to get you thinking of a different approach to urgency in healthcare. The real issue is what we are doing to others. Urgency is the unwanted gift we give to people. Everyone seems to want things now, those quick emails expect a quick reply. Every test, every scan, every deadline, every single bit of care is marked urgent for fear that if we don't, then it just will not get done.

If everything you request or demand is “urgent,” then nothing is. No one will have a clue how to prioritise your work. People have finite time and finite resources. It is just not possible to do everything now. The world around you will just feel permanently tense if you keep doing this, people will not know how to manage you and your requests.

If you mean something is “important, please don't forget,” then tell them that. The next time you want something urgently, have a think about what you really mean. If it is truly urgent, make sure it is clear why. Be realistic, be aware and share information so people know what you mean. Overall, more will get done and fewer mistakes will be made. Life will be a little less stressful both for you and those around you.

It is relatively easy to track everything, mark it as a risk, assign it a colour or a number but this can have unexpected effects down the line. The target becomes the goal, not the task.  “When a measure becomes a target, it ceases to be a good measure” is an adage known as Goodhart’s Law. In healthcare, you may see priorities given to one area at the expense of another because the target is deemed the most important thing.

Making the most of modern technology

What I like about electronic systems is the ability to always have my lists around.

A lot of us are probably still using paper-based systems like my former colleague was – check lists, post-its and folders. When you consider how many of our jobs now arrive via electronic means, it is a little unusual if we persist with those. Maybe an electronic equivalent would help you.

There are loads of apps to try or just explore some of the clever things Outlook can do.  You can colour code, set flags, use deadlines, create priorities, issue automatic responses and create message rules. That last one has helped me recently – every time I make referrals to our multidisciplinary team (MDT), emails go to our cancer tracking team, all automatically, I don’t have to remember a thing. You can set reminders, make lists, use the “Focused” rather than “Other” inbox, put @names in the text for speed, or you can even dictate your emails.

What I like about electronic systems is the ability to always have my lists around. They don't depend on me being near a particular desk or PC. I can tick off some of the small jobs whenever I find myself with a few spare minutes. Ticking things off a list always feels good.

Final thoughts

For those of us in lab medicine, we need to keep sharing a consistent message about urgency in ever more creative ways. Our request forms have that urgent box, and the “even more urgent than that” box. Time and resources are not infinite and mistakes happen when things are rushed. More haste, less speed needs to be scribed onto my door.