CHAPTER 3

Planning and Organizing

Chapter Overview

You will face new challenges and be expected to make decisions in your role as a health care manager. Learning to lead with structure and applying some management tools can help you to take charge confidently as you plan, organize, and get things done.

Topics in this chapter:

• Planning and being proactive
• Organizing and leading meetings
• SBAR: a tool for effective meetings and other decision making
• How decisions are made
• Honoring your commitments for getting things done
• Managing your time and yourself
• Managing my time and myself: what I have learned and recommend
• Chapter summary and key points
• Learning activities for this chapter

Planning and Being Proactive

There are many activities and priorities competing for your attention as a new manager. Levinson and Cooper (2015) acknowledge that your intentions are important in setting the right direction, and learning to follow through turns your good intentions into action.¹

Developing a 30/60/90-day plan can help you get organized and track your progress along the way as you learn how to operate in your new role and determine how you fit into your organization.² Such plans were initially targeted to employees starting a new job in a new organization, and can also help you if you have moved into a new role with new management responsibilities in the same organization.

Guidelines for Your First 30/60/90 Days

• Your first 30 days: Initially, you will be in a learning phase. You will observe and listen to understand how things are done and what needs to be done. You will find out your boss’s expectations of you, begin to develop working relationships with coworkers, get to know the people who report to you and start meeting with them, and gain understanding of the culture of the organization and of the team you are managing.
• From your 30th to 60th day, having listened and learned, you are ready to contribute more to the conversation. Start applying your unique skills and strengths where they can be useful, develop versatility by taking on some additional things, and continue to be aware and focused on your boss’s expectations of you.
• From your 60th to 90th day, you should feel more confident in your role, ready to be more proactive and involved in a broader set of activities such as key change projects, work groups focused on solving specific problems, and committees.

Example: My First 90 Days as a Health Care Manager

Here is how using 30/60/90 days planning like this helped me when I transitioned from the role of therapist on a community treatment team at a remote site into my new position as director of quality improvement at our central administrative office.

• First 30 days: I arrived in my new role with a mission to develop tools and solutions to help clinicians provide high-quality care and services to our clients and patients. To develop a foundation to accomplish this, I organized a “Clinical Site Needs Analysis”³ in my first 30 days.

  My new boss, the medical director, was particularly supportive because he had asked during my interview what I would do to get started on the job and I had responded with a brief description of how I would conduct this needs analysis. I started by finding out where all the clinical teams were located, who led them, and when they had their team meetings. I developed a questionnaire, with input from my peer-level directors, to ask each team about their goals and activities and what my quality improvement team could do to help them do their best work. In short, I developed a plan, asked a lot of questions, and enlisted the support of my peers (the clinical directors), my boss, and my team members for this project.

• 30th to 60th day: In the next phase, I contacted the manager of each team to introduce myself in my new role, explain what I wanted to accomplish, and ask if I could visit one of their team meetings to interview the team. Each manager welcomed me to visit, so I scheduled a visit at each of our 52 teams and completed an interview with all of them.

  In the meantime, I listened and participated in meetings with the other directors to understand organizational priorities, and presented brief updates on my progress in scheduling and conducting the needs analysis.

• 60th to 90th day: In this phase, I completed the interviews with each team, and collected the needs they had expressed into 12 areas I could organize into projects that my quality improvement team and I could implement to deliver help and support to clinical teams.

  This set the stage for launching some major change projects through work groups and committees to deliver helpful tools and processes to remove barriers and enhance workflow. One was a system of electronic templates we developed and disseminated that alleviated the repeatedly mentioned problem of too much manual paperwork for treatment planning and other documentation. (This was before we had the electronic medical record systems now required and adopted by most health care organizations.)

• Results: Thus, by my 90th day in my new role, I had developed mutually supportive working relationships with my peers and their clinical teams, introduced some new operational approaches that I had learned from my prior work in the computer software industry and adapted them to work in our health care organization, established some new cross-functional work groups involving various clinical and administrative representatives, enlisted the participation and commitment of my initial small quality improvement team, attracted some others to join our team, and delivered solutions to 12 problem areas identified in the team interviews.

  This momentum positioned us to become involved with other key organizational initiatives and projects, which established the value of our growing quality team in supporting our overall organizational mission to help our clients recover and lead more satisfying lives.

Being Proactive with Each New Position

Remember to plan proactively for each new position and role you move into, especially in a new organization where other people have not seen firsthand what you have accomplished previously. I realized awhile after I had moved to a new position in a different organization that it was not enough to jump into replicating approaches that had succeeded in one organization; the culture and expectations were different in the new organization. Even though I felt clear about my intentions to meet every team in my new organization because I had experienced the benefits of establishing relationships organization-wide, I still needed to step back and formulate this into a tangible plan that I could use to show others what I was doing and why it was important.

In retrospect, I see that my new boss needed to see well-formulated written plans to show her where I was headed, explain the rationale for my approaches, engage her in ensuring alignment with big-picture organizational strategies, and instill confidence that I had a vision and knew how to execute it. When I bypassed the fundamental steps of writing and presenting my plans to my boss and colleagues, I missed the opportunity to get their buy-in early on and to benefit from their wisdom and experience with the culture and processes in the organization that I was just becoming acquainted with. This would have saved time and energy later and improved results.

It can be challenging to resist the urge to jump in and take immediate action toward pressing goals and priorities before understanding the environment where you are operating. Take a deep breath, look at the full scope of what you are expected to do, identify the strengths and experience you bring with you, and take the time to do some solid planning and communicating to build alliances and support for you and your plans. Apply fortitude and discipline to allocate focused time alone for thinking things through. As you channel your ideas and intentions into written frameworks for planning, consider how to utilize meetings, decision-making processes, expectation management, and time management. Such activities help you build solid plans and follow through to successful results. We explore these topics further as we progress through this chapter.

Organizing and Leading Meetings

An opportunity for new managers to establish their leadership positions with their teams and other departments is through meetings that are purposeful and effective in accomplishing goals. If you have participated in effective meetings that accomplished their goals and helped move the team and organization forward, consider what worked well that you could apply to the meetings you will lead. A common lament is that there are too many meetings, they consume too much time, and they are not productive, as illustrated in Patrick Lencioni’s popular business book, Death by Meeting: A Leadership Fable, “centered around a cure for the most painful yet underestimated problem of modern business: bad meetings.”⁴ Meetings incur considerable time and expense because of the multiple people involved and the time they divert from other activities, such as direct patient care. Thus, we provide some guidance here from observations in health care organizations.

There are different meetings for varying purposes. In most organizations, there is an expectation that managers meet on a regular schedule with their teams of direct reports all together and individually with each of the people who report to them directly. It is important to establish a consistent day and time for regular meetings to support a rhythm, help people prepare as needed, and schedule the rest of their working time. Of course, there will be times when you will need to be flexible and be willing to cancel or reschedule established meetings to accommodate other events and activities such as companywide meetings, external meetings you or your staff are required to attend, company holidays, and others.

You may be in charge of various meetings with different purposes and participants. In some cases, you may choose to delegate the running of a meeting to other team members when it makes sense for the roles they are in. For example, project managers can be very effective in reviewing schedules and tasks for the specific projects they have been assigned to lead.

A weekly administrative team meeting may have a duration of one or more hours, depending on the level of organizational responsibility for setting policy and strategy, which tends to require longer meetings of 2 or 3 hours. There may be shorter clinical weekly team meetings focused on specific patients or clients and their needs.

Daily morning huddles are another type of meeting with clinical leaders and staff, much shorter in duration and designed for prompt feedback on processes such as operating room set up and patient flow. Cloud (2010) described the benefits he had seen of daily, 15-minute morning meetings designed to “cast vision, give information, share stories of success, and infuse strategy, thus giving a daily dose of energy that kept it all moving.” These short meetings kept the team aligned around goals, caught problems early, shared lessons, and acknowledged problems. These short meetings did not require preparation so they did not distract from other work; rather, they energized it and kept things moving.⁵

Working meetings may be focused on particular projects, tasks, and decisions. Work groups and task forces tend to be time-limited groups that are formed to solve specified problems or to complete defined projects. To sustain momentum of carrying out projects, they tend to meet every week or every other week, for an hour or two, depending on availability of members.

Some meetings are nonrecurring. They are called to discuss and make decisions about specific current issues. These might require only one, or a few, meetings to resolve the issue or to complete timely solutions to problems. Table 3.1 provides a summary of various types of meetings.

Meeting Purpose

Be sure to clearly establish and communicate the purpose and structure of each type of meeting you are responsible for leading, and be aware of other surrounding and related meetings. This sets expectations for meeting members’ behavior with regard to what issues and topics should be handled where and facilitates coordination of problem-solving and communication. For administrative and strategic meetings, as well as meetings of time-limited work groups convened to solve specific problems, you should plan and distribute an agenda ahead of time; this allows meeting participants to prepare adequately for topics they are responsible for and serves as a plan for allocation of time during the meeting. This planning can help you prioritize issues and avoid trying to squeeze in too many topics without adequate time to consider and resolve them.

Formal, written agendas could be eliminated for short, focused meetings such as clinical huddles, which follow a daily course of a routine health care process that becomes familiar to participants—such as review of prior day’s work in the operating room, successes and recognition for good work, problems and plans for improvement. Ideally, some form of data feedback is incorporated into these meetings to help team members know what they should work on and if their improvement efforts are effective in implementing the right changes.⁶

For administrative and strategic meetings, you will want to work with an administrative assistant or other team support person if available to you. This is an opportunity to work with that person to enlist his or her help and support, work out schedules and approaches that you are comfortable with, and delegate ongoing details and maintenance of agendas and meeting follow-up to ensure your meetings are effective in accomplishing your team’s goals and work. There are other roles that can be rotated among meeting members; an important one is timekeeper to keep track of time usage and remind people when the discussion needs to be wrapped up, tabled, or delegated to another team or committee meeting.

Meeting Structure

Effective meetings, such as a weekly administrative or working team meeting, are organized with a structure something like this:

1. Roles and responsibilities

   Roles should be clearly in place with each responsible person aware of what they are assigned to do to support the meeting. Roles and responsibilities include:

   Facilitator: As the manager, you should facilitate your team’s meeting, at least initially while you are establishing your new leadership responsibilities.

   Note-taker (also referred to as the Recorder): Be sure to have a note-taker to record decisions and action items for later reference and follow-up. To ensure consistency in recording and follow-up, it is best for the note-taker to be in an established role such as an administrative assistant or team support person if you have one.

   Timekeeper: It can be helpful to have a timekeeper to help the facilitator focus on meeting content and dynamics. This helps ensure you start and end each meeting on time and cover the agenda. The timekeeper responsibility usually rotates among team members, but be aware that some are better at this than others! Ultimately, you are responsible for starting and ending the meeting on time (or early!), so assign timekeepers appropriately.

   Participants and your interaction with them: As the meeting leader, it is also your responsibility to ensure that participants have the opportunity to contribute their ideas. Some members will tend to talk more than others, and some may hold back on contributing. You may need to gently prompt by asking, “Does anyone else have something you’d like to say about this topic?” Be aware of how people are reacting; their body language might suggest some thoughts and feelings they are not expressing in words.

   At times, you will need to address some participants directly to draw them out, explore concerns, and ensure the team gets the benefit of particular knowledge or experience relevant to the issue at hand. For example, “Kris, it looks like you have some concerns about the approach we’re planning to take with scheduling nurse coverage. Do you foresee a problem we should be aware of?” or, “Robin, you’ve implemented accounting systems like this for a long time. How do you think clinical staff will react to the new online expense-reporting requirements?” or, “Dani, you mentioned earlier that you have some thoughts about how we could handle unusually high numbers of patients who could show up some days in the new walk-in clinic. Do we need to put that on the agenda for that planning group?”

   To ensure discussion time gets allocated adequately for those who need to contribute but have not, and to avoid having the naturally talkative members dominate the discussion or decisions, you may need to thank those members for the contributions they have already made and gently emphasize that you would like input from those who have not spoken yet. For example, “We’ve heard a lot of good ideas from different perspectives of many of you. I’m interested in hearing ideas and reactions from others who might still be thinking about these and haven’t had a chance to share your thoughts with us yet.”

2. Introduction and focal point

   This could be a reminder of the meeting purpose, organizational mission, vision, and values, and other guiding principles to align the team. If there are new members or visitors, be sure to do quick introductions to ensure every participant knows each other’s name and role. On one executive team I belonged to, we had recently redeveloped our organizational values and wanted to reinforce our active adoption of them. So, we periodically checked in on one of our company values. Leadership of this section of the meeting rotated and was assigned in the prior week’s meeting. The rotating leader of this section selected a value and briefly talked about an example that illustrated the value at work in the organization.

   For example, many organizations include “teamwork” as a value, so the leader might provide a 1-minute example of how several people in different departments worked together to ensure a patient’s medications were refilled seamlessly after an unexpected hospital discharge just before a holiday. Then two or three other team members could respond with other examples they had seen in action. This part of the meeting reinforced our alignment of operating values of the organization, in this case working as a team to serve our patients. And the rotating responsibility for this section kept this team’s members engaged and practicing their own leadership skills, which often reminded them to recognize the great work of the teams and people reporting to them with feedback directly to them in their later interactions or meetings. For example, “Suresh, during the clinical directors meeting yesterday, Fran and Kim made a point of recognizing how you and your team went out of your way to respond quickly and coordinate everything that needed to be done to keep everyone safe and informed during last week’s emergency in the waiting room. Thank you for all the training you’ve done to prepare your team members and instill in them the value of rapid responsiveness. Please let your team know their efforts were noticed and appreciated.”

3. A brief check-in or question

   A benefit of meetings is their capability to help build relationships and promote collaboration. Managed well, meetings can enhance efficiency through real-time collective problem-solving. For some meetings, this part could be an ice-breaker to help people get to know each other and build alignment. On one executive team I belonged to, this was a new question each week, posed by the CEO, who was the meeting facilitator. Sometimes he asked for suggested questions from team members. These often got us laughing and ready to collaborate and work together. (One of my colleagues shared brief metaphorical fables in which her household and neighborhood pets illustrated some of our organizational goals. These sparked our creativity to help us consider things in new ways for effective problem-solving later in the meeting.) A technique used by our CEO when meeting with groups of representatives from external organizations was to ask each participant, “What will make this a great meeting for you?”⁷ This clarified varying expectations and helped the facilitator guide the meeting to ensure success in the eyes of the participants.

   On another team, we each described briefly one thing going well, to set a positive tone for the meeting. On my own Quality Systems team, we shared some current or past experiences and learned some memorable and amusing things about each other that built our camaraderie, trust, and enjoyment working together to implement challenging projects. Choosing a question that highlights the importance of particular agenda items can amplify the value of the question. Thus, if the agenda includes working on patient experience and satisfaction, an opening question about examples of good customer service that we meeting participants had experienced ourselves can provide context that helps us appreciate the topic and facilitates renewed interest and creativity in problem solving.

   Caution! When you are planning your meeting, be aware of the time consumed per member on an opening question or activity. On a large team of a dozen or more people, this can consume a significant portion of your meeting time. For this to work, you will need to utilize the timekeeper to ensure no one takes more than a minute or two, that no one monopolizes the time with overly long stories and details, and that people learn to hold their dialogue and responses until later.
   This is an opportunity to apply Shari Harley’s (2013) suggestion to set expectations and agreement ahead of time⁸ to make it easier to keep people on track. For example, “These are great examples we’re hearing. And we’ve all agreed that we’ll spend no more than 10 minutes on the meeting opener, and we’d hold our follow-up questions and dialogue until after the meeting so that everyone can contribute something briefly before we get to the other things we need to cover on our agenda. Thank you, Jo, I’d like to hear more about your experience later. Let’s continue—Brett, you’re next.” This will take some practice. Balance fun with practicality and be prepared to repeat and adjust as needed!

4. Follow-up on action items from previous meeting(s)

   This was added as a standing agenda item of a team that had many urgent activities as a result of changes in health care funding. Having a systematic and predictable follow-up on the agenda proved to be very effective in ensuring that team members were aware of and followed through on the action items they needed to complete, usually from the prior week. Occasionally, items would carry through for a second week, but the norm was established to complete most things within the week to avoid backlogs of critical issues and ensure prompt implementation of solutions.

5. Standing agenda items and updates

   These can be periodic or rotating report-outs from designated team members and functions to ensure communication and coordination. This can be particularly helpful if your team members work in different physical areas or functional responsibilities, to increase their awareness of what others on the team are doing, how members can support each other, or share resources and learn from each other. Major organizational projects, such as the implementation of a new electronic health record used by all clinical staff and most administrators, need regular visibility because of the high impact of the project with a strong need to respond quickly and remove any barriers that might threaten the project’s progress.

6. Other updates or problems

   Often this is what most of the meeting time is allocated to and where the hard work gets done. Typically, team members can request time on the agenda. You or an administrative organizer need to work with the requestor to determine the amount of time needed to discuss, the urgency and priority of the item, and to verify that this is the right meeting or forum where the item should be discussed. You need to apply judgment and discipline to slot these requested agenda items into the appropriate meeting and date depending on available time and urgency of resolution.

7. Meeting wrap-up

   This is an important final step to close the meeting and transition what was accomplished back into your team’s continuing work. If your meetings generate follow-up action items, it is crucial that there is a brief review of the items and responsible person for each one, so people leave knowing clearly the assignments and activities they are expected to do. Some meeting facilitators include a very quick round of feedback on the meeting; it could be a one-word description, a numeric rating, or something they liked about the meeting. This provides a gauge for the facilitator and team members about how they are working together and what could be improved, helping to instill shared responsibility in team members for the health and functioning of their team.

Meeting Agenda Format Example

Design a table with the topic areas you will cover and time allowances, as shown in Table 3.2. Include a column to record key decisions and actions from the meetings. This will make it easy to keep track of what was decided and help the recorder complete and distribute notes quickly to ensure people promptly complete their follow-up action items. A blank meeting agenda form is included in Appendix B.

SBAR: A Tool for Effective Meetings and Other Decision Making

A useful tool for preparing for some meeting agenda items, particularly for problem-solving and action proposals, is the “SBAR,” which provides structure and intentional planning to identify the “Situation, Background, Assessment, and Recommendation” in terms of:

 

S = Situation: a concise statement of the problem

B = Background: pertinent and brief information related to the situation

A = Assessment: analysis and considerations of options—what you found out and how you evaluate alternative courses of action

R = Recommendation: the actions you believe are the best solution and for which you request approval and support from others to move forward in carrying them out.

Brief Example for Clinical Care

The Institute for Healthcare Improvement (IHI) provides online tools and resources for using the SBAR approach. An example in IHI’s materials illustrates how a medical treatment team could structure its communication and approach in an ad hoc gathering of team members to respond immediately to a crucial medical emergency with a patient. In that case,

 

Situation is the patient’s medical condition.

Background provides the relevant factors in the patient’s medical history.

Assessment is a brief clinical assessment with relevant diagnostic factors.

Recommendation is the clinical response and treatment recommended by the clinical responder.⁹

Expanded Application for Organizational Problem-Solving

The SBAR approach can be adapted for use with other health care professionals and administrators. It is useful in nonemergency planning and problem-solving to improve processes and decision making throughout the organization. The tool was introduced to our health care organization by our CEO at Mental Health Partners, Kelly Phillips-Henry, PsyD, MBA, who had used it at another organization where she had worked.

SBAR proved to be valuable to organize communication and preparation around problem-solving agenda items and action proposals that people requested for inclusion in meeting agendas. By providing structured discipline and intentionality in articulating the problem and developing recommended solutions prior to meetings, we used our meeting time more efficiently and it was easier for meeting participants to make timely, well-informed decisions.

A brief illustration is presented in the next section. Another example, from an actual project I proposed and led to support service redesign, is provided in Appendix C.

SBAR Example for a Prescription Refill Problem

S = Situation: In the past month, patients have been running out of medications before their refills are processed and delivered. Several patients showed worsening of their symptoms while emergency medications were obtained and prepared for dispensing.

B = Background: We have had organizational changes in our in-house pharmacy that resulted in sudden turnover. Experienced pharmacy staff set up alerts for the nursing team and assisted actively in supporting medication refills.

A = Assessment: One option is to formally shift prescription tracking responsibilities to the nursing team. This requires additional training and ongoing manual tracking.

 

An alternative is to implement automated tracking capability in the pharmacy module of our electronic health record system. Our technology team checked with our software vendor, who can provide this functionality for additional $10K per year, with initial training of nurse users for $2K.

 

R = Recommendation: Invest in electronic software functionality immediately. Install the added software module and train nurses in groups as already scheduled for quarterly staff development starting in three weeks.

Benefits of SBAR

Our use of SBAR was broadened to be particularly helpful in structuring processes that supported but were not part of direct patient care activities; therefore, it was helpful in engaging nonclinical administrators in developing solutions that ultimately improved service to patients and clients (for example, collection of insurance co-payment fees and designing the patient experience in coming to an initial appointment).

By preparing ahead of time and describing succinctly each element of the SBAR, the person bringing forth her recommendation helps others understand the problem and makes it easy for them to support her proposed solution. SBAR helps focus the discussion on solving the problem, which keeps the meeting on track and supports timely, efficient decision making.

How Decisions Are Made

Many decisions are made at meetings but many are not. This section discusses the various ways decisions are made. As a manager, you are responsible for making some decisions, and for supporting other decisions that you did not make yourself or might not have had any involvement in making. It is important for you to find out the extent of your authority as soon as you start working in your management role so you will know the extent of your authority for decisions. Be confidently decisive while careful to avoid overstepping your bounds in taking on decisions that rightfully belong to others.

Dialogue Is Not Decision Making

As Patterson et al. (2012) advise, you need to be aware that “dialogue is not decision making.” In other words, just talking about things with other people and seeming to agree on an approach or solution does not necessarily establish a decision that will be upheld and followed by others. Decisions are made by leaders and managers who have authority to do so, and they may be the ones to “decide how to decide.”¹⁰

Put Decisions into Effect Promptly

As Peter Drucker (1967) stated, “The most time-consuming step in the process is not making the decision but putting it into effect. Unless a decision has degenerated into work, it is not a decision; it is at best a good intention.” Drucker recommended being systematic and careful to make effective decisions that get implemented well.¹¹ Drucker explained that decisions are judgments that represent choices between alternatives based on what is known at the time. He recognized that decisions can generate disagreements.¹² Disagreement and conflict are a normal part of life, and we will look more closely at how to handle them in Volume II, Chapter 1.

Despite the potential to generate conflict, it is wise to make decisions promptly and avoid procrastination. Armstrong (2013) advises that we make decisions faster to free up time for other things, or at least get started on making difficult decisions and allow the momentum to carry through the decision-making process rather than to delay and avoid difficult decisions. Like Drucker, he advocates for being systematic and rigorous in problem-solving and thinking, considering other facts that might be relevant, and learning from your past experience, while recognizing that situations change. It is wise to talk it through to get other viewpoints, especially from those who are likely to disagree. Leave time to think it over, pausing even if only for a few minutes to “avoid knee-jerk reactions” and “to allow yourself time to think through the decision you propose to make. And confirm that it is logical and fully justified.” Consider the potential consequences and think about unintended consequences that could occur.¹³

Manage Expectations after Decisions

After decisions are made, it is important that you know how to follow up to get required actions done. Patterson et al. (2012) recommend that you turn these crucial decision-making conversations into action and results. “Determine who does what by when. Make the deliverables crystal clear. Set a follow-up time. Record the commitments and then follow up. Finally hold people accountable for their promises.” By doing so, you increase the motivation and ability of people to deliver on their promises, and you also create a culture of integrity.¹⁴

When decisions are made, clarifying expectations helps ensure that the decisions are carried out effectively. The Expectation Management Model (which we introduced in Chapter 2 and show again in Figure 3.1) can be applied to move the decision from general discussion to specific implementation. The Evaluation and Calibration steps ensure there is a feedback loop to revisit whether activities were carried out as intended, and allow for renegotiation if adjustments are needed to objectives and the expected level of performance in achieving them.

Managing Expectations through Evaluation and Calibration

Here is an example of how an executive team communicated with its board of directors to manage expectations about the team’s performance in one of its established key performance indicators (KPIs). The particular KPI required that the organization increase the number of people served by the organization. Everyone supported the decision to include this KPI and agreed to the general principle, but the details about how performance in this area would be measured had not been specified.

The organization counted the people it served by combining information from several different sources, including electronic records and separate manual counts on paper. This was necessary because the organization received special funding for several innovative programs that connected with people in need out in their community settings, which precluded the completion of full administrative enrollment in the organization’s electronic health record in an office setting. The organization also was extending its reach in the community through public education and consultation with teachers in classroom settings to support the health and well-being of multiple students in the classrooms. Such activities were tracked by clinicians with specific activity codes that were stored and retrievable in the electronic health record system.

At the end of the measurement period, when counting methods used previously were applied to the latest period, it appeared that the number of people served had actually decreased, particularly with the expiration of one of the grants that had funded services in earlier periods to a specified number of people. However, the senior managers who were leading the innovative outreach and service delivery in the community knew that they were actually reaching more clients and community members. By presenting evidence of the high count of the additional services that actually touched many more lives than ever before, the executive team was able to renegotiate with its board, who agreed that the team was actually surpassing the expected performance in the intended focus of the KPI, which was to increasingly serve more people.

Thus, as the result of reevaluating the counting methods relative to available funding and current service delivery practices, the team was able to renegotiate with its board of directors for recalibration of the measurement of its service volume performance, and achieved better visibility in its scorecard for the work it was doing. This supported the board in its decision to judge that the organization had achieved its expected level of performance.

Note that in this example, the board had the authority to make command-level decisions, which will be explained below, without any input from those working in the organization. Fortunately for the executive team, the board was open to consultation for input about reasonable measurement approaches, which influenced its ultimate decision. We explain more about such different types of decisions in the next section.

Apply the Right Decision Type at the Right Time

Be aware that there are different kinds of decisions that are commonly used in organizations. Patterson et al. (2012) describe them as:

• “Command: Decisions are made by those in authority without involving others.
• Consult: Input is gathered from the group and then a subset decides.
• Vote: An agreed-upon percentage swings the decision.
• Consensus: Everyone comes to an agreement and then supports the final decision.”¹⁵

As a manager and leader, you might use all of these at different times. Armstrong (2013) reminds us, “One of the key skills a leader or manager needs is the ability to analyze and read situations and to establish order and clarity in situations of ambiguity. Leaders need to have a sense of purpose and the ability to influence others, interpret situations, negotiate and express their views, often in the face of opposition.”¹⁶

Command Decision Making

Surely there are times when the top leaders in your organization face tough decisions and need to make command decisions without involving others. Command decisions are most appropriate in crisis situations or for other serious and urgent matters. If the building is on fire, there’s no time to talk with others and decide what to do—just get everyone out of the building!

But the Chief Executive Officer of your hospital might also need to make important decisions about the hospital’s future when faced with major changes such as mergers with other health care organizations, or during major overhauls of government funding and oversight. More often, however, even the Chief Executive, who is ultimately responsible for what happens at the hospital or clinics, consults with others who have the necessary expertise and responsibility for key aspects of running the organization, such as the Chief Financial Officer, Chief Medical Officer, Chief Nursing Officer, Chief Operations Officer, technical specialists, and others.

Consulting as a Type of Decision Making

Decisions made through the consulting approach might include input gathered throughout the organization by talking with direct care staff—nurses, doctors, therapists, and other clinical staff members—along with frontline administrators and analysts to understand the impact of changes such as implementing more team-based approaches to patient care. Even though you may be responsible for the final decision, in most noncrisis situations there is value in receiving additional input, particularly to warn you if someone is aware of something that could cause problems, for example, a policy change that might put the organization at risk of decreased quality of patient care, legal problems, or other undesirable results.

For example, hiring decisions usually involve others aside from only the manager to whom the newly hired team member would report. It is important that others provide feedback on their comfort working with the new person and buy into the decision to select and hire a particular candidate for the job. Others may offer varied perspective and notice “red flags” that signal something problematic about a candidate such as the possibility for patient harm or destructive conflict. So, even though the hiring manager may have the authority to make the final decision on selecting a person to hire, almost always a more inclusive process is used to arrive at the decision through approaches such as consulting (where candidates may meet other staff members who provide their input, but a smaller group makes the final selection), voting, or consensus.

Even when you have the authority to make changes and implement new procedures, be careful to consider the perspectives of those who directly perform the work you are arranging. Consider this example from Marilyn Thomas Leist, EdD. She was an experienced manager who moved into a senior leadership position as Chief Operations Officer in a senior living and retirement community, her first experience in health care, with responsibilities for 24/7 operations. She wisely formed a council of high-performing staff to hear from them and gain perspective in their different areas of responsibility such as independent living, assisted living, dining services, and others. The nursing directors reported directly to Marilyn and helped her learn about medication management and managing staff with compassion. She oversaw workers’ compensation issues and took injured staff members’ needs into consideration by putting them on light duty.

Things were working well with those approaches, until, in working toward the goals of her position to run things efficiently, she tried to reorganize housekeeping assignments—and was surprised when, in her words, “It bombed!” She was aware that the Certified Nursing Assistants (CNAs) become strongly attached to the residents they assist, but had not considered that housekeeping staff and residents also became friends. She learned that the bonds between residents and all the staff members they interacted with were strong; the housekeepers needed to make their voices heard about the change, and the residents needed preparation.¹⁷

The key to your success as a decision maker is to be clear up front about how a decision will be handled. Clearly communicate the process and establish the guidelines to avoid misunderstanding and disappointment later from your team members, which can undermine their support and willing commitment to following you in carrying out the decision. Allowing participation in the planning of changes might not alter the overall decision to make some changes, but it can help you make a better decision that ensures smoother operation of the activities for which you are responsible.

Participative planning may take longer initially to gather a range of ideas and input, but it tends to result in better decisions that gain the support of those who need to implement and operate with them. And it will save you time in the long run by eliminating the need to go back and re-explain decisions, redo plans, and possibly apologize for failing to consider important perspectives of people doing the work. This is more time for you to move forward on doing the right things, with the full commitment and cooperation of your team members and others!

Voting as a Way of Reaching Decisions

While voting can be appropriate and efficient for relatively inconsequential decisions such as where to go to lunch or the color of the chairs in your waiting room, do not be lulled into a false sense of security by hiring a job candidate because the majority of your team voted for that person, especially if you, as the manager responsible for that person’s training and performance, have misgivings or feel uncomfortable working with that person.

Similarly, in scheduling important activities, it may be tempting to vote on convenient dates and times, but be careful that you are not forced by this method to select a date when crucial participants cannot be available. In that case, you may need to extend the scheduling horizon or consider other trade-offs and negotiations to free up team members’ commitments. Be clear and careful in setting and communicating the parameters for decision making and acceptable conditions of the selected action. Keep in mind your option for “bounded consensus,” as described below.

Consensus

Consensus differs from voting in that consensus does not require that every member of a group or team has chosen a course of action as their favorite or best alternative, but the group members come together in a decision in which everyone accepts and agrees to support the decision. Mark Murphy (2014) offers these words of caution about how the illusion of consensus can make people angry when it suggests that people have more influence into a decision that will ultimately be made by someone else. He suggests that the actual decision maker should clarify the rules at the beginning of the process. State the purpose of the meeting, and acknowledge that there are many different good ideas that will be considered by looking at the pros and cons of each one. He recommends being clear and stating, “Ideally, we’ll start moving towards a general consensus, and maybe even achieve one. But in the event we don’t reach a full consensus, then I’ll weigh all the options and make a decision using everyone’s input. This ensures that we get everyone’s best thinking, but also gives us an escape valve so we’re not trapped in this room for 8 hours straight.”

Murphy calls this approach “bounded consensus.” Although the leader may try to reach true consensus, it sets some limits and expectations, and offers the leader and decision-making participants an acceptable way out if true consensus cannot be reached in a reasonable time frame.¹⁸ This reflects Ken Bellian, MD’s, consideration of how we can make people feel good with teamwork and cross-collaboration. As he suggests, “You should always have your say but you don’t always get your way,” which means the final solution might not be exactly as each person defined it, but with everyone’s voice and input, “we built it together.”¹⁹

Whose Decision Is This? Ask Before You Act!

Respect other people’s areas of authority and expertise. This includes hiring decisions that require review, approval, and procedures from your human resources department to ensure fairness in salary and benefits and compliance with employment laws. The decision might involve the organization’s spending and financial policies, or could require special expertise in technical areas such as information systems and technology.

Do not assume because you have seen technology appear to be used seamlessly that a solution you want to promise to an external stakeholder will be quick and easy for your organization’s technical team to develop and deliver. There may be technical constraints and considerations that you are unaware of (such as incompatibility between electronic platforms or electronic security requirements) that prevent the delivery of what you have committed. Situations like these can erode trust and delay delivery of important project goals. It is better to ask before making commitments you might not have the authority or expertise to fulfill.

In earlier sections we looked at how you conduct meetings, and how you record and follow up on decisions made there. Next, we will consider more about how to build integrity and get things done.

Honoring Your Commitments for Getting Things Done

Dobson and Dobson (2000) advise, “Keep your word. Personal honesty is not only part of good character, it’s an essential ingredient in making your professional relationships work.”²⁰ Gene Dankbar, MS, MBA, has worked with clinicians and managers for over 31 years at the Mayo Clinic. He noticed that strong leaders reached out to others to get their ideas, and they were strong in follow-up and follow-through. “They are doers, not procrastinators. They get back quickly, answer e-mail quickly.”²¹ What do you want people to say about you and your follow-through?

Keeping your word requires that you be careful about the promises you make. Do not commit to something if you cannot or will not do it. It is best to under-promise and over-deliver. Make sure you are clear about the limits of what you agree to do—are you agreeing to help someone out just this one time in an emergency or is it something you will do regularly? Be clear about when you can deliver what the other person wants.

Revisiting the Importance of Expectations

Expectations can easily be mismatched with what is realistic if they are not clearly and openly communicated. Suppose the other person wants something today but you know you will not be able to get to it until the following week. Although it might feel more comfortable to avoid specific deadlines so you do not have to disappoint someone now, it is better to be clear about what you can and cannot do so you do not disappoint them later and leave them with the perception that you did not follow through on what they expected from you.

Always summarize and confirm what you have agreed to. This allows you to address discrepancies and find solutions together that strengthen your relationships and improve results. If you know you do not have the time or the resources available to provide what the other person needs to meet his requirements, then it is best to be clear about that right away to enlist help from others or to renegotiate deadlines.

Applying Expectation Management to Renegotiations

Recognize that you will need to be flexible sometimes to adjust to changing priorities, and new requests, especially from your boss or other stakeholders who may have oversight authority. Be straightforward and try to negotiate for realistic schedules, and learn to accept graciously what you cannot change or negotiate.

The Expectation Management Model, which we introduced in the previous chapter (and display again in this chapter in Figure 3.1), helps with such negotiations. Let us review the steps:

1. Identify the activity, behavior, or objective to focus on. These can be the behaviors and activities you expect of your team members, or quantifiable Key Performance Indicators.
2. Specify the target level of attainment. This sets your expected standards for performance. The target can be specified numerically or described in terms of desired observable behaviors.
3. Measure the actual level of performance. This could be numeric (metrics) or qualitative and subjective assessment through observation.
4. Evaluate whether the actual performance meets, falls short of, or exceeds the expected standard level. Also consider whether the target level is realistic and appropriate, not too easy or impossibly difficult, and whether the focus and objective are still appropriate.
5. Encourage performance adjustment if needed, and recalibrate objectives and targets as appropriate.
6. Continue to measure performance and facilitate adjustments as needed.

Each step offers you an opportunity to clarify what both parties expect and define them in clearly recognizable terms to ensure alignment and open up productive conversation to recalibrate (as in Step 5) to adjust requirements if needed in changing conditions.

Give-and-Take Support for Relationships and Commitments

Building relationships can really help you with some balanced give and take. When others grant you favors, such as extending deadlines or loaning you resources, you should expect and willingly support them in turn when they need your help another time; perhaps, you could accommodate their needs or advocate for them with your other contacts who can help them get the resources they need. With that approach, you build your reputation for honoring not only your commitments but also the people who support you in fulfilling these commitments.

Managing Your Time and Yourself

Peter Drucker (1967) observed, “Time is the scarcest resource, and unless it is managed, nothing else can be managed. The analysis of one’s time, moreover, is the one easily accessible and yet systematic way to analyze one’s work and to think through what really matters in it.”²²

Be mindful of the value of your time, its importance to you in your role as a manager, and the effects of your time management on your success. Dobson and Dobson (2000) advise, “Unless you can manage yourself, you’ll have little success managing others, whether down, sideways, or up. The choices you make about your time—how you spend it, how you prioritize it—are at the core of your self-management effectiveness. Since we’ve learned that your ability to influence others involves getting your own act together first, evaluate your personal time management on a regular basis.”²³

Getting the Right Things Done

Douglass and Douglass (1993) observe, “Time management is really self-management. If time seems to be out of control, it means that we are out of control. To bring ourselves back under control, we must learn new, more appropriate habits.”²⁴ So, we wrap up this chapter by looking more closely at time management habits to support you in getting the things done that contribute to your success.

As we have discussed earlier in this chapter, people come to trust you when you do what you say you will do, which means you deliver on your commitments. You were successful in your work as a clinician. You accomplished the goals and met or exceeded the expectations for you in your prior clinical role and that helped you advance into your role as a manager. Most likely, you had effective ways of keeping track of what you, as an individual, needed to get done and stayed on schedule with your requirements. Now, with your elevated and expanded responsibilities as a manager and your new responsibilities for overseeing the operation of your team and the results of the team members you manage, it is time to reevaluate your new responsibilities in terms of what you need to do along with when and how you will get it all done.

The Importance of Goals: The SMART Approach

Your success as a manager is a matter of directing your time, energy, and focus to doing the right things—the ongoing activities that are important to the success of you, your team, and the organization, and getting the right things done at work—accomplishing projects that may be time-limited and working on important and visible goals. Being busy and productive may signal that you are working hard, but if you are not directing your energy to the right things, you will not achieve the success you desire and may just end up feeling worn out or exhausted, especially if you are filling up all your time with activities regardless of their contributions to your goals.

Douglass and Douglass (1993) emphasize the importance of goals as “the building blocks of better time utilization.” If you do not have specific goals and know what the end results of your activities should be, it does not really matter which activity you choose. “No matter what you do, the time will pass. One activity is as good as another.”²⁵ Without goals, it is impossible to determine your priorities.

When you develop your goals, write them based on the SMART criteria, established by Doran (1981) as:

• Specific: With enough description to identify the area and desired results or level of improvement
• Measurable: Quantify or describe the indicators of progress
• Assignable: Be clear about who will work on the goal
• Realistic: What results can realistically be achieved, given the resources available
• Time-related: Specify when the results will be achieved.²⁶

Some of the actual words in the SMART acronym have been adjusted and modified over time.

• For example, “Achievable,” “Attainable,” and “Actionable” are often substituted for the original “Assignable.”
• “Relevant” is sometimes used to emphasize alignment with other priorities or meaningfulness to those who are working toward the goals.
• “Timely,” “Timed,” “Time-limited,” and similar words have been used to capture the importance of prompt startup and keeping track of time and due dates in working toward completion of goals.

The point is that your goals need to be specific enough to work as effective guides in planning, making, and tracking progress. This helps keep you on track and provides visibility to hold team members accountable and motivated in accomplishing agreed-upon goals.

Organizing your goals and tracking your progress on them builds a foundation for effective communication with your boss, who can help you ensure you are working on the right things that align with her priorities and organizational goals. She also can help you identify and clear any roadblocks to expedite your progress and support your success. We will see more about managing your important relationship with your boss in the next chapter.

Time Management Techniques

There are several popular approaches to managing your time to ensure you accomplish your goals. Because interview participants referred to several different useful frameworks and techniques that you may hear about from your team members and other people you work with, we review some major ones and explain their evolution and importance here.

Peter Drucker, in his book The Effective Executive (1967), dedicated the second chapter to his advice to “Know Thy Time.” He recommends starting not with your tasks but with your time. It is particularly important to understand where you are actually spending your time. He believed the foundation of executive effectiveness involves the three steps of:

• Recording where you spend your time
• Managing time to cut back on unproductive demands on it
• Consolidating time to allocate the right duration to focus effectively on the important tasks.²⁷

Early in the field, Alan Lakein titled his pioneering book on time management, How to Get Control of Your Time and Life (1973) and introduced the ABC method of prioritizing that sorts activities into:

• A: “Must Do,” things that have high priority because they are very important, critical items, with close deadlines
• B: “Should Do,” things that are important to do over time and have medium priority at the moment because they are not as urgent as A items
• C: “Nice to Do,” things that have low priority at the moment with low consequences if left undone.

This ABC sorting helped answer the important question Lakein reminded readers to continually assess, “What is the best use of my time right now?”

The enduring idea is to continue to focus on your A-level items before moving to your B list, and do not do the C items while you have higher-priority demands on your time.²⁸ This remains an important question for keeping your priorities in mind even as the field of time management has evolved to the principle-centered work of author Stephen Covey. One of Covey’s books, The Seven Habits of Highly Effective People (1989), was mentioned frequently in conversations with our interview participants, and was included in Covert and Satterson’s (2009) readers’ list of top ten business books.²⁹

Covey’s approaches can help you identify your principles and ethics, distinguish urgent but not important requests from the activities that are truly important for your goals, and establish practices that become habits and lead to your success as a manager of others and yourself. Covey describes effective self-management in the context of independent will as the “ability to make decisions and choices and to act in accordance with them. It is the ability to act rather than to be acted upon, to proactively carry out the program we have developed.” He explains how this involves the discipline to practice the habit of “putting first things first” to “organize and execute around priorities.” The challenge, he believes, is not to manage time but to manage ourselves, to say yes to the right things, the truly important priorities, and no to other activities that are less important and detract from your time and energy.³⁰

Covey presents a Time Management Matrix that divides tasks into four quadrants that represent:

• (I) Tasks that are Important and Urgent
• (II) Tasks that are Important but Not urgent
• (III) Tasks that are Not important but Urgent
• (IV) Not important and Not urgent.

Covey’s approach differs from Lakein’s in that he does not consider Quadrant II to have lower priority than Quadrant I. He explains how the apparent urgency of tasks in Quadrant I, which tend to be problem- and crisis-oriented, can consume your energy and lead to ineffective habits of being reactive and crisis-driven, with recurring waves of problems that never subside because you are not dedicating time and focus to proactively initiate important opportunities.

Quadrant II activities include planning, building relationships, and working on effective activities that help prevent the problems that demand your attention in Quadrant I. As more time is spent in important but not-urgent activities in Quadrant II, less time will be needed to react to the reduced number of important and urgent crises and problems in Quadrant I. The important question becomes, “What one thing could you do in your personal and professional life that, if you did it on a regular basis, would make a tremendous positive difference in your life?” These are things in Quadrant II, where “our effectiveness takes quantum leaps when we do them.”³¹

More recently, Brian Tracy (2017) revised and extended the ABC approach to ABCDE:

• A tasks are very important, with serious negative consequences if you do not do them.
• B tasks are important things that you should do but less important than your A tasks with less serious consequences if they are not completed.
• C tasks are “nice to do,” less important than A and B tasks, with no negative consequences for not doing them.
• D tasks are those that you can delegate to someone else who can do them instead of you.
• E tasks do not need to be done at all! If you can eliminate these activities, you should do so to free up your time.

Tracy explains that this approach helps you to sort out very easily what is important from what is not, so you can focus your time and attention on what you really need to be doing. “Once you can clearly determine the one or two things that you should be doing, above all others, just say no to all diversions and distractions and focus single-mindedly on accomplishing those priorities.”³²

Yes, you have more new and important responsibilities now that you are a manager. The expanded ABCDE approach opens the possibility that maybe you do not always have to do everything on your list immediately. Or maybe everything does not have to be done directly by you. As we discussed in Chapter 2, it is important when you begin to take charge to recognize when it may be most appropriate to delegate some activities that do not require your particular level of skill, expertise, or authority. Delegating them to others on your team can get things done faster while helping them to develop their skills and experience.

And if you and your team are taking extra steps that do not add value for patients or the organization, you might have opportunities to improve efficiency and responsiveness by cutting out time wasters that really do not need to be done at all! However, be very mindful to avoid making unwarranted decisions about what is and is not important to do. You might think some of that frequent handwashing or extra details you enter in your patients’ records are not always necessary, but your safety and quality staff might think otherwise and know of important reasons why some activities are necessary for the health and safety of patients and fiscal health and compliance of your organization.

If you are thinking about changing work flows to eliminate some steps, it might be time to reconsider our sections above on how decisions are made and whether they are really yours to make or ultimately someone else’s responsibility to make and approve. When making changes, it is always important to consider who else needs to know about them because they or their areas of responsibility are affected by the changes. In any case, isn’t it a relief to see how freeing prioritizing can be?

Habits and Systems to Support You in Managing Time and Commitments

Allen (2001) offers another freeing approach by helping you get things off your mind and into reliable systems that help you take the right actions to achieve your goals. Using a reliable system, stored outside your mind and with reminders that you cannot miss, reduces the stress of thinking about things at times when you cannot do anything about them, and ensures that you do not miss following up on something you need to do. Do these things:

1. Get in the habit of capturing into a reliable system outside your mind everything you consider unfinished.
2. Clarify what your commitment is, what actions you need to take, and their schedule for you to fulfill the commitment.
3. Keep reminders of all the actions you determined in the step above, organized in a system that you review regularly.

The keys are to:

1. Free up your mind of all the details so you can focus on your priorities,
2. Use your external system as a focal point to revisit regularly.³³

Make sure you have and regularly use a system for follow-up and review. A “tickler system” sets up reminders for the future, for instance, with lead time before due dates.³⁴ The Weekly Review is a critical success factor. It is the time to gather and process everything you have collected, review your system, update your lists, and become “clean, clear, current, and complete.”³⁵

Timeliness and Visibility

Be sure to allocate and adhere to regular times to review and process the activities you have collected; this helps you avoid building up backlogs that obscure your important priorities and detract from your timeliness in making decisions, responding to and communicating with others, and taking needed actions. Choose a time that works for you.

I have had colleagues handle this successfully at both ends of the spectrum. One who was particularly effective in managing e-mail left the office early to pick up kids in school, and then revisited each day’s accumulation at night after she had put the kids to bed. Another was disciplined in getting to work an hour early every day so she could review open items and plan her day before others arrived and meetings began. Others have used long commute times on public transit to plan for the coming day on the way to work and process remaining e-mail and action items on the way home. Some people block out time Sunday night to address items accumulated during the week and plan for the coming week.

Consolidated Tracking

If you do not already have a consolidated place to track your activities, when you adopt one it will help you feel confident and stay organized, which will increase your effectiveness and reduce your stress. Technology can be very helpful, especially electronic calendars with shared access for appropriate team members. This can provide visibility to enhance communication and promote scheduling efficiency that helps prevent scheduling conflicts. I love accessing my calendar from anywhere on my smartphone to know where I need to be, how to get there with mapping apps, and to update activities and appointments.

For keeping notes in one consolidated and easily accessible place, even a simple paper notebook can be very helpful for keeping you organized. I still see many technically adept people use this “classic” (low-tech) approach to jot down notes, while others enjoy portable electronic devices. A former colleague of mine wrestled with paper and overwhelming feelings of disorganization until he finally invested in a small electronic tablet and cleared his office of all the paper by scanning what he wanted to keep and storing it in a cloud-based system, and shredding or recycling the rest. He found his new uncluttered office to be conducive to his concentration and productivity, and spent less time searching for documents. The office even looked larger and more inviting to work in! His unfettered approach to tracking and organizing quickly became a habit that he was never tempted to curtail.

Apply Discipline and Consistency

The books referred to in the foregoing text are several among the many resources available to help you find and practice effective ways to manage your time and activities. The key point is that you find or develop methods that work for you to leverage your energy into being an effective manager, and then practice them with discipline and consistency so they become habits. Keys to effective time management are:

1. Clarifying your priorities
2. Setting goals
3. Tracking your progress toward your goals
4. Being realistic in allocating and scheduling your time
5. Regular reviews and adjustments

Review and Adjust Regularly

Planning and goal-setting are not one-time activities but something you should regularly review for relevance and progress. This is where it is important to clearly identify your responsibilities from the perspective of your boss and always consider how your activities align with organizational goals. And remember to consider the values of your team members reporting to you and those of your colleagues and other stakeholders.

This means you need to carefully review your activities and requests regularly. First identify the few key things that are critical to your success, realistically determine how much of your time you need to spend on them, and block time into your schedule to ensure you make continual progress on them to get them done. Pick times when you know you are most productive for the kind of work required.

Some people find they have the most energy first thing in the morning or approaching the evening when other activities have settled down and there is more quiet time available. Some people block out days of the week to focus on the work that requires focused time working on specific projects or activities. The actual times these occur is not as important as ensuring that you allocate and protect adequate time to dedicate to these crucial activities.

Make sure you pick times and days that can be reasonably supported and accommodated most of the time by other organizational activities and priorities. If Fridays are a quiet day in your clinics or office, that might be a good day to block out some time. Conversely, Mondays tend to be busy days in many clinics with patients calling to address needs that arose over the weekend, so you might avoid choosing that day to focus on your administrative projects and tasks.

Managing My Time and Myself: What I Have Learned and Recommend

Remember, it is not about how much activity you spend time in, it is the results and what you accomplish while developing constructive working relationships that count! I offer these tips for you to consider, from my experience in managing my time and learning to do things better:

1. Build and value your working relationships. They foster teamwork, make your work life enjoyable, help you get things done, and build the groundwork for you to be able to negotiate when you need to. Be willing to give and receive help and negotiate with others to meet your needs and those of your teams, organization, and the patients you serve.
2. Make sure you allocate time and energy to people and activities you enjoy for your well-being, renewal, and sustaining the relationships you value in your life.
3. Managing your time and activities is not only about planning and setting goals in your mind. Working toward your goals (long- and short-term) must also get scheduled into your work and other activities. Write down the key things you plan to do; this reinforces your awareness and commitment to actually do them. Put them into your calendar or work schedule, with time allocated to actually doing the necessary tasks and details, along with regular recurring times to review your plans and progress toward them.
4. Find or develop a simple, consolidated, and accessible place for you to record important activities and reminders. This will save time and reduce stress in trying to locate important details when you need them later.
   • For me, keeping a paper notebook handy provides a convenient place to jot down notes, record action items for follow-ups, highlight relevant pieces of conversations, and keep track of agreements. I date each page or entry, so I can quickly locate and review with colleagues the details of activities along with the schedules and deliverables we had agreed to. This is not a substitute for more formal and detailed plans, but I find it helpful in keeping track of day-to-day activities, and several of my colleagues found it helpful to refer back to the notes they had seen me take.
   • Technology is great; just make sure any devices you use are charged and that you have access to any required networks or remote storage locations. If you are working away from the office, make sure you have mobile access to the Internet and remote access to any central storage you need. I create electronic reports, plans, charts, graphs, and other documents, and store them in accessible electronic folders that I can easily find or search for electronically.
5. To be truly effective in achieving your goals and sustaining your productive momentum over time, it is essential that you do not overschedule your time and do not overcommit to what you realistically can handle!
   • Be careful about the commitments you accept and the activities you spend your time on. If they are not important or necessary, conserve your efforts for those that are.
   • Be realistic about how much time is actually required to get things done. Avoid scheduling based on optimistic estimates. Allow some extra time into your due dates and schedules, especially if you are learning things for the first time or you need to rely on other people and circumstances beyond your control.
6. Expect the unexpected—that means preserving some open time in your schedule to handle the other ad hoc things that come up. These are things you do not know about ahead of time, but you may be required to do them because they are urgent and important to someone with authority or important to you and your organization. For example, you will be expected to handle crisis events and respond to important urgent requests from your manager, those at higher levels, or important external stakeholders.
7. Be open, aware, and proactive. You might be offered or discover opportunities that feed your professional development and interests, and you do not want to be so overscheduled that you cannot work them in without dropping other important commitments. These could include joining a key committee or a task force in your organization or greater professional community, presenting a paper or workshop at a professional conference, or troubleshooting to resolve a problem that requires your special expertise.
8. And finally, remember that you do not always have to do everything yourself. It is healthy and appropriate to delegate things that do not require your level of expertise or special skills, or that provide valuable learning and professional development to those you supervise. In Volume II, Chapter 2, we will consider more about hiring and managing your important human resources: your team members who report to you, contribute to your team’s and organization’s success, and thrive with your capable management!

Chapter Summary and Key Points

In this chapter, we focused on how to plan and organize to support your successful handling of your new responsibilities. This includes planning and leading meetings and following up to ensure that the agreed-upon activities are accomplished. We revisited the importance of delegation so you are not doing everything yourself and you are helping others develop their skills. We looked at how decisions get made and when to apply different approaches. We reviewed the evolution of time management techniques and offered various approaches you may find useful.

Key Points:

1. Be proactive in deciding what you need and want to accomplish in your new management role.
2. Set up a regular schedule to meet with your team and individual members.
3. Plan your meetings and run them effectively
4. Structure proposals for action before meetings to solve problems efficiently.
5. Develop specific goals and plans.
6. Track progress on your goals.
7. Be decisive; balance speed with participation and elicit participation as appropriate.
8. Choose an approach and schedule time to manage your incoming and ongoing work.
9. Be judicious in accepting commitments and diligent in fulfilling them.
10. Expect and contribute to balanced give-and-take relationships with colleagues to contribute to organizational success.
11. Manage the expectations for what you can deliver in fulfilling commitments to others.
12. Be realistic in your time estimates and avoid overscheduling your time. Remember that changes will arise that are outside your control and you need some room in your schedule to respond to them.
13. The Expectation Management Model can help you evaluate and renegotiate reasonable deliverables when situations change.
14. Delegating and involving others can help you and others grow with evolving opportunities.

Learning Activities for This Chapter

1. List the meetings you currently participate in or lead.
   • What do you suggest for running them more effectively?
   • Review the structure of the meetings you lead most often. How is the agenda working?
   • Use the meeting agenda form in Appendix B (Table B1) to plan one of the meetings you lead.
   • What items would you like to add or delete?
   • How are decisions and action items recorded and communicated in your meetings? What could you adjust in your meeting agendas or notes that could help improve these?
2. Pick an idea you have for a problem to address or something to improve in your organization.
   • Describe what you would like to propose to others to accomplish this solution, using the SBAR format:
     • What is the current Situation?
     • What is the Background: factors or statuses that are relevant to the situation because they contributed to the current status or need to be considered in the solution?
     • What is your Assessment of possible courses of action? What do they involve, what are the costs, pros and cons?
     • What is your Recommendation for how to proceed?
   • How will you prepare and present your SBAR? Is there an existing meeting where it should be sent ahead of time and discussed in the meeting, or is there another forum that exists, or you will need to create?
3. Time management
   • What approaches from this chapter would be beneficial to you for managing your time and commitments?
   • What times and days would you pick to plan and review your work and commitments?
   • What will help you establish habits and routines to ensure that the system you choose will support you effectively? Consider technology and nontechnical approaches, and the existing routines you need to work with or adjust to better meet your needs.
   • What activities are you keeping track of in your head that you could handle more effectively by writing or storing the details somewhere else? Select and try a more systematic approach as discussed in this chapter.
4. SMART goal exercise: Pick three goals and apply SMART planning to them:
   • One that is important for the team you lead to accomplish together.
   • One that is important for your professional development as a health care manager.
   • One that you value personally that will enrich your personal life or work–life balance.
5. Consider a decision you made or were involved in at work.
   • Which approach was used: Command, Consulting, Voting, or Consensus?
   • Why was that an effective approach for the situation, or why would you recommend a different approach? Were there unexpected consequences or useful results of the approach that was used?