Time Management: how hard
can it really be?
Carlos E. Araya, MD
Pediatric Nephrology
• Everyone has demands on their time
• It is commonly thought that:
– Residents and Fellows are overworked and have
little time left over
– No time for personal lives
– Can lead to job/life dissatisfaction
• This lecture will give some tips on how to
manage your time
Inefficient Time Use
• Most time management literature is centered in
the business area
• However, studies have shown the inefficiencies of
• Lurie et al. found that most of the time in a
clinical rotation was not spent in direct patient
care (90 to 180 minutes in a 24hr call).
• If time could be spent more efficiently:
– Direct patient care
– Reading medical literature
– Performing research
Pareto’s Principle and Time Wasters
• Pareto’s 80/20 principle:
– 80% of the time is spent to do 20% of the work
• 3-4 times the amount of time is used to get the
job done
• Due to Time Wasters:
– Ill-defined goals
– Procrastination
– Priorities and deadlines associated with poor
delegation of responsabilities
• Eliminating Time Wasters allows you to
accomplish more work in less time.
Principles of Time Management
• Set Goals:
– Knowing what the goal is before you start a task will
direct energy and save time
• Short and long term goals:
– Allows you to define a value and prioritize
– Example: finish writing the book chapter by editor’s
deadline (long term). Write draft of introduction
(short term)
– Short term goals may be broken down into daily goals
for planning
– Update goals and leave room for error
Set Priorities
• Do the important things first and allow them
more time
• Sometimes we tackle the urgent over the
important things (answering a friends call vs
studying for the boards).
• The four quadrant method is helpful in
Four Quadrant Method
1. Urgent and Important
Pressing problems
Deadline driven projects
(cardiac arrest, floor
emergencies, book
chapters, family
3. Urgent but Not Important
2. Not Urgent but Important
Goal clarification
Crisis prevention
(Research projects, CME,
board certification, exercise)
4. Not Urgent and Not
(Phone calls, visits from
friends or relatives, gossip)
(shopping, watching TV,
gourmet cooking, excesive
sport activities)
Quadrant 1: Urgent and Important
• Quadrant 1 activities are easy to recognize
• Require immediate action and may lead to
inefficiency, procrastination of other important
• However, it is important to prepare for time spent
in Quadrant 1 (know ACLS, common
floor/specialty problems, etc)
• The best way to avoid as much Quadrant 1 are
activities in Quadrant 2 (Not Urgent but
Quadrant 2: Not Urgent but Important
• Most important quadrant
• If quadrant 2 is neglected, quadrant 1 crises will
cause more disruption
• Example:
– I neglected to plan for writing the chapter (Quad 2)
and spent free time watching football (Quad 4), now I
am missing the deadline and are in crises (Quad 1)
• Too much time in Quadrant 1 =
– Stress, stomachaches, marital problems, poor sleep
• Less time =
– Less stress, increased life satisfaction, etc
Quadrant 3: Urgent but Not Important
• It is difficult to determine what falls in this
• It is common to give these activities much more
time than they deserve
• This may lead to trouble
• Example: I spent too much time with a friend
yesterday and did not have time to read up on
rapid sequence intubation prior to my first PICU
call; I got called to a patient with respiratory
distress, and now will struggle handling the crisis
Quadrant 4: Not Urgent and Not
• They cause the most trouble
• Are easy to define, but difficult if unmotivated
to ignore
• Pleasant activities like sports, pleasure
reading, etc are hard to ignore
• They are very important for emotional well
• However, if given excessive time will cause
Communication, Delegation,
• Organize tasks and decide which should be
performed by yourself and which by others
• Communicate assertively, not aggressively when
giving instructions
• Delegating does not end by telling someone to do
a job
– Make sure resources are available to do the job, so
that it can be done correctly
– Follow up with the progress of the job, give guidance
when needed and credit too
• Example: a patient needs a kidney biopsy. Have
the fellow set up for the procedure, then call you
when ready to begin.
Dictations and Chart Writing
• Writing H & Ps, progress, procedure notes,etc
is very time consuming.
• Documentation methods other than
handwriting are more efficient
• Words per minute
– Write: 15
– Type: 20 to 60
– Dictate: 65 to 95
Getting Started
• Daily and weekly “To Do Lists” are helpful
• Smartphones or PDAs have applications that
help people manage their
professional/personal affairs more effectively
• Manage interruptions
• Avoid procrastination
– Primary reason for professional failure
– Four main reasons for procrastination
1. Fear of Failure
• The most common and least rational cause
• Keep in mind that failure is rarely fatal
• Through failure we learn to succeed the next
• Break large projects into smaller parts and
schedule time to complete the smaller
2. Perfection Paralysis
• Expecting to achieve perfection in everything
• When faced with this, ask yourself:
– What does perfection really mean?
– How much will it cost to achieve(energy, time,
– Is it worth the effort?
• A more realistic goal is to do thebest you can with
what you have
• The process of your efforts and not the outcome
is just if not more important
3. Fear of Success
• Women:
– Successful career at the expense of family life
– Make more money than husband = husband feels
– Sabotage their own success
• Overcome it by learning to feel good about
• Have a sense of purpose or mission in life to
get beyond the fear
4. Lack of Self-Discipline
• It is hard to do the most important and
difficult task first
• Set up a reward system
• It is hard to change procrastination behaviors
or old habits, but it is more enjoyable to
accomplish the things you want to do
• Time management is how effectively time is
• Succesfull people manage their time very well
• Most people need some guidance
• Set goals
• Delegate when appropriate
• Avoid procrastination
• Focus your efforts
• Remember it is not time we are trying to
manage… it is ourselves
Thanks for Listening!
Questions or Comments?

Time Management - Pediatric Residency Program