Great question, Pranish, and I’m sure folks here will have excellent suggestions for you.

Of all the professions out there, Medicine — and particularly patient care — is the one whose applications for GTD I’ve considered most challenging and potentially rewarding. I guess we’ll find out now that you’re getting “Management” added to the mix. :)

This one goes without saying, but I’d start by trying to simplify any workflows as much as you’re able. To paraphrase Strunk & White, “omit needless parts.” I know that’s easier said than done in a field that’s full of intractable policies and ingrained mores. But, since it sounds like you’ll have a lot coming at you from minute to minute, it will be important to avoid duplicate efforts, ad hoc one-offs, and any kind of “open loop” (term from the book you’re reading) that will cause you to second guess what you’re doing in the moment. You need to know where stuff goes in this new environment, and the faster that becomes a “no-look pass” for you, the easier the game will be.

Next, I’d make a point of having a capture device that you really trust. For most MDs I know that’s either a Palm or (believe it or not) a Hipster PDA. When my wife and I were in the hospital for our daughter’s delivery in October, I saw at least half a dozen nurses, attendings, and residents who used index cards for everything they needed to track or remember for later (and, no, not a single one had any idea who I was). Whatever system you choose, make sure you can capture task, ideas, and what have you instantly — so much so that you don’t even have to consciously think about it.

The thread through these two is that the busier (and more interrupted) that you are, the more you’ll need to rely on a “trusted system” for making sure the critical stuff gets done right. With all due respect to doctors, there’s a kind of macho ethos around the hours, the responsibility, and the “stuff” you’re supposed to keep sorted using your brain alone. That will work for some folks, but I’d encourage you to be open to very simple compensatory systems that don’t require you to, as I like to say, treat your mind as either an alarm clock or a white board. Know what I mean?

Best of luck, and I’ll look forward to hearing how things go for you!

Merlin’s right (of course) … simplicity is key.

I set people up with GTD for a living, and the number one mistake I see new GTDers make is to to choose 10+ different contexts and try to sort all of their tasks into them. I’m sure someone, somewhere, genuinely requires 10 contexts, but “In Microsoft Word,” “In Firefox,” “In the Kitchen,” etc. contexts easily get out of hand.

I have two main contexts, “Calls” and “Errands.” (I also live in another state part-time, so occasionally an “Utah” context is necessary.) That’s it.

When managing other people, your Waiting On list becomes key. I’d suggest putting a binder out somewhere easily-accessible with a sheet for each person you’re in charge of (alphabetized) so each person can look for themselves at any given moment what you’re still waiting on them for. Make it clear from the start that they are responsible for anything listed in that binder.

Mainly, no matter HOW busy you are — and you will be very busy — you need to schedule a Weekly Review with yourself. When you first start out, it might be an Every Three Days Review. You’ve got to take everything that you’ve captured and make it actionable, and you’ve got to follow up on things you’re waiting on.

Put all of your due dates into a private Google Calendar and setup SMS alerts to your phone. Every Sunday, look at the calendar and make an action card for each upcoming day of the week. (4x6 index cards work great.) If there’s anything time-sensitive during one of those days, jot it down. This creates a multiple-reminder system that makes it difficult for things to fall through the cracks, but is still simple to use.

Give your short timeframe, you might want to hire a coach to get you setup. Developing a solid, trustworthy organizational system that really works for you is a process, and starting out with someone experienced on what works and what doesn’t can shave months off the learning curve. (Shameless self-promotion: I’m available! marina at sufficientthrust dot com.)

While your getting your GTD system set, don’t forget you’ve just taken on the oversight of 40 people. GTD may help in managing tasks, but now you get to set the tone of your leadership style.

My advice is to decide now never to be a dictator or a cheerleader, and always be direct and honest. Hold people accountable for their work (GTD works here), and help each individual discover their talents.

Even in the world of medicine, a professional who can master people management is going to be more successful in the long run.

You say you’re in charge of the department, and responsible for 40 people. That sounds like you’re a manager now. If so, I highly recommend the information at manager-tools.com. It’s a series of podcasts and related notes that are wonderful for the new manager. They’ve been at it a while, and regularly add new material. So, the site can be overwhelming at first. I recommend you start with the “essentials” series. There should be a link to it on the front page. Good luck!

1st - congratulations!!! this is a tremendous and meaningful opportunity. 2nd - read and reread GTD; it is right on the mark 3rd - keep focused on your projects and goals; hospitals are full of meetings and time-wasters designed to keep you distracted from the job at hand 4th - know your employees; know about them as people, their families, etc.; pharmacists are in short supply and good technicians are worth their weight in gold; always remember how much you need them in order to be successful 5th - know your boss; know his/her idiosyncracies and understand what makes them successful and how you fit into that 6th - work all shifts; as a non-pharmacist (i’m assuming), you need to know what happens in the department and how the different processes work; you need to have credibility 7th - develop alliances of peers who are savvy and can give you good intelligence about what’s going on and importantly things you could do better. 8th- learn all you can about process improvement; pharmacy has a process- production side and a clinical side. productivity is a key point of emphasis these days and the best way to enhance is process improvement. 9th -just in case you don’t know, nurses run the hospital — they are your key customer; they can make or break your success for programs you want to do. 10th - patient safety is paramount; push for technological improvements to help.

Good luck - I speak from 35 years experience in hospital administration. Craig

I agree with Nelking and Brianjdoherty - the people are key to this.

Firstly if you don’t have intermediaries who manage groups of the 40 people then you probably need to consider doing this. No-one can realistically manage 40 individuals on their own. Even Jesus Christ only managed 12 key people.

I’ve also found it’s good to remember that if you spend a large proportion of time investing in your people rather than tasks that they could be doing, you’ll get WAY more done. A 5% productivity improvement across 40 people means much more work being accomplished than if you improve your own productivity by 5%!

This may be simple stuff and you may have heard it before but these are two of the things I have to keep reminding myself about.

Pranishk,

I went through something similar several years back. I went from resident to Medical Director of a hospital ward (supervising over 100 community based physicians, their patients, the other residents and staff on the ward) in about 8 hours. I know what you mean by stressful.

The good news is, I’m still here. Our ward even had the best length of stay stats of the whole region after we implemented some quality improvement tools. So it is possible to survive the transition.

Everyone’s situation is different, but I’m happy to share a few lessons learned (lesions learned).

1. You know patient care — that’s what you’ve been trained for, you should know that cold now. Take solace in that knowledge and those skills and make sure you exercise them along the way. I don’t know what your role lets you do, but make sure you have some time with patients or at least around clinical decisions. Its good for the heart and soul.

2. Don’t hide away from admin duties in patient care. It’s tempting to get over involved in the piece you are comfortable with. You do have the admin work to do too, of course.

3. Administration / Planning isn’t like a patient visit. This one I’ve learned time and time again —> when staff come to you for a chat, you’ll try and treat it like a visit and offer up a prescription at the end (of some kind). Sometimes this isn’t the best approach - sometimes its better to let someone work along a path that seems harder than to offer up the prescription off the top.

4. Let people around you support you and ask them what YOU can do to make their job better. Everyone knows your new. Some of my biggest support came from mentors and from senior nursing staff. If you can make someone else’s life a litter better by removing a road block (even a small one) it’ll show you listen and are acting. Then you get their support. Be human with people, they’ll be human back. Pick out a few key advisors who seem keen to help you through the “getting to know things” stage.

5. Develop a project list. I wish I started a big mind map at the beginning of my Medical Director position. Something to share with everyone and a place for people to add to the list. It would have been a great way to collect all the bits but also would be a great way to engage the team and to get #6 started. Projects can be big and they can be small. Put them down and review them with those around you. It is a great way to get to know the workings of the department.

6. Do your job and then take on the job of doing your job better. Once the fear reduces (it does) start to think about where you and the team can add the most value to the organization. I found www.ihi.org along the way. Also too a course in Clinical Quality Improvement. Your hospital may have picked up some other improvement methodology (e.g. lean design from Toyota). Start looking - with your team - on how to improve and start with small changes that build up over time. Grow into your shoes, and then get bigger ones. It can get infectious with staff (in a good, non-antibiotic resistant way) and is good for morale to have successes.

7. Oh yeah - get a system to keep you organized. The 1 index card / patient works great as a resident and for direct patient care. I suspect you’ve got something electronic to manage prescription / dispensing flow through your department. But you DO need a personal system. If you’re an index card user - go for the hipster PDA approach for the next few months. It’s easy to pick up and you won’t be learning MORE on top of the steep learning curve. You can fiddle with other apps over time, but for now capture and process and review. Hipster’s great to start out. I was a PDA user as a resident and started to maintain lists in there. Context is key for me to not be overloaded. “what CAN I do here and now?” is a key question. I’m always great at remembering the things I cannot do in the here and now and that is stressful. Pull out the list of things that can only be done with X and start working your list when your with that person.

8. Don’t let email pile up. Administration often runs on email. Patient care doesn’t. I know several clinicians who have not made this transition and often angst about an inbox full of 300+ unread / unreviewed emails. Merlin’s inbox zero presentation is a great place to start on this one.

I bit of a ramble, hope some of it is helpful.

— Morgan

In “The Checklist” (The New Yorker 12/10/07) surgeon and medical writer Atul Gawande describes an ingenious “trusted system” - the checklist - used to guide medical personnel through complex ICU procedures. By reducing human error, the checklist has been spectacularly effective in reducing infection rates, and saving lives and money, wherever it’s been adopted.

Other checklists are now being developed (by the people who will be using them) in other areas of medicine. According to Gawande, a checklist “helps with memory recall, especially with mundane matters that are easily overlooked”; and it “makes explicit the minimum, expected steps in complex processes”.

Of course, developing the checklist is pure “ubiquitous capture”. (Another GTD term, Pranish, in case you haven’t gotten to that part yet.)

I owe my success to having listened respectfully to the very best advice, and then going away and doing the exact opposite. - G. K. Chesterton

I love the idea of job specific tips.

Have you done one for graphic designers? I’m always @desk, @email/computer with a phone next to me. I have a dozen or more active projects going at any time. Each has tasks and other info that needs to be trackable and accessible. HELP!

Good luck!

Your best observations and ideas for being a positive force in this environment will come within the first month or so, before you become too much a part of the system to see areas that need attention. Your boss should ask for a data dump those things that horrify you, but if not, keep a record of them, anyway, for later. That’s what management does when it works right.

Yes, you’re responsible for 40 people, but within that hierarchy there should be supervisors, sub-department heads, etc. Keep a running, dated record (a page for each critical player), and I’d say in a ring binder for this HR stuff—that way cards don’t slip out! Remember that you’ll eventually have to do evaluations, or document progressive discipline, so keep particulars, such as great strengths and weaknesses, frictions or synergies among staff, with enough detail to jog your memory and to track tendencies for various behaviors. Keep a note as you observe actions (not attitudes), and you’ll build your record as you go. (Of course, some instant action may be required, or you may need to do some OJT to learn the why’s and wherefore’s. The point is, if you jot it down, you won’t have to remember it, and doing it in real time helps authenticate it. These would be your private managerial notes of course, for sharing at appropriate times, and not the “Waiting On” list mentioned by MarinaMartin.

The “instant capture” wisdom from Merlin Mann at the top of the thread probably means that you’ll need regular paper and pen unless you’re already happy with dictating, and can get that information in a usable form quickly. Do not LOSE the planner/PDA. Keep it under lock and key when it’s not tucked under your armpit, which it should be, most of the time. Anything that needs to be documented for discipline or kudos should go to HR per their methods of communication.

I’d say look for the different cultures—either of ethnicity, blue/white/pink-collar workers, unions or CBA’s, etc., respect those existing boundaries, and choose battles other than the really entrenched situations. Don’t micromanage; this operation was in place prior to your arrival in management. You have time to observe where the work flow runs smoothly, where it eddies, dams up, diverts, etc.

Make sure everyone knows any changes in reporting order occasioned by your arrival, and also that staff understand and are observing reporting methods, privacy regulations, and other non-negotiables.

Meetings can be deadly and stress-producing. A short “stand-up” meeting with your sub-groups is better than calling everyone around a conference room table. And unless you have a real reason for a meeting, don’t call one. Try to have a regular 15-minute meeting with each of those with line responsibility to you, who also supervise others.

Remember that these are human RESOURCES. They’ll look for the great things you can bring to the team.

I’ve learned in several circumstances that the direct approach per Nelking’s comments is a successful one to adopt. You’re not there to build community, in which you’d get lots of input and consensus, and make sure to involve people. Neither are you there to ram through edicts or to carry the ball on every play. That said, you might make extra efforts if someone on the staff is under-utilized, marginalized, etc. You’ll see that stuff earlier and later it will become invisible, so, pay attention now.

Have a great year!

Congratulations, pranishk. I am a pharmacy manager for a 1200 bed academic health system. I echo those who advise you to not forget about the people. Pharmacy school and your residency likely gave you a good clinical foundation but very little personnel management training. This is something you must learn and keep learning. You must take care of your peeps. If you don’t, personnel issues can really drag you and the department down.

I recommend you find a mentor or several mentors. These can be past preceptors but I recommend you find folks who can serve as a mentor who work in your hospital - other department heads or even a long time pharmacy employee. They can guide you through the bureaucracy of the hospital. They can teach you who you can go to when you need something done, what committee you need approval from to keep a project moving and can help with wading through budgetary issues.

Learn the regulatory issues that you MUST deal with - The Joint Commission, USP 797, CMS-HQI, State Health Department, FDA, The Board of Pharmacy.

As someone else said - nurses run the hospital - know what they and your other customers expect. Perception = reality so learn how they perceive your department; adjust your reality to improve their perception as needed.

Take Management/Leadership courses - either through the professional orgs like ASHP or ACCP or through your hospital or local college. If are not a member of local/state/national professional orgs - you should join. Remember - just like Verizon - it’s your network that matters - your professional network of colleagues you can turn to for advice/help.

And of course - follow a system that will help you keep track of your projects and close those open loops. I have used GTD for a couple of years now. It helps me to keep track of all my areas of responsibility - Academic, Administrative, Clinical, Committees, Operational, Personnel, Professional Organizations, and Research.

Finally - maintain a healthy work/life balance.

Good Luck. Keep Learning. Never Quit.

Understand, Plan, Act

I am developing an onboarding approach for people starting in a new role, or kicking off a new project. There are 4 basic stages:

Understand (done by day 30) Know your strengths and weaknesses. Look to www.marcusbuckingham.com for more on strengths. Repack your management bags. As Marshall Goldsmith, a great executive coach says, “What got you here won’t get you there.” Understand, map, know the organizational context. Not just what are your objectives, but what are your manager’s objectives? What are the top 3 initiatives for the organization next year. Align your personal path with that of the organization.

Plan (done by day 60) Once you know your strengths and objectives (aka the baseline), develop a clear plan toward your goal. Build in milestone so you can assess your progress at least monthly, ideally weekly. Have a coach, mentor or supervisor who can help you look at your progress and provide feedback. Know how you will engage all your stakeholders. Have a plan for knowing how well you are meeting the needs of your boss, peers, employees, and patients.

Act (in process by day 90) This is where you start implementing your well thought out plan. This is where you start not just engaging the stakeholders but holding them accountable for delivery. Remember, no plan survives first contact so think agile and nimble as you move forward. Accept feedback. Say Thank you. And change. Charles Darwin did not write about survival of the fittest, but rather of the most adaptable.

Last, Sustain (by day 100) Keep in going. Keep the lines of communication open. Improve your skills. Challenge your stakeholders. The goal here is that people shift from knowing the motions to knowing the motives; from being compliant to being committed.

My experience is that if you want to move forward faster you need to stop. Survey the environment and yourself. Check your map and your course. Now, move forward quickly remembering to adjust your pace to the terrain.

Good Luck!

I recommend that you only use 3 “buckets” for your email. After you have deleted the messages you can and forward the ones you can move everything to one of three buckets: Reference, Calendar, or Tasks.

Reference is for anything you might need to look at later. Calendar is for things that need to happen at a specific time. Tasks is for everything else.

One of the best books to read after GTD is Linenberger’s Total Workday Control.

Hope this helps,

Craig