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