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A practice manager's tested tips for more efficient use of email

Stay on top of email without allowing it to take over your working life, writes Fionnuala O'Donnell

Email is an easy way to lose time. Whether you are constantly checking your inbox, drowning in a deluge of messages that require action or deciding where best to file emails for future reference, it is easy to spend hours dealing with messages, with very little to show for the time invested.

Here are my tips for efficient management of email in general practice, as a user of NHS.net, the Microsoft Outlook web app, diary and directory system for NHS staff in England and Scotland. 

Turn off automatic notifications

If you are interrupted every time a new email comes into your inbox or distracted by the floating blue and white message at the bottom of the screen, turn it off. It is rare that something is so urgent you need to follow it up immediately (if something is truly urgent, people will call you).

Studies show it can take 25 minutes to re-immerse yourself in your previous activity after an interruption, so minimise distractions to save time. To switch of notifications in Outlook, go to ‘file’, ‘options’, ‘mail’, ‘message arrival’ and untick the notification boxes before clicking ‘ok’.

Only check email at set points during the day

Even better than switching off notifications is to switch off email entirely, checking it only at set points during the day. This takes self-discipline and I confess I struggle to turn off my email and focus on other things but if you actually close the email browser and work on your most important projects first, you will spend less time scrolling through emails as a procrastination exercise. Wean yourself off constant checking by turning email off for half-an-hour at a time, working your way up to longer periods.

To make it clear you are not monitoring email continuously, set an ‘out of office’ reply suggesting people call you about urgent matters.

Develop a coherent filing and email management system

Either file emails to which you may want to return in an ‘archive’ folder or set up individual folders for emails to mirror your paper filing system, for consistency. Try to keep the number of folders to a minimum.

The following suggested process for managing inboxes is based on advice from productivity expert David Allen. For each email, decide on the most appropriate action:

  • Do it: if it needs doing and will take you less than two minutes to action.
  • Delegate it: if there is someone appropriate to whom you can forward the message. Make a note of who this is and whether/when you will need to follow it up.
  • Defer it: if it is yours to action but non-urgent and will take longer than two minutes put it in a ‘follow up’ folder to deal with at a convenient moment.
  • Delete it: if the message isn’t important, relevant or containing useful information delete it right away.

This process of 'email triage' (see an example of my email management here) transfers all your emails out of your inbox so they are not cluttering it up, taking up capacity or leaving you with a nagging worry that there is something urgent lurking that you have overlooked.

Don’t forget to check the folders to which you transfer emails on a regular basis; perhaps weekly.

Automate processes

In Outlook, use ‘Quick Steps’, a feature introduced in 2010 that applies multiple actions at the same time to email messages. For example, if you tend to move messages to a specific folder or forward them to a particular colleague, Quick Step will do it in one click. Take a look at your emails and work out the most common actions you take.

Looking at my email inbox I came up with the following actions:

  • To file for future reference (in archive) – set up quick step to move email to archive folder
  • Items that need non-urgent action – set up quick step to move to non urgent action folder
  • Items that need urgent action – set up quick step to move to urgent action folder
  • Items that I want to read in more detail – set up quick step to move to read folder

You can set up Quick Steps for each of these actions: when you are in email go to the ‘home’ tab in the Quick Steps group, click the ‘more’ arrow at the side of the Quick Steps box, click ‘manage quick steps’ and follow the prompts to set up quick steps for frequent actions you take.

Use filters

You can apply rules to your email to filter messages in your inbox into folders. Filter actions can be as simple as: ‘delete any message from annoying.person@example.com’ or more sophisticated, for example: ‘Any message that doesn’t contain any one of my five email addresses in the "to" field and does not have the word "urgent" in the subject line should be moved to the "not important" folder.' For further information, read this detailed explanation.

Delete as much as possible

NHS mail has an irritatingly small inbox and you may receive frequent notifications from NHS mail that your mailbox is almost full and you soon will be unable to send messages. When you receive this notification sort your inbox, sent items and deleted items, by size, to find out which are the largest and delete those first. I try to save all (important) large files to my computer desktop as they come in, which means my mailbox becomes less clogged; even if you want to keep the email trail you can delete the attachments from the email as long as you know where you have filed them for when you need them.

Set up distribution lists

If you have a group of people you email regularly (reception; partners; practice nurses; CCG contacts), you can set up distribution lists so you do not need to type in all the names every time. It takes a few minutes to set these up but makes life easier and saves time longer-term, once they are in place. It also means you will not leave people off the list accidentally.

To do this, go into the ‘contacts’ section of Outlook. In the ‘home’ tab, find ‘new contact group’. Click on it and, when it launches, the first thing you will see is ‘name’. That’s where you name your list (eg ‘CCG contacts’). To add people to your list, simply click the ‘add members’ button and choose the address book or other option as applicable.

After saving your group you can, from them on, use the group name in the ‘to’ field of any email in order to send a message to this group of people. To update your group, go back to the ‘contacts’ section, identify your group, open it and use the ‘add members’ or ‘remove members’ buttons to make changes.

Remove yourself from email lists

As you scroll through your inbox, consider whether you actually want to keep on receiving certain emails. While, sadly, we may not be able to unsubscribe from NHS England, regular sales emails from stationers and reps can be prevented. You can either opt to junk these so that they go straight to ‘spam’ or take a moment to unsubscribe. You could save time by using a service like unroll.me which will go through your email for you and unsubscribe you from any emails you specify you no longer want to receive.

Set up a generic practice email address

Practice managers are gatekeepers for a huge proportion of the email traffic into practices. This means we can have eyes on most things but it generates pressure, particularly when you take time off for holiday or illness. Set up a generic practice administration email address that you ask correspondents such as NHS England and the CCG to email. Access to this can be restricted to partners and practice manager so that sensitive financial information is not accessed by everyone, but it does mean more than one person can monitor messages if you are off work. One caveat here: ensure somebody is given key responsibility for monitoring this inbox or each person with access may assume one of the others is checking it.

Colour-code the emails sent only to you

Emails sent only to you are often high priority; those that copy in ‘the world and his wife’ are either primarily for information or are something you can deal with after the ones meant for your eyes only. You can colour-code emails sent only to you so they catch your eye when you open your email inbox:

To highlight emails sent only to you:

  • Click the ‘view’ tab; ‘settings’; ‘conditional formatting’
  • Click ‘add’; name this ‘messages to me’ and then click ‘condition’.
  • Tick the check box next to ‘where I am’  and select ‘the only person on the "to" line from the drop-down’. Click ‘ok’.
  • Now click the ‘font’ button, and set Outlook to highlight emails sent only to you using your preferred formatting.

Discourage inappropriate use of copying in

Ask colleagues only to copy you into messages when it is genuinely necessary, warning that you may only skim-read those that are not specifically for you. Some people 'cc' others in emails in order to delegate some of the responsibility for whatever the message contains and may assume your tacit agreement to messages into which you are copied, should you not reply. While you may want to be kept ‘in the loop’ about certain issues, being copied into every single email certain colleagues send will clog up your in-box and mean you have to read through irrelevant correspondence between others.

Use good email etiquette

When sending emails yourself, there are some basic tenets that make up good email etiquette:

  • Always use a subject line and make this clear and concise - something that makes the topic obvious for when you come to search for it again. If it refers to a 'CCG meeting', for example, include the date or a key subject so that you can differentiate it from all the other CCG meetings about which you might email colleagues.
  • Email only those who need to be emailed, everyone has enough email to deal with without being copied into emails that they don’t really require. Only 'reply to all' if everyone need to read your reply, otherwise simply reply to the sender.
  • Keep the email body copy clear and concise and re-read messages before sending to check they make sense and are not littered with typos.
  • Make clear what action is required in the body of the email or make it plain that no action is required.
  • If you are including images, check their size; very large images may not be delivered to recipients with insufficient inbox space. If sending several large images, send them one-at-a-time.
  • Set up distribution lists, rather than using previous emails and ‘replying to all’, if the email concerns a new topic. This initiates a new email trail so people realise it is a fresh topic and makes it easier to identify the trail in future.
  • Never say something in email, you wouldn’t be happy to say in a public meeting and be very careful when you 'reply to all'. 
  • If you are attaching a file, attach it when you first start writing the message so you don’t forget to do it.

To conclude: if you lead by example and encourage your teams to follow the above advice, it should mean more efficient and precise use of email, freeing up precious time for you and your staff.

  • Fionnuala O'Donnell is a practice manager in Ealing, West London, and a CCG board member.

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