Medeconomics’ recent survey results should act as a wake-up call to practices.
Practice managers are calling for support, which is a serious cry for help from professionals who generally absorb changes and associated workload with minimal complaint.
The time is ripe for professional bodies (for both GPs and practice managers) to address workload issues to prevent an exodus of experienced managers from general practice.
But, assuming help is not just around the corner, what can practice managers be doing themselves to manage their precious time?
What are you and your staff doing with your time?
- How do you know your team is working with maximum efficiency?
- Are you using your day in the most efficient manner?
Almost certainly, pleas for additional staff will fall on deaf ears. Be proactive and look at how the time of existing staff is spent (not least to back up your case for recruitment). ‘Productive general practice’ tools, devised by the (now defunct) NHS Institute for Innovation and Improvement, are still available online and are worth consulting.
While this kind of exercise initially involves time and energy, it can be very revealing to scrutinise an area of activity (for example, the back office) and find out what is really going on and where there is waste. Every practice could do things more efficiently and investing time identifying how could have significant long-term benefits.
Take a critical look at how you spend your day with a focus on some of the following:
Spend less time on email:
- Do not waste time reading emails which do not require your attention (do not allow yourself to be ‘cc’d into everything).
- Unsubscribe from obsolete distribution lists.
- Consign persistent unnecessary emails to spam.
Distance yourself from crisis management: Resist the temptation to be there, rescuing everything that goes wrong in the practice. Someone else can do it and report to you if it is not fixed.
Delegate: Really, you can; in fact, you must. If you have eradicated wasteful activities elsewhere in the team, this is an opportunity. The first step is to write down the following and pin it up somewhere you see it every day: ‘For peace of mind, resign as the general manager of the universe.’ When a team member says: ‘Do you have a minute?’ apply the following rules:
- Do not accept the problem as ‘yours’, automatically responding with ‘leave it with me’.
- Establish instead that you will find a solution in partnership with the team member.
- Make sure the team member leaves your room with a solution to the problem and the responsibility to apply it.
- Make it clear that they can come back to you if further problems crop up.
Deal with interruptions: Interruptions damage time management by double the duration of the interruption itself, distracting you from the task in hand and disturbing your train of thought.
Agree rules for how and when colleagues can interrupt you and apply them consistently. If this is achieved hand-in-hand with effective delegation, it will buy you space and time. GPs are not interrupted during a surgery except in specific circumstances. You can request a similar policy, defining your boundaries.
Grade tasks according to urgency and importance: Work which is important but non-urgent can be timetabled for a (relatively) quieter time (with time built in for urgent tasks that might come up suddenly). Tasks that are both urgent and important (for example, financial and contract year ends) need prioritisation. If work is non-urgent and unimportant consider whether it needs doing at all. Scan it quickly and either delegate it to a junior staff member or bin it.
Some activities, although not obviously producing a tangible result, are still important. Team maintenance comes into this bracket. Ensure your team members’ ‘psychological contracts’ are tended and motivation is maintained.
Rethink meetings: Do not waste your time, and that of everyone else, on poorly-managed meetings. First, consider whether a meeting is appropriate and necessary. If it is, ensure you have an agenda; that the key issues appear on it (in the right order) and supporting information is available. Ensure the right people are able to attend; the timing is convenient; and there is a competent chair. Review the whole decision-making structure in the practice and make sure that preventable problems are eliminated.
Are you managing performance?
Most practices must, at some time, deal with poor performance from certain members of staff. If this is left unaddressed, it is likely to sap the energy of your best performers and undermine their respect in your management. If they leave as a consequence, you will spend time and money recruiting a replacement for someone valuable, while being left with the poor performer.
Monitor performance by doing the following:
- Re-define and review roles and job descriptions.
- Hold regular one-to-one meetings with team members.
- Set explicit standards against which you can measure performance.
- Update and redistribute your performance management policy.
- Give regular feedback to all staff and manage performance actively when it is not up to the standard of the rest of the team.
- Update and redistribute your absence management policy.
- Manage sickness absence with immediate and automatic back-to-work interviews.
- Take action on persistent short term absences (stick to your policy and take advice if the situation could lead to dismissal).
Practice managers are dedicated generalists, committed to the practice and its patients and prepared to work hard. Taking the time to review time management could have significant benefits for all.
- Fiona Dalziel is a practice management consultant