Mitch Joel's posting: "5 Ways to survive your inbox" describes a set of habits one might use to maintain control:
- Create folders.
- Create rules.
- Get it done.
- Create a hierarchy of response.
- Tell people – in your emails – how to work better with you.
See his post for the details and editorial. None of this is a new idea – though I like the way he describes #5 quite a bit – and will admit that I have used this tactic myself.
But why should we work so hard to apply these principles? Shouldn't the software facilitate this work? As care providers – isn't it ESSENTIAL that the software do this FOR us? One shouldn't have to think like an IT expert. Mitch describes a set of technical tasks. Let's change the terms a bit – and consider this from the perspective of a care provider interacting with patients electronically.
What it might look like:
- Create folders. Categorize. "Folders" are old-school. We don't need legacy metaphors that evoke images of manila folders into which we throw 8.5 x 11" documents. We need to categorize messages so that we can see patterns, find "like" messages together, or look at things together. For example – I may want to see every time that Mrs Smith and I have discussed her sore knee. I may want to look at all of my conversations with Dr Jones. I shouldn't have to deliberately create these categories. The SYSTEM should. And the system should automagically categorize every message properly. Is that too much to ask? I don't think so.
- Create rules. Prioritize. Stuff that's important needs to get dealt with right away. Less important stuff can be done later. How does Google know what search results to show us first? Did I create a rule for that? Of course not. While rules exist – they are transparent to me. Google learned from my actions what content is important to me and what is not. With a clinical messaging system – the same should happen. The system should learn what's important and what is not so important. I can then focus on the important messages now ("Mr Smith's INR is 4.5") and the less important ones later ("The fridge in the break room will be cleaned tomorrow.")
- Get it done. I'll keep this one as-is. "If you can get it done in 60 seconds or less, do it right away." Have you tried the e-mail Game? If not – you should. It's good. And it's a good example of a "focus" mode that one could employ to power through 80% of a clinical inbox in 8 minutes or less.
- Create a hierarchy of response. I think this one's redundant of #2 above. Prioritize. Not just content but people. Stuff from some people is generally more important than stuff from some other people. The system should learn that – and prioritize the messages accordingly. Hooray – Five rules is now FOUR rules! We've reduced the cognitive load by 50% already. :-)
- Tell people – in your emails – how to work better with you. Facilitate Best Practices. Process is important, and wherever possible – the system should understand "lean" processes that have been well defined – and should facilitate them. This might mean that there are limitations of the system that enforce these processes. For example – it's probably clinically inappropriate for a message with an important clinical question or task to be sent to more than one person. Have you ever received a "please do this" e-mail that is addressed to seven people? No surprise that everyone thought the other six would take care of the task – and it never gets done. So while a clinical messaging system may be technically capable of sending a task to seven people – the system design should not allow it – since it's not consistent with best practice. ONE "target" should be required for all such messages. Even if that "target" person is permitted to re-assign the task.
Now it's audience participation time! What OTHER suggestions do you have for Clinical Inbox Management?