Decision Triage

sss-no-time-no-rush

“It’s when you realize that you are out of time that you must focus on not rushing.”

 

TASK AT HAND: This week I’m thinking about the last minute, the eleventh hour, time as it expires. We are constantly rushed and hurried in our professional commitments and personal relationships. In these pressured moments, we tend to rush when, in fact, we should be deliberate and purposeful with our strategy. As time slips away, we can succumb to bad decisions but there are strategies you can use to avoid errors in these situations.

“As time expires, each second is worth more.”

First, realize that, as time expires, each second is worth more. I like to think of the eleventh hour in terms of relativity. Although one second is one second, in the closing moments of an assignment or instances where a quick decision is required, I like to think of those seconds as “more valuable” than previous ones. When you only have minutes to act, each second is crucial. When you have days to decide, deliberation can be consummate with a longer time window, and seconds seem to matter less.

Previously, on the Decision Triage post of the Sunday Surgical Scrub (you can find it here), I emphasized that, in the last minute, every decision must be made right away and that all triages become urgent in this context. For example, in surgery, I imagine expanding each second to feel like minutes so that I can carefully execute the maneuvers that will bring the outcomes that are required. If there is an unforeseen complication or adverse event – where there is a very small amount of time to correct the error – it is here, I cannot rush! Realizing each second here is worth more than at any other time during the surgery, I can focus solely on these intense junctures. This approach allows speed and efficiency, without ever being rushed or forced into shortcuts.

“Quiet your mind, then plan and execute!”

The feeling of “running out of time” is an external force. It comes from outside you and is then transferred onto your inner self. This creates needless self-inflicted pressure. Quiet your mind, then plan and execute! When you are left with what seems as no time and limited options, still your mind and see beyond the time frame. Find the character of the decision  and align yourself with the basic principles of what you want to achieve.

 

MEDICINE & MACULA: I was in Toronto this weekend for the 56th Annual Walter Wright Symposium, Retina 2016: A Practical Approach to Navigating the Future.

walter-wright-2016

On Saturday, I presented a talk on my approach and techniques for infectious endophthalmitis. The evolving paradigm calls for early surgery and aggressive treatment to salvage vision from this devastating infectious condition.

044_rs0916_North_RK.indd

 

GRATIS: “Why do they call it rush hour when nothing moves?” -Robin Williams

 

My best to you,

David Almeida

david@davidalmeidamd.com

Read more

triage decision sss

“Don’t fight the problem, decide it.” -George C. Marshall

 

TASK AT HAND: This week I’m thinking about triage. In medicine, triage is the process of assigning degrees of urgency. In any hospital Emergency Department, you will find a Triage desk that functions to grade the severity of your ailment. Triage decides if your problem is an emergency (must be assessed and resuscitated right away), emergent (needs assessment very soon), urgent (important but can usually wait some amount of time), or nonurgent (can wait). An emergency has the potential to kill or seriously harm your patient and needs to be addressed right now. An emergent condition has the potential to inflict significant morbidity and cannot be delayed any significant amount of time. An urgent state needs to be assessed but usually lacks immediate temporal gravity.

Over the years, I have found that you can apply this same triage process to decision making. One can formulate strategy by triaging decisions and prioritizing subsequent actions. Whether you are taking inventory of personal sentiments, deciding on a strategy for an ambitious project, or developing a new idea, the ability to triage allows you to set priorities, execute strategy, and engage in effective delegation. The goal of decision triage is to emerge from the deluge of questions with a set of priorities aligned with your strategy. Clarity for success by means of deciding how to tackle multiple problems.

now

I triage decisions using these same emergency principles: an emergency requires an answer or decision right now – no exceptions! I reply to all emergent decisions within 12-24 hours. For urgent decisions, I reassess later. Nonurgent matters tend to be delegated elsewhere. Try this next time you are asked to solve a problem or your input is required. If the issue has immediate consequences, deal with it straightaway. Don’t procrastinate and don’t delay. Is it emergent? If so, you have some time. Relatively urgent? Maybe you can delegate this task or move it down your prioritized to-do list.

In triaging decisions, will almost always find conflict and disagreement because, what to one is an emergency, to another is only urgent. What do you do when this occurs? Make sure you communicate clearly so that trust is built in your assessment skills. Lead by example and never trivialize the conflicts of others. When in doubt, have the best interests of others in mind. Selfish behavior is based out of insecurity. Act selfless and create value for others in your triage. This is a key principle of successful decision making.

“Nothing is more difficult, and therefore more precious, than to be able to decide.” –Napoleon Bonaparte

As the quote above emphasizes, the ability to decide deserves your judicial attentiveness. Decision making and strategy are topics we revisit frequently here on the Sunday Surgical Scrub and you can think of decision triage at the top of the algorithm. Once you decide on the priority of the decision, you can use the many tools presented here to resolve the crux of your conflict and put forward the best decision.

 

Caregiver burden fig

MEDICINE & MACULA: Check out our new systematic review pertaining to depression and burden among caregivers of patients with visual impairment. While caregiving allows those with vision problems to better adapt, it has been shown to take a toll on the caregiver on various levels, such as invoking depression and burden. Recognition of this is key for awareness, prevention and management.

burden study paper

Thank you International Ophthalmology for publishing our study! Check out the study here.

GRATIS: One last note on the decision triage system above. By frequently using this method of triage for decision making, I have found a wonderful unexpected side effect: I gain perspective by realizing that few things are a true emergency that require destabilization to correct. This calming vantage point will allow you to appreciate that many decisions – whether we like or not – are just not that important. Find those that are, prioritize them, and then successfully attend to them.

My best to you,

David Almeida

Read more