Time Management Hack – Turn off those notifications.


My attention wandered.  Again!  I’m having alot of difficulty getting this blog post written.  Every time I get my thoughts organized and get into the groove of writing, something pulls my attention away.  Hey, look!  A new Facebook notification, a new email, a to-do list reminder… it’s no wonder nothing is getting done.

Facebook notifications done

I’m pretty sureI’m not alone here.  A quick review of the relevant literature reveals that this is not just a common problem, but an epidemic among knowledge workers.  I suspect this may be even harder for those of us who are in workplaces with constant human interactions to also distract us.

Just how often do we get distracted?

According to business research firm Basex, interruptions cost the US economy more than $650 billion per year.  Jonathan Spira, the chief analyst at Basex, recently compiled an update of research based on surveys and interviews with professionals and office workers.  They reported that 28% of their time was spent on interruptions and ‘getting back on task’ after the disruption of their attention.

OK, so we get distracted alot.  So what?

Research has shown that interruptions can increase task performance time.  This is primarily because it takes time to get back into the flow of the interrupted task.  Recent research by Microsoft reveals just how much notifications can disrupt your workflow.  By tracking all of the computer activity of 27 users over a 2 week period, they quantified how much work was accomplished on primary tasks and the impact of interruptions on the time it took to perform them.  They found that participants spent an average of 10 minutes on switches caused by notifications.  Strangely, workers typically not only visited the notifying application, but also several others before getting back to work.

What was the impact?

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The workers took, on average, took a total of 15 minutes to return their attention to their primary task.  This is bad enough, but consider also that 27% of interruptions resulted in more than two hours of time lost before resumption of the primary task.  Combined with a variety of other research that indicates that multi-tasking increases the amount of time to complete tasks, the evidence is clear.  Those notifications aren’t just a way to make you more aware of the incoming information.  They are a mechanism that invariably pulls you off task and makes getting things done more difficult.

What to do?  Turn notifications off!

Email, Facebook and Twitter aren’t meant to be instantaneous forms of communication.  By clustering your interaction with these communication forms, you can create blocks of focused time where you can get more accomplished.  This is a simple, but valuable time management strategy. Your distracting friends can always text you if they need something right now.  Maybe we’ll need to turn that off next.


Iqbal S, Horvitz E. Disruption and Recovery of Computing Tasks: Field Study, Analysis and Directions. CHI 2007.

Mark G, et al. No task left behind?: examining the nature of fragmented work.  CHI 2005, 321 – 330.

Spira J. The Cost of Not Paying Attention: How Interruptions Impact Knowledge Worker Productivity.  Basex. 2005.

Jobs Applied: Take Responsibility End to End


Apple has always taken full responsibility for the user’s experience.  This is in contrast to other companies such as Microsoft and Google that take a more open approach – allowing others to use the software with hardware created by others.  An open approach yields more variety in products, but maintaining control of the entire product – from hardware, to software to the sale of the product is what has created a differentiated and premium consumer experience.  Steve Job’s penchant for controlling everything can be reframed as taking responsibility for the entire customer experience.

In physical therapy, we can adopt the same approach.  We can take responsibility for every aspect of the patient’s interaction with us, from when they first dial a number to when we fondly ‘graduate’ them from therapy.  How can we get a handle on the massive number of interactions patients have with us?  Perhaps creating a customer interaction map can help us to identify each touchpoint where we interact with our patients.  What if instead of capturing our patient’s rating of their experience at just one point we could create a map of the key touch points to identify where we can improve?  This idea is written about extensively but not commonly utilized in healthcare.

touchpointsBecause healthcare is a service industry, invariably a great many of the touch-points our patient’s have with our companies will be with specific people rather than a call center, website or automated system. In chasing down this idea I came across a really nice HBR blog post here and I also noted that it is strikingly similar to the approach the Cleveland clinic used in a dramatic customer service turnaround described in this HBR article that anyone in the healthcare business should read.  When the Cleveland clinic decided to turn around their satisfaction ratings as reported to medicare they started by identifying every interaction that patient’s had with staff.  They learned that the physician accounted for less than 5% of the interactions during a patient stay.  This information cued the leader’s of the Cleveland clinic to focus attention on interactions that had not been previously thought to be vital.

Below is a list of interactions I made for our practice… the first step in mapping the key touch points.

Patient Interaction List

The next step would be identifying key points, and either looking at established metrics or creating new measurement methods to quantify our patient’s satisfaction at each point in their journey.  As an example, one of our practices identified that they had a larger than expected number of patients who did not complete their course of care.  The patients were returning after the initial visit, but approximately 15% would drop out by the 3rd visit.  They created a list of interactions similar to the one listed above and tracked how well they thought they were doing and how satisfied the patient was at each point in ‘the journey’.  The staff identified that patients were often not being greeted by the therapist until they had performed as much as half of their exercise intervention.  In the form of a test, the physical therapists resolved to greet the patient and discuss their status while they were warming up.  While difficult in the beginning, before long this habit became an established part of the clinic flow and the number of patients dropping from care in the first 3 visits dropped to a more typical 8%.


Obviously some of these interactions are more important than others, but the leadership lesson of ‘take responsibility from end to end’ is that we should pay attention to each of these interactions and always assume that we can take action to improve them.  When we can make each of these interactions as positive as possible for our patients, we will have created a differentiated experience that will be very hard to compete with.

Violently execute!


I have found that coming up with strategies, setting goals and knowing what to do is often not the problem facing us.  Its finding the time and energy to get these things done!  General George Patton said:

“A good plan violently executed now is better than a perfect plan executed next week”.

I’ll take that further and say that a mediocre plan that is executed is better than a perfect plan written on a piece of paper in a desk drawer. What plans do you need to execute on?  Get violent with them!

“The key is not to prioritize what’s on your schedule, but to schedule your priorities”  Steven Covey.

7 Habits of Highly Effective People.

Jobs Applied: Simplicity


“It takes alot of hard work, to make something simple, to truly understand the underlying challenges and come up with elegant solutions”  Steve Jobs

Steve Jobs was famous for his focus on making complex problems and products more simple.  When Apple wanted to disrupt a market – it looked for industries or categories that were making products more complex than they needed to be.  I think itunes is a great example of this.  Love it or hate it, it is simple to use.  So simple, in fact, that millions of people prefer to pay $1 or more per song, when they can quite easily find the same music for free.  You might argue its about copyright infringement, but I’d argue its about simplicity.

“Simplicity is the ultimate sophistication.” – Leonardo DaVinci

Surely the US healthcare system could use a dose of simplification!  Let’s review the steps required for a patient to come in to see me in my private practice.

  1. Get hurt (simple)
  2. Make physician appointment (referral required by law in most states)
  3. Explain to physician that physical therapy can help injury
  4. Brush off advice to take medication and ‘actively rest’
  5. Obtain physical therapy referral
  6. Schedule physical therapy appointment
  7. Give receptionist ~30 pieces of data for insurance verification
  8. Fill out 8-10 pages of paperwork
  9. See physical therapist and begin treatment (unless its a work injury, then see steps 10 – 12)
  10. Physical therapist sends in paperwork requesting permission to begin treatment
  11. Wait 5-7 days
  12. Begin treatment

This got me thinking.  A great deal of this could be simplified by moving to Pennsylvania (a direct access state – remove 2,3,4 and 5) and by accepting cash only (that would take care of 7, half of 8 and 10-12 ).  The downside, of course, is that this simple solution only works in certain states and for patients with cash to burn.  There is alot of this that is simply outside of our control other than advocating for a change.

Simplicity is about subtracting the obvious and adding the meaningful.” – John Meada

Steven Covey writes about a useful principle called the ‘circle of concern’ vs. the ‘circle of control’ (here’s a neat review).  Clearly most of the steps a patient has to go through would fall into our circle of concern, but outside of our circle of control.  However, there are a few that we do control directly.  Probably the highest leverage item in our list that we could simplify is #8. the paperwork a patient fills out when they hit our door.

intimidating_stack_of_divorce_forms_and_papersIn most practices we already had to collect more information than the patient has to give to get a credit line to verify their insurance.  Looking through my forms (yes, guilty!) we ask the patient to write their name and birthdate no less than 7 times, their social security number 3 times, etc.   We also ask them to describe their pain numerically, graphically and in detail… then proceed to ask them about it verbally not 5′ later.  The entire process is redundant, since we use an EMR anyway.

A believer in the circle of control – I’ve got a new Next Action.  I’m going to think like Steve Jobs and simplify steps 7 and 8 for every patient trying to connect with our practice.

Next: Take Responsibility End to End

Time Management Tech Tip: GMail

Google Apps Important

Gmail provides one of the most useful ways I have found to prevent being overwhelmed by your inbox.  A few years ago, our practice switched from Outlook to Google Apps.  This is Gmail for business.  While I had enjoyed a Gmail account for personal use, our switch to Google Apps allowed me to use what has become one of my favorite email hacks.  Controlling the flow of information and how I process it is one of the best ways I have found to manage my time.

With a setting easily accessible the preferences menu, you can tell Gmail to utilize an algorithm to decide whether a message is ‘important’ or ‘not important’.  If you have any trouble, check out this help link.  This has been invaluable, because I typically will leave anything Gmail doesn’t think is ‘important’ until later, then spend just a few minutes at the end of the day and delete it all in one fell swoop.  Clustering tasks like this together is one way to improve your time management and avoid distraction.

How does Gmail decide what is important?

1)  Who you email

2)   Which messages you open

3)   What keywords are common in messages you open

4)   Which messages you reply to

5)   Which messages you star, archive or delete

Gmail takes a little while to figure out your preferences, but after a few months, I found that I almost never had a message I cared to open slide past the ‘important and unread’ inbox.  It also reacts to your tweaks, you can mark that annoying co-worker who directly emails you all the time as unimportant and after a few times, they stay unimportant until you change your mind.  Just to be safe, though, I make it a practice to scan the ‘unimportant emails’ at the end of the day and delete them.  This 30-second email hygiene task helps when I need to search for an email later.


“Repetition of the same thought or physical action develops into a habit, which repeated frequently enough, becomes an automatic reflex” Norman Vincent Peale

The Power of Positive Thinking

Jobs Applied: Focus

“Deciding what not to do is as important as deciding what to do” Steve Jobs


One of the major strategic shifts that Steve Jobs made upon returning to the failing Apple in 1997 was to sharpen the focus on the company on creating just a few products… but pouring all of their energy into making those products fantastic.  That’s why even today Apple, arguably the number 1 computer company in the world, only has 46 products.  Only 13 of those are in their core hardware business (the rest are software or accessory products -I found that tidbit here).  Spend a few minutes browsing the Dell website and you can see how remarkable this is.

Isaacson, in the article that spurred this Blog series, describes an annual strategy meeting Jobs would hold with his ‘top 100’ people.  He would ask them to brainstorm what 10 things they should be doing… slowly narrowing all the ideas down until he got to 10.  He’d prioritize them… and then drop the  bottom 7.  This narrowing of priorities down to 2 or 3 is a strategy theme that seems to be everywhere once you look for it.  Perhaps the most well known of these ‘no more than 3 priorities’ advocates is Jim Collins, of ‘Good to Great’ fame.

Create a ‘stop doing’ list. Work is infinite; time is finite. If you have more than three priorities, you have none … – Jim Collins

The principle of playing to our strengths and figuring out what one or two things your firm can be excellent at has been an ongoing theme in our Executive Program in Private Practice Management.   Part of focusing on your strengths is to accept that it is acceptable – perhaps even preferable to be mediocre or even suck at alot of things if you are going to be world-class at anything.   I, for example, am steadily losing my skill at manual therapy.  For the first decade of my career, it was all I thought about.  I obsessed about it, studied it, practiced it… I practically manipulated anyone who I could get to lie down on my portable manipulation table.  I did my best to put in Malcolm Gladwell’s 10,000 hours.  Now I’m focusing on other things – such as learning to write better blog posts.  If I want to become a master at THIS, then I can’t spend a big chunk of my time practicing THAT.

“My success, part of it certainly, is that I have focused in on a few things.” — Bill Gates

Our practices, similarly, can’t be amazing at everything.  We probably can’t be the best place for an endurance athlete to be seen and also the best place to go if you have a stroke.  We probably can’t be the women’s health mecca and also the very best at treating cervicogenic headaches.  We could certainly collect some people who have these skill sets – but we as a practice can’t be the best at everything and as the number of therapists gets larger, Cindy’s special skill set in treating elbow pain becomes more and more difficult to use as a differentiation.

“A person who aims at nothing is sure to hit it.” – Anonymous

The lesson the rest of the business world is trying to get across (and that was executed on by Steve Jobs) is that it is better to figure out what you are the BEST at and then use that to differentiate your practice from the others.  Everything else is a distraction and could prevent you from achieving the amazing practice you envision.

Coming up next week…. Simplify.

Annual Mean Wage of Physical Therapists, by state, May 2012

Physical Therapist Mean wages May 2012

Here is a chart with the annual mean wage of physical therapists, by state from May 2012 from the US Department of Labor, Bureau of Labor Statistics.

For my staff… don’t get too excited, Texas’ wildly inflated salaries include such locations as my hometown of Amarillo, Texas and beautiful Nuevo Laredo, where a friend of mine will give you a six figure salary tomorrow.

My point is that you should take this information with a grain of salt. It includes all practice areas, experience and responsibility levels.  For example, starting salaries in Austin, TX for outpatient physical therapy in a private practice setting are in the mid $50s.  Unless you work in home health or are a manager of some kind you are unlikely to see $80s, much less the upper end of that register.

Oddly enough, Colorado was featured as the #2 state to be a PT in the article I mentioned here.  Look for more of this kind of information coming soon under the category ‘Geography of PT’ – my new hobby.

Do these numbers seem real to YOU?