The Tyranny of the Urgent

In my recent blog entry "It's not a job, it's a lifestyle", I mentioned that I reserve 50% of my schedule for the work of each day and 50% for more longitudinal work. Explaining this balance justifies another blog entry.

Providing cutting edge clinical applications to a hospital is journey. It requires daily efforts to refine workflow and encourage adoption but it also requires a multiyear plan to ensure future needs will be met. Three years ago, it was clear that e-Prescribing would be very important. However in 2004, faxing to retail pharmacies was all we had. Today, with the Surescripts connection to retail pharmacies and the RxHub connection to mail order pharmacies, we have fully electronic transmission for 90% of our prescriptions. The only way we were able to support all aspects of e-Prescribing including formulary enforcement, eligibility checking, community drug history with drug/drug interactions, and prescription routing was to focus a portion of each day on our long term goals without being derailed by each day's distractions.

I call the distractions of each day, "the tyranny of the urgent". Everyone believes that long term goals like medication safety are essential, but each day some stakeholder has a new, mission critical project that is expected to trump existing priorities. Of course there are legitimate urgent projects that must be done for quality, safety, compliance or return on investment, but if we allowed every project proposed each day to defer our multi-year plan, we'd never accomplish our long term goals.

Thus, I spend 50% of my day on email, phone calls and the tyranny of the urgent, but reserve 50% of each day for those projects which will create revolutionary change three years from now. To do so requires two kinds of plans.

My Operating Plan outlines the goals of each year - ensuring that each business owner's strategic priorities are met on a yearly basis. To ensure stakeholders understand the major themes of our yearly operating plan, I produce a thematic summary. The FY08 summary can be found here

I also have a 5 year plan which outlines the "big picture" so that all stakeholders know where we're going year to year. That plan can be found here . Of course I watch for major industry trends and refine the 5 year plan in response to changes in technology, legislation and compliance requirements, but in general, the 5 year plan is a predictable roadmap of what we'll accomplish over the long term.

Many days, it feels like my job is driven by the contents of my Inbox, but in order to create a successful organization, I have to insulate my staff from attempts to change priorities on a daily basis. Instead, my job is to triage the entropy of my inbox into a few short term urgencies while protecting the operating plan and five year plan. At times, this triage exercise is challenging and I involve my various governance committees when decisions are politically charged or involving competing stakeholder priorites.

My advice to CIOs is to develop standard escalation processes and use those well defined processes each day in response to the tyranny of the urgent. Do not let your inbox dictate your strategy or priorities. Keep your eye on the big picture. As Jim Barksdale says, "The main thing is to make the main thing the main thing."