“You can do anything, but not everything” (David Allen) was a quote I used to see regularly when working in Toronto hospitals. It was meant to inspire serenity and perspective. The ENTJ in me thought differently. If I could do anything, then surely I could do everything? Full disclosure here, I subscribe to the Ernest Gallo philosophy of “we don’t want most of the business, we want all of it”.
“You can do anything, but not everything.” The key words missing at the end of that sentence, for me, are: “at once”.
As I built my surgical career, my various roles often had me working 140 hours per week (including overnight calls). My pagers and phones rang incessantly with jobs to be done. Every department’s request was urgent. Everyone higher up in the organisation bestowed advice about the dangers of slipping up. Something had to give: I had to learn how to triage.
The word triage itself derives from the French word “trier”, and was originally applied to a process of sorting, probably around 1792, by Baron Dominique Jean Larrey, Surgeon in Chief to Napoleon’s Imperial Guard. The original triage systems were based on prioritizing mass-casualty patients in battlefield settings into immediate, urgent, and non-urgent. With the development of organised medical systems in the western world, the late 19th/early 20th century witnessed the emergence of triage within overcrowded emergency departments in the US, UK, and Europe. Triage at this time consisted of a brief clinical assessment that determined the time and sequence in which the patient should be seen, using their limited resources. Modern emergency departments must juggle the issues of increasing demand, increasing financial pressures, staff limitations, burnout, technological and medical advancement, and an ability to save the lives of patients who previously would not have survived. Emergency services now use a modified traffic light system, adaptable to different patient cohorts (children; elderly; surgical; cancer; psychiatric), for triage:
|Green: Low risk. Non-urgent |
Amber: Moderate risk. Semi-urgent
Red: High risk. Urgent/Critical
Black: Nothing can be done. Comfort measures only
As I progressed through my surgical career, I quickly adapted to triaging each job I was given. Those jobs that could wait–even for a couple of hours–would do so. You live in your very own Maslow’s hierarchy, but the needs are external, not internal. Getting two calls for critical tasks such as an urgent call to theatre, and to the emergency department at the same time? Nightmare.
I found quickly that good quality communication, and the development of a strong professional network whom I could call on in a crisis worked well. I did my homework on not just the medical staff, but nursing, administrative staff, porters, office staff, cleaners, telephone operators, and even canteen staff. You take the time to get to know people, and let them get to know you, and suddenly, everything seems a little more cohesive, more efficient, and more tolerable. Also no harm in having your favourite panini and coffee pre-made while you whizz past the canteen on yet another important job. When it comes to urgent tasks, you will invariably fail on some. But how you make people around you feel? That stuff sticks. People. Matter.
You will note that I haven’t mentioned the importance of trying to juggle a family life as well. My wife spent much of those years in a role akin to a single parent, holding down her own job and studies. My life could be summed up using a modified version of Porter’s Five Forces:
Thus it is with the MBA. It is an intensive program by any standard, and having prior exposure to covered topics does not grant immunity. With assignments, and reading, and presentations, and exams, and potentially even day jobs, the concept of triage is as relevant to this endeavour as it is to any branch of medicine/surgery.
Our direct resources in this case are limited, and include time, freshness, vigour, communication, and motivation. One needs to apply these as required, and to risk-stratify assignments and tasks.
Here we move from the Napoleonic wars at the start of the blog to Comrade Napoleon in the George Orwell novel Animal Farm: “All animals are equal, but some animals are more equal than others”. There are only so many hours in the day, only so many brain cells available at one time, only so far your “favour network” can stretch.
Do I take bloods on the imminent surgical patient, or the strictly timed bloods on the transplant ward at the other end of the hospital? Sounds easy, get the patient to theatre, and get a telling off from the transplant consultant. What about leaving the operating theatre mid-operation to deal with an emergency that no-one else can deal with? What do you say to each family? You may consider this to be a systems issue, and perhaps it is, but the important thing is to be able to live in the grey. To quickly make decisions that need to be made, and accept the consequences.
Some things can and must wait, and indeed sometimes there’s nothing that can be done. You must control the controlables, accept that there are things that you cannot control, and develop communication networks to help to try to bridge the gulf between the two. Remember: You can do anything, but not everything at once.
—Fardod O’Kelly, EMBA Class of 2022