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December 05, 2019
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Excess task loading: An overlooked dimension of provider and practice stress

An expert offers tips on what to do when too many tasks are on a practitioner's plate.

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“Start by doing what’s necessary; then do what’s possible; and suddenly you are doing the impossible.”
– Francis of Assisi

“The only way to discover the limits of the possible is to go beyond them into the impossible.”
– Arthur C. Clarke

The term “task loading” comes to us from NASA and the military, where elite astronauts and deep-sea divers are evaluated for their ability to handle the escalating task list that emerges in these critical environments.

John Pinto
John B. Pinto

Wikipedia, as usual, puts it well: “Task load indicates the degree of difficulty experienced when performing a task, and task loading describes the accumulation of tasks that are necessary to perform an operation. A light task loading can be managed by the operator with capacity to spare in case of contingencies.”

Unfortunately, few eye surgeons in this jazzed-up environment experience anything remotely akin to “light task loading.”

Doctors, moving through an average day in the office, have a routine of ordinary, predictable, patient-focused tasks:

  • asking each unique patient the right questions to understand their condition;
  • ordering the right tests and making the right outbound referrals;
  • clearly dictating to the scribe;
  • encouraging compliance;
  • remembering to ask the patient to refer their friends; and
  • returning phone calls and emails.

They also have, layered over this baseline of duties, the usual barrage of intermittent, sometimes hard-to-predict, hard-to-pace tasks:

  • dealing with an uncooperative board in the midst of a business crisis;
  • negotiating with a troublesome landlord;
  • replacing an administrator who has abruptly departed;
  • responding to a malpractice threat;
  • evaluating the cost and patient care benefits of a new piece of testing equipment; and
  • composing a journal article on deadline.

All of these routine and nonroutine tasks, patient by patient, project by project, keep the average ophthalmologist — and even an exceptional one — on their toes.

When a new task is added to a doctor’s routine, some docs (probably like some NASA astronauts) adapt easily and serenely. Others less so, and some avoid taking anything else on because they know they are chronically at their task loading limit.

We see this vividly in ophthalmology, where some surgeons implant 50+% premium lenses while others have a hard time cracking 5%, even if they believe in the technology. They are simply too overtasked to remember to consistently bring up advanced lens choices with patients.

Insights about this can help all of the stakeholders in this profession better understand how surgeons function and their natural, highly individual limits to change or take on new projects.

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Picking up the Wiki thread, “In underwater diving, task loading increases the risk of failure by the diver to undertake some key basic function which would normally be routine for safety underwater. A heavy task loading may overwhelm the diver if something does not go according to plan.”

Does this feel familiar on some days? Are you on the verge of drowning in tasks? Here is what you and your staff can do about it:

  1. Be aware of your personal upper capacity for clinical and surgical volumes. If you are already at these limits and are experiencing additional stress or responsibility (learning a new procedure or EMR program, undergoing divorce, recuperating from illness), be proactive. Tell your staff to reduce patient or case volumes.
  2. Pace yourself and the sequencing of change. Unless you are especially resilient, do not move offices, start a LASIK program and take on a partner-track associate all in the same 3 months.
  3. Develop enough operational and strategic intimacy with your partners and administrator and enlist them to throw down the flag when they see you (or the company) becoming overtasked.
  4. Delegate or abandon low-yield responsibilities before you take on higher-yielding new ones. If you are excited about launching a medical retina practice to augment your general ophthalmology work, trim primary care patients from your schedule.
  5. Do not go it alone. Most business tasks can be taken over (or at least teed up) by a less-occupied colleague, your administrator, attorney or consultant.
  6. Do a better job vetting any new opportunity. Are you thinking about starting an ASC? Talk with a colleague who still remembers what it took to open his center. Gather all the financial particulars. Secure an expert’s feasibility study.
  7. Realize that money can solve task-loading excesses. Money allows you to offload excess patient volumes to an optometric extender. Money can pay for a personal assistant to take chores off your too-full plate. And money can paper over the costly errors that arise if you unintentionally become overwhelmed.
  8. Introduce your administrator and partners to the concept of task loading; when considering new initiatives, ask, “Do we have the capacity to take on this new responsibility? Will this new activity edge out more important things? Is now the time to move forward with this, or should we delay?”
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P.S.: If you are a member of industry reading this, take note. A generation ago, there was no Physician Quality Reporting System, no electronic medical records, no femtosecond laser surgery and at most only one new procedure to master per year. Your surgeon customers today are increasingly at the end of their tether. They may be excited when they see your offering in the comparative calm of a national professional meeting. But when they return to their stressed-out office and are once more task-rich and time-poor, even the most compelling testing or treatment equipment is hard to adopt and master. There is precious little bandwidth left today for the average surgeon to try out new things. That is why most adjunctive services added to a practice (think refractive surgery, advanced dry eye care, hearing aids, skin resurfacing, cosmeceuticals and the like) sputter out. Surgeons launch these new service lines in a peppy moment of weakness but cannot sustain the level of energy and attention needed to support them over time. You can overcome this problem in several ways:

  • Manage your customer’s expectations regarding how much time and attention it will take to adopt and master your product. Have a frank discussion about whether they have decks that are clear enough to do something new.
  • Put as much effort into post-sale training and support as you do into closing the deal. There are only about 15,000 active ophthalmologists in America, and they all know each other. Your reputation rests on customers being able to not just buy your product but to successfully use it and then rave about you to their colleagues.
  • Make sure your MD-customer has at least one staff member who is a champion for your testing or treatment device, or it is going to live in a closet a year after it has been purchased.