What we can learn from the emergency department in the office

In many work environments, busy work also leads to significant stress, confusion and errors. But in a hospital emergency department, employees know exactly what to do when a lot comes at them at once. What can we learn from this? How do you create a simple plan together with your colleagues that brings order to the daily chaos?

A normative framework, what is that?

Two years ago I wrote a piece about setting priorities. The most important advice was to create a ‘normative framework’. A simple list of goals, clearly arranged, numbered by importance. This way, when things are busy and everything seems equally important, you can quickly decide what to prioritize.

It is an idea that is as simple as it is brilliant, but unfortunately I did not come up with it myself. I came across it in research into the daily work of nursing stafffor whom setting priorities is often a major challenge.

For example, when nursing care is busy, work is often left behind. But if there are no clear agreements in this area, each nurse chooses which tasks are skipped. That happens in silence; colleagues do not know what is parked.

The relative quiet of the ER

Putting one task ahead of another can lead to moral stress: you want to do everything right, but that’s not possible. You also don’t know whether you are making the right choices. By explicitly agreeing on priorities together, this burden no longer falls on the shoulders of individual employees, but the organization as a whole bears responsibility.

The funny thing is that this has been around for a long time in various places in healthcare. Consider the triage system that hospitals use in emergency rooms. Anyone who is in immediate danger will receive immediate help. And if you have a fracture that does not get worse from waiting a little, you can first browse through old issues of Doctor and Car.

Since I started studying this topic, I have discussed it dozens of times in workshops and seminars with a variety of professional groups. The response is almost always: we don’t have this, but we want it! How do you approach that?

Therefore, a simple step-by-step plan, developed during these sessions. This allows you to set up your own triage system together with colleagues.

Clarity in seven steps

1. Identify the goals that you consider important together. Think of goals that revolve around customer focus, good employment practices, collaboration, sustainability and profitability.
2. Make an inventory of dilemmas: where do those goals conflict? For example, where do customer focus and profitability hinder each other?
3. Discuss these dilemmas together: what gets priority in a collision and why? For example, what do you do when it’s busy and what is left behind?
4. Based on these conversations, create a joint list of goals, numbered in order of importance.
5. Also describe relevant examples: what wins when important things collide? Example: if working safely takes extra time, the deadline shifts.
6. Check whether the same order is used in daily management. Pay attention to social and material incentives.
7. Also immediately write down a date on which you will go through this process again. This way your list stays up to date and receives attention.

Three comments here.

• Sometimes you can combine goals. Think of customer-friendly and efficient working through a better website. But when goals really conflict, you must clearly agree on what takes priority. Otherwise, difficult choices will always end up on the plate of individual employees under time pressure.
• In some organizations, priorities are constantly changing. Not a man overboard. In that case, go through the seven steps more frequently and faster.
• Sometimes managers do not cooperate. Not bad either. Then create together with your colleagues, bottom upa list of priorities and send it to management with the message: until further notice, this is how we work.

And does it work?

Making a list of priorities is necessary, but not enough. In practice, step 6 is especially difficult. Your triage system only works when the other stimuli in your daily work are tailored to it. Consider: targets, compliments, budgets and what managers tolerate. Otherwise, it is not what is officially at the top of the list that wins, but what is socially and materially rewarded in practice.

I know a successful Flemish construction company that a few years ago agreed the following priorities with its employees:

1. Safety, the employee’s right.
2. Quality: the customer’s right.
3. Efficiency: the employer’s right.

This works well in practice. But imagine that management would mainly encourage implementers to deliver quickly and save on costs, then this beautiful framework would have been a dead letter long ago.

It often happens that priorities and incentives do not correspond. A classic research by business expert Donald Sull and colleagues survey of 7,600 executives showed that only 11 percent of them felt that their company’s budgets were in line with strategic priorities.

Practical

Many organizations, large and small, give their employees too many and conflicting goals. There is usually a lack of clear prioritization. This leads to stress, poorer performance and conflict.

A clear normative framework, a triage system for daily work, helps. But only if the daily context supports the triage.

The next challenge now is: when do you plan the first meeting about this? And will your colleagues give this sufficient priority?

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