GTD and The Invention of the Medical Record

In my work with Mayo Clinic in news media relations, I always look for applications of the principles of Mayo’s medical practice. Mayo Clinic is the first and largest integrated, not-for-profit group practice in the world. I figure the same principles that make Mayo Clinic successful as a medical practice would be likely to lead to success in relations with news media, too…and in my personal life. Or at least they would be a good place to start.

One of Mayo Clinic’s innovations, just over 100 years ago, was the unified patient record. In that day it was revolutionary to even think of physicians working in teams instead of taking individual responsibility for their patients. But Dr. William Mayo and Dr. Charles Mayo knew what they didn’t know, and that knowledge in medicine was growing so rapidly that they needed to combine the expertise of others to get the best results for their patients. As Dr. Will put it, “…In order that the sick may have the benefit of advancing knowledge, union of forces is necessary.”

The Mayo brothers saw that to have that “union of forces” it also was necessary to have a centralized medical record for each patient, instead of each physician keeping notes in a journal. One of the early Mayo partners, Dr. Henry Plummer, developed this pioneering system that is taken for granted today. It wasn’t obvious at the time.

Now Mayo Clinic has a completely electronic version of the medical record, which enables specialists to collaborate even more efficiently, because they can be looking at the same patient’s records and images, even if they aren’t together in the same office…or even in the same state.

How does this relate to GTD and “stress-free productivity?” David Allen says an external, trusted system is essential. You can’t keep it all in your head. You need to put your information into a system that you know you will review regularly, and from which you will be able to get the information when you need it. With that, you can be “in the moment” and focus on what you’re doing right then, instead of thinking about what you’re not doing.

Mayo Clinic is able to efficiently diagnose and treat more than 500,000 patients a year because its systems are organized so every piece of information needed is available at the point of care delivery, and because processes are set up to get data into the system quickly, easily and completely. Caregivers know and trust that all of the information is in the system. That, and the salaried model for compensation, enables physicians to take as much time as they need with each patient, without feeling stressed and hurried.

So how have we applied this to our media relations work? Our media relations team has developed a similar system for press calls, so when a journalist calls for a comment from one of Mayo’s medical or scientific subject experts, or in response to a news release, we can track what happened with that call. It’s a trusted system, because every call we receive is entered into it.

That’s probably why GTD resonated with me so much, and why I just took the plunge after reading the book on my plane ride home from Jacksonville.

Taking the time to organize a system really fits with Mayo Clinic’s heritage, too. When Dr. Plummer invented the centralized medical record in early 1907, he just disappeared for a few days to do it. When he came back, he had invented the basic structure that is still used today, nearly 100 years later. I suppose he could have just said he was too busy with the press of patients to see, that he couldn’t make time to get away and do this planning. But patients all over the world are better off because he made the time.

Your investment of time in establishing your GTD system probably won’t have such an enormous payoff for all of humanity as Dr. Plummer’s did. But who knows? Maybe it will.

It will make a long-term difference for you personally. By developing a system that lets you make your decisions up front about where different kinds of information should go, you will save a huge amount of time in your everyday life. You won’t find yourself caught in dilemmas, wasting time trying to decide where a given bit of information belongs. You will have some rules and structure that reduce these collecting and processing decisions to a snap, because you’ll know where things should go.

It is practically necessary to have both paper records and electronic systems for organizing your life. Paper isn’t going away, and virtually everyone today also needs a system for tracking the electronic inputs, too…e-mail, at a minimum. In a future post I will look at systems for both physical and virtual organization.

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GTD Roadmap: Meeting Morpheus

The Matrix

One of the high points of my last year with GTD was attending the DavidCo Roadmap Seminar in Minneapolis on May 5. I had taken the red pill by just plunging into the GTD system, reading the book and trying to apply it consistently. The book alone is more than adequate to help you make great personal productivity progress, even imperfectly applied. Like Neo in The Matrix, I started to see new ways of doing things, and how to defeat the Agent Smith of procrastination.

Attending the Roadmap would be another great way to start, or to re-energize your application of GTD. Hearing David Allen in person is like meeting Morpheus.

In The Matrix, Neo learned jujitsu and Kung Fu in 10 hours. A day with David at the Roadmap seminar won’t make you a Black Belt in GTD, but it’s still a worthwhile investment.

You can read more about my experience with GTD in the last 51 weeks here. Also, check out the Black Belt Productivity blog. I just discovered it while composing this post. It’s going in the list of feeds I read.

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GTD Mediocrity Still an Improvement

In a previous post I mentioned how David Allen touts the Two-Minute rule as one GTD change you can make that will put you ahead of 90 percent of homo sapiens, and how it can make your team more productive even if you are the only one using it.

Some GTD purists would say you aren’t really doing GTD if your weekly review isn’t up to snuff. I agree to a point. But I had an experience this week that reminded me of how even imperfect implementation of GTD, or only doing parts of it, can still put you miles ahead in the race to excellence.

One thing I have done really well in these last 51 weeks is sort through my email to get my inbox to empty, as I described here. My weekly review, on the other hand, has frequently been lacking. And sometimes I get messages moved to my @Computer, @Calls or @On-Line context folders (which means I have decided the Next Action that I want to do as soon as possible), but I don’t always act on it as quickly as I would like. The message can languish there for weeks (or even sometimes months), as other, more recent messages are piled on top.

That’s certainly not ideal, but it’s still an improvement over 11,000 messages in the inbox, for two reasons:

First, sometimes the person on the other end of that message will call me or otherwise get back in touch. By having the message in an appropriate context file, I’m able to find it more quickly to be able to respond.

Second, I do sometimes work my way through those context folders and make it all the way to the bottom. I did it just this week with someone with whom I had decided to do an informational interview about positions open in our department. When I had put the message in @Calls several months ago, the positions weren’t open yet. Now they are. So in a sense it was mediocre, in that I didn’t get in touch as quickly as I would have hoped, but at least the marker for the open loop wasn’t completely buried. Better to be buried under 20 calls than beneath 5,000 undifferentiated messages.

So, we’re doing the information interview on Friday. In my pre-GTD days, that message could easily have been lost forever.

I am convinced that doing a mediocre job of using GTD still has made me immeasurably better at handling the onslaught of email and other inputs coming into my life. And just the taste of the empty inbox spurs me on to do better in the Review and Horizons of Focus parts of GTD. But even having just the Collect, Process and Organize phases working pretty well has made a huge difference for me.

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GTD vs. TOE – The Case of the Rapid Rebate

After reading Getting Things Done on that fateful plane ride a year ago next Wednesday, one of my first steps was to throw away some of the books on organization that had previously guided my personal organizing efforts.

Among these was Stephanie Winston’s The Organized Executive, henceforth known as TOE. I recycled it because it had counseled something directly counter to the David Allen GTD system.

It’s probably bad manners to link to a book you don’t recommend. “If you can’t say something nice…” And TOE probably does have some good advice. But one of Stephanie’s points that had stuck with me was the idea that you should create file folders with broad enough categories that they would typically be about a half-inch thick, so you can ideally find what you’re looking for in 30 seconds or so.

David Allen, conversely, says you need to be willing to have a file folder with just a single sheet of paper, if that’s what will help you find it.

That’s a serious difference of opinion. Which way works better was obvious me when I had to re-file energy rebate forms for my new furnace and air conditioner. The utility company had kicked my application back to me because one of the model numbers and its efficiency rating weren’t matching the database, so I needed to find my receipts and get the forms corrected.

Because I had followed the GTD model (including buying the label machine to make filing fun), I was able to find the documents, go to the utility office, get the form corrected and return home…all within less than 30 minutes, and my $500 rebate was on the way. That’s getting things done.

The problem with the TOE method is you artificially try to create categories, or shoehorn documents into an existing folder, and then when you’re trying to find it again you ask, “Now, what category would I have chosen for that?”

I suppose it’s conceivable that under the TOE method I might have filed these receipts under “Utilities” and been able to locate them fairly quickly, but I’ve had enough experiences when I couldn’t put my hands on documents several months later because I didn’t know whether they were under “Household” or “Home Repair” or “Utilities” or “Misc. Receipts” or one of several other broad categories.

TOE’s problem, or rather my problem with TOE, is you have to try to recreate the complex filing decision process at retrieval time that you used when you first filed the document. And if you guess wrong, you end up digging through a relatively thicker file, only to come up empty-handed and frustrated. I may not have been doing the TOE method correctly. I may have misunderstood how to do it. But I didn’t have the same problems with GTD.

With the GTD system, using one simple A-Z general reference paper filing system, it was easy to guess that the receipts would be filed under “Air Conditioning” or “Furnace.” I had used “Air Conditioning” so I found it instantly. But even if I had used “Furnace” the paperwork would have been in the second place I looked, and it wouldn’t have been packed in with several months of utility bills or other irrelevant papers.

I guess this is my way of saying, “Trust the system.” Start out by trying to follow it to the letter. The recommendations David Allen makes are based on a couple of decades of experience with people whose lives are a lot more complicated than mine, or probably yours. If it can work for them, it can work for you.

Then, after you get confident with the proper form, you can improvise and jazz it up if you’d like.

I’m sure Stephanie Winston’s new and improved TOE that takes modern technology into account has some good advice. I had an edition that was probably 15 years old, so it was probably good to toss based on its vintage alone.

But GTD works well with paper files and index cards, or with the latest gadgets. I’m a geek. I love how blogs, for instance, can be used as a quickly searchable general reference file. To the extent you can use electronic systems and indexing utilities on your hard drive or blog to quickly retrieve information, you could cram everything into the same virtual folder, as long as you can remember any key phrase in the document.

But paper isn’t going away. That’s why the GTD system, complete with electronic label maker, is well worth following.

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Of GTD, iPods and File System Flu

If you were sick with a fever and felt awful, you would take a couple of days off to get plenty of rest, drink lots of fluids and otherwise take care of your body so you could come back both feeling good and also more productive.

You wouldn’t be getting much done anyway with that all-over achiness, and you’d be running the risk of infecting your coworkers, too. And when you came back to work, the business would not have disbanded and been forced into liquidation because of your absence. Somehow, everyone would have muddled through.

So why is it you think you can’t possibly take a couple of days to do the GTD mindsweep and get your filing system organized?

Let’s face it: if you’re like most people (and like I was), your filing and organization system is sick. It’s causing lots of discomfort and inefficiency not only for you, but for everyone around you. You’re operating way below your capabilities.

So, I’m not suggesting that you call in with a fake illness, but that you find a way to set aside the time to get a good start at implementing GTD. Block two days for vacation so you don’t have any meetings or appointments scheduled, but then show up for work and spend that time clearing your psychic underbrush.

That’s what I did last year, just as I was getting started with GTD. I had previously scheduled a four-day getaway weekend with my wife, Lisa, for our annual Christmas shopping trip. With six children, it’s nice to get away for a few days, just the two of us, and wrap up our shopping all at once.

But then Lisa got the idea that instead of buying our offspring a bunch of smaller presents that collectively add up to a triple-digit price tag for each child (but yet six months later none of them would likely remember what they had received!), we should get them each an iPod or something of similar significance.

I quickly agreed. That meant:

1. Our shopping was done, so we didn’t need the shopping excursion
2. I could sell my vacation time (and use the money we would have spent on the getaway hotel) to pay Steve Jobs and my fellow Apple stockholders for the iPods, and
3. I had a couple of days without appointments scheduled that I could devote to establishing my GTD system.


It also means they’re getting a lot less for Christmas this year.

I’d recommend you consider following our 2005 example, and not just because I own 0.00000012 percent of Apple’s outstanding shares of common stock. By giving an iPod, this year’s present won’t just blend into what you’ve given other years, unless you have a habit of being extravagant. And if you take the two days to clear the decks in implementing GTD, you will feel more refreshed than you would have if you had taken the time off.

You’ll also be off to a healthy start on 2007, with less stress…which may (along with your flu shot) keep you from losing time to illness.

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