The Importance of MBA Triage – Lessons from a Healthcare Perspective
“You can do anything, but not everything” (David Allen) was a quote I used to see regularly when working in Toronto. 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? The key words missing at the end of that sentence for me were “at once”. Full disclosure here, I subscribe to the Ernest Gallo philosophy of “we don’t want most of the business, we want all of it”.
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 (1766-1842), 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. Emergency departments had been developed due to the rapid rise in accidents and emergencies in various industries (quality control, safety, and audit were not yet in existence). Patients would be brought via police patrol wagons or by hearse. 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.
The health burden on emergency services throughout the world is increasing. Patient expectations are rising, and systems 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. The focus is now on risk stratification, communication, and immediate specialist care. Modern departments now use a modified traffic light system for triage which can be adapted for different patient cohorts (children; elderly; surgical; cancer; psychiatric):
Green: Low risk. Non-urgent
Amber: Moderate risk. Semi-urgent
Red: High risk. Urgent/Critical
Black: Nothing can be done. Comfort measures only
I learned early in my career as a surgeon of the importance of triage. As I progressed through intern, senior house officer, registrar, specialist registrar, and fellowship roles, often working up to 140 hours per week including overnight calls, and with both a pager (sometime several) and a phone ringing incessantly for jobs to be done, something had to give. Every department’s request was urgent. Everyone higher up the pyramid than you bestowed advice about the dangers of slipping up. You live in your very own Maslow’s hierarchy, but the needs are external, not internal. I quickly adapted to triaging each job I was given. Those jobs that could wait (even for a couple of hours), would do so. Getting two calls for critical tasks such as an urgent call to theatre, and to the emergency department at the same time? Nightmare. 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:
Developing a system of triage, good communication skills, and to borrow a phrase from Norma O’Callaghan – a personal “board of directors”, saved me from failure and burnout. Thus, it is with the MBA. Many of the candidates in both the full-time and executive programs have a strong background history in business, accounting, finance, and marketing. 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, fatigue, 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”. Some things can and must wait, and indeed sometimes there’s nothing that can be done. The conclusion from this is that you must control the controllables, 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.