Time Management of Tuzla University Clinical Center Health Managers.

INTRODUCTION: Time management is an important aspect of successful leadership and involves mastering your own work and time instead of allowing them to master you. Time management is a daily process that is applied in order to rationally use time, work schedules, lists of tasks, delegation of responsibilities and everything else that helps to efficiently use time.
MATERIAL AND METHODS: This research was prospective, descriptive, analytical and controlled. There was 100 medical worker involved, who have managing jobs of different levels and 100 medical workers who do not have managing jobs, who represented the control group. The questionnaire on "time stealers" according to Sewert. Demographic data was gathered according to the questionnaire on self construction. RESULTS AND
CONCLUSIONS: Based on conducted research, it was established that there were differences in frequencies of certain "time stealers" in managers of different levels of University Clinical Center Tuzla; the "time stealers" are more frequent among these with shorter length of service; These differences are significantly more frequent (p<0.05) for some questions e.g. being distracted by phone calls, meetings that are held just for the sake of having a meetings, insufficient, one-way or bad communication with superiors, and have negative effects on management of business hours.

INTRODUCTION

Healthcare management (leadership/management in healthcare) is an organized and developed system of responsible policies, functions and tasks carried out by a chosen and responsible individual at different levels of healthcare, in order to improve health (1). Although it is not easy to define a health manager one could say that health managers are, regardless of whether they are managers of healthcare, healthcare programs or healthcare services, healthcare professionals who perform management functions and tasks and are responsible for the creation of resources, their rational use in order to achieve the set goals of their organization, institution, program, not taking into consideration any spare time and effort involved (1, 2-5).

Time management

Time management is a daily process that is applied in order to rationally use time, work schedules, lists of tasks, delegation of responsibilities and everything else that helps to efficiently use time (6-9). In any business, including the work of healthcare professionals, most of the energy and time is lost if there is a lack of clearly defined objectives, planning, priorities and views. There are several ways to have more time - avoiding doing unimportant things, in other words clearly defined priorities and goals, such as delegation, which in fact means leaving the jobs to others, but not the responsibilities; effective work on what must be done, or managing your time (9-12).

In order to start with the planning, setting priorities and organizing specific activities , the first step is taking notes for at least one week in order to analyze the way in which the time is spent. Such a view of the time spent providing the ability to detect “time stealers” (13). “Time stealers” prevent an individual to perform tasks of greater value or importance. There are two general categories of “time stealers”: external, such as phone calls and unannounced visits; and internal, created by an individual, such as lack of self-discipline, delay, indecision and personal disorganization. Today there are various management strategies that can control “time stealers” in order to prevent the consumption of time, which in reality does not exist (14).

According one study, 49% of nurses manage their time well, 38% are trying but not consistently manage time, 10% do not know how to manage time while 3%, or one nurse out of 40 knows how to manage time. The most common “time stealers” were the paperwork, saying “no”, the telephone, visitors and meetings (15).

Starting from the fact that research related to time management in managers in health care facilities has never been done before in our country this research was conducted with the following objectives: a) Identify the major “ time stealers” of managers on different levels in the University Clinical Center Tuzla; b) To determine the existence of differences in the frequency of some “time stealers” of managers on different levels in the University Clinical Center Tuzla; c) To determine whether the amount of work experience affect time management of managers on various levels in the University Clinical Center Tuzla.

According to the objectives the following working hypothesis were set: time stealers have a significant impact on time management of all managers in the University Clinical Center Tuzla. There are differences in the frequency of some time stealers of managers at various levels in the University Clinical Center Tuzla; amount of work experience in management positively correlates with the management of working hours of managers at different levels in the University Clinical Center Tuzla.

MATERIAL AND METHODS

The study was of a prospective character, descriptive, analytical and controlled. It was conducted at the University Clinical Center Tuzla. Before starting the research written approval had been requested and obtained from the Ethics Committee of the Institution.

Respondents

The study included 100 health professionals who have managerial positions: head nurse of divisions (n=36); head nurse of departments/organizational units (n=22), heads of departments/organizational units (n=22), heads of divisions (n=20) who were the tested group and 100 health workers of all profiles (nurses of departments/n=50; doctors of departments/n=50 ) who do not have leading jobs in the University clinical center Tuzla, who represented the control group (K1 - nurses; K2 - doctors).

Methods

Questionnaire “time stealers” Sewert (2008) was used. The answers are classified according to the Likert scale consisting of five levels - not at all, rarely, sometimes, often or always. Demographic data of a questionnaire had constructed were collected as well, which included data related to gender, age, length of experience and management level.

Statistical design

In the analysis of the results obtained standard statistical parameters were used: mean and standard deviation with the use of T-test and X-square test to assess the significance of the difference. The difference is denoted as significant for p<0.05.

RESULTS

Leading time stealers

Firstly it was analyzed leading “time stealers” of the heads of departments (N=22). Three questions: Does the insufficient number of employees affect your work? Do you think that you are overworked? Do you think that you daily perform too much of the administrative work that should be done by someone else?; out of 22, 95.46% responded with “sometimes and always” fewer (90.91% have replied positively in the same way according to the Likert scale to the questions: Do phone conversations disturb you? How often do you have to deal with insignificant tasks and problems? Does the introduction of new technologies disturb your daily work? Do you think of yourself as a person of authority?

The first two questions (Does the insufficient number of employees affect your work? Do you think that you are overworked?) and last one (Do you think of yourself as a person of authority) are not, of course, the real “time stealers “. In the case of head of divisions (lower level of leadership in relation to the head of department) the most positive responses (90.00%) were obtained to the questions: Does the insufficient number of employees affect your work? Does the use of computers make your daily work easier? Of course this second question is not a time stealer, nor is the first one in its true sense. To the question: Does the insufficient number of employees affect your work? all 50 surveyed physicians (control group K2) answered “sometimes or always”. As many as 90% were positive answers to the question: Do you find it difficult to say no, which is why you often do favours for others when you should be doing your job? Do you have to often perform tasks that others were supposed to do?, which are the real time stealers, and the same percentage of positive responses was to the question: Do you think you are overworked?

Head nurses of clinics/departments have the highest level of nursing leadership. To the question: Does the use of computers make your work easier?, all 22 respondents answered positively (sometimes and always), but questions 2,9,12 and 19 from the Questionnaire about time stealers (you have to often perform tasks that others were supposed to do? Does the insufficient number of employees affect your work? Do you think that in your daily work you perform too many administrative duties that belong to others? Do you think you are a person of authority? the answer was positive in 95.46 % of cases.

Head nurses of divisions are a lower level management in nursing than the head nurses (the level of heads of department). Of the 36 of them, 94.44% answered positively to the question: Does the use of computers make your daily work easier?, 91.67% answered positively to the question: Does insufficient number of employees affect your work?

In the case of nurses on divisions (control group K1) the highest number of positive responses (90%) was to questions 2, 9 and 11 from the Questionnaire on time stealers (Do you often have to perform tasks that others had to do? Does the insufficient the number of employees affect your work? Do you think you are overworked?)

It was tested by a proportions test whether the relative frequency of positive responses (sometimes and always) differs significantly in groups of heads of the clinic/department and heads of divisions. The relative frequency of positive responses was statistically significantly higher with the heads of clinic for questions: 6, 7, 12, 13 and 19 (How often are meetings you attend held just for the sake of having a meeting?; Does an inadequate workspace affect your work?; Do you do too much administrative work belonging to others during your work day?; Do conflicts with colleagues and other associates affect you? And think you are authoritative person?). Questions 7, 13:19 are not really “time stealers”. Cases marked with two stars are examples of unilateral testing, that is, we tested whether the frequency with heads of departments/clinics is higher than the frequency of the heads of divisions (Table 1). These are the questions 5 (How often do you have to deal with unimportant tasks and problems?) (Typical time stealer) and 19 (not a time stealer).

Table 1.

Testing the statistical significant difference of the proportion of positive responses. * Statistically significant bidirectional testing ; ** Statistically significant- single direction testing

Question	Heads of divisions (N = 20)	Heads of clinics/departments (N = 22)	z	P
	Sometimes/ always	Sometimes/ always
1	13	16	0.54	0.588
2	14	18	0.898	0.369
3	13	20	2.044	0.040*
4	11	16	1.20	0.232
5	15	20	1.38	0.167
6	8	15	1.83	0.039**
7	8	16	2.14	0.032*
8	10	12	0.30	0.768
9	18	21	0.69	0.493
10	12	16	0.87	0.382
11	13	21	2.51	0.012
12	14	21	2.21	0.027*
13	5	12	1.95	0.050*
14	1	/	1.06	0.289
15	2	/	1.52	0.129
16	18	20	0.10	0.920
17	3	6	0.96	0.333
18	11	17	1.529	0.126
19	14	20	1.72	0.043**

The proportion test tested whether the relative frequency of positive responses (sometimes and always) differ significantly on the management level - head of clinics and the head nurses of clinics. Relative frequencies that are significantly higher than the 50% are labeled, which means that the majority of respondents in the corresponding groups answered “sometimes and always”. Times when a statistically significant difference was found bidirectional testing are indicated by a double asterisk. Cases of unilateral testing are indicated by a triple asterisk.

It was found that the frequency of time stealers in question 11 is significantly higher in heads of clinics than in head nurses of clinics (one-way test). A statistically significant difference was observed in matters of the questions 14 and 15 but those time stealers are rare (none are found with the heads of departments and clinics and with nurses only in 4 out of 22 respondents).

The proportions test tested whether the relative frequency of positive responses (sometimes and always differ significantly in the management levels of heads of departments and head nurses of departments. Relative frequencies that are significantly higher than the 50% are marked which means that the majority of respondents in the appropriate groups answered “sometimes and always”. There is no proof of a statistically significant difference in frequency of time stealers in Heads of departments and head nurses of departments.

Time stealers and employment tenure

According to the third goal and the third employment hypothesis the possibility of the connection of time stealers and employment tenure was analyzed. It was found that time stealers were more frequent in people with shorter tenure (less than 30 years) for the questions 1, 2, 3, 6, 9, 10, 11, 12, 16, 18 and 19, moreover that the difference is statistically significant on the level P<0.05 for the questions 3, 6, 8, and 19 from the Questionnaire on time stealers (Table 3). In the analysis of the frequency of time stealers compared to employment tenure in head nurses of clinics it was found that more than 50 respondents answered questions 2, 3, 5, 9, 11, 12, 16, 18 and 19, and that the proportions test didn’t determine a statistically significant difference in the frequency of time stealers among head nurses with less than 30 years of tenure and those with more than 30 years of tenure (Table 4).

Table 3.

Differences of „time stealers“ frequencies in heads of clinics according to employment tenure * Statistically significantly greater than 50; ** Significantly different

Distributions of hads of clinics according to employment tenure
Questions	Tenure ≤30 years N=18		Tenure >30 years N=4		Z	P
	Freq.	%	Freq.	%
1	14	77.78*	2	50.00	1.13	0.259
2	14	77.78*	4	100.00*	1.04	0.297
3	17	94.44*	2	50.00	2.34	0.019**
4	12	66.67	2	50.00	0.63	0.537
5	16	88.89*	4	100.00*	0.70	0.484
6	14	77.78*	/	0.00	2.92	0.003**
7	12	66.67	4	100.00*	1.35	0.176
8	8	44.44	4	100.00*	2.02	0.044**
9	17	94.44*	4	100.00*	0.48	0.630
10	14	77.78*	2	50.00	1.13	0.259
11	17	94.44*	4	100.00*	0.48	0.63
12	16	88.89*	4	100.00*	0.70	0.484
13	8	44.44	2	50.00	0.20	0.840
14	1	5.56	/	0.00	1.22	0.220
15	1	5.56	/	0.00	1.22	0.220
16	17	94.44*	4	100.00*	0.48	0.630
17	6	33.33	/	0.00	1.35	0.176
18	15	83.33*	2	50.00	1.44	0.150
19	18	100.00*	2	50.00	0.002	0.002**

Table 4.

Differences of „time stealers“ frequencies in head nurses of clinics according to employment tenure. * Statistically significantly greater than 50; ** Significantly different

Head nurses of clinics according to empoloyment tenure
Quest-ions	Tenure ≤30 years N=16		Tenure>30 years N=6		Z	P
	Freq.	%	Freq.	%
1	11	68.75	4	66.67	0.09	0.926
2	15	93.75*	6	100.00*	0.63	0.531
3	13	81.25*	6	100.00*	1.14	0.254
4	7	43.75	3	50.00	0.26	0.793
5	12	75.00*	6	100.00*	1.35	0.176
6	11	68.75	4	66.67	0.09	0.926
7	10	62.50	2	33.33	1.22	0.221
8	9	56.25	4	66.67	0.44	0.658
9	15	93.75*	6	100.00*	0.63	0.531
10	9	56.25	3	50.00	0.26	0.793
11	12	75.00*	6	100.00	1.35	0.176
12	15	93.75*	6	100.00	0.63	0.531
13	10	62.50	4	66.67	0.18	0.856
14	4	25.00	/	0.00	1.35	0.176
15	3	18.75	1	16.67	0.11	0.910
16	16	100.00*	6	100.00*	0.00	1.00
17	6	37.5	1	16.67	0.93	0.350
18	13	81.25*	4	66.67	0.73	0.467
19	15	93.75*	6	100.00*	0.63	0.531

In the case of heads of departments the proportions test did not find a statistically significant difference in the frequency of time stealers among heads of departments with more than 30 years of tenure and those with less than 30 years. The proportions test did not determine a statistically significant difference in the frequency of time stealers among nurses with less than 30 years of tenure and those with more than 30 years of tenure either.

DISCUSSION

Managing of work time

In any job, just like in healthcare, the majority of time and energy is lost due to lack of clear goals, planning, priorities and points of view (1, 16-18). There are multiple ways of obtaining more time - avoiding dealing with unimportant things, clear prioritizing and determining of goals, so called delegating, which actually means leaving some jobs to others, but not the responsibility; effective work on what must be done, that is, managing your time (11, 17-21).

To start planning, prioritizing, and organizing certain activities, the first step is keeping a record for at least a week so you could analyze how time is spent. That view on spent time gives the opportunity of revealing time stealers (13). Time stealers prevent an individual from performing activities of greater importance or value. There are two main categories of time stealers: external, such as phone calls or unannounced visits; and internal, created by the individual himself, such as lack of self-discipline, procrastinating, indecisiveness, and personal disorganization. Today many managerial strategies are available which can be used to control time stealers, in order to prevent spending time that you do not even have (14). In the analyzes of the frequency of time stealers or time management in managers of the first level it was determined that the main time stealers among head nurses of clinics (95.46%) are doing work that others should have done; not enough employees, and too many administrative work that belongs to someone else. When it comes to heads of clinics the biggest time stealers are; not enough employes and being overworked (95.5%), followed by being disturbed by phone calls and doing unimportant jobs and dealing with unimportant problems (90.9%).

According to a recent research done in Croatia in which 16 nurses that are in managerial positions and 66 nurses that work in shifts were analyzed, it was determined that the most common time stealers are; problems in organization (frequently doing other peoples work); bad organization of visitation; postponing time costly and difficult tasks; long and badly organized meetings, bad systematization of jobs, job descriptions and competency; lack of self-discipline; constant and irrelevant phone calls; not enough unsystematic communication among team members; bad prioritizing in giving health care; a lot of meaningless walking around and unclear deadlines extensive paperwork; as well as “not finding a purpose” in what is being done (15). According to another research the most common time stealers were paperwork, saying “no” to the phone, visitors and meetings (15, 22).

In the case of heads of departments (a lower level of management than chiefs) the most positive answers (90.00%) were obtained to the question: Does the lack of employees affect your work? The time stealer following the previous one in frequency (75%) is dealing with unimportant jobs and problems.

Responsible nurses of departments are a lower level of management in nursing than head nurses (level of chiefs of departments). Of them 36, 91.67% positively replied to the question: Does the lack of employees affect your work? Followed by the time stealer: Often doing tasks that others had to do, in frequency (83.3%), which is followed by: being disturbed by phone calls and too much administrative work that belongs to others (77.8%).

It was tested by a proportions test if the relative frequencies of positive answers (sometimes and always) referring to time stealers statistically significantly differ in the groups of heads of clinics and heads of departments. The relative frequency of positive replies is statistically greater in heads of clinics referring to attending meetings that were being held just for the sake of having a meeting and doing to much administrative work that belongs to others.

It was tested by a proportions test if the relative frequencies of positive answers (sometimes and always) referring to time stealers statistically significantly differ in the groups of head nurses of clinics and responsible nurses of departments. The relative frequency of positive reply is significantly greater in head nurses for doing too much administrative work belonging to others.

While comparing chiefs and head nurses of clinics referring to time stealers or time management there were not statistically significant difference, except for the matter of being overworked. That is to say that the chiefs feel overworked statistically significantly more often than head nurses of clinics, which surely affects management of working hours. Time stealers are present in doctors with no managerial responsibilities (Control group C 2) but not as much as in the ones with managerial responsibilities. This confirmed the first hypothesis that “time stealers“ significantly affect time management in all managers at the university clinical center of tuzla, as well as the second hypothesis that the differences in the frequency in certain time stealers exist for managers of different levels.

Employment tenure and time management

According to the second goal and the hypothesis the possible connection of the frequency of time stealers and employment tenure was analyzed. It was determined that time stealers are more frequent in those with shorter tenure (≤30 years) for the questions related to doing favours for others when own work was supposed to be done; frequently doing jobs others should have done; phone calls; dealing with unimportant jobs and problems, pointless meetings; insufficient, one-way or bad communication with superiors; daily unpredictable situations, being overworked, doing too much administrative work belonging to others, not delegating tasks to lower ranked staff. These differences are statistically significantly more common (p<0.05) for the questions that refer to being disturbed by phone calls, meetings being held just for the sake of having a meeting, insufficient, one-way or bad communication with superiors.

In the analysis of the frequency of time stealers in comparison to length of tenure in head nurses of clinics it was determined by a proportions test that there was no statistically significant difference in the frequency of time stealers between the nurses with ≤30 and those with over 30 years of tenure. The proportions test also did not determine a statistically significant difference in frequency of time stealers between responsible nurses of departments with ≤30 years of tenure and these with over 30 years of tenure. In the case of chiefs of departments on clinics a statistically significant difference in the frequency of time stealers between chiefs of departments with ≤30 years of tenure and those with over 30 years of tenure was not determined by the proportions test.

CONCLUSIONS

It was established that there were differences in frequencies of certain „time stealers“ in managers of different levels of University Clinical Center Tuzla. The „time stealers“ are more frequent among these with shorter length of service. These differences are significantly more frequent for some questions e.g. being distracted by phone calls, meetings that are held just for the sake of having a meetings, insufficient, one-way or bad communication with superiors, and have negative effects on management of business hours.

Table 2.

Testing the statistical significancein the difference of the proportions of positive responses: head nurses of clinics–head nurses of divisions* Statistica. lly significant two way testing ; ** Statistically significant one way test

Question	Head nurses of clinics/departments (N=22)	Head nurses of divisions (N=36)	z	P
	Sometimes/ always	Sometimes/ always
1	18	14	1.01	0.311
2	30	21	1.37	0.169
3	28	18	0.37	0.712
4	16	9	0.26	0.792
5	26	18	0.83	0.407
6	21	16	1.11	0.268
7	22	12	0.49	0.620
8	14	13	1.50	0.135
9	33	21	0.55	0.581
10	23	12	0.71	0.48
11	25	17	0.65	0.518
12	28	21	1.80	0.035**
13	5	14	3.92	<0.001*
14	2	4	1.53	0.126
15	10	4	0.83	0.407
16	34	22	1.13	0.261
17	10	7	0.33	0.743
18	21	17	1.47	0.141
19	25	21	2.38	0.020*