Recently* I watched a CHADD webinar featuring Brandon Slade of Untapped Learning.
Like many ADHD coaches, he highly recommended time blocking as a mode of visualizing time. It’s one of those things you hear so much it could be on a “Time Management for ADHD” bingo card — but this time when I heard it, something different resonated in my brain:
I realized that I like bullet journaling because I when I do it I can literally see the week taking shape under my hand, in a way that doesn’t feel the same when using digital products.
Brendan’s suggestion was met with a question, the same question that most of us who have time blocking habits have: what do you do when the unexpected happens and throws everything else out of whack?
The stock ADHD-coach answer to this usually boils down to “the best that you can”, but Brendan added on a suggestion that you “prioritize”.
He’s right, of course, but that kind of felt like when someone tells an ADHDer to just “try harder to focus.”
Prioritize how? How can a person prone to task paralysis, time blindness, and impulsivity tell the difference between the things you should be doing, the things you want to be doing, and the things that need to be done?
It feels like a daunting, impossible decision, which at the same time is incredibly important.
Wait a minute, I thought as I listened to the presentation. That sounds familiar.
There’s a word for that kind of decision making process: TRIAGE
I served for two years as a volunteer EMT, and part of the training is preparing for a “mass casualty incident” (MCI). I was fortunate in that I never faced one — they were much less common in the early ‘90’s than they are today — but there was a particular part of training that stuck: triage.
It’s not a fun process — it’s about looking at who you can help, and who you can’t, and prioritizing their care accordingly.
(I also recognize that it’s eminently possible that some people reading this may have been affected by an MCI, so I’m not going to take the metaphor very far.)
Instead, I’m going to paraphrase the Editor-in-Chief of the Journal of Emergency Medical Services (JEMS), A.J. Heightman, who wrote about ways to simplify the triage process and make it more effective.
I’m going to adopt his triage process to a much less damaging but also stressful “disaster” — when your perfectly-time-blocked day is thrown into disarray by some unexpected event, and you’re trying to figure out what to do with your tasks and appointments:
Mr. Heightman starts out with what he termsThe 75/25 Rule:
Approximately 75% of the patient volume at an MCI (Mass Casualty Incident) requires BLS (basic life support) care. This is a group that can be placed in a school bus with some EMS personnel, a kit and a radio, and be transported to a more distant hospital. These patients have minor injuries and fit the definition of green/low priority.
Most of your tasks and appointments in a day — hopefully three-quarters, at least — should not be lifestyle-threatening. That is, they are things that if they aren’t done now they won’t majorly affect your quality of life, plans, etc. (if you say “everything I plan to do is urgent and important!” then you need to do some other planning and capacity work, my friend).
When you have a sudden change of plans, the first thing to do is look for those “green” items — things you can put on the metaphorical bus with a quick “let’s postpone” text or email and send off to the future for a later version of you to take care of.
Mr. Heightman continues:
Of the remaining 25% of patients, approximately three-quarters of them are patients of concern–but not critical… We’re concerned about them; we treat them and monitor them closely…but they aren’t going to die in the next 20 minutes.
Before we get bogged down in statistics, notice that he has just taken that remaining 25% and divided it into quarters again. In terms of our daily tasks and appointments, these are the things that truly do hurt to postpone — they may mean projects get delayed, people get disappointed.
We can still be “concerned about them, treat them, and monitor them closely.” That means not just a text or email, but also something like:
- reviewing the next steps in a project, leaving a breadcrumb for when you can take care of it
- delegating some part of the task or appointment, and hoping for the best.
- setting alarms for yourself to check in at the end of the day (or whenever you’ve handled the final 25% of 25%.
I’m going to paraphrase Mr. Heightman’s article, replacing “patients” with “tasks”. The italicized words are mine:
The remaining 25% of your tasks, approximately 10% of all tasks [editor’s note: actually about 6.25%, if I’m doing math right], are truly critical. They have conditions that, if left untreated, will result in extreme damage to your quality of life unless care is administered today.
I call these critical tasks “prime”…These get a red tag, need immediate, intensive, constant care, and should be taken care of and gotten out of the way before most others, if possible.
Sometimes they still won’t get done.
Triage, even for something as simple as your to-do list and schedule, is not fun at all. It’s not just that you’re faced with all the things you intended to do, wanted to do, or all the projects that you have on your plate.
No, it’s much worse than that. You don’t get to choose the task that most needs to be done.
Instead, you have to be realistic about your capacity and start with the one that you are most able to do.
I talked with a newly-minted combat medic friend while writing this article, and he put it simply:
“When I’m in the field, if somebody has a heart condition, that’s beyond my ability to treat. If it’s as simple as giving a couple of aspirin, sure, but I’m not going to be giving CPR while there are others bleeding out…Nobody likes to talk about it, but we can’t save everybody.”
While we most likely won’t have life-or-death situations when our schedules get disrupted, it may feel like it. And we have to accept that.
The good news, though, is that it rarely means that a project or relationship is damaged beyond repair. And even if it does, you are still here, able to mitigate the results — because, as Brendan put it, you made the “highest and best use of your time”.
There is no easy fix when you have something disrupt your perfectly organized and set-up schedule. You have to make some hard decisions, often quickly. That’s exactly what a triage system is all about.
What would triaging today look like?
One way to get better at doing hard things is to practice them – emergency services have simulated mass-casualty incident exercises all the time.
In the less-life-threatening realm, a lot of daily/weekly review formats include the question what if you could only work two hours next week? What would move the needle? (hat-tip to Sandra Halling). This is designed to help you prioritize your tasks for the day or week.
I’m going to make it harder, by asking you a question from right this second, as you’re reading this article:
If you could only complete one task or appointment (not both!) in the next 24 hours…what would it need to be?
When you answer that question, you’ll have practiced triage. And then – I hope – you can breathe a sigh of relief, because you actually have the same regular 24 hours ahead of you that you did before I asked the question. Quite a relief, eh?
Personally, I hope you never do have to be this draconian about your days. I want you, me, everybody to have as much time as they need and want to do the things they need and want to do.
Just in case, though, practice triage every once in a while. It’s one of those skills that it’s better to have and not need than the other way around.
* There’s a little Alanis-Morrissette flavor to me talking about this webinar now, because it was on improving executive function — but I had put off watching it for months because I simply didn’t feel like I had the time.