One of the keys for using this matrix effectively is to understand what is truly important and what is really urgent:

These two attributes placed in a two-by-two table create four quadrants (I-IV). To prioritize a team’s work, the leader needs to be constantly evaluating which quadrant the team is working in. Quadrant IV represents those tasks that are non-urgent and not important (i.e., distractions). Examples of distractions are the lengthy discussions about last weekend’s football game, many of the phone calls and emails that we receive, or “checking” Facebook. Clearly team member’s time should not be spent in this quadrant. Similarly, quadrant III represents issues that are not-important but are perceived as urgent (i.e., interruptions). Many teams may spend a good deal of time on both distractions and interruptions. A good team leader will recognize when this is occurring and reprioritize and reorient the team’s work.

While the distinction between what is urgent and what is not urgent may be straightforward, it is more difficult to identify what is truly important for the team. As discussed elsewhere in this book, the ability to understand which tasks are most important relies on knowledge of the desired future state the team is working towards—i.e., the vision for the organization. Quadrant I tasks include the important, urgent work and represents where most of us spend our time, i.e. “putting out fires”. These tasks are by definition important to the team and aligned with the vision of the larger organization. For a surgeon, quadrant I tasks obviously include unplanned clinical care, such as reoperations for complications. These are clearly important and immediately shift all other priorities—no matter what they are—to the back burner. Dealing with complications falls under our very important long-term goal of being a good doctor. But it should be recognized that if most of the time is spent in this quadrant, less attention is spent on the tasks that support our most important longer-term goals (quadrant II).

Good strategies for limiting quadrant I activities are essential. Of course, any practicing surgeon cannot completely eliminate unplanned clinical care. But it can be limited with a more controlled clinical practice, either by having scheduled shifts of clinical activity (e.g., trauma or acute care surgery) or by having a lower morbidity elective practice (e.g., minimally invasive surgery). Perhaps this is why many surgeons slow down their clinical practice, either the volume or the complexity, when they take on administrative roles where they bear more responsibility for long-term goals (e.g., chief medical officer, department chair, etc.…). A leader would not be very effective if they were missing all of their important meetings or did not have the necessary cognitive energy to address the complex problems that come with such roles. Recognition and explicit consideration of this trade-off is important for every leader.