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Tame Your Inbox Like an ER Doctor

Did you know that people send and receive an average of 121 emails per day? That’s 847 a week, 3,388 a month, and 40,656 a year!

It’s time to tame your Inbox and separate vital project and company communication from the endless noise and promotional emails with the only Inbox specifically designed for construction.


The Harvard Business Review posted an interesting article on how to tame your inbox like an ER Doctor, here are our key takeaways:

1. Streamline communications by keeping subject lines, format, and headings consistent.

2. Clearly direct requests to specific individuals wiith concrete timelines.

3. Ask for clarification when you’re added to a thread, or use Commnia’s Inbox visuals to catch up on email threads in just a few clicks.

4. Team situational awareness is paramount both in the ER and construction to keep everyone informed on what needs to be done in real-time. Commnia’s Inbox is transparent, keeping communication accessible even if a team member is absent or leaves the company.


Full article from the Harvard Business Review below:

As the Covid-19 crisis intensified in New York City there was a related parallel surge that posed a real threat to communication in the crisis — an explosion of critical email that at first exceeded our capacity to keep up. There was a real risk that important information would get lost, stalled, or fail to reach the right people, and that the sheer volume and density of expanding threads would distract people from their essential work. To address the threat, we applied crisis resource management (CRM) principles familiar to every emergency physician.

CRM, derived from crew resource management — an aviation safety protocol — is a method for managing teamwork during a resuscitation or other medical emergency, with effective communication at its core. As emergency physicians, we are trained to apply CRM principles in balancing the workload in a busy emergency department (ED), prioritizing tasks, ignoring distractions, navigating uncertainty, and relentlessly solving complex problems. The exact choreography of care changes depending on the patient volume and severity, with different tempos for patients arriving via ambulance or from mass-casualty events. We realized that managing the flood of crisis-related email needed to be similarly choreographed. Of course, some argue against using email in general, in favor of more nimble communication modalities such as Slack, BAND, WhatsApp, or team sites. But the reality is that during the Covid-19 crisis communication flooded in through every door, window, inbox, and app it could find. Email in hospitals remains largely the dominant form of digital communication; it can’t be ignored, but it can be tamed.

Here’s how we have applied CRM communication principles to effectively manage email communication in during the crisis.

1. Streamline communications and clarify roles.

A team of experts is not the same as an expert team. Having many leaders in a resuscitation room creates cacophony and makes it difficult for a team to focus and prioritize tasks. During the crisis, many well-intentioned leaders from various pillars of the organization composed daily emails with important but oft redundant updates — and the sheer volume of information made it nearly impossible to absorb during busy clinical shifts and other duties. Early in the response we designated a single person to serve as the department email summarizer who would synthesize this daily deluge into a more digestible and consistent format sent at the same time each day. The subject line, format, and section headings were all standardized to reduce cognitive load and focus limited attention on the rapidly changing protocols for testing, clinical care pathways, personal protective equipment availability, and wellbeing initiatives.

Clearly stating the title and roles of people on each email was another important step. Consistently including this information spares people the trouble of decoding who the recipients are and why they’re on the thread and assures that everyone on an expanding team is aware of each other’s roles. For instance, when adding Dr. Romney to the cc line, the sender would include the note “+Dr. Romney, Vice Chair of Quality, as she is overseeing mortality reviews.” Soliciting this information from other senders, though possibly awkward, helps all recipients get on the same page and can help later in dispersing the crowd and keeping the focus on action-oriented teams. For example, when somebody was included solely for situational-awareness purposes, they could later be “moved to the bcc line to spare their inbox,” (language that explains their departure) allowing them to see that the team is moving forward while excluding them from subsequent group messages once their role in decision making is achieved.

2. Command and request clearly.

In the resuscitation bay there is no room for vague requests. “Thin-air” statements or “asking the room” refers to requests that are not directed at an individual, such as “can somebody please get me a scalpel.” In the ED, directly asking a person by name to do a specific task provokes a faster response and is more likely to evoke vital additional information (“we’re out of scalpels!”). Similarly, when you’re sending emails during a crisis, avoid the passive voice, clearly direct requests to specific individuals and provide concrete timelines and instructions on how to report back when the action is complete, to close the loop. Email is commonly abused as a tool for putting work on somebody else’s desk without having to confirm that they can take it on. During a crisis it is essential that the person initiating an email solicit a closed-loop response that the message has been received, that the delegated party can complete the action, and that he or she will reply again when the job is done.

The subject line can be used like a step-stool the leader stands on to get more attention during a code. Noting action requests in the subject line with open and closed brackets can help readers to prioritize the message.  For example, “Subject: [Response requested by end of day] re: Status of mask delivery.” Once teams are familiar with a common language they can shift to shorthand (e.g., AR = action requested, or EOD = end of day).

3. Ask for clarification when you’re added to a thread.

In a crisis, people’s reflex is to add recipients to an email thread to assure that everyone is on the same page. This can be important, but for the recipient brought into a conversation midstream, it can be time-consuming to piece together what’s going on. Sometimes, after spending several minutes reading and re-reading a lengthy email, the intent of the message and your role remains a mystery. In the ED, when a new member joins a resuscitation in progress, a standard CRM practice is to give them a recap. For example, “This is a 40-year-old male brought in cardiac arrest following a motor vehicle crash. We are on our third round of epinephrine.” When you’re copied onto a chain, rather than spend time reading long threads to reconstruct the narrative simply ask for clarification: “Sorry, long email sent, can you please clarify why I’m added now and how I can help?”

4. Build and maintain situational awareness.

The ultimate team goal during any resuscitation is to rapidly adopt a shared mental model of the situation. This assures that everyone understands each other’s roles, the patient’s status from moment to moment, and what needs to be done. With several people working simultaneously and focusing intensively on one problem (say a sudden heart arrhythmia), “task fixation” can occur causing the team to miss something else that’s also urgent (like a blocked breathing tube). To assure that the team avoids task fixation and maintains broad situational awareness in a resuscitation, emergency team huddles often start with a call for quiet in the room followed by a concise game plan and clear instruction about roles, including hand offs.

Crisis emails can adopt a similar strategy. To avoid unnecessary noise in an email, explicitly state who you want to hear from and who you don’t (“please don’t reply unless…”). A communications technique called SBAR (for “situation, background, assessment, and recommendation”) facilitates efficient communication and hand-offs during an acute events, and can be usefully applied to email. As our emergency department responded to the escalating Covid crisis, using this format in emails with other departments helped keep communication concise and focused on outcomes. Comments buried in the body of a message are the equivalent of mumbling during a resuscitation; if you have something important to say, bring it to the top and say it loudly with an SBAR. For example, “Situation: Face mask shortage. Background: Last weekend we ran out of face masks on Saturday. Assessment: We need a strategy to ensure weekend supply chain is maintained. Recommendation: Can we either get extra supply on Friday or have a facilities contact that our administrator on call can escalate directly to this weekend if supply runs short again?”

5. Foster atmosphere of open information exchange.

Communication in a crisis relies on team members feeling a sense of psychological safety — that they are free to speak openly without fear of repercussion. In the ED, we expect team members to speak up, especially to prevent a mistakes such as a medication error. But evidence shows that unless team members feel safe speaking openly, even vital information like this is often suppressed. Email can be a particular challenge in this regard; it is notoriously poor at conveying tone and so people may feel even less comfortable speaking up as it can be harder to convey the context and spirit in which a comment is made. Acknowledging this at the outset, especially when speaking frankly in email about a concern or problem, will help to provide context and foster an open exchange.

Psychological safety is a fragile construct that requires constant nurturing. Remember that unlike in a trauma room, you can still communicate one-on-one via emails, and some replies may be best done individually if there is any risk of somebody feeling they are being publicly reprimanded or embarrassed through reply-all. Just as in the emergency department, the more this communication script is rehearsed and incorporated into the work culture, the safer members will feel sharing information. As a leader, one way to facilitate this via email is to amplify a recommendation made by a junior team member that hasn’t yet been acknowledged. For example, “Andre asked an important question about staff safety. Myriam, what are your thoughts on this?”

It is time to resuscitate our inboxes. Though there is still a lot to learn as a community about how to communicate with each other during a crisis, developing more standardized formats for email communication will help to build a culture of productive discourse using this medium. Establishing a single point of information delivery and avoiding use of inbox except for communication and tracking of action items can help us focus critical email resources on addressing the topics that need the most attention. Leverage the skills of CRM like an ED doc to tame your inbox and communicate effectively during a crisis.

Need help taming your Inbox? Commnia’s Inbox can help! Book a demo today to see it in action.


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