I was becoming really nervous about my lack of preparation for a strategic planning retreat. The CEO, the senior executive team, and several physicians and board members were going to meet in three days to discuss a variety of important issues. One of my assignments was to present a 30 minute review of an important project. This would set the stage for selecting one of several possible approaches to the project. I would need to do some deep work for this presentation.

First, I had to create an outline of my presentation and complete some background research. Then, I would design my slides and organize and rehearse the presentation. Because I had not even formulated the overall message of the presentation, I was getting really anxious about it.

I had little uninterrupted time at the office to prepare because I had double-booked my usual meetings in anticipation of attending the retreat. At home, I was similarly unable to extract myself from the usual interruptions of phone calls, texts and other urgent problems.

Enabling Deep Work

I decided to use one of my time-tested tactics to help me focus and create some dedicated thinking time for this problem. On the following Saturday, my wife was planning to run a short errand. I informed her that when she left, I was going to go on a brisk walk, so not to worry if I wasn't home when she returned.

I followed the plan and walked for about 45 minutes around our neighborhood. During that time, I was able to focus and mentally review the pros and cons that I wanted to present. I fashioned a short list of steps for the proposed project and a timeline in my mind. When I thought about a couple of background items that I needed to follow-up on, I dictated a reminder into my cell phone voice recording app.

By the time my walk was completed, I had a pretty good idea of the outline for the presentation. The approach I would take to present it and the final recommendation I would be making were much clearer. After dinner that day, I began creating the PowerPoint presentation based on the ideas I fleshed out during that walk.

Cal Newport Sheds Light on Deep Work

Since reading Cal Newport's book, Deep Work: Rules For Focused Success In A Distracted World, I have struggled with the best way to present my review of the book to my readers.

I could do a simple book review, but my conclusions could be easily summed up in a single sentence. It's an important book about a very important topic that every physician leader should read.

I could spend several thousand words summarizing the book. But I doubt I could do a better job than the analysis presented by The Productive Physician: Do You Want An Extraordinary Life? Choose Deep Work.

I've come to the conclusion that the best approach is to highlight some of the important concepts, and some examples of deep and shallow work as physicians, leaders and executives.

Intense concentration!

Definition of Deep Work

Let me start by defining what deep work is. According to Newport, it is: “Professional activities performed in the state of distraction-free concentration that push your cognitive capabilities to their limits. These efforts create new value, improve your skill, and are hard to replicate.”

It's counterpart, shallow work, he defines as: “Non-cognitively demanding logistical-style tasks, often performed while distracted. These efforts tend to not create much new value in the world and are easy to replicate.”

Some examples of deep work that involve intense concentration could be:

• research for a book or article,
• writing a comic strip, a book, a journal article, a serious blog post or even a script for a movie or a play,
• creating a new course to teach,
• preparing for an important planning meeting,
• spending time analyzing quality improvement data, or
• preparing a 30 minute board report.

Examples of shallow work include:

• running a meeting,
• processing work emails,
• scanning the literature,
• meeting with direct reports, and
• other day-to-day routine tasks that could potentially be delegated to others.

Value of Deep Work vs. Shallow Work

Although there are great benefits to the outputs derived from deep work, it doesn't mean that shallow work is unimportant. Or that all deep work is valuable. Spending hours focused on a new video game will result in output of little value, as intense and focused as it may be.

Without shallow work, much of the deep work cannot be pursued. The operation of families, businesses and communities require shallow work.

CEO Example

For example, much of the work of the CEO of a hospital or other business is shallow work. The CEO is often a political animal (no insult intended) who spends a great deal of time interacting with his/her employees and community. Coordinating and running executive meetings, interacting with the board, and attending fundraisers are not deep work (according to my understanding of Newport's definition). But these activities are integral to leading a large organization.

There might be time devoted to intense concentration, such as digesting new research or envisioning strategic options. But even these activities can be done in a group setting in which the CEO is facilitating a review and discussion rather than personally engaging in deep work.

Sometimes, the CEO’s primary responsibility is in support of deep work by others. It's critical that there is sufficient time for deep work by those who lead the divisions and departments of the organization.

I'm not clear on whether certain other activities that require intense concentration constitute deep work. Surgical procedures might be a form of deep work. Pharmacists reviewing and processing medication orders might fit the definition. Does a nurse cross-checking an order and retrieving medications at a dispensing cabinet qualify, since it requires intense focus, at least for a few minutes?

Important Shallow Work

Other extremely important functions, including bedside nursing care, the activities in the laboratory, physical therapy, and other ancillary services of the hospital, housekeeping, etc., often don't involve deep work. However, they're all necessary for the running of an effective health care organization.

When shallow work becomes too pervasive and distracting, however, it will interfere with deep work. Without an appropriate balance between the two, intellectual progress and creation of new value will suffer.

Effective Leaders Use Deep Work

After reading through the book twice, I've concluded that deep work is an important part of the physician leader’s life. I've also realized that the ability to engage in meaningful deep work depends on two primary factors:

• developing the ability to focus intensely on important work for extended periods, and
• consistently avoiding the distraction of shallow work.

Without accomplishing both of these aspects of deep work, it’s benefits will be elusive.

For example, you might be really good at achieving a state of intense concentration. But if you allow 100% of your time to be spent in shallow work, then that ability is of little use.

On the other hand, you might avoid all distractions (television, social media, email, etc.). But if you don't cultivate the ability to achieve a state of intense concentration, it does no good to set aside a specific time to do so.

Luckily, Newport’s book helps us to address both issues.

Routines for Developing a Deep Work Habit

Deep work usually requires quiet time alone so that our attention can be focused on a specific problem or task. And because such intense mental work can be exhausting, it is usual for it to last no more than a few hours at a time .

Because of this intensity, Newport has found that there are four distinct ways to approach deep work that he calls your “depth philosophy.” Integrating depth into your life serves two purposes. It enables you to improve your ability to concentrate, and it provides some assurance that you will have the time to do so.

Monastic Philosophy

The Monastic Philosophy may not work for most physicians. It involves drastically reducing shallow work by avoiding almost all distractions, including email and social media. This would be akin to locking yourself in your office and only engaging occasionally in conversations with your colleagues. Distractions are avoided at all costs.

Bimodal Philosophy

In the Bimodal Philosophy, you split your time between intense mental work and shallow endeavors. Each period may last a day or longer. During quiet time, it's as though you are practicing the monastic philosophy, but there are frequent extended periods when shallow work dominates. This approach probably does not fit the lifestyle of most leaders (except, perhaps, for those that work primarily as researchers or writers).

Rhythmic Philosophy

The Rhythmic Philosophy for deep work might be a better approach for physician leaders. Simply set aside time each day or two to do deep work. It might be possible in a corporate setting to block out two hours of uninterrupted time on Mondays, Wednesdays and Fridays to devote to tasks such as analyzing quality data, writing a white paper, or preparing a board presentation.

Journalistic Philosophy

Finally, you might consider the Journalist Philosophy as a viable approach to supporting your deep work. In this method, you switch into deep mode whenever there is down time or an open slot in your schedule. This approach can be effective. But it depends on the discipline of moving into deep work frequently, and the ability to shift from shallow activities to deep thinking quickly. This ability requires practice because most of us are easily drawn back into shallow work.

Develop a Routine to Use Deep Work

One common theme made evident by Newport and other authors concerns writing: it is important to develop a routine around writing (and other deep work). Do not leave it to chance or “feeling inspired” to do the work. It is necessary to schedule specific time and use deep work regularly.

Newport also recommends several practices to adopt as a way to develop the intense concentration and energy needed to focus. These methods include:

• walking in nature, thereby enabling “focused-attention mechanisms to replenish,”
• scheduling specific Internet time, and avoiding it at all other times,
• setting very short deadlines for deep work, forcing yourself to work with great intensity,
• practicing productive meditation, in which you focus attention on one well-defined problem while walking, jogging or driving, and
• memorizing a deck of cards (using a specific method that he describes).

Drastically Reduce Time Spent in Shallow Work

Newport also alludes to various methods to reduce the time in unnecessary shallow work, thereby increasing the opportunities to practice and engage in deep work.

Some are addressed in his description of the four depth philosophies. But he also provides advice on other ways to reduce distractions. Some of the methods that the physician leader might apply include:

• schedule every minute of each day,
• reduce interaction with email, similar to what I described in my September Monthly Leadership Favorites,
• limit engagement with social media to only those that add value,
• delegate as many tasks as possible,
• say “no” to requests for your time that are not highly valuable and pertinent to your goals,
• eliminate meetings without a specific goal, and end them early when possible, and
• reduce distractions by disabling notifications from emails, texts and social media accounts.

What I Do to Get to Deep Work

In order to reduce the amount of shallow work, I use all of the approaches listed above. But I must admit that I'm still trying to learn how to say “no” and protect my discretionary time.

When I was working as Chief Medical Officer, I routinely had my assistant block out time for an hour or two several times a week. This allowed me to work uninterrupted on important projects that required intense thought and creativity (Rhythmic Philosophy).

At home, I squeeze in uninterrupted blocks of time to read, write blog posts, work on an eBook, or prepare for my new podcast (applying the Journalist Philosophy). This works for me because I developed an ability to shift quickly into intense concentration as a child.

When I grew up, I was the oldest of ten children. My family of twelve lived in a three bedroom bungalow. I generally studied in the middle of the dining room, surrounded by my siblings and their friends while they ran around playing tag and other games. This taught me to focus intently, ignoring the chaos that surrounded me. I continued this practice regularly through high school and college.

And I still do deep mental work while on 30- to 60-minute walks. These are mostly devoted to creative thinking, like developing new ideas and outlines for articles.

I haven't tried to enhance my attention skills by learning to memorize a deck of cards, but I'm thinking of giving it a try later this year.

In Closing

In conclusion, as a physician leader, and especially a healthcare executive, I believe it's important to devote a sufficient amount of time to deep work. It will enhance our effectiveness and productivity, allowing us to create more and lead better.

Please list more examples of shallow and deep work for the physician executive. Or answer the following question:

Which of these activities do you think use deep work, and which demonstrate shallow work? Please list your answers in the Comments.

1. Performing 3-vessel coronary artery bypass grafting (CABG): deep or shallow?
2. Bathing a bed bound patient: deep or shallow?
3. Preparing an employment contract for a newly recruited general surgeon: deep or shallow?
4. Writing an annual report summarizing the quarterly quality and satisfaction measures for a multispecialty medical group: deep or shallow?
5. Running a quarterly medical staff meeting at a large medical center: deep or shallow?

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