Juggling Priorities as a Management Challenge

A major challenge for first line managers (FLMs) in health care is managing competing demands. They face requests and demands from distinct healthcare stakeholders: patients, patients’ families, their bosses, their employees, managers of other units, physicians, community members, and health care researchers. They have reporting obligations to some, professional responsibilities towards others, and personal commitments as well. The pace, breadth, and amount of demands easily exceeds FLM’s capacity. The options at this point can feel daunting: (1) refuse some demands entirely, (2) do some tasks half-way, or (3) push oneself at a faster pace or for a longer time than anyone can sustain for very long. Each of these options is sufficiently stressful in itself, but further distress arises because they all involve conflict with other people.

In our interviews and surveys hospital FLMs identified these conflicts as among the most stressful dimensions of their worklife. Better management of these conflicting demands would make a major contribution to sustaining their workplace mental health. Because of the social dimension of the problem—all of these conflicting demands arise from people—effective action must address the inherent social tensions as well as the policy or workflow dimensions. Managers cannot revamp their work priorities one day without expecting pushback from other people. Everyone’s work is intertwined with everyone else’s work.

The social dimensions are complex. Managing conflicting demands may require:

    a) Negotiating work priorities with one’s director,

    b) Persuading high status professionals to moderate their requests,

    c) Discussing mutual expectations with employees,

    d) Reviewing treatment options with patients and their families,

    e) Resetting expectations with family.

    Managing conflicting priories is a complex process embedded in the operating procedures and culture of hospitals. There is not going to be a one-size-fits-all solution to apply rigidly in all settings. An effective process will have at its heart an active dialogue.

    This challenge calls for a slow resolution, not a quick fix. Although relaxation exercises are a wonderful thing, they are not going to resolve conflicting priorities. Over the following posts we will consider approaches to increasing awareness of the problem, identifying who is accountable for addressing the problems, and considering action plans that could alleviate the tension of conflicting priorities.

    This issue has major implications for the performance and wellbeing of managers and their workgroups.

    I’d love to hear your ideas.


  1. In healthcare, front line workers are not the only ones dealing with multiple priorities. Staff nurses juggle increasingly difficult patients. Not every facility has patient lifts and little team work is evident when no one has the time, tools, or social support to take care of their own patient load. My biggest concern are those organizations that express no concern for the systems issues that cause patient care errors and discipline the individual nurse who ca’n’t do it all. i believe transformational learning organizations still do not acknowledge the system issues that create barriers to not only patient safety but employee safety.


    1. Thank you Peggy. I agree that the overall move with doing more with less has resulted in too many nurses having too much than can reasonably be covered in the time & energy available. Often, when it comes down to doing less with less, everyone is avoiding the hard choices of what activities will have a lower priority, but something really must go without the necessary resources.

      I do hope you track the following posts over the next couple weeks. The conversations about adjusting work expectations have been lacking on all levels of healthcare organizations. Pretending we can do everything is not a viable way to go forward.


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