In the early 1980′s when I was running a small software company while attending Stanford as an undergraduate, my business activities were limited to the number of phone calls I could receive in a day. At most I could have 5-10 phone teleconferences.

In 2010, with email and social networking, all of the limits on synchronous group interaction have disappeared and I now have limitless meetings per day. When you count the emails I send, the blog comments I respond to, and the Twitter/Forums/Texts/Linked In/Plaxo/Facebook interactions, I can have 500 meetings a day.

What does that really mean?

One of my staff summarized it perfectly when I asked him what keeps him up at night

“The flow of email and expectation upon us all to respond quickly  has become more challenging for me than probably most because of the great diversity of areas that I cover. I’ve been making changes and removing myself from unnecessary support queues(previously used to monitor day-to-day), delegating as much as possible, and making the needed staffing changes.”

The demands of 500 virtual meetings a day on top of the in person meetings results in what I call “Continuous Partial Attention.” A one hour in person meeting implies that you’re 50 virtual meetings behind by the end of the face to face time, forcing attention spans to fade about 10 minutes into any in person meeting. The modern electronic world has removed all barriers to escalation and facilitated scheduling. Anyone can interrupt anything 24x7x365. Instantaneous frictionless communication is analogous to the revolution in the publishing industry where anyone can be an author/publisher/editor without any triage.

What’s the best strategy for dealing with this communication overload? Here’s a few I’ve experienced:

1.   Declare an end to the madness and stop doing mobile mail and texting. Some senior executives have taken an inspiration from the Corona Beer Advertisement and thrown their Blackberry into the ether.

2.   Put up a firewall around your schedule. One of my staff published an out of office message this week. When I asked him about it, he said

“I’m just trying to take some time and my outgoing message is helping to filter out the emergencies from the last minute stragglers that want to something that doesn’t really need attention until after the break as I’m trying to finish up the necessary end of year items.”

3.  Accept the chaos and schedule around it, creating an open access schedule that reserves half the workday for the asynchronous, unplanned work of each day.

4.  Ignore your emails. Some senior executives just never respond and have inboxes with thousands of unanswered emails.

5.  Delegate email management. Some executives delegate email to trusted assistants who separate the wheat from the chaff, escalating only a few emails a day to the executive they support.

At the moment, I still do #3, but I must admit it’s getting more challenging. I receive over 1000 emails a day and try to respond to each one, but for the past 6 months, I’ve been deleting unread every email that begins

“Hi, I’m Bob at and our products…”


“Hi, I’m a venture capitalist and I’d like an hour of your time to…”

Hopefully, I’m answering my critical asynchronous communications in a timely way and only ignoring those communications which are a lower priority. At 500 email and social networking responses per day, I’m approaching the limits of my bandwidth, which I never thought would happen.

I do my best and clear my queues every night before sleep. If I’ve somehow missed you in my 500 meetings a day, please let me know!

John Halamka, MD, is the CIO at Beth Israel Deconess Medical Center and the author of the popular Life as a Healthcare CIO blog, where he writes about technology, the business of healthcare and the issues he faces as the leader of the IT department of a major hospital system. He is a frequent contributor to THCB.

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2 Responses for “500 Meetings a Day”

  1. pcp says:

    “Ignore your emails”
    I assume this applies to physicians?

  2. Samuel Stenes, MD says:

    You are a smart guy. I am shocked that you can not handle the communication. Hey man, just do your job. Let the doctors at your place put up with all 9of the jabberwock and gibberish you now call an electronic medical record.
    You know, I almost puked when I read your diatribe, I was laughing so hard.
    When was the last time you used the meaningfully unusable and useless CPOE machines at your place to take care of a patient in hypovolemic shock?
    That you do nothing to help the doctors be more efficient and safe with medical care by ridding them of the shackles of the CPOE gear is despicable. Go wallow in your twitters, texts, emails, about how safe HIT is.

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