This site is intended for health professionals only

Time management masterclass: Saying no

Delegating and declining requests for your time will give you greater control over your working life, says performance coach Sarah Christie

The implementation of time management strategies requires assertive behaviour with other people so that you can manage their expectations and enable you to communicate your priorities successfully. It will also help you say no to requests that you do not have time for, shorten conversations with talkative colleagues and patients, eliminate gossip and delegate some tasks that shouldn't be done by you.

Remember that you need to focus your energy on your priorities and not be distracted by trivial activities. Your time must be used wisely, on projects and tasks that will yield you or your practice the greatest results.

Body language

It is essential for you to understand what assertive behaviour looks like and understand that we communicate with other people in three different ways. Not only do we use words to make ourselves understood, but we use our tone of voice in specific ways to convey meaning and we use facial expressions and gestures, even our posture, to convey how we feel.

Our words are known as verbal communication and unfortunately carry very little influence over people. It is our non-verbal behaviour, our tone of voice and our body language that have a very large influence over others. So if we want to come across as assertive and confident, we have to sound it and show it, as opposed to just saying it.

Assertive body language means making good eye contact with someone when you speak to them. This will be crucial when you need to say no to someone's request or ask them to do some work for you. Your posture should be upright and not slouching in the chair. You should smile as much as possible, to show that you are not reacting in a hostile or aggressive manner. Ensure that your arms are not folded in front of you, which is known as closed body language and can be misinterpreted as discomfort or anxiety. Similarly, make sure that your hands are not clenched together, as this also can appear as nerves.

When delegating work or declining someone else's request for you to do something that interferes with your priorities, your voice must be moderately loud and clear and not timid. You must speak at a reasonable pace, not too slow and hesitant and not too rushed. The same principles apply when handling patients.

For example, when a patient enters the room welcome them and invite them to sit down. This is essential in order to build good rapport with an individual and put them at their ease. However, instead of beginning the appointment with an open question, such as, 'what seems to be the problem today?' you must control expectations.

Try this opener: 'As we only have 10 minutes together, what would you like to focus on today?'. Another statement could be, 'We only have a short time together, so what is your main concern?'

Mind your time

Then it is your responsibility to keep an eye on the time. If the appointment is nearing its end you could say, 'We only have a minute left, so I am afraid we must close this conversation.' Or, 'I'm afraid our time is up. If you feel you need more time in future, please book two appointments back-to-back.' It will be up to you to educate your patients about the time they can spend with you and always have these conversations in a pleasant, respectful, but firm way.

When you need to end a conversation with patients or colleagues, it is entirely appropriate to break rapport. This sends a non-verbal cue to the recipient and they will take the hint. Breaking rapport is as simple as breaking eye contact. If you are with a patient, begin the wrapping up process, by processing a prescription, all the time smiling and nodding as they continue to talk. However, they will notice what is going on and prepare to leave also. If they do not, make sure your tone of voice sounds like a statement when you say, 'See how you get on and if your symptoms persist, come back and see me.' Stand up as you say this and your patient will follow you, without thinking about it. Open the door for them and smile as they exit. You have now kept to time and handled your patient beautifully!

Pass work on

When delegating some of your low priority tasks to colleagues, use similar assertive techniques. Maintain good eye contact and say, 'I would appreciate it if you could have this ready for me by Wednesday.' Avoid passive language, such as, 'I wonder if you could do me a favour?' You are making it too easy for them to refuse. Be clear and firm. 'As you know, I have an urgent deadline to meet, so I must focus on this presentation. I would appreciate it if you could make these telephone calls for me. Here is the information you need.'

Finally, when saying no to someone, try not to feel guilty. Maintain your assertive body language, look them in the eye and be truthful. 'I am very sorry, but on this occasion I don't have the time to help you.' If it helps, show the person your diary or plans for that day. Let them see for themselves how organised you are and that you have planned some important tasks for the day. They will soon learn that you are happy to help when you have time and respect the fact that when you say you cannot help, you will be telling the truth.

Sarah Christie is an author and performance coach who leads management and leadership programmes for clinicians and non-medical managers. Her website is

Credit: Flickr, smemon87 Time management masterclass