Priority Matrix — a tool for complex decision-making and strategic planning

It’s a pleasant Saturday afternoon. Marjorie Marshall is relaxing on the couch with her tablet while her bathtub fills. She’s checking her accumulated airline miles and dreaming of a trip to Hawaii. She’s also flipping through a catalog of concrete birdbaths like her grandmother used to have. Yes, it’s a fine Saturday afternoon, indeed.

And then it all changes. At the same time:

• A mailman comes to the door and the dog goes crazy
• Her phone starts ringing
• The bathtub overflows, water pouring into the hall
• Her 5-year-old douses his Legos with lawnmower gasoline and starts looking for the matches

“Quick! What should I do?” Marjorie’s mind races — in a millisecond, she reasons:

• The trip to Hawaii: It can wait.
• The concrete birdbaths: Those can definitely wait.
• The mailman: Not an emergency.
• The barking dog: Not an emergency. The dog will stop when the mailman goes away.
• The bathtub: An emergency that may take some time to fix.
• The kid experimenting with fire: A bigger emergency that must be stopped right now!

Almost unconsciously, Marjorie prioritizes several competing interests in order of potential gain, potential loss and the effort required to realize the gains and prevent the losses. Her brain creates a “priority matrix” to deal with a relatively simple situation.
As practice managers, every moment of our day is filled with competing interests. A priority matrix can help us determine the quick wins, the worthy long-term projects, the low-effort marginal improvements and the concrete birdbaths.

Breaking down the priority matrix

A priority matrix is simple. An x-axis and a y-axis divide an area into four quadrants. The y-axis (vertical) represents impact level: The higher you go, the more impact you expect. The x-axis (horizontal) represents the effort you must spend to accomplish any task or idea: The farther right you go, the more difficult the task. Each idea or task must be evaluated on these grounds and placed in the appropriate quadrant relative to other items. Pro tip: sticky notes work great for project matrixes, because they’re easy to move around!

As hectic as Marjorie’s day is, she can manage it: the most urgent task she has — preventing the fire — is actually easy to accomplish. She must keep the matches hidden (she should also clean up the gasoline, but you get the point). You’ll also notice that she has separated her flooding problem into two tasks:

1. stopping the flooding immediately; and
2. fixing her pipes.

Stopping the flooding must be done as soon as the fire is prevented, but fixing her pipes is a more long-term and high-cost initiative. It’s crucial, however, so Marjorie will need to make a plan.

Using your priority matrix

The tie-in to practice management should be clear. On any given day, you may have a vendor meeting, physician compensation negotiations, four new front desk hires and a merger proposal to review. Nothing may be so clear as a fire or a busted water pipe. Could prioritizing according to effort and impact be a good way to arrive at a workable to-do list? Might it also help you decide how to delegate the work?

Using your priority matrix YOUR way

There are many variations on the priority matrix, and some people even call it by different names. One name is the “Eisenhower Matrix,” because President Dwight D. Eisenhower is often credited for developing it. As our 34th president was a pretty high-achieving individual, I think we can take that as a solid testimonial of the matrix’s power.
 
For Ike, items that fell in the lower-left quadrant (low effort, relatively low impact) were what he considered projects to delegate. The items in the upper-right (high impact, high effort) were major projects that needed to be carefully scheduled. The projects in the lower-right (high effort, low impact) were marked “DO NOT DO – WASTE OF TIME.”  
 
Should the birdbath really be relegated to the “waste of time” quadrant? Well, it certainly shouldn’t make it into Marjorie’s Saturday afternoon, but maybe the long-term benefits to Marjorie’s state of mind make it worth keeping around for the ebbs in the action, or maybe Marjorie ought to consider it a major impact/major effort project and plan for it.
 
You are free to adapt your matrix as fits your life and the life of your team.

Happy prioritizing, happy decision-making!