The ‘Three Rs’ of email effectiveness

Resist, Reorganize, and Respond


PING – you look down at your phone and the words “URGENT – Meeting Today” stare back at you. The elevator door opens, and you step inside – 1 minute, the seemingly perfect amount of time for a quick inbox check.

Dr. Ryan Nelson, Ochsner Health System, New Orleans

Dr. Ryan Nelson

As a hospitalist, chances are you have experienced this scenario, likely more than once. Email has become a double-edged sword, both a valuable communication tool and a source of stress and frustration.1 A 2012 McKinsey analysis found that the average professional spends 28% of the day reading and answering emails.2 Smartphone technology with email alerts and push notifications constantly diverts hospitalists’ attention away from important and nonurgent responsibilities such as manuscript writing, family time, and personal well-being.3

How can we break this cycle of compulsive connectivity? To keep email from controlling your life, we suggest the “Three Rs” (Resist, Reorganize, and Respond) of email effectiveness.


The first key to take control of your inbox is to resist the urge to impulsively check and respond to emails. Consider these three solutions to bolster your ability to resist.

  • Disable email push notifications. This will reduce the urge to continuously refresh your inbox on the wards.4 Excessively checking email can waste as much as 21 minutes per day.2
  • Set an email budget.5 Schedule one to two appointments each day to handle email.6 Consider blocking 30 minutes after rounds and 30 minutes at the end of each day to address emails.
  • Correspond at a computer. Limit email correspondence to your laptop or desktop. Access to a full keyboard and larger screen will maximize the efficiency of each email appointment.


After implementing these strategies to resist email temptations, reorganize your inbox with the following two-pronged approach.

  • Focus your inbox: There are many options for reducing the volume of emails that flood your inbox. Try collaborative tools like Google Docs, Dropbox, Doodle polls, and Slack to shift communication away from email onto platforms optimized to your project’s specific needs. Additionally, email management tools like SaneBox and OtherInbox triage less important messages directly to folders, leaving only must-read-now messages in your inbox.2 Lastly, activate spam filters and unsubscribe from mailing lists to eliminate email clutter.
  • Commit to concise filing and finding: Archiving emails into a complex array of folders wastes as much as 14 minutes each day. Instead, limit your filing system to two folders: “Action” for email requiring further action and “Reading” for messages to reference at a later date.2 Activating “Communication View” on Microsoft Outlook allows rapid review of messages that share the same subject heading.


Finally, once your inbox is reorganized, use the Four Ds for Decision Making model to optimize the way you respond to email.6 When you sit down for an email appointment, use the Four Ds, detailed below to avoid reading the same message repeatedly without taking action.

  • Delete: Quickly delete any emails that do not directly require your attention or follow-up. Many emails can be immediately deleted without further thought.
  • Do: If a task or response to an email will take less than 2 minutes, do it immediately. It will take at least the same amount to retrieve and reread an email as it will to handle it in real time.7 Often, this can be accomplished with a quick phone call or email reply.
  • Defer: If an email response will take more than 2 minutes, use a system to take action at a later time. Move actionable items from your inbox to a to-do list or calendar appointment and file appropriate emails into the Action or Reading folders, detailed above. This method allows completion of important tasks in a timely manner outside of your fixed email budget. Delaying an email reply can also be advantageous by letting a problem mature, given that some of these issues will resolve without your specific intervention.
  • Delegate: This can be difficult for many hospitalists who are accustomed to finishing each task themselves. If someone else can do the task as good as or better than you can, it is wise to delegate whenever possible.

Over the next few weeks, challenge yourself to resist email temptations, reorganize your inbox, and methodically respond to emails. This practice will help structure your day, maximize your efficiency, manage colleagues’ expectations, and create new time windows throughout your on-service weeks.

Dr. Nelson is a hospitalist at Ochsner Medical Center in New Orleans. Dr. Esquivel is a hospitalist and assistant professor at Weill Cornell Medicine, New York. Dr. Hall is a med-peds hospitalist and assistant professor at the University of Kentucky, Lexington.


1. MacKinnon R. How you manage your emails may be bad for your health. Science Daily. Published Jan 4, 2016.

2. Plummer M. How to spend way less time on email every day. Harvard Business Review. 2019 Jan 22.

3. Covey SR. The 7 Habits of Highly Effective People: Powerful Lessons in Personal Change. New York: Free Press, 2004.

4. Ericson C. 5 Ways to Take Control of Your Email Inbox. Forbes. 2014 Mar 17.

5. Limit the time you spend on email. Harvard Business Review. 2014 Feb 6.

6. McGhee S. Empty your inbox: 4 ways to take control of your email. Internet and Telephone Blog.

7. Allen D. Getting Things Done: The Art of Stress-Free Productivity. New York: Penguin Books, 2015.

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