1. Baker, Edward L. MSc, MD, MPH
  2. Orton, Stephen PhD


The Management Moment" is a regular column within the Journal of Public Health Management and Practice. Janet Porter, PhD, and Edward L. Baker, MSc, MD, MPH, are serving as The Management Moment Editors. Dr Porter is Associate Dean for Executive Education, The North Carolina Institute for Public Health, School of Public Health, at the University of North Carolina at Chapel Hill, and Dr Baker is Director of The North Carolina Institute for Public Health, School of Public Health, at the University of North Carolina at Chapel Hill. This column provides commentary and guidance on timely management issues commonly encountered in public health practice.


Article Content

Quite some time ago, as voice mail began to play a role in our work lives, a former director of the National Institute for Occupational Safety and Health (NIOSH) provided a wonderful insight. Drawing on the workplace distinction between "self-paced" work and "machine-paced" work,1 he referred to the advent of voice mail as "machine-paced work for executives." By this he meant that the pace of work was beginning to be influenced by the use of a particular form of information technology. Implicit in this characterization was the understanding that this new technology carried with it a risk of causing or contributing to occupational stress, as was the case with other types of "machine-paced" work (eg, the assembly line).


Just as voice mail represented a means of improving the efficiency of information exchange, so we are now faced with a more complex array of information technologies designed to enhance productivity and speed information flow. E-mail has now become the most visible sign of "machine-paced work" for executives, and a recent computer "killer application." Everyone has to have it, and it has changed the work paradigm. E-mail represents a huge productivity multiplier, virtually eliminating time and distance as barriers and allowing highly efficient, asynchronous communication between individuals and across groups.


The downside is that someone has to read all that e-mail. The time we spend sending and receiving has become a significant part of each workday. For example, a 1999 internal survey conducted by the Intel Corporation revealed that approximately 3 million e-mail messages per day were sent or received by Intel employees. The average worker's in-box contained 200 messages and approximately hours per day were spent managing e-mail. To address this challenge, Intel started an e-mail training program to create a more efficient e-mail culture.2


E-mail usage now "paces" our day by creating expectations for rapid response to messages. How often has someone asked you, "Did you get my e-mail?" These expectations create a culture of checking e-mail to see whether "something important" has arrived-a particularly challenging issue for those of us on the obsessive-compulsive side (which many managers and leaders tend to be). A July 2001 Gallup Organization Survey showed that 51 percent of workers checked e-mail every hour while 32 percent checked it continuously. With the advent of the personal digital assistant, continuous e-mail checking is becoming a fact of work life for more and more managers.


Time spent on e-mail has opportunity costs, of course. The pervasive use of e-mail has led to a decrease in face-to-face communications; we sometimes send e-mail to the person in the office next door rather than having a brief chat. As discussed in previous The Management Moment columns, partnership development and staff development demand time spent in meaningful dialogue to achieve a higher level of mutual understanding. The time we spend being "paced" by the electronic world has shifted the modes and often the quality of interaction.


E-mail does diminish the quality of communication. E-mail removes layers of meaning that would be conveyed in person, through facial expression, tone, and body language for instance.3(p2) Because of the pace and volume, most of us read and write e-mail at top speed, instead of reading and writing slowly and carefully. The way we use e-mail often creates misunderstandings, mistakes, and communication gaps. The challenge is "to stop volume from simply overwhelming value."3(pxiii)


Do any of these trends have a health impact? Several years ago, one of us was discussing these trends with another former NIOSH director and we decided that a scientific article was needed on this subject. At that time, many articles were being written about the occurrence of a newly described condition-chronic fatigue syndrome. We decided to title the article "Electronic Fatigue Syndrome." Unfortunately, the prospective author was "too busy" responding to e-mail messages to write the article. Perhaps the term killer app has a double meaning.


If we apply basic principles of prevention (the cornerstone of public health) and of good management, certain practices emerge as ways to recognize and prevent the potential adverse effects of the "electronic fatigue syndrome." As a central principle, workers must take control of the technology, rather than letting the technology pace their workday. Recent research on the control of job stress has found that high job demands, lack of job control, and lack of special support are key predictors of the occurrence of stress-related adverse health outcomes.4 Therefore, prevention of potential adverse effects of the overuse of e-mail should focus on ways to "limit exposure" and to develop concrete approaches by which individuals can control their interaction with the technology. One aspect of the prevention strategy is to develop better social systems to delineate "appropriate use" of e-mail.


We suggest a few single strategies:


1. Limit checking e-mail to specific time blocks: perhaps the start and end of each workday. By doing so, you will first condition yourself to control your own impulse to check e-mail more often than necessary, and you may be able to condition coworkers (especially those who report to you) to do the same. Most e-mail represents "urgent, not important" work.


2. Treat e-mail as we used to treat paper: handle each message only once. Respond, delete, or file. Avoid resending and avoid letting messages accumulate in your in-box.


3. Train software through the use of filters. For example, you can create filters to automatically file messages from specific listservs into folders, or label as "junk" any message from a sender not in your address book.


4. Create a filing system, including an action file. Resist the urge to accumulate a mountain of e-mail messages in your files. Create a "five week" file for messages that do not need to be saved forever, and then delete the messages once they are older than 5 weeks.


5. Use plain language. Think of the context in which people read your e-mail: be clear and concise.5



* Short sentences, short paragraphs


* Be clear and direct: focus on one issue


* Use good document design (like signposts and headings)


* Be aware of "referents" to prior e-mails that the recipient may not remember



1. Finally, do not manage by e-mail!! Management is about relationships; e-mail is a way to share information. We believe that, although e-mail can help us be more effective managers, it can get in the way and is not a substitute for the basic process of management and leadership discussed in this column.



In summary, although e-mail can help us in our roles of managing and leading in an increasingly technology-driven work environment, we should be alert to the potential for "electronic fatigue syndrome" as more time and energy are directed into e-mail-related activity. We suggest that by limiting the time spent on e-mail very strictly, by developing technologic techniques to manage e-mail, and by avoiding the tendency to misuse e-mail, workers will enhance their control over this technology. Furthermore, by controlling the pace of work, rather than having pace controlled by e-mail, workplace stresses will be better controlled and managerial effectiveness will be maximized.




1. Hurrell JJ, Ariotequieter C. Occupational stress. In: Levy BS, Wegman DH, Baron SL, Sokas RK, eds. Occupational and Environmental Health. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2006:382-396. [Context Link]


2. Overholt A. Intel's got (too much) mail. Available at: Accessed March 1, 2006. [Context Link]


3. Brown JS, Duguid P. The Social Life of Information. Boston: Harvard Business School Press; 2002. [Context Link]


4. Karasak RA, Theorall T. Healthy Work: Stress, Productivity, and the Reconstruction of Working Life. New York: Basic Books; 1990. [Context Link]


5. Brenner R. 101 Tips for writing and managing email: a handbook for professionals. Available at: 2005. Accessed March 1, 2006. [Context Link]