I work mostly on the desktop. Pinning tiles to the taskbar is okay, but they still take up too much room even when small icons are enabled. So I still enable the Quick Launch bar, which lets me have two columns of shortcut icons on my vertical taskbar (Oh, and another thing I do immediately is switch the taskbar from the bottom to the left side of the screen).

Since I use multiple (four) monitors, another thing to do when I set up Windows 8 is select which monitor will be my Start Screen monitor, and then put a different wallpaper on each monitor to make it easier to identify which is which.

Next, because on each of my main computers my fourth monitor is a large screen TV, I enable Windows Media Center and configure it to open on the TV.

Next come the usual "fixes" to Explorer that pre-date Windows 8 (show file extensions, show hidden files, etc.), IE 10 desktop version (get my toolbars back, add "Email link" icon to the command bar, etc.) and Control Panel (switch to classic view).