Budgeting for a Hospital On-Call Management System

This is the next part of a four-part series about Hospital on-call management systems. In our first post titled “How hospitals transition from binders to the web” we learned about the problem discovery process. This is where we discovered and validated that we indeed had a problem. In the second post titled “Selecting the best on-call management software vendor,” we learned the process of identifying top needs and learning about all of the available choices in the marketplace. This post will focus on how to get your on-call management system project funded.

Now that you clearly understand your problem, you have validated that it exists and you have identified several key features that are important to fix the problem. You have also reviewed all of the vendors with solutions and you have chosen who you consider being the best partner. The next part is how do you get it funded? In my experience, it all comes down to four “P’s”, people, process, priority, and problem. Below we will explore all four and how they tie together.


In every hospital, there is a clear process and procedure for attempting to initiate a new project such as an on-call management system. Chances are if you are a Director or Vice President you will be very familiar with the process, if not you will need to do some research. The budget process will be the very foundation that you build your case upon. If you are unable to get your hands around how the process works, you may want to forfeit the project or transfer it to someone who can. Some of the things that you will learn are, who needs to sponsor the project, what will you need to show in terms of a return, how long will it take to get approval, what if the project is denied, and other important information that you will need to know. Do this first.


In every organization, there are priorities and initiatives that are agreed upon usually at the Board of Directors level. These priorities, initiatives, and goals are used as guidelines to be sure the organization is focusing on the right “things”. Remember there is usually 2 or 3 times more project that is requested than there is funding available for. Because of this, it is important for the hospital to prioritize. You need to know what your organization’s priorities, initiatives, and goals are and what the tie-in is to your project. For example, many organizations have initiatives around patient care and physician satisfaction, and employee satisfaction. On-call management directly affects all of these areas.

Here are a few example arguments.

    • When a patient is waiting in the ED, the longer that it takes the ED to determine who the correct consulting physician is and then to notify them will affect how long the patient has to wait in the ED before further testing, admission, or discharge. Each time the ED pages the wrong doctor due to misinformation on the call schedule the quality of the patient experience is diminished and care is possibly compromised.
    • Physicians are dissatisfied when they are called/paged incorrectly due to an error in the call schedule. The level of dissatisfaction greatly increases in the evening and overnight if a physician is called/paged when not on-duty.
    • Telecom and Emergency Department administrative employees are often verbally reprimanded by the physician when he/she is called/paged incorrectly due to an error in the call schedule. This verbal reprimand leads to employee dissatisfaction and is a contributing factor to high turnover rates in these administrative-type positions.

Aligning with top initiatives is one of the most important steps in the “funding” process. This is where you will clearly build your case as to why this project is more important than another project because it directly aligns with the organization’s priorities, initiatives, and goals.


Each project needs a “White Knight” or sponsor. You need someone at a VP level or higher that buys into your project. Often in an on-call management situation, you can find an influential doctor who will help build your case to hospital leadership. Without this person, your project will most likely not move forward. This person will act as a Lobbyist and hopefully will help your cause. Another person it would be good to get to know is the person whose budget this will be coming out of. This should not be a surprise to anyone. Many times for an on-call management project it will come out of IT’s budget, but I have also seen it come from the ED and Medical Staff. Be sure to research this in advance. You may need to set-up a meeting between IT, Medical Staff, and the ED and try and figure out who has funds and who would be the best fit.


One of the last questions you will be asked by the budget committee is “what is the ROI?” Determining an ROI in projects like this it is very hard due to hard and soft costs. But you should be able to easily determine how much it is costing the hospital today to achieve the undesired results. In an on-call management project you will want to be sure to include all areas of cost:

    • Clinic person who creates the original call schedule
    • Person at hospital in MSO that receives all schedules
    • Person at hospital MSO that collates/organizes schedules
    • Person at hospital MSO office that verifies the accuracy of daily shifts
    • Person at hospital who creates daily call roster
    • Person at hospital who sends out daily call roster
    • Person at hospital who manages changes to the schedule
    • Person at hospital who communicates daily changes to the schedule

Also, you may want to include a flow-chart to illustrate your point.

Without understanding the budgeting process, positioning your project to align with the organization’s goals, priorities, and initiatives, getting the right people to assist you, and having a clear understanding of what it costs today to achieve the undesired results your project will likely become cannon-fodder.

Key Takeaway

Do your homework, all projects are good projects, some are just better prepared for the budgeting process, make sure yours is one of the prepared.

Stay tuned for the final post about implementing an on-call management system at your hospital.


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