Call Scheduling Software and “Teflon” Implementation

Remember Teflon, the “non-stick” coating for cookware? It is also a nickname for political situations when criticism or responsibility cannot be made to stick. When it comes to physician call scheduling software implementation failures within healthcare systems or multi-specialty clinics, it also seems an appropriate term.

On the surface, all stakeholders in the project are on board, there is appears to be buy-in from the schedulers, supervisors, and physicians. The implementation plan is in place and started. Then, at some point, the “Teflon” is discovered and the project is in trouble. This is more than resistance to change; this can kill change.

What are some indications of a Teflon implementation?

Many issues seem to be ultimately about turf and control. Some may be about inertia and the difficulty of change. All require early, strong internal leadership intervention to ensure successful implementation.

Silos: If departments and specialties do not work together on the same over-all vision and time-line, but work on their own “module” their own way, you could end up with the integration train-wreck issue. Each unit looks good unto itself (successful local implementation), but the schedules are not standardized overall. When you put it together, the “silos” cannot understand one another’s scheduling schemes, and consequently, there is a lot of finger-pointing.

No Leader/too many Leaders: Similar to silos, but on a “unit” level, if there is no clear, single leader, there is an opportunity for misunderstanding and misdirection. The “Teflon” person or department has lots of ways to sabotage the project simply because there is no-one he/she is clearly responsible to. He can ignore the project and its schedule for multiple, seemingly credible reasons.

Differing Personal Priorities: This person seems to take on the project, but prioritizes according to his/her own sensibilities. He may be a leader within a department or specialty, he may be a strong-minded employee without a clear superior to report to, or he may be a co-owner Physician. Wherever he is, he hasn’t bought into the “mission” at hand and has a mission of his own.

Hero: This person may be your internal “visionary”. Used to running his/her own show, he may wait until well into implementation before pointing out what “won’t work” or injecting an idea beyond the scope of the software. Since the desired functionality cannot be fully implemented in time, it results in delayed launch or cost overruns. However, the Hero looks good since the “fatal flaw” was pointed out… no matter how late.

Busy Betty, Busy Bob: Whether Busy Betty or Busy Bob, this person never says no, and somehow always gets everything done, with or without complaint. This person has done the scheduling forever and knows where all the warts are. Not only is change difficult, but it may also be threatening. Most of the time, this person is an administrator, but may also be a Physician Scheduler. If so, a delicate political negotiation must take place since top-down “just do it” appeals will most likely be resisted. It may also be that this person simply needs to be temporarily relieved of some scheduled duties in order to handle the implementation of new on-call scheduling software.

How can Teflon be overcome?

    • A “Master” internal Client Sponsor must be actively engaged and have the authority to make critical decisions regarding implementation.
    • The vision must be clear, defined, shared, and supported amongst all the stakeholders and upper management
    • Communication must be frequent and honest if problems and issues are to be avoided
    • Envisioned timeline and methodology process should be followed and not allowed to lapse.
    • Adopt a change management process early that all stakeholders must follow.
    • Early, strong leadership assurance and intervention is essential.

Silos: Communicate the common purpose across divisions. Assign an internal “super-user” who can act as a non-threatening peer resource. This person can positively “cross-pollinate” as she moves through the divisions acting as a coach during implementation.

No Leader/ Many Leaders: Without clear, top management leadership, sustainability will be a problem. If a manager gets moved, promoted, or changes jobs, suddenly everyone remaining is left with the question “Why are we doing this?” This leaves a political power vacuum that will be filled, possibly not in a way to benefit the original vision of the software implementation but more to suit the local vision of a solution.

Differing Personal Priorities: It is in effect, a conflict of interest if the leadership of a department or specialty has a significantly different outcome in mind for the implementation than the leadership of the organization. There may be a conflict of interest policies already in place to review.

Hero: Getting these personality types involved early with stakeholders may be crucial. Following a defined “change management process” and “freezing custom work” will help overcome last-minute discoveries and allow the implementation to move forward. After the physician scheduling software is integrated, these ideas could be reviewed and possibly implemented as a Phase II project.

Busy Betty and Bob: Usually this is a single individual empowered with the key task of determining the physician on-call schedule. There are many reasons why change may be difficult at this level, including social standing, and can be especially difficult if this is a co-owner Physician. Internal leadership and people leading the change process should be sure they communicate the four “change management Ps” effectively and firmly. The 4 Ps are:

    • Purpose: Why are we doing this?
    • Picture: What it will look and feel like when complete.
    • Plan: Step-by-step, how we will get there, and who are the internal support people?
    • Part: What this person can (and needs to) do to help move the project forward!

Key Takeaway: Poor communication and mismatched expectations lie at the root of many on-call physician software implementation failures, but “Teflon” integration can be avoided with early planning and strong internal leadership.


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