Generating the Perfect Physician On-Call Schedule

Perfection, the ultimate desire! Is the pursuit worth it?

Is an on-call schedule “good” only when each individual Provider is satisfied (no unhappiness)?

Automated physician scheduling software can do many things such as save you time, help you generate consistent results, and provide transparency of the process. But software has never solved in-house political problems or replaced the leadership of a seasoned on-call scheduler making an educated judgment call.

Some schedulers get so excited about the possibilities envisioned with their new scheduling software, they forget it remains a tool; it is not artificial intelligence. Usually, three things begin to happen . . .

Three traps of dissatisfaction eager schedulers tend to fall into:

    1. They assume the scheduling software is an artist that will automatically create the perfect masterpiece for them that they have in mind. They forget evaluation is a subjective judgment and therefore by definition imperfect. Even when on-call scheduling software generates even tallies and spread, beauty remains in the eye of the beholder, and accountability remains with the scheduler.
    2. They create many complex rules chained together with multiple levels of scheduling as conditions for filling the assignments. They forget the many exceptions to their rules or they try to cover every “what if” scheduling condition.
    3. They begin to run scenarios, generating a future feature list, looking to solve problems beyond what they bought the software for. The “problems” may be political in nature even originate in a different department entirely! A certain amount of this is great and may inspire features worth adding to the program. It may also make the scheduler aware of additional features the program already has that the scheduler wasn’t aware of. However, schedulers may forget they need a documented, repeatable scheduling process for the here-and-now that they can use to get today’s job done. They may get hung up in the “nice to haves”. What was the original problem we came to solve again?

How can the three traps be avoided?

  1. Perfect is when “all the Doctors are happy”, really? This is the ultimate desire, and is often expressed. However, it is also often impractical. The irony is that while “perfect” may exist as a concept that keeps us trying to make the schedule better, anything we judge as “perfect” changes after a cooling-off period. This is why we can judge something perfect one day, and flawed the next day without making a single change. The only thing that actually changed was our ability to judge the quality objectively.

A “good” on-call schedule, created in a documented manner by a consistent scheduler, who understands why the schedule “looks like that” because he/she uses a repeatable process … may be more valuable than having a “perfect” on-call schedule one month out of the year, and disaster the rest.

  1. Too many conditional rules chained together actually hinder getting the physician on-call schedule out due to all of the various constraints. This is especially true if the rules are in flux or “designed by committee”.

Some rules may be in place to avoid “looking stupid” by forgetting something. These are fine for the most part, but when they are there to “cover your ass” for an outlier incident, they also limit flexibility. Document why a rule is being used. Where did it originate? Is the rule for on-call still pertinent? Are you letting Dr. Difficult dictate your scheduling process?

  1. If the goal is to generate a reliable, justifiable schedule, then you need the right scheduler, using the proper scheduling software, following the correct process every time. The “correct process” and “every time” seem to be the most difficult pieces. Scope creep (solving a different problem), and a “scheduling team” made up of changing opinions are significant hazards not solved by the on-call scheduling software.

Key Takeaway

“Good” may be a better goal than absolute perfection for the on-call schedule. The scheduler needs to avoid being trapped in a permanent state of dissatisfaction with every schedule created. He may not need to make it perfect, but make it work. At some point, any changes made no longer make it better really, but just different.


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