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Handling Physician On-Call Scheduling "Fires"

Aka: I don't want to do it THAT way again!

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Alert: Are you in a state of flux, on dead-line, with high wind warnings (change is coming), and short tempers combined with a drought of information and/or communication? Then you have a scheduling Fire!

Causes: changes crunched into less than 30 days with a loose or no “policy” to guide you.

Examples:

    • On-Call groups merging
    • Changing locations or office coverage
    • Changing rules of how coverage is determined
    • Groups splitting up-missed expectations of what is “fair”

Goal 1: Get to the root of the problem and get aligned around a temporary policy and process of what they were going to do for now, and schedule a date to discuss a permanent “fix”!

Goal 2: Get a schedule out there for now so assignments are covered, using the best information you currently have on hand. Iterate the live on-line schedule as needed so everyone has an up-to-date copy at all times, but remember the “Fire” scheduling process is a temporary solution.

With today’s 4-hour news cycle, coupled with technology in general, we have created an “I want it now” society. We expect immediate gratification, and it seems the solution should be is just a quick mouse click away as well.

Turning Out a Great Schedule Still Requires Time

Turning out a great schedule still requires time, just like turning out a great term paper or any other project with a deadline. Once the rules and process are determined, a great schedule can be generated again and again, but the first one takes planning, and planning takes more than 2 minutes and “one person” consensus.

What if you simply don’t have the time and you MUST get this out NOW?! Then you are going to need an Iterative on-call schedule.

On-call Scheduling software will greatly assist in putting out your FIRE, but it cannot rescue you entirely from a fire that doesn’t have a policy and rules in place. You will still need to define your schedule and what “fair” is in the eyes of your Group.

When in a rush, we often rush conflict resolution. And more likely there may be attempts to avoid confrontation in the first place by withholding information or candor. This rush-to-deadline is the root of stress, mistakes, and misunderstandings. This is why you must schedule a future meeting to determine agreed-on “rules” and the on-call scheduling process.

A successful “rescue story” of how scheduling software saved the day may have left out that the “quick results” were only possible because a previous policy and process were behind it, and an experienced scheduler with authority pulled it together. Doing the hard work of planning and execution is not immediately visible to the end “user” of the schedule. (see BBQ schedule below)

What to do when Scheduling under “fire”?

Determine how much time is really needed to plan and generate your schedule. Then Stick. To. Deadlines!
Note, there are two parts:

    • Planning
    • Generating

1. Planning:

    • To determine the date you need to have information collected prior to scheduling, work from the “publish” date backward.

— Your schedule is due out when? That is your “target” deadline

    • Now, how much time do you need to collect requests?

— Back that out

    • When is the deadline you are going to use for the vacation submission cut-off?

— Back that out

    • Who will enforce your policies so you don’t have so many last-minute changes?

No “sheriff in town” means additional issues for you! Avoid heated conversation that could touch off an additional fire, but don’t avoid the conversation!

— Back out the time you need to redo the schedule if the policy is not adhered to.

    • How much time you do need to personally review the schedule before you pass it up for approval?

— Back that out

    • Who else needs to approve before release? The time needed to implement “other” approvals/ changes.

— Back that out

    • This is your real “initial” get-started deadline you must adhere to if you are going to hit your target deadline.
    • Did you discover you really needed to start this LAST week?!

2. Generating a “one-off” on-call schedule while under “fire”:

These temporary patches may rescue you, and will help identify issues you need to address to make sure your next schedule is a great one!

    • BBQ grill scheduling can use paper if necessary
    • Use Excel Import, to upload an Excel pre-formatted “sign up sheet” for on-call, and the scheduler is alerted to conflicts due to vacations, etc…
    • Pre-agreement for the one-time template, just get it done. Everyone works out swaps for vacations after release.
    • Generate a schedule with minimal rules you already know. The scheduler has authority and experience. Not a “newbie”. Fair initial tallies are important, swaps and vacation requests not in place are handled after release using the Provider Request feature for tracking and ease of use.

For a permanent “Fire Out” solution: A Fierce Conversation will be in order.

Do the work, stay focused and persistent, be generous in spirit, value and nurture relationships, remember it takes time and each time will usually improve things. You won’t be doing insane scheduling next time!

Key Takeaway:

That “over-night,” successful, great On-Call Physician schedule everyone loves? It was actually months in the making with planning and discussing policy, AND the rules/process used are actively reviewed each year.

 

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