How to Handle Physician On-Call Scheduling Software Fairly

I recently read an article in Harvard Business Review about “How to Manage Scheduling Software Fairly”. I was surprised by how many scheduling software implementation problems Starbucks workers and On-Call physicians have in common.

Man vs “the machine”. Starbucks uses automated software to schedule its 130,000 baristas, which tends to give them last-minute schedule notice and, too frequently, schedules night-closing back-2-back with morning-opening in order to “optimize” its workforce. By taking into account “more data than any human could process”, Starbuck’s software is able to schedule shifts in 15-minute increments to maximize staff/patron coverage. While great for profits, this tight “on-demand” solution creates havoc with baristas’ at-home schedules and relationships. Talk about stress and unhappiness!

Like Starbucks, Clinics have to balance the needs of their patients (patrons) with the needs of the business and physicians (staff). Clinics also turn to automated scheduling to solve the problem instead of manually plotting each provider into shifts on paper or Microsoft Excel. This frees expensive physician-scheduler time and can help balance the on-call schedule needs of the Emergency Department and physician at home. But is “magical” once-click scheduling a reality? Is it really possible to have just-in-time scheduling of staff?

Over-implementation of automation introduces new problems. Taken too far, esoteric rules created to please a few providers clash with the desire for a predictable life by providers as a whole. Automation doesn’t help keep “fairness” when the scheduled time-periods are so short that the tallies simply cannot even out. However, if there are not enough rules, there is too much unpredictability for the Providers.

A dirty little secret from Starbucks: “even the most advanced scheduling software, incorporating every bell and whistle, tends to be wrong at least as often as it is right when the time intervals are short”.

Reality gets in the way:

  1. Tracking everything is not more accurate. In response to the “wild west” of no rules, some Clinics try to implement very specific rules for each and every provider OR use the same global rules for everyone. Because Schedulers can now get accurate tallies, they try to make them precisely even for every individual week/month rather than over a reasonable time-frame that allows for a “catch-up” period to account for high vacation months and other variables. This creates distortions in the tallies and unrealistic expectations of what they can and should be.
  2. A lot of flexibility isn’t necessarily a good thing. Locum and part-time Providers can help up to a point, but having many part-time physicians requires greater coordination between all providers. If on-call is shared between Clinic Groups, there are even more moving parts. Last-minute time-off or highly variable periods of Provider availability followed by weeks of unavailability defies any scheduling software solution.
    No consistent rules + No Holidays prescheduled = No viable, reliable schedule.
  3. Perfect schedules do not exist. To produce a perfect, optimal schedule, Providers must all submit their needs for days off in advance, the same number of staff need to be available over similar time-periods, Providers must all agree to the same global rules (especially regarding weekend coverage), and the schedule must be turned out for a long enough period of time for tallies to equalize (say every 7 months for some groups instead of 7 weeks). Then you might generate a one-click “perfect” schedule. How realistic is that? Rules change, Providers cut back to part-time for a couple of months, Dr. Difficult dictates his schedule, and all others fall in place after that… THAT is real-world scheduling.

So what should Schedulers do? First, know there is considerable variation in how the same software is implemented in various Clinics across the nation. Each Clinic must balance their own software schedule results between pure-value for management and pure-value for Providers.

Here’s the dilemma:

  • Push an online scheduling system with same-rules-for-everyone too hard… and Providers leave.
    OR
  • Push for too much flexibility with individual rules for each individual provider, and software becomes prohibitively expensive, or won’t generate a schedule at all.
  • Don’t push hard enough for conformity-of-use (Provider Requests, uniform calendar format, online viewing, or iCal subscriptions instead of printing/faxing)… and management loses value.
  • Rely on “cold automation” that doesn’t spend time “living” the schedule or know the Providers personally, and it feels like “the machine” has unfair scheduling power.
    OR
  • Use strictly a human Physician-scheduler, and there will be accusations of favoritism or “gaming the system”… even if profoundly untrue.

The answer is to take appropriate advantage of on-line scheduling software’s automation to structure the initial, equitable schedule so most of the positions are filled, spread evenly and the tallies are fair at that point. This makes sure the initial positions are impartial and unbiased. Then use your Physician-scheduler or executive assistant experience to fine-tune the schedule according to reality “on the ground”. Having experienced “living the schedule”, this person will have less work to do by having an equitable schedule to start with, and the resulting on-call schedules will have more transparency than pure manual scheduling will allow. They will also be completed MUCH faster!

Failure of physician scheduling software to 100% create fair schedules with one-click is not a “bug” in the software. There will always be nuances and variation in any particular Clinic’s on-call calendar that is too complicated for scheduling software to take into account. However, online software is accessible by schedulers and providers, so requests and modifications can be handled speedily in real-time. No more last-minute surprises of “Oh! I’m on a call?”

Key Takeaway:

Ultimately, the success of a software scheduling system depends on it serving both the Schedulers and the Providers being scheduled. By empowering Schedulers and Providers to use the schedule interactively, they can be learning rather than submitting to top-down compliance. The results can far exceed any static “dead” paper/Microsoft Excel document or something that is a “one-click” scheduling solution.

*Inspired by and paraphrased from the HBR article found here.

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