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Physician On-Call Scheduling and On-Call Management Blog
by Justin Wampach

Avoid Physician Scheduling Software Implementation Failure

Posted by Justin Wampach on Tue, Oct 18, 2016 @ 03:23 PM

ID-100308213.jpgLet me begin this post by saying that anyone who is in the business of creating and selling medical software wants every project and customer to be a complete success.  Not only for financial reasons, but for the simple fact that you don’t go into the business of solving problems for people only to let them down.  What doctor wants his patients to fail and die?  Probably none.  So let’s begin with the understanding that both sides (vendor partner and medical group/hospital) are hoping that each project is a huge success.   For more info on vendor partners check out my blog post "11 traits that your physician scheduling vendor should have". 

Sometimes no matter how great your intentions are, the software implementation fails and the customer stops using your product.  I have taken some time to examine some of the similarities in projects where we have not had successful implementations in order to learn how to do a better job.  Although not all projects are the same, when it comes to failure there are some striking similarities.

Lack of clear goals.  If everything is important than nothing is important.  Each project should begin with a clear understanding of the top 3-4 things that they wish to accomplish immediately.  For many of our new customers it is to (1) get the physician schedule online, (2) simplify the scheduling process through automation (3) get the physicians schedule into his/her smartphone.  If you are a medium size Cardiology practice and you are using paper and pencil or Excel today, accomplishing those first three items would be a big step forward.  Without clear goals, that are reasonable and achievable, everything becomes important and a priority.

Lack of time.  Physicians and or management sometimes forget that like themselves, everyone on their team is busy.  This can become a problem if someone is given an implementation assignment without having some relief of current tasks.  Adding more work to someone’s plate who is already overwhelmed is a clear receipt for failure.  If the project is as important as a new physician workforce automation system, then it deserves to have someone who has time to complete the project.  In addition, this does not mean having access to someone who is supposed to be answering the phone or is with patients who are “under” while they are trying to learn or assist with implementation. 

Lack of understanding.  People who do not understand the “why” can inadvertently sabotage the project.  Whenever we kick-off an Enterprise level implementation we try to begin by having the CEO or a senior executive send out a note to each person who will be involved in the project explaining why, out of all of the stuff that is going on, they have decided to implement this new solution.  In healthcare every project should be able to be tied back to the goals and master vision of the organization.  For most, everything begins and ends with patient care.  If your team does not understand who this project benefits and why, they are unlikely to want to participate.  This can be even more challenging if the “daily users” are not the direct beneficiaries.  In this case it is even more important.  Clear, concise messaging, from senior administration is key to implementation success.

Scope creep.  Scope creep is a direct descendent of not having clear project goals.  Without clear goals, everyone is wondering “what’s in it for me”.  And if there is nothing in it for them, they will try and add things to make their life’s easier.   Scope creep happens typically after people’s initial understanding of what needs to be accomplished gets completed.  Then users begin to want more, and often what they are looking for are things that they feel are complimentary based on their roles within the organization.  For example, someone who works with the physician scheduling and also works with compensation will often advocate for payroll integration.  Not that payroll integration is bad, in fact it’s a great idea, but more often than not most organizations have a sophisticated HR system that manages this function, alone with other things, perhaps like PTO.  Scope creep is typically at an end user level.  For example, if payroll integration is important, then it becomes an organizational goal that is discussed in the beginning of the project and there is a lot of thought put into how payroll and scheduling work together.  If everyone is crystal clear in what the organization is trying to accomplish in the beginning, then once complete the scope creep can be channeled into brainstorming future features to help solving the organizations next set of needs.

Lack of follow through.  This one is and has always been the toughest for me to understand.  We have seen project failure plainly due to people’s unwillingness to get the work done.  What is even crazier is that typically these are people who are supervised by others who also do not follow-through.  Part of this comes back to a “lack of understanding” of why this is important.  Especially if it is not going to directly benefit them.  During an implementation, leadership needs to choose people who have proven themselves in the past to be able to accomplish their assigned task.  Assigning even a small part of an implementation to someone who does not follow-through will place the entire project in jeopardy.  People need to be held accountable for their assigned work.

Resistance to change.  “The current way of doing things has worked well and I’m not going to change.”  Or, “this new way takes way too much time and I’m not going to participate.”  “We’re going to keep doing it the old way.”  Sometimes hearing these comments makes me want to burst inside.  Resistance to change often comes from someone with little authority, but a lot of power within the organization.  Resistant users camouflage themselves really well.  Most often the power they have amassed has come from either time on the job or the difficulty of the job.  They see themselves as irreplaceable or in a position where they know that they have the organization by the preverbal balls and aren’t afraid to twist.  Change is difficult, every book on change acknowledges that fact on page 1.  Typically change happens for a reason, often to make something ultimately better.  When you have someone who is very resistant to change one of the only levers that you can pull is to appeal to their sense of team and patient care.  This new system is necessary because …  As we grow, in order to provide better patient care, we need to …  Once they understand the “why” sometimes your resister can actually change to become an advocate.  Identify the resisters early, it might take some time to bring them around.

As you can tell, this is not a comprehensive list of reasons why software implementations fail, but it is most of the biggies.  One key theme throughout this post is around communication.  There is no substitute for having senior leadership communicate the “why”.  Not only should this be done first, but a best practice would be to continue the “why” campaign throughout the project.  People tend to support things that they understand, even if they don’t fully agree.  Implementing physician scheduling software has many benefits that are worth some of the trials and tribulations of getting up and running.  There is not much worth doing that isn’t a bit challenging when you are in the middle of it. 

Key Takeaway:  Spend as much time on planning and communicating your implementation as you did on purchasing the physician on-call  and work scheduling software.

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Image courtesy of pakorn at FreeDigitalPhotos.net

Free On-Call Scheduling Software Trial

Posted by Justin Wampach on Tue, Sep 27, 2016 @ 02:29 PM

ID-100259490-1.jpgTypically, a free trial is a great marketing offer to give a prospective buyer the chance to try it, before they buy it.  You know, kind of like a test drive.  I’m fairly certain that you will agree with me that some things lend themselves to a free trial better than others.  For example, a free trial of a colonoscopy, is most likely not a great concept, whereas a software trial seems to be a proven concept.  Regardless of how complex the software is, prospective users want to get in and “try-it-out”.  What’s the motivation to try anyway? It’s a great question, but one I don’t have all of the answers for.  I suspect that when people are looking for a “trial” they are not convinced that whatever product you are offering is the right fit or choice.  We exist in a world where people are less apt to try something for fear that failure will be seen as a negative or perhaps a fire-able offense.  Trying something reduces the risk of an error.

There are two types of on-call scheduling software trial users:  the first is most likely a physician who is at home on either a day-off or a weekend.  They are the person who has to create the next call schedule for their physician group.  There busy or perhaps they have put it off and put it off, and now it’s due in a few days.  As they begin the process a little voice in their head says “why the hell are you doing this again, isn’t there an easier way, like software?”.  They go to Google and find our website and look to our trial as something that will save them from the current situation that they are in.  Once they realize that there is work involved in transitioning from paper to software, they get frustrated and give up, and do the work by hand as they have been doing for years.  This first type of user is not an ideal candidate for a trial as they are not looking for a solution as much as they are looking for something to save themselves from a frustrating situation.  This type of person would be better served putting out the current fire on their own and then looking for a long term partner to help them transition from paper to automated software.

The second type of trial user is the one who has done their research.  This is often a practice manager or physician who is concerned about making the wrong buying choice.  They are not in a time crunch; they are in an evaluation stage.  They understand that learning something new takes time.  They are not putting out a “fire”.  They are taking a test drive.  This type of user has also taken the time to really understand the needs of the group, and often has a checklist of important features that they are comparing between software providers.  This prospect is very well informed.  They want to not only see how everything looks and feels, but they want to see their doctor’s names and assignment information on the screen instead of the what was presented during the sales demo.  These are very detailed people.  This trial user already feels pretty confident it’s going to work or they would not be willing to invest the time to try.  But they are concerned with buying something that doesn’t work for the group and having egg on their face over a bad decision.  That’s why they try first, confirm, then buy.  This person is the ideal trial user.  Most likely this user will complete the trial and become a paid user.  They will also communicate with you and give you great feedback; it really doesn’t get any better than this.

Consider this from a business prospective, software companies like Call Scheduler have most of their costs on the front end, training and set-up.  So a company has to feel very confident in its ability to satisfy needs of prospects if it is going to offer something for free that will cost them money.  At Call Scheduler we’re confident, that’s why we offer the trial and it’s free.  We’re pretty certain that at the end of the trial or sometimes in the middle, you are going to confirm your feelings that we are the solution of choice and you will convert to a paying customer.

Key Takeaway:  I think a free trial can be valuable for a prospect if they go into it with the proper expectations and have not been procrastinating.  After all there’s more to life than scheduling.  

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For more information about making a change to physician on-call software check out my blog post: Sure Signs You're Ready For A Change

Image courtesy of Stuart Mils at FreeDigitalPhotos.net

What Does It Mean to “Schedule Happy”?

Posted by Justin Wampach on Fri, Sep 16, 2016 @ 12:50 PM

ID-100376693.jpgIn a previous post I wrote about turning a skunk into a rose.  The skunk being the duties associated with creating, maintaining and communicating the on-call and work schedule for a group of physicians.  The post was meant to be a little tongue-in-cheek, while maintaining a level of truth regarding one of the toughest and most unpleasant jobs within a clinic or medical group.

Over the past several months I have been thinking about what it means to “schedule happy” in the context of creating on-call and work schedules for physicians.  I was able to narrow my long list down to 6 very key items that must be present to achieve scheduling happiness.

  1. People who are able to “schedule happy” have the proper tools to do their job.  This is the foundation upon which happiness is built.  I can assure you that most people who are responsible for the physician scheduling process, who only possess manual, tools, such as paper, a pencil, a calculator, dry erase board and perhaps Excel are not scheduling happy.  They are frustrated with the manual process, the amount of time it takes to complete, the inability to run scenarios, and not having any flexibility when it comes to last minute changes.  Having the right tools are paramount in being able to “schedule happy”.
  2. People who are trying to achieve scheduling happiness also need to have access to accurate information. This information includes past tally reports, past and current day-off request’s and holiday information.  Much of this information is used in the beginning of the “create a new schedule” process.  Without this information you are forced to make an unreasonable amount of changes to accommodate people’s requests.  Each time you make a change to a schedule, it effects other things on the schedule.  It is like a waterfall, what starts out small, can have a large impact in the end.  Accurate information when you need it is a key to scheduling happiness.
  3. In order for a “scheduler” to be happier there needs to be a common understanding of what tools are available and what their limitations are. For example, if you go out today and buy a brand new SUV and bring it home to your partner and the first thing they ask you is if it can fly, the wind will be out of your sails immediately.  Of course it can’t fly, there are no flying cars.  This is similar to the physician on-call schedule creation process, people need to understand what the tools were designed to do and what their limitations are so that you can get the most out of your investment.  We often hear stories of HR, practice administrators or doctors making promises to new physicians coming in to the practice about their schedule.  They are told, you decide how and when you want to work, and we will accommodate it.  This type of comment is not reasonable without understanding the effect of that making that promise.   Everything has limitations.  The closer you are to those border limits the more money you will need to invest in order to make your need a reality.  Adjust your expectations and find common ground so that everyone’s needs can be reasonably accommodated.
  4. Another aspect of “scheduling happy” which is similar to “common understanding” is reasonableness. Tools such as Call Scheduler are not going to solve your provider shortage problems.  Although we can help you predict when your problems will become apparent, you cannot magically schedule the work of 10 doctors with only 6 doctors, and keep it fair.  Consider an example of installing only 3 tires on your car.  No matter how hard you try, your car will not drive or operate very well with only 3 tires.  Not even if you put them on differently or in a new order.  You need to have 4 tires in order for your car to operate correctly.  Tools to help you “schedule happy” do not contain magic, they require adequate resources in order to get the right doctor in the right place at the right time.
  5. The fifth aspect of “scheduling happy” is “Buy-in”. Similar to installing a new EMR or CPOE system, everyone needs to be onboard with the new change.  Clinic leadership needs to do a good job of explaining to everyone why projects such as a new physician scheduling system are important to the achieving the mission of the organization.  Everyone needs to buy-into the why.  If you have buy-in, people will be understanding of the new process and the changes.  This buy-in is probably one of the most important steps to achieving happiness.  Without the buy-in you will most likely be trying to maintain two systems, the old one and now a new one.  That is the worst case scenario.  In addition to buy-in you also need a “white knight” who will come to your rescue when you have someone who is not buying in and needs some convincing. 
  6. The sixth aspect of “scheduling happy” is time. It takes time to create a happy environment.  It takes time to learn a new system.  It takes time to transition from a paper system when most of the knowledge in someone’s head.  It takes time to run different scenarios to see which results you like better.  I know you want to save time by just making the purchase, but unfortunately it’s just not that easy.  It takes time to save time in the end.  Anything worth having is worth taking a little time to set-up and configure. 

Key takeaway:  We want you to schedule happy.  We also want you to know what’s involved in that process.  Think of happiness like trying to lose weight, most overweight people want to lose weight, but they don’t want to put in the work to make that happen.  Very similar to scheduling, if you desire happiness, take into consideration the six steps above and be willing to put in the work to make it happen.  Happiness starts with you!

Image courtesy of Brawny at www.freedigitalphotos.net

Physician On-Call Schedulers Resistant to Change

Posted by Justin Wampach on Fri, Aug 26, 2016 @ 12:00 PM

think-different-bubble-represents-change-now-and-revise-100303198.jpgWe often have physicians contact us who are very excited about making a change from manually creating the physician on-call schedule to using software to automate the process.  They like the features, they are supportive of our monthly per provider pricing model.  They think we’re a great fit, and then they talk to their counterpart who also helps with the schedule.  They don’t want to use software, they are happy with how things are today and see no need to change.  In fact, they see the change as some sort of a threat.   Although most doctors have fairly strong personalities, they are not ones for causing too much turmoil within the practice.  So often times the dreams of automatically having the schedule in their phone or being able to make a vacation request from their phone is squelched by a resistant employee who is afraid of change.  Is there any way to reduce or eliminate resistance on the front end or do we just have to deal with it as it comes up?

According to a recent article on The Balance.com website by Susan Heathfield, “resistance to change can be covert or overt, organized or individual.  Employees can realize that they don't like or want a change and resist publicly and verbally. Or, they can just feel uncomfortable and resist, sometimes unknowingly, through the actions they take, the words they use to describe the change and the stories and conversations they share in the workplace.”  In a medical practice or hospital “the more powerful the resisting employee, in terms of job title, position, and longevity, the more success he or she will have with their resistance.  Resistance to change appears in actions such as verbal criticism, nitpicking details, failure to adopt, snide comments, sarcastic remarks, missed meetings, failed commitments, endless arguments, lack of support verbally, and outright sabotage” says Healthfield.

Now that we can diagnose resistance based on some of the symptoms we just learned about, how do we move forward?  Here are some ideas:

  1. Embrace a culture of trust. Employees trust leaders and companies that are open, honest and transparent.  Everyone hates surprises, especially without one hell of a good reason.
  2. Share the vision. Be sure everyone understands what you are trying to accomplish, and for who’s direct and indirect benefit.  Tie decisions like this back to patient care.  Its ok to tell your team that “were buying this software to assist the physicians”, not everything has to benefit everyone.  See my previous post Who are you buying on-call software for?
  3. Ask for input. Be sure you are doing your best to rob from Peter to pay Paul.  It’s never a good idea to make someone else’s life better by making someone else’s worse.  Be sure you understand the implications of something new.  Get input from everyone, not just the people at the top.
  4. Create realistic expectations. Try not to paint too rosy of a picture of what utopia looks like.  Try to talk more about what the process looks like.  Nothing is perfect in the beginning, especially with software.  Sometimes it’s even a bit worse in the beginning because you are learning something new and having to get a work product completed.  Look to the big picture and go back to your original vision.
  5. What’s in it for them. If there is nothing to benefit the user who is resistant, you may not be able to achieve success.  Find a few things that will be better for everyone.  This gets back to the concept of not robbing Peter to pay Paul. 

If you are implementing a new physician oncall scheduling system in your practice or hospital with transparent communication and a high level of trust, you will gain a great advantage.  But remember you are dealing with humans who have emotions and responses that are amplified during times of change. 

The key takeaway is that there is a right way and a wrong way.  Although the right way takes a bit more time, energy and the use of kid-gloves, the alternative is resistance and even sabotage.  Spend the extra time, it will be worth it in the end.

PS, if you have experienced a failure in the past with integrating something like on-call scheduling software, be sure to look beyond the commercial vendor/partner features and capabilities, which is what your team will most often point to as reasons for failure.  Most vendor/partners want nothing more than for solutions to be successful.   The absolute last thing they want is a customer to leave and revert back to what was not working when you first meet.  They have invested a lot of money and time to create commercially viable solutions.  Sometimes you may need to look internally and ask yourself as an organization, why won't this work for us?  Why are we so different from others who it has worked for?  Did we sabotage the success of this ourselves?

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Image courtesy of Stuart Miles at FreeDigitalPhotos.net

On-Call Software Vendor or Partner, What’s the Difference?

Posted by Justin Wampach on Tue, Aug 16, 2016 @ 02:25 PM

ID-100230129.jpgWhen searching for new solutions to complex problems within your hospital or medical practice are you looking for a vendor to sell you something to fix the problem or are you looking for a partner to help you fix the problem?  What’s the difference?

As a software company we work with a lot of other companies who assist us in finding solutions to complex problems that we encounter.  For example, they may be problems around building a new “rule” or “auto-scheduling engine” for scheduling our doctors.  Or it may be around user experience and user interface design.  We look outside the company for solutions because it is either not something that we are “experts” at or it is something that we are not going to do every day, so it makes sense to find temporary help.

Over the past 20 years in business I have learned a few things about the different types of organizations that you can work with to help you solve your problems.  What kind of probems specifically?  I have narrowed the types of organizations down to two, vendors and partners. 

Vendor

Partner

Wants to sell you something

Wants to help fix your problem

More concerned with their needs

More concerned with your wants

Wants to close the sale for his commission

Wants to close the sale to help you faster

Is concerned about today

Is concerned about you tomorrow and next year

Tells you what you want to hear

Tells you the truth, even if its not to his benefit

Is an advocate for his company

Is an advocate for you, his customer

Tells you a bunch of stuff

Askes you a lot of questions

Is willing to close the sale

Is willing to walk away from a sale

Doesn’t want to deliver bad news

Doesn’t want to, but will deliver bad news

Wants to succeed

Wants you to succeed

Considers you a prospect / customer

Considers you a prospect / partner

Talks a lot about his product and business

Talks a lot about people who he has helped

Will send your call to voicemail

Will answer with a smile

 

As I was talking about vendors and partners regarding this blog post, one of my colleagues gave me a great analogy, she said that a vendor will sell or give you a hammer.  A partner will also sell you a hammer but also show you how to use it to build the kind of house that works best for you.

I think that there are very real differences between a vendor and a partner.  I would encourage you to identify who the true partners are within your hospital or medical practice.  Thank them for the great partnership that you have created.  If they have helped you, don’t be afraid to help them.  I would also encourage you to identify the vendors within your organization.  Ask yourself why these people aren’t your partners.  Maybe it’s you and maybe its them.  Perhaps your organization doesn’t promote a culture of true partnerships.  Maybe you have a strong purchasing department that strips away all of the value that a true partnership brings to the table.  Either way, figure out how to change the relationship.  It is in your best interest to surround yourself with quality partners that want to help you succeed.  You need help, everyone needs help. 

All of the relationships at Call Scheduler by Adjuvant are partnerships.  We rely heavily on our partners to help us run and grow our dynamic fast paced physician scheduling business.  On the flip side, we are looking for hospitals and clinics that value partnerships and are looking to solve the oncall problem once and for all.  We want to work with people and organizations who appreciate how much we care and what value that provides. 

We want to follow the golden rule, do unto others as you would have done to yourself.

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Image courtsey of Patrisyu at FreeDigitalPhotos.net 

Scheduling Physicians is EASY with SaaS

Posted by Justin Wampach on Fri, Jun 24, 2016 @ 11:16 AM

ID-100259561.jpgOur point of view is that software specific to creating, changing and communicating a physician’s on-call and work schedule should be easy to buy, easy to set-up and easy to use.

What is the purpose of software?  According to blogger David Longstreet “the answer is obvious, the propose of software is to solve problems”.  What is the purpose of software as a service (SaaS)? First let’s define what SaaS is?  SaaS is a method of software delivery that allows data to be accessed from any device with an Internet connection and web browser. In this web-based model, software vendors host and maintain the servers, databases and code that constitute an application. This is a significant departure from the on premise software delivery model. The purpose of SaaS is to give users all of the features and functionality of software, without all of the expensive hardware and maintenance associated with operating software.

Call Scheduler is a SaaS based physician scheduling software system.  Check out a previous blog post "SaaS -vs- traditional software" to see some of the differences.  Or let’s look at some of the problems that our prospective customers have come to us to solve:

  1. It takes too much time to “create” the physician schedule
  2. It is too hard to remember all of the rules for all of the doctors when creating the schedule
  3. I can’t create more than a few weeks at a time due to its complexity
  4. Processing day-off and vacation requests is very time consuming
  5. Keeping track of how many vacation and day’s-off each physician has had or will have is very complex
  6. Managing the changes each day/week/month is time consuming
  7. Communicating the changes to the schedule is very time consuming
  8. People don’t keep up with the schedule changes and the wrong doctor gets called
  9. Keeping track of the number of assignments each physician has or will have during a certain period of time is a lot of work
  10. Manually entering your on-call assignments into your smart phone is time consuming
  11. Communicating who is covering “call” for our medical group to the hospital is time consuming
  12. Going back in time to see who was “on-call” last November 3rd is very time consuming
  13. Our schedule creation process in not documented. It lives in someone’s head. 

The SaaS delivery model is perfect for medical practices and doctors due to its low cost of entry and non-existent maintenance fees.  Physician scheduling software is also a perfect SaaS match because it solves many very complex problems, for very busy people, without large IT infrastructures.

Top Benefits of SaaS as it relates to scheduling physicians:

  1. Access to the software and it’s information should be easily accessible from any device with an Internet connection
  2. Low initial costs. No servers to buy or manage, no special computer systems or people to manage them.
  3. Low initial risk. No multi-year long term agreements, or huge up front investments
  4. Does not require on-site set-up and configuration, customers should be able to set-up and configure with minimal assistance.
  5. Free upgrades and improvements without having to download anything, just log-in
  6. User directed iterative software development. The application features are always expanding based on customer needs and wants.  Everyone benefits from everyone’s ideas.
  7. Multitenant software architectures can scale indefinitely to meet customer demand.
  8. APIs that let you integrate with existing Practice Management or EMR systems.

Key takeaway:  Just because you can access software via a web-browser does not mean it’s delivery model is SaaS.  The benefits of using the SaaS delivery model when scheduling physicians for both on-call and “work” are tremendous and should not be discounted.  The future is here.

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Image courtesy of Stuart Miles at FreeDigitalPhotos.net

Topics: oncall

On-Call Scheduling for Dr. Difficult

Posted by Justin Wampach on Thu, May 12, 2016 @ 02:05 PM

ID-100325654.jpgAt what point does Dr. Difficult become Dr. Pain-in-the-ass for the person who is charged with creating, updating and communicating the physician call schedule?  I think if you ask any scheduler they would tell you the turning point is when they can no longer use standard tools to accomplish their scheduling task, because of this one doctor just has to have it their way.

I am writing this blog post today in support of schedulers who struggle dealing with difficult people who have the power and influence to make an already difficult task selfishly more difficult.   Also please check out a post titled "How to Handle Physician On-Call Scheduling Software Fairly"

During the sales process, in the early stages of “discovery”, I typically learn the trials and tribulations of the groups that I am speaking with.  I often hear about the organizations desire to create some sort of “standardization” around scheduling.  Most of the time they are coming to Call Scheduler because they have not been successful in doing this on their own.  After spending some time “pealing the onion back” I often learn that the major barrier to on-call scheduling standardization is one or two physicians who are unable or unwilling to accept what everyone else considers fair and equitable. 

Taking a standard process and modifying it for one or two people is what is commonly referred to as “feeding the dragon”.  This means that by complying with the “only for me requests” we are not only enabling this type of behavior, but it also has negative impacts on the other providers, staff members and the organization as a whole.  So how does the “only for me” behavior of one or two have negative impacts?  In my opinion it all comes down to time and energy.  Typically, small groups are able to find common ground for the good of the order.  Not everything has to, or is going to be perfect for everyone involved. 

Here are some examples of Dr. Difficult’s behavior:

  • Every time I see my name it has to be in green. I couldn’t possibly find my name on a sheet of paper or calendar if it’s not colored in green.
  • Everyone is supposed to use the electronic day-off request area to request time off, except its ok for Dr. Smith, he’s not computer savvy.
  • All providers do weekend call as Friday, Saturday, Sunday. Not Dr. Difficult, he will only do Saturday and Sunday.
  • All providers will do back-up the following week after they take call. Not Dr. Difficult, in fact he needs a day off the day before and after being on-call.
  • Difficult changes his vacation or day-off requests after the schedule has been “blessed” as final. Now the schedule has to be re-done.
  • Difficult calls you and says, I can’t work next Friday, you need to find a replacement.
  • All doctors agree to a 3-month schedule and will turn in day-off and vacation requests for the next three months. Not Dr. Difficult, he only knows his personal schedule one month at a time.
  • Difficult has a secretary or intermediary make requests for him so if it is not accurate he has someone to point the finger at. He is never wrong.
  • All requests from Dr. Difficult are last minute and considered a fire that requires immediate attention.
  • Difficult wants a new printed copy of the schedule each time a change is made and he would like to see what the change was highlighted. Everyone else can look on-line.
  • Difficult frequently says, “why am I doing your job for you”?
  • Nothing is ever Dr. Difficult fault or problem. Always someone else’s.

In the medical community I see a strong tendency to feed the dragon by allowing and accommodating individual requests at the expense of the group.  In my world of software, the typical savings and return on investment comes from creating a fair standard that everyone can live with.  What we often her happening is that in the end they can’t standardize on a process because it is only that way for everyone but Dr. Difficult.  Therefore, attempting to standardize becomes less of an automated process and increasingly more manual, in order to accommodate everyone.  In that case, the scheduler often times says, I may as well just do it the old way.  I guess everyone will just have to suffer.

Some remedies may include having a “white knight” or senior person that Dr. Difficult respects explain to them the ramifications of their unique demands, and the stress it puts on the rest of the group.  If Dr. Difficult isn’t a complete narcissist, which he often is, he may come around for the good of the order.

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Secure Texting-Get Ahold of the Wrong Doctor Faster

Posted by Justin Wampach on Thu, Apr 14, 2016 @ 11:57 AM

ID-100367140.jpgOver the past 5 years there has been a massive insurgence in the secure text messaging market, aka secure texting.  A lot of companies from telecommunications equipment manufacturers, stand-alone companies and even some scheduling companies have dipped a toe into this texting software arena.  Great news for physicians, right?  Everyone wants to ditch the pager.  They are old, out of date, and the replacement costs are often more expensive than a smart phone.  The concept is that everyone already has a smart phone, so why not securely send a text message to the on-call doctor?  It sounds good on the surface, right?  Well, that depends on the problem you are trying to solve.  If the problem you are trying to solve is “how do we contact and communicate with the correct on-call physician,” then perhaps secure messaging is only part of the problem.  In a previous post I asked the question should secure text be part of on-call management software?  

I would argue that adopting a secure messaging solution prior to correcting the “accurate on-call information” problem that exists in most hospitals, is premature.  What you have done is find a new way to contact the wrong doctor, faster.  Whoops.  Many hospitals are still managing on-call information via 3-ring binders and dry-erase boards.  With the volume of daily changes to physician schedules increasing, and the availability of physicians decreasing, schedule accuracy is a key dependent in this equation.

Let’s review the typical hospital on-call process:

  1. Physician schedule is created at clinic (quarterly)
  2. Physician schedule created by clinic is distributed to the hospital for ED specialty consult coverage (monthly)
  3. Hospital receives each specialty on-call schedule from all clinics, archives schedule (monthly)
  4. Hospital reviews each clinics on-call schedule and manually creates a “daily call roster” (daily)
  5. Hospital distributes “daily call roster” to ED and nursing units (daily)
  6. Physicians call hospital to make same-day on-call schedule changes (daily)
  7. Hospital manually updates the “daily call roster” for each change (daily)
  8. Hospital distributes updated “daily call roster” to ED and nursing units for each change (daily)
  9. ED physician needs consult and looks up “who is on-call” via “daily call roster” (daily)
  10. ED requests that telecom “page” or “text the on-call doctor” for xyz specialty (daily)
  11. Telecom “pages” or “texts” doctor who they think is on-call (daily)
  12. Doctor responds and accepts or declines the request for a consult (daily)

In this typical hospital on-call model you will note that the “messaging” or “activation” portion of this process is step # 11.  Now clearly messaging is a very important step in the on-call process, and it is a very worthy problem to solve.  My question is, when should this be solved?  Does it make sense to have a new, fancy system to communicate with doctors, when your current system to identify which doctor to communicate with is outdated?  To me, that is a classic example of  ”putting the cart before the horse.”

I think if you were to survey a group of doctors, most of them would tell you that how they are notified, is far less important than notifying the right physician.  No one wants to be paged or messaged incorrectly if they are not scheduled to be on-service.

Key Takeaway:  It’s possible that knowing who is on-call, and making sure that information is up-to-date and accurate is far more valuable to doctors than what technology is used to notify them.

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Image courtesy of Goldy at FreeDigitalPhotos.net

Physician Scheduling Standardization

Posted by Justin Wampach on Tue, Apr 05, 2016 @ 01:27 PM

ID-100328777.jpgOver the past 10 years I have been confounded by the lack of physician scheduling standardization I see inside of corporate owned healthcare systems.  In most organizations each medical specialty or department, eg. cardiology, neurology, ear, nose, throat, etc. have a different process and system for creating, maintaining accuracy and communicating the physician schedule.  The lack of standardization in scheduling doctors has forced users to invent their own individual solutions to common problems that are being experienced by others within the same organization.  I believe this is referred to as “reinventing the wheel”.  Not only is this a contributing factor to physician dissatisfaction when it comes to “scheduling”, but it is just plain silly and inefficient.

What are standards?

Standards are a document that is established by consensus and approved by a recognized body, that provides for common and repeated use, rules, guidelines or characteristics for creating a physician schedule, aimed at the achievement of the optimum degree of order.

Simple examples of current healthcare standardization:

  • All employees in the clinic, regardless of department answer the phone in the same way.
  • All patients “check-in or register” in the same day, regardless of department.
  • All of the exam rooms similar.
  • All patients are billed the same way
  • All payments are collected the same way, regardless of specialty
  • All of the staff (doctors, nurses, support) get paid on the same payroll cycle.
  • There a parking policy regarding where each type of staff is supposed to park.
  • Lab specimens collected the same way regardless of department.
  • Medical records are documented the same regardless if you are a patient of Cardiology or Internal Medicine.
  • Usernames and passwords follow a standard naming scheme to allow for consistency and ease-of-use when it comes time to provide end-user support.

Why are standards important?

Standards provide the following:

  • Adherence to standards helps ensure reliability.  As a result of reliability, users perceive standardized processes to be more dependable, and in turn raises user confidence.
  • Adherence to standards helps maintain fairness.  As a result of fairness users will feel as if their interests are protected and they are not being treated differently than their peers.
  • Economies of Scale. Standardization provides a solid foundation for basic business benefits such as economies of scale.  This is most beneficial in terms of receiving the best price and discount level for your organization.
  • Cross training. Standardization provides the ability for one person to be able to assist another in similar duties because everyone is using the same tools.
  • The ability for things to work together relies on products and services that comply with standards.

What are some economic benefits to standardization?

  • Short and long term cost savings. Companies actively involved in creating “scheduling standards” will reap short and long term cost-savings more than those that do not participate.
  • Competitive advantage. Organizations are motivated to participate in standardization because they gain an edge over non-participating companies in terms of insider-knowledge.  Easy access to accurate information is valuable.
  • Cost reduction. Standardization can lead to considerably lower scheduling costs.
  • Vendor/client relationship. Standards have a positive effect on the buying power of a healthcare system.
  • Strategic alliances. Standardization encourages cooperation between all parties in the “chain”.

 In most large clinics and care systems I have spoken with about the lack of physician scheduling standardization they tell me that it is next-to impossible to get everyone to agree.  They say to me” do you know how hard it would be to get Cardiology to schedule in the same way that Neurology does?”  So instead they allow the physicians or someone in the organization to invent a way of doing the work.   Regardless of the time it takes or the inefficiency of the process.  Oh and by-the-way, what gets invented is changed and modified by every new physician or administrator that comes into the practice.  If you ask a scheduler why something is done the way it is, you will often get the response, “not sure, we have always done it that way” or “Dr. Smith wants it done that way for him or herself”.    

Key Takeaway:  I will not discount how painful and difficult creating the physician scheduling standardization will be, but I will guarantee that the benefits to physicians, patients and the organization as a whole will far outweigh the pain it takes to get there.  After all, you’ve practically done it with everything else, this shouldn’t be different.

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Can't get enough?  Check out another great blog post about on-call "Why am I doing the schedulers job for her?"

Image courtesy of Stuart Miles at FreeDigitalPhotos.net

Topics: oncall

Who Are You Buying On-Call Software For?

Posted by Justin Wampach on Wed, Mar 16, 2016 @ 02:22 PM

Who are you buying on-call software for imageWho’s life should be made easier by the transition from a manual paper based on-call scheduling system to software, the person who creates the schedule or the doctor who has to do the work?  I vote both, and even a few extra people, if you can afford it.

Long gone are the days where you need to choose between the doctor and the scheduler when evaluating features while looking at making the switch.  In fact, I think if you are investigating correctly and objectively you will think about all of the “users” and do your best to find solutions for all of their problems. 

Before you buy, it makes sense to not only know who your users are, but to truly understand their needs.  This is known as being “tuned in” to your audience.  In order to become “tuned in” there are a few things you need to do.

  1. The first step is to identify who your users are:  Specifically in terms of scheduling doctors for work and on call, here is a list of the users:
    1. The person who creates the schedule, also known as the “Scheduler”
    2. The person who has to work all of the assignments on the schedule, also known as the “Physician”
    3. The organization or group who needs to know “who is on call for …” is typically known as the “Hospital Emergency Department”
    4. Another organization who needs to know “who is on call for…” is the “Answering Service”     
    5. Another group of people who need to know where the physicians are and what they are doing is known as the “Office Staff”.
  2. The second step is to understand what they need from the software and why?

User

Need

Why

Scheduler

Auto Scheduling engine/rules

Automate the creation, save time

Scheduler

Tally reports

Prove fairness to providers

Scheduler

Process vacation/day off requests

Automate process, save time

Scheduler

Training / Support

To become proficient

Scheduler

Ability to make changes

Manage changes

Physician

Submit vacation/day off requests

Easier and more accessible

Physician

Reports

To show the schedule is fair

Physician

Smart phone integration

See when scheduled

Physician

Electronic swaps

Easier way to make a change

Hospital ED

Electronic schedule

Eliminate data entry

Hospital ED

Change editor

Manage Changes / EMTALA

Hospital ED

Combined daily call roster

Share accurate on call information

Answering Service

Electronic Information

Reduce errors

Office Staff

Daily provider schedule

To know where all the Doctors are

 

  1. The next step is to prioritize your users.  Although this might not be a fun meeting or conversation because some people may feel less valuable or less important than others, it still needs to happen.  What is the pecking order in your organization, who needs to be serviced first, second, third and last?  In many clinics and or departments within a hospital would prioritize the physicians first, followed by the scheduler, then the hospital, then the office staff, and lastly the answering service.  If you skip this step, you will be trying to solve everyone's problem and most likely will solve no one’s problem.

  2. Now that you have identified your users, what is important to each of them and where they fall in the pecking order, you are now ready to begin compiling a list of your needs.  You are also at the point where you need to understand how your needs effect the cost of the product you are looking at.  For example, if you are a small clinic that is physician owned, and one of the physicians is also the schedule creator and you have a small budget. You are going to have to make some tough choices and perhaps not meet the needs of the hospital, or your clinic staff or the answering service’s needs, because your needs supersede the available budget, so therefore you need to adjust who needs the software.

Getting back to the theme of this blog post, of “Who’s are you buying the software for” as you can see is a tricky question to answer.  It is also a question that takes some research and time to understand and in order to be able to answer intelligently.  Of course the global answer is that you are trying to solve everyone’s problems, but is that really realistic?  Do you really have the money to make that happen?  If not, hopefully this post will shed some light on how to get better tuned in to your users and how to evaluate and make the final decision.

Key Takeaway:  Oncall software is not going to solve everyone’s problems, by trying to do so, you may not end up solving anyone’s problems.  For more information about researching or purchasing on call software you may be interested in this blog post:  The 10 Golden Rules of  Buying On Call Software.

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Image courtesy of Stuart Miles at FreeDigitalPhotos.net