Are the New York Giants a better team than your management team?

What does Eli Manning and the New York Giants team have in common with you and your team at the clinic?  You're probably saying, not much, but there is a lot more similarities in the two teams than you might think.

              

Football Team	Medical Practice
Highly paid players	Highly paid doctors
Large up-front investment	Large up-front investment
Each player is a specialist	Each doctor is a specialist
Paid staff to support team	Paid staff to support doctors
Players want to be on a winning team	Doctors want to be in a winning practice
Highly paid coaching staff	Highly paid management team
Players can be traded	Doctors can leave

One of the major differences is that football players listen to their coaching staff.  Although the players make more money and have more status and influence, when they get together as a team, they listen to their leader and are all on the same page with the same goal in mind, WIN.  Let’s compare that to a physician owned clinic.  In that scenario, the Doctors run the show and although there is an administrator, I don't think that many groups look them as business experts.

In the game of Football, what is needed to win is points.  You get points by scoring touchdown and field goals.  You score touchdowns and field goals by working together as a team.  Out on the field, everyone is important.  In this past Super Bowl, if Eli Manning didn't have teammates defending him, he could not do his job.  The team wouldn't be ready to play if there wasn't staff and facilities for practices.  It also would not be possible without fans.  Who wants to play in an empty stadium?  Everyone is a star on the team.  Although some stars are better than others, everyone’s contribution is key to success.  A football team is a well oiled machine.  When the machine works it is in its best position to win games.

In the business of Medicine, what is needed to win is profit.  You earn profit by treating patients.  You treat patients by working together as a team.  In the clinic everyone is important.  Without certain members of your team, for example, maintenance, physician on-call scheduler, accounting, you cannot effectively compete.  When you compete without your staff, you are at a disadvantage and increase your chances of loosing.  There are no stars on the team, everyone is equally as important.  If you strive to provide the same level of quality and service each time, everyone’s contribution needs to count.

So when you ask yourself if the New York Giants are a better team than your management team, show me the rings. 

Although I am not a big sports fan, I am always fascinated at how teams work together for a common goal, winning.  I think that health care and independent clinics specifically can learn some valuable lessons from how these big-fancy teams win.

Top 7 Reasons to Outsource your on-call schedule

My company for years has been hymming and hawwing about offering an outsourced call schedule generation and publishing service to our customers.  I was finally able to convince our Board of Directors that this would be a great service to offer busy clinics and doctors who find this task to be one of the worst.  Here is some of the justification that I used when I was trying to sell the idea to my Board of Directors, perhaps you will find it useful if you need to talk with whoever makes these decisions in your practice.

Just so we are all on the same page, Outsourcing is the process of contracting a business function to someone else, according to website Wikipedia.  Typically the business function is something that is commonly performed in-house.  The concept of outsourcing helps firms perform well in their core competencies and reduces the rise of skills or expertise shortage in areas of the company. 

The top reasons for outsourcing call schedule creation and publishing;

1. Cost savings, the lowering of the overall cost of the service to the clinic.  Our schedulers are faster and more experienced than yours.  Therefore it costs us less to produce similar results.
2. Focus on core business, if your people are your most valuable resource, then free them up from tasks that do not generate revenue.  Let them focus on what is important.
3. Knowledge and wider experience.  With all due respect, our schedulers are more experienced than yours; because we have worked with so many different specialty groups we have seen-it-all.  This experience allows us to bring something to the table that you may have not had before.
4. Catalyst for change.  An organization can use an outsourcing agreement as a catalyst for a major change that could not be achieved before.  This is a perfect scenario for doctors who have been unwilling to change their rules and scheduling methods, making creation nearly impossible.  
5. Process improvement.  Most organizations do not have the physician schedule creation process documented.  If something happened to the scheduler, most clinics would be left with a big mess.  Outsourcing can improve a process by creating a standard way to achieve the same results and then documenting the process.  If you choose to take the schedule creation back in-house, most likely it would come to you in better shape than when you originally handed it off.
6. Take it back.  Outsourcing is not permanent; you can take back the work at any time.
7. Scalability.  With the consolidation of practices happening at lightning speed, it’s not a bad idea to think about how you would handle an increase in workload in the creation of oncall information.  

Call Schedule creation and publishing can be done remotely and delivered digitally and our company can leverage the scale and economy of outsourcing to deliver high value services at a vastly reduced end customer prices.  As you can see the reasons for outsourcing are plentiful, considering the low level of risk associated with a service such as outsourced on-call schedule creation, I think it is definitely worth giving it a try if your practice is constantly struggling with the horrible job of creating, maintaining and publishing the oncall schedule.

3 Cost Effective Steps to a Modern On Call Schedule

How much time do you currently spend creating, maintaining and publishing your physician oncall schedule?  What tools do you use to assist you?  If you are still creating the schedule by hand and then entering it into Excel or Outlook so that it is accessible to your Doctors online, you might be a good candidate to modernize your process.

The reasons for modernization are pretty simple to understand, the main features that most new users love are:

1. The ability to program rules into the system
2. A scheduling engine that will assist you in placing people in jobs
3. Automatic tallies to prove fairness
4. Easy way for providers to request and document time off 
5. Simple way to view the on-call information online

If your ready to take the next step and look at the "new way" here are a few tips that will assist you so that you do not waste your time.

1.  Access your requirements.  What are the top 3-5 things that you expect the software to assist you with.  Put them into a priority list.  Remember that software will not solve world hunger or all of your scheduling needs, make sure you know what is most important for you to get the most value.

2.  Evaluate solutions.  Go to www.google.com and search for call scheduling software or physician scheduling software. Check out a few of the top search results companies and see what they have to offer.  Use the top 3-5 requirements that you discovered above and make sure the software has those features.  Check out a demo.  Look at the references page to see what their current customers think of the product.  The best piece of advice I can give you for this step is to make a decision.  Updating a software system in an office should be a fairly simple decision.  Just make sure that you have an out if it turns out not to be the right choice. 

3.  90-day-trial.  I am a big advocate of trying before buying.  Keep in mind that call scheduling software requires set-up and data entry to use the system, but it is worth the effort for a fair evaluation.  As long as you have a full feature trial I would also suggest finding a paid trial.  With a paid trial you will most likely have free training and support.  These are critical services as a software newbie.  I would pick a trial over a money back guarantee any day, why?  Because in a “money back guarantee” you’re not the one who decides if you get your money back, the person that has your money is.  Don't pay for services in advance and take that risk.  All SaaS call scheduling software providers offer monthly, pay-as-you-go options.

Modernizing your on-call scheduling process with software is an easy investment that will become more valuable each time you use it.

 

How do you know when your oncall management system needs an upgrade?

In my last blog post "Who should manage on-call in a hospital, medical or administration?" we identified who the key players are that are involved in many Hospitals and why I felt that call schedules and daily call roster creation that is managed by the medical staff works better. 

How do you know if oncall management at your hospital is the best it could be?  That depends on where this daily critical service resides in your hospital.  Are you hearing or seeing of these symptoms?

• Clinics in your community fax or email their monthly call schedule to the hospital.
• Community clinics call schedules are kept in faxed paper form in a 3-ring-binder at the hospital.
• Someone at the hospital is responsible for collecting community clinics on-call schedules and keeping track of them.
• Someone at the hospital creates a paper "daily call roster" and faxes, emails or tubes the roster to areas throughout the hospital.
• Who is on-call for a certain specialty is not available on your intranet.
• Providers have to call someone to determine who is on-call.
• Providers changing on-call shifts at the last minute is frustrating and confusing to the Emergency Department.
• Occasionally the wrong doctor is called or paged due to incorrect oncall information.
• The Transfer Center is frustrated with the quality of their oncall information.

The above are symptoms of an on-call process that needs updating and modernization within the hospital.  In a hospital, the question of "who is on-call for ...?" is asked hundreds of times per day in a medium sized facility.  Knowing the answer and having it be correct is easy when you are using an on-call management system.  

If your already thinking about upgrading or installing an oncall system, be sure to check out our Whitepaper on "Justifying the cost of an on-call system", that will identify some of the value buckets that you can use with your leadership team to identify current costs so that you can do an ROI.

When your oncall management system works, here is what you will experience:

• Community clinics make call schedules for their doctors using software and they do not have to send the hospital copies of their schedule.
• The hospital oncall management system "electronically talks" with each of the clinics on-call systems to "grab" the necessary information that the hospital needs. 
• The hospital oncall management system automatically maintains a live "daily call roster" that contains accurate information from the clinic schedules showing who is oncall for each specialty.
• Accurate on-call information is easily accessed by the Emergency Department, Transfer Center, Telecom, and on the Hospital Intranet for everyone else. 
• Last minute or evening changes can easily be made, documented and communicated to the hospital call schedule.   
• The wrong doctor is not called.

In summary, not having an adequate oncall management system can cause disruption in service to your patients and irritation by your physicians and staff.  This is a process worth improving.  The benefits are worth the investment.

Who should manage on-call in the hospital medical or admin?

Who should manage on-call in the hospital?  That’s a great question.  In a hospital on-call has many sides.  There is the creation of the individual specialty clinic call schedules, the creation and maintenance of the daily on-call roster, maintaining providers contact numbers and maintaining provider protocol information.

The purpose of on-call in the hospital first and foremost is to serve the emergency department physicians who need specialists to assist them in the admittance and treatment of presenting patients.  This is done via a daily on-call roster that is used to determine which physician is responsible by law to respond and help.  Secondarily it is used by many others within the organization, physicians, nurses, and administration to support patient care.

Although each hospital is very different, I have seen on-call management over and over in the following areas; Medical Staff Office, Emergency Department, Information Systems, Telecommunications and Nursing Support.  Med Staff, nursing support and the ED are all medical units.  IS and Telecom are administrative units.  They both have a different view point.

Who are the players involved in on-call at a hospital?

1. The hospital Medical Staff Office dictates who and how on-call will be covered for each specialty. 
2. Specialty clinic staff creates, maintain and publish a call schedule for their group of physicians.
3. Physicians agree to the oncall assignments they are responsible for covering.
4. Someone in the hospital receives and manages all of the on-call schedules from specialty clinics.
5. Someone in the hospital creates a daily on-call roster.
6. Someone in the hospital distributes the daily on-call roster throughout the organization.
7. Someone in the hospital makes changes to the daily call roster as they come up, both day and night.
8. The Emergency Department uses the daily call roster to determine which physician to call.
9. The hospital operator often pages the requested doctor.
10. The patient who is sitting in a bed waiting for all of this to happen so that they can be seen and admitted or discharged.

We have found that organizations may have better results if on-call is managed in the Medical Staff Office.  Here's why. 

1. The Vice President of Medical Affairs has clout and a title that can get things done in an organization.  When they mandate that something is done a certain way, it is usually done that way.  For example, standing orders or credentialing.  Other physicians respect this person and will comply with their requests.
2. The Medical Staff Office already deals with the physicians on a daily basis.
3. If there is a issue with a specialty clinic not complying, the Medical Staff Office can deal with it from a physician management point of view.
4. Policy and procedure will be created with the best interest of the patient in mind.  No politics or job protection going on.

When on-call is managed properly every player listed above is considered when making decisions regarding on-call.  On-call information is readily accessible by all the players listed above, and to the patient the process is seamless and they think that the specialist was already in the hospital when they presented to the ED.  It just works. 

When on-call is not managed properly, you can and will have a host of problems.  Be sure to check out my next Blog Post when I will highlight what those problems look like and provide some proposed solutions.

To answer my above question, I think it is better to manage on-call in a medical department; I have seen better results (regarding compliance and data accuracy) and faster implementation of on-call management. 

Remember, the right provider in the right place at the right time does not happen by accident.

Call Scheduling Software: Everyone has an expectation

Although I have been advised not to editorialize in my blog (duly noted) I thought that it might be useful to have a brief chat about expectations.  Prospects, customers and vendors all have different expectations about how things will work regarding doctor scheduling software. 

Here are a few call scheduling software prospect and customer myths that I can dispel.

1. I should only have to pay for what I use in the software.
2. The software should set itself up (including all of the information about my providers).
3. You don't need any training on how to use call scheduling software.
4. Software will schedule my providers just like I do with Excel.
5. I want you to be my partner, but I will not treat you that way.
6. The software should be able to accommodate that certain things only happen sometimes.
7. The schedule will display the way I want it.
8. The schedule will show up in my phone the way I want it.
9. Software customization (custom programming) should be very easy and inexpensive.
10. The software should be damn near free.

When you stop and think about it there is no way that a company can program to meet everyone’s needs or wants.  The more you use software the more you become ok with that.  In fact, as soon as we (Software Company) make a decision and choose a direction we know for certain that some will like it, some will love it, and some will hate it and think that we are idiots because we did it that way.  This gets back to a former blog I did about the Parato Principal, better known as the 80/20 rule.  Most software companies create products that meet 80% of the customer’s needs within their specific market.  Perhaps if you never find what you are looking for in software you need to adjust your expectations. 

Similar to prospects and customers having certain expectations of us as a company, we also have certain expectations of you as a prospective customer. 

To be fair, here are a few call scheduling software Vendor myths that I can dispel;

1. We don’t like it when you tell us that our software sucks.
2. We don’t like it when you don't do your homework.
3. Our trainers have no clue how people create, maintain and publish a call schedule.
4. We don’t like being stood-up for demos and training.
5. Sometimes "why something works the way it does" is just because it does.
6. Our trainers have others scheduled after you, so we cannot do it all at once.
7. We don’t like being called on a Sunday night because you forgot your password and you don’t want to call your scheduler to bother them.
8. We don’t like it when customers lack of planning become our emergencies.
9. We don’t like when our software is blamed for your organizations dysfunction.
10. We don’t like it when you don't pay your bill and we have to call and ask for it.

I think there are a few takeaways from this blog post. 

First, it is important to be realistic and reasonable with your expectations.  Also remember that expectations change and you must communicate your changes if you wish to be satisfied.  And lastly, remember that if you expect your expectations to be meet, others do as well, this should be a two-way street.  You can have everything you want, just not all at once.

5 Risks of allowing your Docs to change their own on-call schedule

There are risks that need to be considered if you are going to allow all of your physicians to have the ability to modify the on-call schedule without any oversight.  In my opinion the risks outweigh the benefits.

Risk #1. Fairness.  Most all schedulers create the schedule with fairness in mind.  All providers demand even tallies.  When you allow your providers to modify the schedule fairness needs to be taken into consideration.

Risk #2.  Skills and Privileges.  Does the provider that you are trading with have the proper skills and credentialing to work your assignment? 

Risk #3.  Personal Liability.  What happens if no one is oncall, when there is supposed to be?  Critical patient presents at ED.  ED physician evaluates and proceeds to find the on-call consulting physician.  No physician found.  Patient is transferred to another facility.  Patient takes a dive while in transport.  Patient dies.  EMTALA investigation regarding the transfer.  When the legal team at the hospital steps in and finds out that a doctor took himself off of the call schedule because he was tired after a surgery.   Guess what happens next?

Risk #4.  Too many cooks.  Most doctor scheduling software companies have designed their software for a special user called "scheduler", this user has certain privileges in the software that others do not.  Some would call this a super-user.  Super-users are usually highly trained in the software use.  Super-users have the ability to "screw up the program" because of what they can do.  The larger the number of super-users in any system, the greater likelihood that someone will accidently screw something up.  Real super-users know how to fix their mistakes without having to call tech-support.

Risk #5.  Bizarre results.  If you are using web-based software by nature you can work in collaboration with someone very easily.  At Adjuvant we take advantage of this when we train our Call Scheduler Classic and Lite customers.  Both customer and trainer logs into the same account and they can both see the same results.  If customer changes something, all the trainer has to do is hit the "refresh" button and the new change is updated.  This same principal is true for multiple people to be using the software at the same time, all trying to manually schedule and every time they refresh the screen they are seeing other days scheduled, notes made and so on.  The bizarre results were not "bugs in the system" they were caused by multiple users logged into the same schedule at the same time and both making changes.

There are many more risks associated with allowing all of your providers to have the ability to create and make changes to the on-call schedule. 

5 Disastrous Misconceptions about On-call Software

I think it is helpful when everyone is on the same page.  Most of the time when my expectations were not meet in the past was because I made incorrect assumptions.  I thought I might be able to clear-up some misconceptions before you start looking for physician scheduling software.

Misconception #1.  Software should be free or low cost and have all the features.  This misconception comes from some in the software industry who have developed great software for free.  The cost of software comes from client focused development; bug fixing/testing, integration, training and support, and sales and marketing.  Although few customers want to pay for sales and marketing expenses, everyone wants support/training and new features along with a product that is free of bugs.  As you know, this takes money.  You should want your vendor partners to make money so that they can continue to offer you good products and great service.  This cannot be done for free (at least for too long)

Misconception #2.  Oncall software will replicate our current paper/Excel process.  If you use Excel to create your doctors call schedule, I'm sure that you have noticed that you can put anything in any "cell" that you want.  You can break your rules and preferences; you can create a schedule one day-at-a time.  Although many things are possible, it does not always mean that you should.  Creating a call schedule using call scheduling software is different than with Excel.  Do not try to force your current process into a new system.  Be open to change.  Think about what you want to accomplish and why as opposed to focusing on why the software is doing a certain thing.  Excel is predictable; most on-call software was designed not to be, in order to create a better, schedule.

Misconception #3.  Software will save you time right out of the gate.  Let’s be real here.  Everything takes time to set-up and configure as well as master.  When you have mastered the software, most any software, it will save you time.

Misconception #4.  You don't need any training.  In order to be a ninja master, you need training.  How much training depends on your comfort level with using software in general.  People who do not get proper training on how to use software always blame the software when they cannot accomplish what they want to do.  Non-trained users are usually the first to jump ship.  If you are not committed enough to schedule and attend training, then your problem is probably not significant enough to warrant the purchase.  In other words, if you don't want training, save your money on the software!

Misconception #5.  Our rules and process are probably too complicated for a software system.  This is sometimes accurate.  Some medical groups are very complex.  For example a group of 25 Cardiologists with 50 jobs at 10 locations.  This is pretty complex.  What is important here is to understand that nothing will solve all of your needs.  Nothing is 100 push-button and if it was you probable would not want to pay the fees.  What you should be looking at is a prioritization of what is important (most to least).  Also what is important to your Doctors, sometimes software is not going to save the scheduler time at all, but it will assist in communication of the call information to the providers.   Remember what is important.  If you don't know, you should not be looking.

With the proper expectations of what physician scheduling software can and will do, along with a clear need and established budget range is a great place for any shopper to start.

The Battle Between Rules vs. Preferences in Oncall Software

As you may or may not have noticed I have been consistently publishing weekly Blog articles since about March 2011.  Anyone that has ever written a Blog knows how difficult it is to create content that will be valuable to its readers.  In a recent audit of my work by a seasoned professional I was told that I need more of an insider vs. expert point of view.  Please bare with me as I try to find my new style :).

Do you know what the difference is between a rule and a preference as it relates to call scheduling?  I bet you don't.  I speak with all types of people who create, maintain and publish on-call schedules I find it interesting how may people talk about their need for rules.  Everyone needs rules.  What we find more often than not is that unless you have been using on-call software you probably have a lot of preferences and a few rules.  Whats the difference, lets find out.  According to our friends at Wikipedia, a rule usually refers to standards for activities.  Preference on the other hand refers to evaluative judgment in the sense of liking or disliking an object.  Preference can be notably modified by the decision-making processes.  Do you see the difference?  One is a standard (that happened every time) and the other is an evaluative judgment (may or may not happen). 

Now that we understand the difference between rules and preferences how does it relate to oncall software?  As I stated above, most prospects come to us with a list of what they consider rules.  They consider them rules because when you are using something such as Excel to create and maintain your call schedule, it (Excel) will allow you to put whatever text you want in the cell.  Although you may call it a rule, unless it happens every time it is a preference.  For example, in Excel 2+2 will always equal 4.  Always. 

Examples of Rules:

1. If Doctor "A" is oncall Friday, then he is also oncall Saturday and Sunday.
2. If Doctor does not have "Ob/Gyn" skill than he will require a back-up
3. If Doctor works oncall Saturday and Sunday then he is off-call for 7 days.

Examples of Preferences:

1. Dr. Smith prefers to work oncall on Mondays
2. Dr. Green prefers to work with Dr. Brown oncall Fridays
3. If I am doing Outreach of Thursday I would prefer not to be oncall on Friday.

As call schedule creators continue to migrate away from Excel into other oncall scheduling specific software they will need to convince their providers to become more aware of the difference. 

What the big deal, right?  Well the big deal is that most computer programs are programmed a certain way.  Most of the call scheduling software that exists today is rule based and will not accommodate preferences.  Your providers will need to decide between automation and accommodation.  The more you accommodate every one of your partners specific needs, you will be sacrificing automation.  whether this will be acceptable or not will be determined by the power and position of the person creating the schedule. 

The long and short of it is that if you are looking for a low cost, easy system, ditch the preferences and focus on the rules.  If you have a lot of money to spend and time I suggest customizing a solution or purchase an existing one and wait hours while it runs.  The choice is yours.

When hospitals and clinics don't play nice about oncall scheduling

When hospitals and clinics don't play nice who wins?  I’m not sure, but I do know it's not the patient.  I was working with a few current clients who are part of the same medical community.  The community hospital (who is part of a large system) purchased an on-call management system (Call Communicator) from us to help eliminate their on-call communication problems better known as the "wrong doctor getting called" or unclear information regarding who is oncall.  This hospital made the decision to purchase a version of Call Scheduler for each medical clinic in the entire community.  The hospital also agreed to pay any ongoing maintenance fees.  In my opinion the hospital moved forward on this initiative for the following reasons;

1. Increase physician satisfaction by making sure the wrong doctors are not called.
2. Increase patient care by reducing the time it takes ED and Telecom staff to identify and locate the correct on-call doctor.
3. Reduce the risk of an EMTALA fine by having the proper on-call documentation.
4. Increase employee satisfaction by not getting yelled at if the wrong doctors are called.
5. Putting the responsibility of call schedule accuracy in the hands of the call schedule owners (the clinics).

Out of 20 clinics within the community there are several who have refused to participate in this free program and will not use the provided software to maintain their own schedules.  They have basically said to the hospital, screw you or in Minnesota-nice "go fly a kite".  What this means is that the hospital now has to make exceptions for a few organizations because they do not want to make any waves. 

In another example we have a hospital that has sent out several meeting requests and asked all of the schedulers from each clinic to join them at the hospital for a 1 hour free refresher on "maintaining your on-call schedule".  Not only did several of the groups just not show up, but I heard from one of the doctors at one of the groups say "when our administrator gets those things she just throws them away".  WHAT?

Now clearly I have frustrations because as a company we are trying to help hospitals and clinics formalize a new way of communicating oncall.  I have a personal stake in the success of these programs.  But let’s think about it from another point of view, how does the patient benefit from the clinics not getting along with the hospital?  They don't.  I think that as professionals these organizations need to grow up and start thinking about the patients instead of the "old things" that have put up walls between organizations.

In my world when a clinic refuses to cooperate with a hospital implementing a new oncall management system it says that "when our patients present at your hospital we don't care how long you or they have to wait to track down the correct doctor.  I think that is just plain wrong.  That is poor business, poor customer service and just plain selfish.  When hospitals and clinics don’t play nice about oncall scheduling, the patient is the one that looses.