When making the decision to purchase physician scheduling software there are some “things” that you should carefully consider that are above and beyond the monetary investment that your group will be making. These are what are known as “soft costs”. Sometimes referred to as indirect costs, soft costs are business costs that are not involved in the direct process of a business operation. While essential, these types of costs generally focus on ancillary issues that do not affect the day to day production process. Many physicians and administrators do not calculate these costs in to the total cost of ownership and sometimes they are surprised that there it takes more than money to transition from a manual physician schedule creation process to software such as Call Scheduler.
Before you begin your new project you might want to consider the 6 items below;
Time to learn something new. Whether you are a physician, administrator or support staff person, it takes time to learn something new. In fact that time must be somewhat un-interrupted. This means that the on boarding process should not be done while sitting at a busy front desk with phones ringing or while in surgery with a patient under anesthesia (true story) or while driving in your car. Although the time it takes to get up and running with new doctor scheduling software is minimal, it does require your undivided attention.
Information to set-up and configure a new system. As stated above, the time to get up and running is minimal if you have the necessary information. The basic set of information will always include names of each doctor, contact info for each doctor, a list of jobs that need to be worked, days and times of the jobs that need to be worked, an understanding of skills that are required to work the jobs, and a copy of current schedule. Without this basic set of start-up information you could spend more than double the normal amount of time to set-up and running. If you are new to the scheduler position be sure that those who support your position are aware of how important this information will be to the success of the project.
Time to experiment. This is different from learning the software. Experimentation is an orderly process carried out with a specific goal in mind, verifying or falsifying your hypothesis. This process of experimenting “provides great insight into cause and effect by demonstrating what outcomes occurs when a particular factor is manipulated” according to Wikipedia. Our company provides a “sand-box” play area for customers to use to experiment with new ideas in a safe environment where their results will not be seen by the doctors. We have noticed that because the traditional way of creating a physician schedule is very manual and time consuming, there has been little if any experimentation done to improve the process.
Patience. In a recent blog post “On-Call Software: Are you stuck in a dip” a colleague of mine talks about “A dip is a temporary setback that can be overcome with persistence. The trick is to recognize if you are in a “temporary” setback worth pushing through or something permanent and worth quitting.” It takes patience to learn something new and also to be able to push through the tough times. It also takes patience to be lead through a process. We sometimes feel this most when we are training physicians and administrators. Both of these groups are not used to being back in a classroom type environment and sometimes try to drive as opposed to ride. Although were pretty good at regaining control sometimes we need to be patient as well with new customers.
Flexibility. There are two types of new users that we train. The first type is interested in learning and understanding what the capabilities are with our call scheduling software and how they can take advantage of as many of the features as possible to make their job easier. The other type of user is the one that says, “we have been doing it this way for years and your software has to do it the same way and give us the same results” and if it doesn’t, than your software doesn’t work. Making a change to a system that has been in place for many years will require some flexibility. Before you begin ask yourself, what are the top 3 or 4 things you need the software to accomplish? Remember that once you have achieved those goals it is human nature to now want it to do more. Be reasonable flexible, nothing, with the exception of a custom program will do everything you want.
Decision making authority. Make sure that all of the right people are at the table when making your transition. Our largest failure rate is of new clients that come on without any prior information or any decision making authority. When every decision requires someone approval by someone who is not present, very little gets done. When very little gets done, people get frustrated. When people are frustrated it is sometimes easier to give up and go back to the old way, even if it is more painful. Like in the Jim Collins book “Good to Great” you need to have the right people on the bus.
Key takeaway: Successful implementations don’t just happen, and when they do it takes more than just money.
Image courtesy of Stuart Miles / FreeDigitalPhotos.net
Something that technology and software companies are not very good at is accepting that some prospective customers do not really want to change; they actually want the same, only newer. If you have ever heard the crude saying “you can’t polish a turd” it means that something inherently bad cannot be improved. Although many would disagree that you can polish a turd, why would you want to?
In my world, on-call schedule creation for clinics and on-call management for hospitals we run across prospects who don’t want to take advantage of any of the new advances in the software or services, all they want is a newer version of what isn’t working today. Why do you think this is? What does this mean for the organization?
Here are two examples:
Jane Doe is the physician scheduler for 10 Cardiologists. Jane has been doing her job for over 15 years. The level of complexity in Jane’s job has substantially increased over the past 15 years. Jane begins looking for a software tool to help. During Jane’s investigation she realizes that all of the software that exists today does a lot more than just help create the physician schedule. The new software has the ability to handle the doctor’s time off requests, facilitate and communicate changes, and provides easy ways for the doctors and others to view the schedule via the Internet and smart phones. When Jane realizes that all of the solutions offer the same new features she narrows down her choices and chooses the software that will best meet her needs. During training Jane informs the trainer that she doesn’t wish to use any of the “new” features she just wants a way to automate her existing process.
Another example is of Jeff. Jeff is the IT director for a large specialty hospital who has been tasked with helping find a new on-call management system for the hospital and specifically the Telecommunications Department who pages the doctors who are on-call. Jeff did not spend any time looking outside of the Telecom Department and therefore is not familiar with the needs of the Emergency Department or Nursing Units, of which both use the on-call information as much if not more than Telecom. The current system, which is old, not customizable, not supported any more, and not favored by anyone in the organization performs 2 tasks; (1) allows departments to manually enter their call schedule into the system, (2) allows for simple changes to schedules (only by Telecom). As they begin to investigate new systems Jeff realizes that the new on-call management systems do a lot of things, many that he does not think he needs. During on-site vendor presentations Jeff makes it clear that he does not wish to see any of the new things, he is only focused on replacing what the current system does. The current system, you know the one that no one likes.
Here are 5 sayings that are signs that your organization encourages better sameness:
- We don’t do things that way
- No-one would use that
- We could never get everyone to use that
- That’s not important to us
- Our doctors don’t do it that way
Would it make more sense for both of the fictitious characters above to think outside of their worlds and departments and truly try to gain an understanding of what is best for the whole organization? By doing so each may discover that the new features that are not important to them are in fact important to someone trying to do their job at the hospital or clinic. If you are always trying to replace something with something similar, knowing that the vast majority of people don’t like it, you are most likely trying to polish a turd. You may not be tuned-in enough to realize it is a turd in the first place. Trying to polishing a turd leads to better sameness. Better sameness leads to complacency. Complacency in a clinic or hospital leads to poor patient care. Poor patient care leads to unemployment.
Here are 5 tips to avoid better sameness:
- Be sure that you are tuned in to your users and their needs.
- Identify different types of users, e.g. doctors, nurses, critical care areas, non-patient care areas.
- Be sure that each user group is represented when investigating solutions that impact the whole organization.
- Don’t discount new features that are designed to improve the process just because they are not important to you.
- Try to not only think about how your decision will impact the organization today, but how about in 5-10 years, which is the average life of a enterprise solution.
Key Takeaway: Companies don’t develop new features for not. The new features are typically the result of a perceived necessary improvement. Be sure that you are not discounting new ideas because they do not help you. This can lead to better sameness, which does not appear to help anyone, especially the patient.
Image courtesy of Stuart Miles / FreeDigitalPhotos.net
If you are a Physician or Nurse do you have access to the daily call roster without having to call someone? Most small and medium sized hospitals do not allow this? Why is this? What is the benefit to the patient if a provider has to call someone for information that is or should be located in a secure area online?
As I speak with hospital leaders such as CIO’s, VPMA’s and CMIO’s I get very different reasons and responses when I ask them why this information is not available without a phone call, I have listed them below.
Reasons to not make daily on-call information available:
Telecom Department Control. Until recently most hospitals that had Telecommunication Departments have been responsible for maintaining the daily call roster, taking incoming calls from all areas of the hospital asking “who is on-call for …” and then paging the doctor and connecting them with the person who originally needed them. For many organizations it is very difficult for Telcom to release control over this area as it holds power. Another reason is that this has been a primary function and without it could result in loss of staff and possibly relevance. I have ever heard some say “well they have to be here anyway, we might as well find something for them to do”.
A good question to ask your telecom department is, when someone calls and asks” who is on-call for Cardiology?”, and you tell them and they ask you to page the doctor, does telecom vet the caller and ask why they wish to page the doctor? Most all of them will say “no”. If an appropriate person calls with that request, we just do what they ask. If there is no governance, than I would argue that it can be completely automated and does not need to be controlled by a department.
It has always been done that way. For some hospitals this is the best answer they could come up with. I also hear that no-one wants to change, and the doctors won’t do it that way.
Doctors don’t want their phone numbers “out there” on the Internet. This is a misconception that goes back to the disbelief that you can safeguard information on the Internet. I don’t know any hospitals that publish on-call information on the public Internet. Every hospital already uses an internal Intranet that restricts users to be on-site or within a certain IP range to prevent information from going outside of the organization. I think that most would agree that if you are on-call, the method and contact number to reach you should be available to any healthcare worker with a legitimate need to reach the on-call physician.
Doctors don’t want other Doctors or nurses to call them. I was told this from a VPMA. I was shocked. As a patient it makes me feel real safe knowing that regardless of the issue or circumstances some Doctors just don’t want to be bothered. As a consumer, I say you should have thought about that before agreeing to the terms of your medical staff appointment. In the doctor’s defense, I will say that if a doctor is called incorrectly or for no good reason by a staff person there should be a review process that has disciplinary actions associated with it to prevent unnecessary calls.
We just don’t do things that way. I am not sure what this means exactly. When I hear this it says to me that we do things the way that is most convenient for us and our doctors and not the patient.
My question when I hear any of these statements is “who made this decision, when was it made, and when was it last reviewed”? Some of the initial privacy concerns that people have disappear with time and as they become more familiar with technology and see the benefits. I think that decisions like the ones listed above are made by a non-medical level person without input from medical staff or patients. And it is not reviewed or questioned enough to have the policy reviewed. Restricted access to on-call information leads to delays in patient care. There should only be delays in patient care when it is in the best interest of the patient to have that delay. A delay in patient care just because, is not acceptable and should be changed immediately.
I think that organizations that are hiding information from other Doctors and Nurses are doing a great disservice to the doctors, nurses and patients by adding an unnecessary layer of red-tape to go through, just for the heck of it.
Key Takeaway: A medium sized hospital will ask the question of “who is on-call for …” more than 400 times per day. If you are a doctor or nurse and you have to call and ask someone else for this information, you should ask yourself the question, why is this information being hidden from me?
Image courtesy of David Castillo Dominici / FreeDigitalPhotos.net
"I'm a Doctor and I love creating the call schedule for myself and my partners in my free time without tools or pay"....said no one ever!
If you are a physician who creates the schedule for your group are you part of the problem or part of the solution? I spoke with a Doctor just before writing this post who is an Anesthesiologist and the President of his practice in addition to creating the call schedule. We were talking about the process he uses to create the call schedule and even though he has access to software to help him, it is not the "right" choice for him and he is looking at other software solutions like Call Scheduler. I asked him if he was compensated specifically to do this "scheduling" job, he responded no. Although he is paid a small stipend to be the group President, he stated that the scheduling job just came with it.
Most Doctors who create the schedule for their group do so on their own time, on their own computer, generally outside of the clinic. Although all of the doctors know who the “lucky person” is that creates the schedule, most have no idea what is involved and would be very surprised at the complexity of what seems like a simple task. I equate this to the person who plows snow at our office in Minnesota. No one really cares who does this or how it is done, unless it is not done after a storm and we have to wade through knee deep snow to enter the building. No one realizes or cares quiet frankly what tools, equipment, insurance, background, and process go into making the lot clear, again, unless it is not done to someone’s satisfaction. There are many thankless jobs like this in each business, for example office cleaning, payroll services, tax preparation, and building maintenance.
In a 2010 post “Call Scheduling: A Thankless Job” I discussed how in the early days of modern clinics it was common for each partner of the practice to be responsible for certain non-medical duties such as lawn care, snow plowing, office cleaning and pay roll. Over the years all of these tasks have been given back to the clinic to perform and pay for someone to be responsible for the task. After all when was the last time you saw a partner in a cardiology practice vacuuming the lobby? I think that many would agree with me when I say that the reason for this “give back” was that others in the group did not perceive it as valuable, probably complained about the results, and the person who was doing that task said “screw-it”.
Why is creating the schedule for the physicians different? Because I am not a doctor, I cannot say for sure, but I think it is because doctors like to help and in many practices there is still someone willing to “help”. I would argue that this type of help is actually causing more harm than good. Here are some reasons why:
- Your partners don’t understand how complex the task has become
- Your partners don’t realize how much time it takes
- Your partners don’t realize it takes extra time to be able to prove fairness to avoid conflict
- Your partners may think it’s someone else’s problem
- Your partners may think it doesn’t cost us anything today to do the job
- Your partners do not appreciate the “true cost” of this duty
- Your partners may not see the job as important
At some point in the future you will need or want to reassign the duty of creating the doctors call schedule and because of the items listed above it will be like trying to “give away a skunk”.
As a business owner I have some thoughts on how to get yourself out of this current situation or avoid it all together, but I am going to save you the commentary. I will say this, I think that the only doctors who should fall for this assignment should be a Resident, and they probably don’t know any better and are not in any position to turn down a task assigned by an Attending or Administrator.
Key Takeaway: If you are a doctor and you create the schedule for your doctors without tools or significant pay, you are not only short changing yourself and undervaluing your time, but you may be perpetuating a bad business practice and therefore part of the problem.
Image courtesy of Idea go / FreeDigitalPhotos.net
After attending the HIMSS (Health Information Management Systems Society) annual conference in New Orleans in March it was not a big surprise that there were many new vendors offering secure text messaging services and applications for physician communication.
According to Forester Research, approximately 6 Billion SMS text messages are sent per day, yes that is billion with a "B". Putting this into perspective, there are approximately 7+ Billion people living in the world. With these texting numbers growing each day, it is not hard to believe that physicians want in on the action. Recent research shows that 85% of physicians have an iPhone, Android or Blackberry smart phone. Doctors need to be extra careful when texting other doctors about patients and specifically patient data or information that is used to make a medical decision although many in the “under 45 age bracket” are already texting regardless of security concerns.
Today all secure text messaging solutions are predicated on the user downloading an “app” for their phone, installing the app and configuring it to be part of some “network”, like your clinic or hospital for example. Once each provider has downloaded and configured the app, they can just choose one of the contacts from your “network” and securely text away. But now that you can, what will you do with this cool new ability?
Some of the many uses for the SMS or text message include:
- Texting for activation (paging the doctor) who is on-call
- Texting for communicating with other providers about a patient or case
- Texting for communicating with nursing staff about a patient
- Texting for patient “push” updates (change in status)
- Texting to update the EMR (change in status)
Since there are many uses for this type of texting, a secure text message application seems to be a perfect software candidate to stand alone. I can see one compelling reason to integrate this into an on-call system, but there are many reasons to let it stay a separate product with API’s to allow for data sharing.
Today almost all hospitals maintain some sort of paper daily on-call roster which helps the ED determine who is on-call for a certain specialty when they need a consult. Some larger organizations may have developed an in-house database system that replaces the paper with a “PDF” or spreadsheet of the call roster. From what I have observed what most hospitals are missing a way to “activate” the doctor right inside of the on-call system. Some may say, wait; telecom systems can page the doctors. You are correct; if you have a sophisticated telephone system/telecom center there are “operators” who have the ability to page a doctor. But doctors cannot page each other and neither can other providers like nurses or others who have direct patient contact. With certain privileges it can be done, but I would argue that the telecom method of paging is old and out of date and does not serve the best interest of the patient. It only serves the interest of the doctor who does not want people calling him/her directly.
I would also argue that while most all organizations use alpha numeric pagers today to notify doctors, it is only a matter of time (1-5 years) before this is phased out at what will be a rapid pace and replaced with 2 way instant SMS communication, after all the phones are already in place.
There is no doubt in my mind that in the near future you will be able to “choose a doctor” that is on-call “now” and send him/her a secure text message directly from viewing the hospital “daily call roster”. I do not think that on-call and secure text messaging should be an exclusive pair and here is why. I don’t think it is in the best interest of the patient. For example telecommunications hardware/software companies specialize in equipment and services have recently begun providing an on-call module to their system offering for hospital telecom centers. Because they have developed their offering from one point-of-view, the telecom view, we find half-assed on-call products (labeled as solutions) that only focus on telecom’s needs and basically ignore the needs of others, like doctor’s nurses and patients.
What would prevent this same scenario with on-call companies and secure texting. What if companies like us develop easy ways to “activate” doctors via secure text, and did not care about texting for communicating with other providers about a patient or case or texting for communicating with nursing staff about a patient or texting for patient “push” updates (change in status) or texting to update the EMR (change in status). In a hospital, if you are tuned in to your customers you will remember that the customers are patients, not users.
Although there is a compelling reason to work together, via API’s, I do not see the reason for an all out takeover of the secure text messaging world by on-call software companies.
Key Takeaway: Just because you make coffee and toast at the same time each morning does not mean that the coffee pot and the toaster should become one unit. Some things are better left alone.
Image courtesy of Stockimages / FreeDigitalPhotos.net
Medicare payments to physicians for services performed began to shrink by 2% on Monday, April 1, 2013 under the automatic, across-the-board budget cuts called sequestration. Can outsourcing some duties in the clinic help you off-set the reduction in pay? I think so. Saving money has always been one of the drivers for considering outsourcing, but it usually fell behind more strategic motivations, such as focusing on core competencies or freeing internal staff for other initiatives. However, in these tighter economic times, more medical groups are turning to outsourcing as a means to reduce and control certain costs. Is it possible to save money through outsourcing? Of course! Are you guaranteed to save money if you outsource? Of course not!
To a large degree, your ability to save money depends on the structure of the deal and the experience of the outsourcer, but your group’s willingness to accept change is perhaps the most important factor. It’s important to remember the old adage, "Doing the same things with the same people in the same way gets the same results." To which we can add "for the same or even higher costs."
Gaining cost savings is not rocket science; it’s a matter of reducing workload, using resources more effectively, and releasing freed resources. The first two steps provide the means to free resources, but the actual savings come from releasing those resources.
Outsourcing to Reduce Workload
This step is obvious-if we do less work, we need fewer people resources. The trick is to identify and retain value-adding work, while eliminating extraneous and lower-value tasks like creating the physician call schedule. Physician scheduling may be a good outsource candidate because it is often the responsibility of a physician or administrator simply due to the complexity of the work and the consequences if done incorrectly.
Outsourcing to Increase Efficiency
Once the workload has been reduced you will need to use that new found time efficiency to accomplish new work that has a monetary value back to the organization. For example if your scheduler who is a physician can redirect the 8-10 hours per month of time spent creating, maintaining and communicating the physician schedule to billable patient care you will see an immediate benefit. In the case of administrators it is a little more difficult. Many administrators that have this duty assigned to them often do this work at home or on the weekend. Extra unpaid work is often a contributing factor to burn-out and seeking new employment. The cost savings recognized here may be not having to replace a burned-out administrator.
Outsourcing to Eliminate Resource Costs
The previous steps lay the foundation for cost savings. The actual savings are gained through one or more of the following method:
- Downsizing. Downsizing includes releasing newly freed staff members. Outsourcers can often transfer redundant personnel to other assignments.
- As more and more baby-boomers enter retirement age there will be more and more schedulers choosing to retire. Outsourcing as a replacement plan to hiring a new scheduler will show an immediate savings.
If your organization has the management backing, political skills, and fortitude to implement the above steps internally, an outsourcing solution is likely to provide the greatest cost savings.
If pursuing outsourcing is your method of choice, find an experienced outsourcer who is willing to contractually guarantee cost savings across the life of the engagement. Be sure to review the approach the outsourcer will use to achieve the promised reductions. And remember, significant cost savings cannot be achieved without significant changes to the current physician scheduling environment.
Key Takeaway: Outsourcing the physician call schedule can immediately save you money and possibly replace the 2% loss of revenue from the Medicare payments cut.
Image courtesy of David Castillo Dominici / FreeDigitalPhotos.net
When you are a medium, large or mega hospital how do you know how far to go when trying to solve a technology problem? Well from talking and visiting many hospitals across the United States I would tell you that there is not a clear answer to this question. I think the reason that an answer doesn’t exist is that within a hospital there are many silos and one silo doesn’t always care what the other silo is up to. I would argue that it should.
This post is going to discuss how a hospital decides “how to” and “how far to” solve an evolving on-call management problem. Let’s frame up a scenario and look at the options.
The hospital is a large specialty hospital with very complex on-call needs. They have over 40 specialties and throughout the organization they generate about 80 call schedules. The hospital currently has a home-grown on-call system that allows each “schedule generator” to manually enter the call schedule into the “system”. The change process is cumbersome and often the wrong provider is called due to lack of accurate information. There are many problems with the outdated system and the hospital has decided to purchase something new.
The “new system” purchasing process was handed over to Information Technology (IT) to find vendors, decide what is important, and choose a vendor. IT created a “requirements” document that outlined what the hospital wanted the new system to do and gave it to each potential supplier to be sure their system could meet the hospitals requirements.
After careful review of the requirements document it appeared that the hospital was trying to replace the current system. Now at first glance that might not sound like a bad idea, but what if the original system either intentionally or unintentionally omitted more than half of the “whole process”? Let me explain what I mean. The current system has Department Chairs or head Doctor manually creating a call schedule each month for his specialty. Now some of the 80 call schedule creators may have gone out and purchased “call schedule creation” software on their own. They did this so they would have some tools to assist them in the creation, maintenance and communication of the schedule to the other doctors. The “scheduler” gives the final monthly call schedule to an “administrative-type” person who then manually enters it into the current outdated on-call system. This is done so that the hospital operators can look-up who is on-call and page the proper doctor when requested. In summary you have one of the highest paid people in the department, a doctor, creating the call schedule; some even paying for software, and then someone else manually enters the information into the telecom system. Keep in mind that with 80 call schedules it is possible that some day the hospital may have each department using a different software scheduling tool.
The above mentioned requirements document is not concerned how the doctors create the call schedule, nor is it concerned that the new system will still require manual data entry of the schedule into a system or about the fact that the hospital is paying for several different types of software, none that talk with one-another and in the end still require duplication of information.
My question is why would the hospital not want to solve the entire problem? I think the answer is that they are not looking far enough into the organization. Maslow's hammer, popularly phrased as "if all you have is a hammer, everything looks like a nail" is particularly fitting for this post. The hospital in the scenario above is looking for a system replacement, not a solution.
What should they be looking for can only be answered by the overall strategic direction of the organization. Is it their goal to have several disparate legacy systems that don’t talk with each other? If so, wasn’t that the technology of the past 20 years. Or is it their goal to have true solutions that span across the organization to solve large complex problems?
As a business owner there is a time and a place to band-aid things in the organization. Usually that is during your start-up phase or during an economic downturn where you are forced to cut costs. A specialty hospital rooted with more than 100 years of history and profits is not in that position and I would think is looking at making strategic decisions that have a greater impact on the organization as a whole.
Deciding what problem to solve within your organization is relatively easy, but deciding how far to solve the problem takes a lot of thought and alignment to the organizations strategy. Be sure you have the right people making that decision.
Key Takeaway: It is possible to solve 100 % of half the problem.
Image courtesy of Carlos Porto / FreeDigitalPhotos.net
This is the last post of a four-part series about Hospital on-call management systems. In our first post titled "How hospitals transition from binders to web" we learned about the problem discovery process. This is where we discovered and validated that we indeed had a problem. In the second post titled "Selecting the best on-call management software vendor" we learned the process of identifying top needs and learning about all of the available choices in the marketplace. In our third post "Budgeting for an on-call management system" we focused on how to get your on-call management system project funded. This final post is all about the implementation of your new on-call management system.
Now that your project has been given the green light by administration, meaning that it was budgeted for, you can begin to plan your implementation. This can be the easiest part or the biggest pain-in-the-butt depending on your process. Listed below are 10 tips for a successful implementation.
- Choose a project owner. Someone with authority needs to own this project so that there is an advocate within the hospital. I would push to have this person be the VPMA or another high-ranking official. A project without an owner is a failure waiting to happen.
- Review project objectives. This is the best place in my opinion to start. Habit 2 of the bestselling book “The 7 Habits of Highly Effective People” is “begin with the end in mind” this will refresh your memory as to why you started this on-call project in the first place.
- Set-up an onsite kick-off meeting. You will need the support of your project owner or the Vice President of Medical Affairs (VPMA) to help with this step. Set up a meeting and present to him/her a draft letter that will be sent out on his/her behalf to all of the local clinic administrators or department chairs explaining the new on-call management initiative at the hospital. Also in this letter you will ask for their participation at a kick-off meeting that will be held at the hospital. Get them to commit via RSVP. Be sure that everyone responds. The administrators that don’t respond you will need to either contact directly or have the VPMA send them another reminder. Setting up this kick-off meeting is one of the most important things you can do to ensure project success.
- Host the kick-off meeting. At this one hour meeting your first job is to sell the project. Refer back to your objectives and tell the story of “why”. You will need to convince your audience of administrators and physician schedulers that there is a critical problem that the hospital has decided to address and here is how they will be doing it. It is important that the VPMA give this portion of the talk. Getting initial buy-in at this meeting is very important. The second half of the presentation should be showing the audience the new system and how great it will be for the clinics, their doctors and the hospital.
- Schedule training while on-site. We always recommend having a representative from the company that you have chosen to work with on this project be at the kick-off meeting. I usually like to have one of the trainers that the physician schedulers will be working with so that they can associate a name with a face. Do not let any of the schedulers leave that meeting until they have scheduled their first training session. This is another must. By getting their commitment right then and there to work with you it will be tougher for them to blow off the project in the future. Setting up appointments will also be a good gauge of how the group might participate or not.
- Set-up a system to show progress. As you begin to train your new clinic physician schedulers some will take longer than others. But I would suggest an online webpage that you can set-up to show project process. We recommend that you list all of the clinics that need to be trained. We set this up on a website that the client can follow along with. Each clinic starts out with a red dot next to their name, when they complete training and agree to maintain their call schedule we change the dot from red to green. When all of the dots are green, our client can go-live with their new on-call system. The hospital should be reviewing this progress page at least weekly to be certain the project is moving in the right direction.
- Identify the lagers. During this process there will be some people who do not wish to take part in training. Because the system requires everyone’s information in the on-call system in order for it to be useful, the hospital will need to make a decision about how to handle this type of situation. Some hospitals will tie participation to the doctor’s hospital privileges; some will choose to manually enter the schedule for the uncooperative group and everything in between. The most important takeaway here is that you have a plan to deal with the uncooperative. Most projects will have about 10% of these types of users.
- Agreement to keep updated. As stated in tip # 5, it is important to get a final sign-off to get the physician scheduler to commit to maintaining the call schedule in the new system. If you can get this in writing it is even better. This is all about accountability. You might even want to consider a policy that addresses what happens if the information is not kept up to date. You will want to monitor this closely for the first 6 months to be sure that everyone is doing what they committed to.
- Go live. Now you have this new great system fully populated with schedules from each of the clinics or departments. This project will be all-for-not if it is not announced properly and placed in a visible location on your Intranet. We have seen projects fail because no one in the hospital knows where the damn on-call system is located. This should not be a secret; it should be just the opposite. This is a self serve system that all care givers need to be aware of. Coordinate a meeting in advance of your launch date to discuss placement on the Intranet with your IT or web team. Also discuss with your internal communications team how best to get the word out. The good news is that you should be able to track the traffic on the new system. Your traffic should steadily increase each day the system is up and running. If not, this may indicate a communication or location problem. Do not skip this step, if no one knows it exists or where it is located it will likely not be used and the project will be considered a failure.
- Six month and 1 year review (clinical and departmental). I have not found a perfect system yet. But, what I have found are good processes to review what is working and what could be improved upon. This will be important in a new system to conduct at the 6 month and 1 year mark. Be sure to include all departments such as ED, ICU, Labor and Delivery, Telecom and anyone else that has a lot of on-call request needs. Also do not forget about direct care providers. I would survey nurses and physicians to be sure the system is meeting their needs. This is not only a great follow-up method, but it can also be a place where great new feature ideas come from. Never be afraid to ask what could be improved upon.
Key Takeaway: By following these 10 steps and you will increase the implementation success rate of your new on-call management system. Missing any one of these steps could be the difference between success and failure.
Image courtesy of Stuart Miles / FreeDigitalPhotos.net
This is the next part of a four-part series about Hospital on-call management systems. In our first post titled "How hospitals transition from binders to web" we learned about the problem discovery process. This is where we discovered and validated that we indeed had a problem. In the second post titled "Selecting the best on-call management software vendor" we learned the process of identifying top needs and learning about all of the available choices in the marketplace. This post will focus on how to get your on-call management system project funded.
Now that you clearly understand your problem, you have validated that it exists and you have identified several key features that are important to fixing the problem. You have also reviewed all of the vendors with solutions and you have chosen who you consider to be the best partner. The next part is how do you get it funded? In my experience it all comes down to four "P's", people, process, priority and problem. Below we will explore all four and how the tie together.
Process
In every hospital there is a clear process and procedure for attempting to initiate a new project such as an on-call management system. Chances are if you are a Director or Vice President you will be very familiar with the process, if not you will need to do some research. The budget process will be the very foundation that you build your case upon. If you are unable to get your hands around how the process works, you may want to forfeit the project or transfer it to someone who can. Some of the things that you will learn are, who needs to sponsor the project, what will you need to show in terms of a return, how long will it take to get approval, what if the project is denied, and other important information that you will need to know. Do this first.
Priority
In every organization there are priorities and initiatives that are agreed upon usually at the Board of Directors level. These priorities, initiatives and goals are used as guidelines to be sure the organization is focusing on the right “things”. Remember there is usually 2 or 3 times more project that are requested than there is funding available for. Because of this it is important for the hospital to prioritize. You need to know what your organizations priorities, initiatives and goals are and what the tye-in is to your project. For example, many organizations have initiatives around patient care and physician satisfaction and employee satisfaction. On-call management directly affects all of these areas.
Here are a few example arguments.
- When a patient is waiting in the ED, the longer that it takes the ED to determine who the correct consulting physician is and then to notify them will affect how long the patient has to wait in the ED before further testing, admission or discharge. Each time the ED pages the wrong doctor due to misinformation on the call schedule the quality of the patient experience is diminished and care is possibly compromised.
- Physicians are dissatisfied when they are called/paged incorrectly due to an error in the call schedule. The level of dissatisfaction greatly increases in the evening and overnight if a physician is called/paged when not on-duty.
- Telecom and Emergency Department administrative employees are often verbally reprimanded by the physician when he/she is called/paged incorrectly due to an error in the call schedule. This verbal reprimand leads to employee dissatisfaction and is a contributing factor to high turn-over rates in these administrative type positions.
Aligning with top initiatives is one of the most important steps in the “funding” process. This is where you will clearly build your case as to why this project is more important that another project because it directly aligns with the organizations priorities, initiatives and goals.
People
Each project needs a “White Knight” or sponsor. You need someone at a VP level or higher that buys into your project. Often in an on-call management situation you can find an influential doctor who will help build your case to hospital leadership. Without this person your project will most likely not move forward. This person will act as a Lobbyist and hopefully will help your cause. Another person it would be good to get to know is the person who’s budget this will be coming out of. This should not be a surprise to anyone. Many times for a on-call management project it will come out of IT’s budget, but I have also seen it come from the ED and Medical Staff. Be sure to research this in advance. You may need to set-up a meeting between IT, Medical Staff and the ED and try and figure out who has funds and who would be the best fit.
Problem
One of the last questions you will be asked by the budget committee is “what is the ROI?” Determining an ROI in projects like this it is very hard due to hard and soft costs. But you should be able to easily determine how much it is costing the hospital today to achieve the undesired results. In an on-call management project you will want to be sure to include all areas of cost:
- Clinic person who creates the original call schedule
- Person at hospital in MSO that receives all schedules
- Person at hospital MSO that collates/organizes schedules
- Person at hospital MSO office that verifies accuracy of daily shifts
- Person at hospital who creates daily call roster
- Person at hospital who sends out daily call roster
- Person at hospital who manages changes to the schedule
- Person at hospital who communicates daily changes to the schedule
Also you may want to include a flow-chart like the one below to illustrate your point.
Without understanding the budgeting process, positioning your project to align with the organizations goals, priorities and initiatives, getting the right people to assist you and having a clear understanding of what it costs today to achieve the undesired results your project will likely become cannon-fodder.
Key Takeaway: Do your homework, all projects are good projects, some are just better prepared for the budgeting process, make sure yours is one of the prepared.
Stay tuned for the final post about implementing an on-call management system at your hospital.
In my last post On-Call Management: How Hospitals Transition from Binders to Web I outlined the first 12 steps to follow to answer the question "do opportunities exist in our hospital to improve the on-call management and activation system?". If you followed the "12 steps" you should know if you have a need and you should have convinced others, through validation, that there is opportunity for improvement. Great work! You are about 33% finished with the process.
Sometimes choosing a supplier or service provider is as simple as asking a friend who they use in their business. Other times you need to go through a formal selection process. If you are following the process in the first post by now you should have a few possible candidates that you have done an initial, basic review of what they have to offer. This is important to be sure that you are both talking about the same type of solution. At Adjuvant this is very important because every once in a while we will be in the middle of our initial "show-and-tell" when we discover that the prospect is looking for appointment scheduling software, not software to manage many physician on-call schedules. In an effort not to waste anyone’s time this is an important step not to be missed. Once complete this should help you narrow your potential vendor/partner choices down to 2 or 3 at most.
- Re-review the problem to be sure everyone is still on the same page and nothing has changed regarding the size and scope of the problem.
- Identify the decision making process in your Hospital for vendor selection
- Who needs to be involved
- Any special criteria that needs to be considered?
- Re-identify the top 3 things that each user group needs to accomplish for the project to be considered a success. For example: Information Systems may be concerned about , minimal downtime of the system, daily back-up of system data, and end user training and support. Telecommunications may be concerned about, the ability to auto-generate a Daily Call Sheet, ability to easily make changes to the schedule after hours, and the ability to have a log of changes made to the schedule. The Emergency Department may be concerned about the accuracy of information, protocol and phone number information, and 24 hour lock-out / EMTALA mitigation.
- Set-up an on-line demonstration where the vendors can each demonstrate the top 3 things that each user group needs to accomplish for project success. I would not wait until you invite the vendors for an on-site presentation to see this being demonstrated. This will ensure that you are not buying “vaporware” or if you are you are well aware of it. Give each vendor 40 minutes to demonstrate and allow the group 20 minutes to ask questions.
- Now is the time to understand each vendor pricing model. You do not need a final bid or contract, you are just looking at general numbers to be sure that everyone is in the general ball-park. ***** Here are a few things not to do*****
- Do not compare the price the vendor gives you with your annual salary
- Do not assume that anything is too expensive. Your job is not to decide, but to gather facts, and present solutions.
- Based on what you and the group has learned up to now about each vendor and solution, now is the time to narrow your choice down to the best 2. Invite both of them to your location for a demonstration and process discussion meeting. At this meeting be sure to invite the following:
- You and the committee
- Potential users from each defined user group
- VP level person who’s budget this project will come out of
- Physician representative (VPMA or CMIO would be good candidates)
- After you and your colleagues meet both vendor candidates and listen to the demonstrations and value propositions, it is time to choose your favorite based on what is best for the organization. Remember vendor selection does not mean that a project will move forward, it just means that now you are ready to secure your budget.
Key Takeaway: Now is the time to be sure that your top needs can and will be meeting with the choice you make. Be careful to monitor that the team does not to load up on every wish in the world, but stick to basic things that are necessary for success. If you do not manage this key feature idenitification process things can quickly spin out of control and no-one will look like a good candidate.
*Stay tuned for the next post that will take you through the budgeting process.
Image courtesy of Stuart Miles / FreeDigitalPhotos.net