“… it only took me a couple of hours with a pencil, a Sharpie and a blank calendar. . . a lot cheaper than what you’re offering, my time notwithstanding.” This is an actual email that I received last Friday from a Medical Doctor specializing in Pediatric Medicine. I am not a rocket scientist or a medical doctor, I am a business owner and something seems off to me. I don’t think the Doctor is looking at this accurately. Let’s do the math.
According to Medscape.com the average salary for a Pediatric Medical Doctor is around $250,000 per year which comes out to $120 per hour if you assume 2080 work hours per year.
- 3 Month Call Schedule Creation – 3 hours @$120/hr=$360 per schedule * 4 schedules per year = $1440 per year to create the call schedule.
- Call Schedule Maintenance – 1 hour per month of changes, swaps and other manipulations to the call schedule. 12 hours per year * $120/hr = $1300 per year to maintain the call schedule.
- Call Schedule Communication – 1 hour per month to take calls about the schedule, send out draft and final copies each time there is a change to each physician, inter-office distribution, answering service and the emergency department at the hospital. 12 hours per year * $120/hr = $1300 per year to communicate the call schedule.
Annual Creation Cost $1440.00
Annual Maintenance Cost $1300.00
Annual Communication Cost $1300.00
Total Annual Investment: $4,040.00
What you and your partners didn’t get:
- Historical data of assignments, holidays and swaps
- Tally reports
- Provider request area
- Auto sync with smart phones
- Viewable on-line
- Excel import/export
- Documented process
- Someone to call for help
- 27 hours of your personal time at home
Creating, maintaining and communicating the call schedule for a group of 12 providers by hand is not cheaper than software. In fact, it’s more expensive than a 12 month subscription to Call Scheduler, and you are shorting yourself several valuable benefits that would be very useful to a scheduler. If you’re still not convinced that your time is valuable, let me identify a few things you may want to consider now that you have some extra time each year.
Some ideas of things you can do with your new 27 hours of free-time this year
- Play 13 rounds of golf
- 27-30 intimate encounters with your partner
- 2 years’ worth of weekly lawn mowing
- Play in 30 tournament games of cribbage
- Have 6 guy’s/gal’s night out with friends
- 13 – 2 hour volunteer sessions at Kids fighting Hunger
- Run 5 full 26.2 mile marathons
- Drive your car from New York, NY to Denver, CO
- Read 324 books to children
- Read 1 years’ worth of The Harvard Business Review
- Walk 81 miles (approximately 3 mph)
- 54 trips with your kids or grandkids to get ice cream or frozen yogurt
Regardless of the math or cost, time is valuable. As an executive, my time is really valuable, I can only imagine how valuable a physician thinks of her/his time. Especially if you have a family. The moral of this post is that what most of have the least of is personal free time. Because of all the hard work, we have is profit to invest in our businesses to be sure we are making the best use of our time.
I cannot say for sure, but I would bet you my last pair of clean underwear that any doctor who creates, maintains and communicates the call schedule for their partners, without getting paid, would much rather be participating in any of the activities listed above over creating the damn call schedule. Not sure, just a hunch.
Key Takeaway: Life is short, play more, schedule less.
Image courtesy of Stuart Miles/ FreeDigitalPhotos.net
If you are a physician or administrator who creates the call schedule for the doctors using Excel, this post is specifically for you. I have heard the phrase over and over “I’m too busy to even look at something new”, “we’re too busy with (fill in the blank)”, and “the doctors are so busy” so often that it doesn’t even phase me anymore. After some thoughtful reflection, I was unable to identify a group of professionals who are not busy. Can people be so busy that they can’t take time to learn about something relevant to their business that will save time? Really?
Adjuvant Technologies is the second company that I have started. In my first company and even the first few years of Adjuvant, I was always busy. Often times too busy to eat lunch or even arrive home at a reasonable hour. Over the years, trusted advisors, as well as members of my Board of Directors would advise me to begin to off-load some of the administrative duties that were always making me so busy. One of the main reasons that prevented me from giving up some of these tasks was the daunting task of turning things over to someone else, bringing them up to speed and then managing the process. It seemed easier to just do it myself. Although nervous, I thought I would take the advice and give it a try.
One of the first things I “turned over” to someone else was the daily book-keeping and accounting duties. Although it was a long set-up process, looking back it was one of the best moves I made. Although I am still very involved, I do not have to perform all of the daily duties. This gives me more free time to do my job, which is selling, writing blog posts and running the business.
When I look back several years, doing the accounting was a way for me to keep busy with a task that was relatively simple, gave me some sense of accomplishment and was easier than picking up the phone and trying to talk to a doctor or clinic manager who was always too busy. It was actually some form of not having to do my job, because I was busy with something else.
When I look at this in contrast to on-call physician scheduling software, I do wonder why there are so many busy doctors that take on the task of creating, updating and communicating the call schedule for themselves and their partners. And on top of that, when they do it by hand or with Excel and not take advantage of software such as Call Scheduler. Perhaps it is like doing a brain teaser, something to take their mind off of work, patients, families and other “stuff” that looms in doctor’s minds.
In my company we have decided intentionally not to be “too busy” to look at and explore things that will help me and the team manage and grow the business. Because we are open to new, relevant ideas and concepts, we continue to find “bits of goodness” that hopefully my competitors are “too busy” to see. One example of this is the blog you are currently reading. Although we try and write weekly, sometimes we miss that goal. Most companies are far too busy to blog, just ask them. Another example is that we use a robust Customer Management System (CRM) to manage all of our sales and customer activity. Many companies don’t use CRM systems like this because they are “too busy to set-up and continue to enter information into”. We invested into this system so that we can do a better job memorializing the conversations and interactions that we have with our customers. This should make it easier on our prospects and customers in the long run.
I try and make decisions that are in the best interest of the business and our customers. If I am too busy to look at something new that can save me time and help our customers, I may need to re-evaluate if I am doing my job.
Key Takeaway: Maybe you are too busy NOT to look at something like physician scheduling software.
Photo courtsey of unknown artist
Software development is very expensive, time consuming and risky and should not be taken lightly. Software companies spend years iterating the development to create systems that can be sold and generally accepted into the market. I can’t imagine why any software business owner would develop something that does not meet the market’s general need. If you are looking at on-call scheduling software that requires or even offers large or unlimited customization, you are looking at a vendor who did not develop their software for you, and are trying to squeeze a square peg into a round hole.
Our development philosophy at Adjuvant is to strive to have 80% of the features that our target market customer need to do their job out of the box, without any customization. As healthcare changes, ambulatory practices and hospitals continue to have their needs change around on-call schedule creation and system wide data management. This is a moving target that lends itself well to a web software model that is always developing or modifying to meet the industry needs.
The reason for this approach is that although we recognize that each organization is different, the similarities far outweigh the differences. Many of the differences are people’s individual different styles of working and are not actually true differences. For example, every physician practice that we work with wants tally reports so that they can prove that the schedule that they have created is fair. The tally report is part of the 80% standard, what is different is how people want the information displayed. The reason for this is that most users have spent so many years creating their own system to get their work done that if it doesn’t do it “their way” they don’t want to use it.
This is very similar in other industries as well. For example when the first computerized accounting software was released in 1973, SAP’s software allowed companies to do their purchasing, invoice verification, and inventory management automatically. Although this was revolutionary, most small companies had no desire to make the switch. One of the main reasons for this was that they did not want to standardize their process. Ironically also in 1973 the Financial Accounting Standards Board was created. Chances are if your company went with SAP in the 70’s it was because you were a large company that demanded standardization. You would not want each business unit creating their own process for accounting. Low and behold in 2014 do you know any business that does not use standard accounting software?
Similarly, Astrologers began recording detailed information about their patients’ medical conditions in 1596. Over the next 350+ years physician offices began to create standards for recording patient health information. Although each clinic was different in how it charted, much of the same information was contained in each patients chart. Today when an organization purchases EMR software they are not customizing more than 20%. The EMR Company has done its research and is “tuned in” to its market to know what the majority of their customers need. The point I am trying to illustrate is that the similarities are much greater that the differences.
When it comes to physician on-call scheduling software the situation is similar. Most groups throughout the US, Canada and even places like Australia do things generally the same. The differences come in peoples individual preferences.
Don’t get me wrong, there are some very compelling reasons to make some customizations, such as;
- You can modify any feature you wish
- You can dictate special lay-outs, forms, color, and button placement
- You can make things look and act like the “old way”
There are also some major things to remember about customization, such as;
- Customizing features for an admin-staff member who may leave or change positions down the road is risky and expensive
- Custom development takes a considerable amount of time and money to scope and create requirements
- Custom development takes time to develop
- Custom development takes time to test
- Custom programming is very expensive and often requires re-do’s
- Custom programming typically requires custom support
- User needs and preferences change over time making customization irreverent
- The process you are customizing is unlikely able to be used by other departments
- You lose the ability to cross train schedulers among multiple departments
- The ability of your vendor to say “that’s just what you asked for”
Take the time to find the similarities before you find reasons to customize. Demand that your staff do things the way most others do it in your industry, even if that means change. Standardized processes are developed for the good for the organization, nor the user doing the work.
Key Takeaway: Choose an on-call software vendor that has created and followed the industry standard features. There is no reason to reinvent the wheel and build your own software when general software is widely available. Any more than 20% customization is too much in my opinion.
There is a saying, "if everything is important, than nothing is important". I think this is ture.
Whenever you are in the market to make a purchase, regardless of size or price, it is important to know what you are trying to accomplish. Typically key stakeholders in any purchase have to make some upfront decisions in order to narrow the marketplace.
For example, when you are in the market for a new home (I grew us the son of a successful Realtor) a good Realtor will have an initial conversation with her buyers to better understand what they are looking for. How many bedrooms do you need? City or country living? Two story or ranch home? Fireplace, yes or no? Gas or electric cooking applicances? School district preference? All of this information helps the Realtor narrow down the choices of the properties in which she will show the prospective customer. Without this, it would be very”hit and miss”, and could potentially waste peoples time showing them a 1 bedroom home when they have a large family. In the sales world this is referred to as the “discovery process”.
Knowing What’s Important
In my customer’s world of clinical practice, the internal discovery process should not be any different. When you are researching physician on-call scheduling software all of the stakeholders need to identify and agree upon what is important.
Here are 10 discovery process steps:
- Send out a meeting notice to all involved stakeholders. Be sure to include everyone. Doctors, schedulers and administration. This will insure that the dream machine is paired with realistic financial expectations.
- Have a brainstorming session. This session needs to accomplish two things. First, agree on the purpose of the project and put in writing. Second, identify needs, not wants, desires or pipe dreams. Also be realistic, especially if you are working with a tight budget. Write each idea on a large easel pad piece of paper. Everyone should be able to give input.
- Narrow down the first round of choices to 10. Purchase a pack of “red dots”. Give each person 5 red dots. Let them place their red dots next to items that are most important to them. The top 10 ideas with the highest number of red dots next to them are the winners.
- Narrow down the 10 to a top 5. Now give each person 3 dots and use the same process as above to narrow your top 10 choices down to 5.
- Out of the top 5, identify if any of them are deal breakers. Typically some of the top items are so critical that you could not meet your goals without them. Make sure you know what they are in advance of looking at product demos.
- Prioritize the top 5 in order of importance. Give an order to your list of most important things. The reason we do this is this is that certain items have a hefty price tag associated with them. This will help you in making a decision later on down the road.
- Establish a budget
- Look at demos and match your needs to products
- Match your budget to products
- Try and buy
It is very common for consumer’s needs to change as soon as the original sets of problems are solved. For example, when I was young I couldn’t wait to get my driver’s license so that I could drive a car. At 16, anything that had 4 wheels and an engine was good enough for me. It was only a short time later that I wanted something more than bare-bones transportation. I wanted a car with little rust and a cool stereo system and air conditioning. It wasn’t until my first sets of needs were meet that I even thought about other, cooler stuff. That does not mean that my original car did not meet my needs. It meant that my desires changed. Although I wanted a cool car with all the bells and whistles, my budget did not allow for it. In order for me to continue to be happy I needed to remind myself why I bought the car and thought about what it would be like not having a car and going back to the old way.
The expansion of needs is common in my field of physician on-call scheduling software. According to our trainers, while most of our prospects come to us to try and fix the on-call scheduling problem, once we accomplish that (I might add, which we do well ) they want the software to begin to do things it was never intended to do. Some of those things include nurse or patient scheduling. Since we do not do those things well, sometimes new customers are frustrated. What I wish I could remind those people is, “that’s not what you bought it for”! Yes it would be great if our solution could solve many of your other problems as quickly and easily as we helped you with physician on-call scheduling, we can’t, and it is unreasonable for you to think we should be able to.
If you find yourself in this situation where you are frustrated that your new solution will not help you with “side tasks” that are other than what it was intended for, pause and re-review what you discussed at your discovery meeting. Make sure that your original needs are being satisfied and be fair and realistic about new desires. And always remember what your alternatives are, for many of our customers it is back to paper, pencil and Excel.
Image courtesy of Stuart Miles / FreeDigitalPhotos.net
This blog post is about two separate but equal topics (a) having realistic expectations of your vendors and (b) creating a lasting relationship with vendors to help and allow them to succeed.
Many would agree that the practice of medicine is not an exact science. It is more attuned to an iterative approach or trial and error process. Imagine how frustrated practioners’ would be if their patients didn’t have any patience. Imagine how odd it would be if a patient refused to continue to work with you because you couldn’t eliminate each and every problem that the patient currently has or new problems that may present as a result of a treatment plan. Most of us would think that person’s behavior and expectations are absurd.
Who’s fault is it if a doctor prescribes a treatment plan to a patient and the patient is unable or unwilling to comply?
Is it reasonable to assume that a patient with a severe enough problem to see a physician will have to make some modifications to their current life or lifestyle in order to experience healing or a reduction in symptoms?
Is it reasonable to assume that not everyone in a patient’s family is going to agree with the provider’s choice of treatment?
I remember several years ago I was in the Emergency Department of my local hospital with a head-splitting migraine. I was in so much pain that I had someone take me to the hospital in the middle of the night. As a patient that needed help, I was willing to do whatever the providers wanted me to do in order to stop the pain. I remember the doctor coming in and saying that they wanted to do a Lumbar Puncture to rule out Meningitis. I am very aware that this is not a procedure that many people are thrilled about having. I was in so much pain that I rolled-over and said “do whatever you need to do to make the pain go away”. Thankfully shortly thereafter (after some good drugs)I woke up without the headache. As I was recovering I overheard the patient in the next room arguing with the staff about having a procedure. I thought to myself, you must not be really sick enough or you wouldn’t have the fight to argue. People who are in true pain will take the advice of experts to stop it.
When you as a health care provider or clinic manager are in pain due to an outdated business process like on-call scheduling, and you take the time to see advice from a professional (like me) for god sakes, listen to their diagnosis and follow the treatment plan. Quit giving us every excuse in the book as to why you can’t change. As I stated above, people who are experiencing true pain will take the advice of experts or at least give it an honest try.
The second part of this post is about building lasting relationships with vendors. Imagine this scenario, it’s 4:30pm on a Friday afternoon and you are in the process of creating the call schedule for the next 3 months for the 20 specialists in your practice. You make several mistakes, hit an unknown combination of buttons and mouse clicks and before you know it, your schedule is gone. Ooh shit, now what are you going to do? If you were a client of ours, you would call our office and tell the person on the phone that you have an emergency and the operator would find one of our team members to call you back ASAP. Yes, even on a Friday evening. That staff member would do everything in their power to “fix things” for you. Chances are that when you got off the phone your schedule would be restored. Most good companies that truly have a passion for what they do will bend over backwards to help a customer.
Why is it that many good companies like ours feel like customers don’t have that same level of loyalty? Why is it that some customers are willing to cancel their service just because their staff won’t change or because of a trivial, one-off requests? Also why is it that some customers will not give you a chance to fix something or implement a good idea, and are definitely not willing to pay any more money?
Let me let you in on a secret, as vendors, we actually want to help you. We actually want things to work perfectly for you. We want you to be happy so that you continue to be a customer.
I ask that you treat us like a good employee. Let us make mistakes, tell us when they are wrong, create a corrective action plan, let us fix the problems that you have identified. Give us a chance at succeeding.
After all it is less expensive and less disruptive to your company to communicate problems and give vendors a chance to resolve them before you take a nuclear approach and terminate the relationship and have to start all over again.
Key Takeaway: If you have a problem that is not in your area of expertise, listen to the advice of the experts, and in the words of Crosby, Stills & Nash, … honey, love the one you're with!
Image courtesy of Olovedog / FreeDigitalPhotos.net
How will scheduling doctors be differnet in 2028? Do you think that we will be doing it with computer chips built into our heads, or using some star Treck Communicator device? Before we look at the next 15 years, let’s look at the last 15 years.
Back in 1998 our founder Patrick Zook, M.D. had already developed the DOS version of Call Scheduler and was working with clinics to implement this new software to help create a call schedule. Although 1998 was not pre-Internet, most clinics at the time were still not using the Internet like we use it today. Many clinic computers were still “green-screen” dumb terminals. Almost all of the new sales Dr. Zook was making were to who we refer to as “early adopters”. People who are typically on the cutting edge of technology and like to use the latest and greatest stuff. I would say that in 1998 the vast majority of ambulatory specialty clinics were creating the physician call schedule by hand using pen and paper. Some of the fancier groups were using Calendar Creator to make the schedule look more like a traditional schedule. Getting people to use the computer was one of the greatest sales hurdles that we encountered in the late 90’s. The trend went from creating with paper to using Microsoft Excel.
Jumping ahead 15 years to today we see different challenges. I have listed some of today’s biggest challenges below:
- One of the largest changes that we see today is the government EMR mandates that have inundated healthcare and will continue to for years. Although EMR’s hope to provide tremendous value in the future, their implementation has been painful and very expensive. For most organizations, while going through the transition from paper to electronic, all other IT projects took a back-seat.
- Another challenge is that we see most of our users are now actual Doctors. This has been steady changing over the years. Most of the schedules have become so complex and such a point of contention between the physicians that the clinic has not been able to attract and keep administrative staff in this position. Often it has been handed up to the clinic administrator and then a lateral hand off to a lead physician because the administrator is not prepared to deal with the challenges of the scheduling position. The challenge with physicians now doing this work is that they are so time limited that often it is easier for them to continue with an old outdated process, using paper or Excel, rather than taking time to learn something new.
- As discussed above, now that physicians are the schedulers in many clinics the time that it takes to implement new initiatives has become problematic. This happens because the physician scheduler has not been given any administrative time to accomplish this task. Without extra time allocated the doctors are expected to maintain their RVU’s and complete the schedule on their own time. Since RVU’s can only be done 8-5 and M-F, the user does not have the time to change. Even when it is necessary and supported by the entire practice.
- Although most clinics do not know how much it costs them today to create, maintain and change the call schedule that everyone bitches about, but they do know that any proposed expenditures will be meet with great resistance. Because many of the schedulers are doctors, and they do this on their own time, and without compensation, the group does not value the work done. Because of this, it is tough to get the group to buy-in to an added expense.
- One of the challenges that we see as a contributing factor to on-call being so contentious is around physician retention/fairness/life balance. The demand for specialty care providers is great, especially in rural USA. Because of the shortage current providers are being stretched thin. In addition newly minted medical doctors are not agreeing to all of the call-duty time that their colleagues had done in the previous generation. Young doctors are demanding fair schedules and do not want to be over scheduled on evenings, weekends and holidays.
- One final challenge to physician scheduling in 2013 is that expectations seem to have shifted. Users, who are now mostly doctors, want software to do everything. Keep in mind that most of them are going from Excel to scheduling software, but their expectations move quick. They immediately expect systems to meet their every need and demand. They also expect these new features to come without a cost.
As we look ahead 15 years, what will have changed? Here are some questions that I have; maybe the answers can help us predict the future:
- Do you think there will still be a shortage of specialty providers?
- Will there be any independent physician owned specialty clinics?
- What will the next large government technology mandate be?
- Will doctors still be creating the schedule or will they be using software and be able to hand off the duties to a person down the chain of command?
- Will RVU’s be a thing of the past? Will doctors have more free time during the day to achieve administrative functions?
- Will there be more money available for time-saving projects?
- Will physicians be more apt to want to be on-call?
- Will the government outlaw the ability to be paid to be on-call?
I don’t know the answers to any of the questions that I listed above. What I do know, based on 18 years of running businesses is that things don’t usually move backwards. Shortages don’t get better, budgets don’t get bigger, problems don’t just spontaneously resolve themselves and there will still only be 24 hours in a day.
I predict that the physician scheduling market will be much more condensed, with fewer choices in the market, more robust rules and flexibility and a much larger price-tag for the software each year. The scheduling will continue to more work and less call and the rules will continue to be loose preferences that require a lot of flexibility.
Key Takeaway: Get moving forward. Things are not ever going to be as easy as there are today. Spend the time now to automate those mundane tasks like physician scheduling and you will have some more time in the future to worry about new problems that you aren’t even aware of today.
Image courtesy of Victor Habbick / FreeDigitalPhotos.net
It’s first thing Monday morning and as I arrive in the office and I overhear a support call underway being handled by the person on the other side of the cubicle wall as myself. Now mind you, most everyone probably begins their Monday morning at work the same way, slowly. Drink a little coffee, review weekend emails, and maybe briefly browse the news or the local paper. But this is not how it begins for everyone; support people are available whenever the phone rings and a customer has a problem or needs help. This morning was not any different.
In my experience there are two types of support people that you might reach when you call a company for help; the first type, after you explain the problem is very quick to offer up a solution that pawns you off in another direction or to another person. Very rarely do they actually understand your situation or is anything their fault, it seems their goal is to transfer you as quickly as possible. The second type of person is a stubborn person that looks at helping you as their life’s mission and feels bad if they can’t help you. In fact they often will try to help even if it not the fault of the company. These people often use Google and other resources to find outside of the box solutions and truly are trying to help the person on the other end of the phone solve their problem. When I did support earlier in my career, this is the type of person I was.
Since the first day we opened our doors at Adjuvant, without anyone mandating that this is how we will serve our customers, we have been in this amazing service second camp. The team at Adjuvant that services our Call Scheduler customers are truly good people. I am always amazed by the dedication and commitment that these people have to our customers and their problems. When speaking to a doctor, clinic administrator or administrative person who does the scheduling, most of the time when they call, they need an answer now, and or they need to be pointed into the right direction as to who can help them. Although were fun to talk with, some users when they call are angry or frustrated that things are not working the way they expected them to and now they have to take time out of their schedule to call us for help.
Here is an example. A few months ago, a very prominently named client called us to tell us that they were no longer receiving emails notifying them that a provider has submitted a request. Now please note that with the amount of customers /users that we have, when there is a problem, our phones start ringing off the hook immediately. We know pretty quickly when something is not working as it should. Although every problem has to have a “first phone call to support” and sometimes users are canaries in the mine, most of the time if no others have reported a problem, we are fairly certain it is not on our end. In this situation we had not received any other calls about the issue. The support person who took the call did the appropriate research and was able to narrow the problem down to an email issue of the customer’s side. We knew it was on their side because we had proof of mail delivery to their mail-server. We instructed the user to call there IT Department and let them know that we felt as if there was an email issue on the user side and provided them with some supporting documentation. Keep in mind that most support people love to blame others for issues; it is always someone else’s fault. Most IT departments default answer is “not our problem must be on your end” to every call they get. I personally think that is why users call us first; at least we listen to them and try. The shortened version of the story is that the clinic IT people had upgraded this users email software when they were on their regular day off, and when they came back to work, the first thing they tried to do (using call scheduler) did not work as it had in the past. The problem was on the users end and once IT was properly convinced, they were able to fix the problem and they thanked us for our help. Our team probably spent an hour, if not more troubleshooting this problem that as it turned out had nothing to do with us or our software.
The reason I write this post today is to highlight how important and valuable the support process is when you are a user and are having technical problems. Since most of our clinical users are not at a desk during the day, it is imperative that we can help them with problems as soon as they occur. Technical support is something that many companies charge additional money for. Some even charge a premium to receive a response to your support questions quickly. In fact I pay that for both Dell and Salesforce.com. I have always found this to be funny that I would need to pay a premium to get help right away from someone that spoke good English. Isn’t that just considered good customer service? For large companies like Dell and Salesforce.com, I guess not.
It is our philosophy at Adjuvant that access to high-quality; professional support staff for all of our Call Scheduler products should be at no additional charge and should always have a priority goal of solving the user’s problems without handing them off to someone else. That is why we offer unlimited technical support at no additional fee. Although problem solving is not easy, it is one of the most important components to any customer relationship.
Key Takeaway: It’s easy for a company to shine during the sales process, but it takes a commitment to quality and caring for your users to shine when your customers are not happy because something is not working the way they expected it to. We hope you will always feel comfortable to call us when you need help. We promise to do our best to answer your questions quickly without pointing any fingers.
PS, to any of our support people who happen to come across this blog post, Thank you, you rock at your job. We love you!
Image courtesy of David Castillo Dominici / FreeDigitalPhotos.net
Should someone within the walls of a hospital be responsible or “own” on-call for the organization? Of course the answer is YES. If there is no owner, is it possible to have a system that works flawlessly? Every process in every organization needs an owner or someone that is accountable for the success and failure of the system.
In many hospitals that we speak with ownership, if there is any, of the on-call process can be found in many different areas of the hospital. Medical Staff office, Emergency Department, Administration or Information Technology are some likely candidates.
Why no owner?
Many times there is not an owner because the previous owner tried and failed at bringing together the critical stakeholders and gaining agreement. If you consider all of the people/stakeholders involved: individual clinics throughout your community, the emergency department, nursing units, telecommunications, hospitalists, local answering services, the transfer center, and other hospitals. Just to name a few.
Because there are so many groups, there are many moving parts in trying to coordinate the needs of each of these groups. Anytime there is a lot of moving parts the level of complexity increases substantially. Another reason on-call management is tricky is because of “who” is on the call schedules. Physicians have the status and freedom to make changes to process with little regard to the impact on other areas of the organization. Therefore any changes to this system need to be approved by a physician committee that always seems to have something better to deal with than on-call. If there is ever time for a discussion the ability to agree on standards is unlikely. Therefore many employees say, forget it. Because of this, this owner should have considerable power and the ability to enforce, all on behalf of patient care.
It is common in businesses to see consequences to lack of ownership, such as ”silos” being built. Silos are independent structures that are erected that have little interaction and concern for other areas within an organization. Silos are not concerned with areas outside of their own. The people within the silo, their goal is to improve their silo. Silos are very common when it comes to on-call. The silos go all the way back to the individual clinics. Most clinics do not care about on-call at the hospital as long as their doctors are not called incorrectly. There is little concern for what happens once the monthly calendar is sent over to the emergency department. In a medium sized community, this means that upwards of 30-40 clinics that each have on average 10 doctors do not share a common vision, or even understand how everything works together.
Symptoms that no one owns on-call at your hospital:
- When there is an on-call problem or issue no one knows who to call
- Each department accesses on-call information in a different way
- There is not two-way communication between the hospital and local clinics regarding daily schedule changes
- There is not a standard policy for how schedules are created
- There is not a standard policy for how schedules are communicated from clinic to hospital
- There is not a standard policy for how changes are made during business hours
- There is not a standard policy for how changes are made after hours and on weekends
- Individual schedule creation is not a concern
- Schedule fairness for physicians is not a concern
- How physicians access the schedule is not a concern
- Support areas such as telecom can make changes to the entire system without someone from medicine getting involved
What’s the big deal?
You might be reading this and asking yourself, so what? Without an owner comes waste. Without an owner your systems don’t talk with each other. Without an owner both hospital and clinic staff are duplicating work, sometimes daily. Without an owner the quality and accuracy of the information is unknown, this leads to the wrong doctor being called. Without an owner the systems and processes that you put in place are not being followed and that cause people to have to do more work. Without an owner the systems that you are already paying for are not being used and therefore you are spending money without accountability. This is all before we talk about longer than normal patient wait times in the ED or how patient care can be compromised in certain situations or physician satisfaction. When you look at on-call at the community level, it is a very big and expensive deal.
The coordination of on-call at a hospital is a big deal. Without an owner you will see a host of problems. The leader must understand the medical and administrative side of both the clinic and the hospital and have the ability to implement and the authority to say no. On-call problems can vanish with a strong, quality leader.
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Transformational change is a big buzz phrase in the business world today. Although there is not an official definition, transformation is thought of as a shift in the business culture of an organization resulting from a change in the underlying strategy and processes that the organization has used in the past. A transformational change is designed to be organization-wide and is enacted over a period of time. According to Robert Gass, a co-founder of the Rockwood Leadership Institute, “Transformational change is distinguished by radical breakthroughs in paradigms, beliefs and behavior. In transformational change, what was seen as obstacles may morph into opportunities, apparently irreconcilable opposites may come to be seen as creative tension, and change that seemed improbable or requiring long development may quickly come into being.”
What is the difference between a regular change and a transformational change? Regular change seems to be more of a process of continuous improvement. Always trying to do or be better. But sometimes we are trying to improve something that is inherently broken.
I heard a story yesterday about the Washington Monument and how it was disintegrating at a rapid pace. They needed to make a change or it would crumble. At first a group of engineers got together and determined that the Monument was in such bad shape due to the use of harsh chemicals. One of the engineers began to ask more questions, why do we use such harsh chemicals? Well it turns out that pigeons poop all over the monument and they need strong chemicals to clean off the bird poop. Asking another question the engineer wanted to know, why do we have so many pigeons? Apparently pigeons eat spiders and the monument has a major spider problem. Why so many spiders? They eat gnats, and lots of gnats, and the monument has a lot of gnats. Why are there so many gnats? Gnats are attracted to bright lights at dusk. The ultimate transformational solution to this problem was to turn the lights on at a later time.
Transformational change involves asking the question “why” a lot. The more you ask why, the more you uncover about the situation. The more you uncover, the more you learn about true problems. The more you understand the true problem, the better chance you have of implementing a solution that works.
Many clinics and hospitals that I speak with are set in their ways. One example of this is how it required an “act of Congress” to force organizations to adopt electronic medical records and then many incentives for the systems to talk with one another. One of the reasons for this is that the benefit of electronic records was not only with the clinic or hospital. There will ultimately be many beneficiaries’ when all systems are up and running and can communicate with each other. Someone had to create a large vision that was bigger than a clinic or hospital. They needed a vision for health records in the USA. Normal continuous improvement would have never taken you there.
My question above asking if modifying your on-call process can be transformational is a large question. I ask this because many feel that the call schedule is just this little “nothing” thing that is done at a clinic and does not deserve any attention, and in most cases it is such a nothing task that it is done for free by one of the partners on their own time. No-one wants to do it, or think about it, but everyone will bitch about it if it’s wrong.
When we begin to dissect the on-call process at most clinics it turns out that on-call has a major impact on patient scheduling, physician availability, physician fatigue, and physician satisfaction, just to name a few. At the hospital level it has a major impact on patient wait times in the ED, door to balloon time for cardiac care patients, how long you sit in a bed waiting for a consult, how quickly you are given a treatment plan and admitted, overall patient satisfaction, on-call physician satisfaction, ED physician satisfaction, communications, and inbound transfers to a facility, and that’s just the list off of the top of my head.
I am certain that something with as many critical interconnected components as on-call (process) should be carefully scrutinized annually to see if it is meeting the needs of all of its stakeholders. In order to make a transformational change, because of its complexity, on-call requires a multi-disciplinary, whole system approach for it to be successful, irreversible and enduring.
How do you know if something needs changing? Close your eyes and imagine how things will be regarding your problem in 5 years if you do nothing. Most can agree that something like on-call stinks today and will continue to skink in 5 years if no changes are made.
Albert Einstein said that “problems cannot be solved by the same level of thinking that created them.”
Key Takeaway: Start by asking your group why you have not reviewed your on-call process lately?
Image courtesy of Porbital / FreeDigitalPhotos.net
Let me begin this post by saying that I do not receive any compensation from any smart phone company for writing this blog post. If you are a physician, regardless of your specialty, age or gender, you must have and learn how to use your Android or IPhone.
I had a physician in my office this morning that was not using his smart phone to the fullest extent and therefore was still carrying around a small paper calendar in his pocket to make sure he knew when he was on-call and supposed to be doing hospital rounds. Not that there is anything wrong with this, but if you have and carry a smart phone, why not use it.
I have listed 6 "things" that every professional should know how to do with their smart phone. By using most or all of these things you can rest easy knowing that you are getting your money's worth out of this monthly business expense.
- Google is one of the coolest companies in the world. They not only offer their free flagship “Gmail” accounts, but they also have a great calendaring program as well as “Google Drive” (formerly Google Docs) which allows you to store existing documents (for free) or create new word processing, spreadsheet or presentation documents using most of the same tools as Microsoft Office. They are also the gold standard in mapping with their “Google Maps” app. Gmail, Google Calendar, Google Drive, and Google Maps each have an app for all smart-phones. Each of these apps are a must have and must use for every physician.
- Work email access. If you do not do these already, go to your IT person and have them work with you so that you can access your work email on your phone. Almost all organizations use either Microsoft Outlook or have an Exchange server; both are compatible with every smart-phone.
- Calendar Syncing. When you go to schedule a haircut or a dental appointment, you should be able to quickly open up your phone, go to your calendar and see all of your work and personal and even your on-call assignments all in one central location. This should be your central calendar. The easiest way to sync your work and personal calendar is to use Google Calendar. Have your IT person help you with the work calendar. Tell them you want to be able to see it on your Google calendar online. Anything that you can see on your Google Calendar with your desktop or laptop you can see on your smart phone.
- On-call schedule syncing. Once you have your Google calendar set-up and you can see things both on your phone and desktop or laptop computer, then follow these directions to get your Call Scheduler on-call assignment schedule to keep your calendar in sync with Call Scheduler. IPhone users can go to: http://blogs.call-scheduler.com/justins_blog/bid/57029/How-to-get-your-physician-call-schedule-into-your-iPhone and Android users can go to: http://blogs.call-scheduler.com/justins_blog/bid/57326/How-to-get-your-Doctors-Call-Schedule-into-their-Android-Phone. If you have any problems call our office at 877-435-8826 and someone will walk you through the process. It is really simple.
- Web browsing is one of the most basic smart-phone functions, but one that is sometimes underused. If I were a physician I would be sure and have a “shortcut” link to my entire groups schedule on the home screen on my phone. This can be used if you ever need to see who is available to swap shifts or you just want to see who is on, when you know it’s not you. Follow this link to see complete instructions: http://blogs.call-scheduler.com/amys_blog/bid/65602/One-Touch-Access-to-your-On-Call-Schedules-on-iPhone-and-iPad
- A few other “must-haves” and “must know how to use” smart-phone apps that I would highly recommend would be Evernote, Dropbox, Pandora and of course the most basic of all text messaging.
Your smart phone is not just for talking on, in fact the trend is that it is being used much more for other things and people are talking less. "Surprisingly, talk time is only 26 percent of the total. The rest of the time the smart phones are being used to surf the Web, send text messages, check e-mail, use a social network or play games" according to Blogger John Breeden II in his post published on June 4, 2013.
Don't be afraid to learn how to use your phone. If you are an Android user, go to the store where you bought it and ask them for help, or you can always go to Google or YouTube and search for “how do I …” and you will find a ton of great advise from fellow users. The same is true for IPhone users. You may also get great service by going to an Apple store and talking to one of their smarty-pants. Also never be afraid to ask your local 15 year old, they probably know more than the workers at the store.
Key Takeaway: Take the time to learn how to use your darn phone. And don’t even tell me you don’t have the time, that’s an excuse and you know it. Professionals make time to learn things that are important to making them better in their business. This is one of those things.
Image courtesy of Stoonn / FreeDigitalPhotos.net