In many physician owned medical groups business decisions are made in a group setting. Often times the group's administrator will collect items that require decisions and bring them to a bi-monthly meeting where the stakeholders can decide if and how they want to spend the groups money.
In a previous blog post "Call Scheduling: A Thankless Job" I talked about the history of why there is a doctor creating the schedule in the first place. I also give some advice on what to do if your partners do not value the extra work that you do.
I speak with physicians all the time who are tasked with creating the call schedule, but when they ask their partners for some assistance in the form of software like Call Scheduler, they deny the request. Why do they do this? I think it is because creating the call schedule is not their problem, and they either don’t realize how difficult it is, or they don’t care. If the shoe were on the other foot, their decision might be different. The unfortunate thing about this scenario is that many times the physician scheduler does not want to push back or make waves and instead will just "do it" to keep the peace. This causes dissatisfaction between the physician partners and it will manifest itself in some way at some point within the group. It may not be identified or even discussed, but believe me; if you have been the victim of this behavior someday you will want to get the group back.
Just yesterday I received an email from a newly minted Chief Resident. As you know, one of the glorious duties of the Chief is to create the call schedule for the troops. Most cases the University department has a small budget to help the Chief out with expenses like call scheduling software. This young doctor told me that he has to pay for it himself. I was surprised that he was willing to do that. What that says to me is that the work is so bad that a student would be willing to pay for a solution that ultimately benefits the University.
In situations other than the Chief Resident, a doctor that has been given a difficult task, such as physician call scheduling, without any tools to complete the job, should strongly consider giving the job back to his or her partners. Why? Because if it is important to your group that the right doctor show up in the right place at the right time (EMTALA law) to serve your and others patients, than it should be important enough to the group that the person doing the job has the proper tools to do the best job possible, especially if your time is as valuable as a physician.
I think the worst thing you could do is say, "ok" and go on about your duties. If you can, demand that your group fix the problem. You’re a Doctor; your time is very valuable and, should not be wasted. If this is your scenario remember your time is being undervalued, you are being undervalued and being on-call is being undervalued. Don't let that happen, in this case you have the ability to make it stop.
If you are the victim of someone else’s decision not to buy on-call software, hopefully this will be some good food for thought.
When a medical organization gets ready to make a change to their physician call scheduling system there are several early indicators to success that you should be on the look-out for.
- You're willing to make modifications to your current process. This is a "biggie". It is imperative that you come to the table with an open mind. Unless you are creating custom software specifically tailored to your groups needs, you will need to be somewhat flexible regarding the old way versus the new way. Have a discussion with your providers to gain a good understanding of the things that your group will and will not modify.
- You're willing to make some changes to your current rules. Similar to number 1, you need to have some bit of flexibility here unless you are prepared to have the software built for you. Remember this is very expensive. Most companies like ours work hard to deliver 80% of what most medical groups needs when it comes to creating, maintaining and publishing call scheduling software. It is not cost effective to develop the other 20%. Instead of looking at this as a limitation, look at it as an opportunity to standardize your practice with other practices. Also be aware that if you need to accommodate every rule that every doctor comes up with, you will be doing a lot of manual scheduling (not that there is anything wrong with that).
- You're willing to make some changes to your schedule length. There is a mathematical equation that helps us determine what the optimum length of a call schedule should be to get the best tallies. That equation is based on the number of providers you are scheduling, the number of jobs you are scheduling and the amount of vacations/days off that you allow. Be open to this. Most software will not be a good fit if you are trying to make weekly schedules and need fair tallies. Most of the scheduling limitations today stem from the schedulers available time or the large number of changes from the providers after the schedule is "final".
- You have identified your group’s top 3 needs. This is another "biggie". Take time to meet with your providers and understand what are the top 3 "deal breakers" or according the Urban Dictionary "an element in the making of a deal, essential to one of the parties. Without it, that very party would never consent". Clearly understand what the group cannot live without. I would caution you to limit your list to a few. When and if your top 3 needs have been meet, then go back and see what the next needs should be. The purpose of this is to understand what is important and focus your efforts there.
- You have established a budget or have funds available. Although most people I talk to say that they don't have a budget, they do have discretionary funds available to accomplish certain strategic initiatives. If you do not have this available you are probably not too serious about solving your problem. That's ok, let’s just be clear about where you are in the buying process so that you are not bombarded with "are you ready to buy yet" from your sales person. I would also encourage you to develop a budget to accomplish things that are important to the group’s success. This will allow the group to move forward quicker regarding decision making.
- You have time set aside to configure and learn a new program. If you are "up to your eyeballs in alligators", now may not be a good time to take on an additional project. This should be taken into consideration. Not having time or not making time can derail a new software project faster than anything else I have seen. If a real problem exists that needs to be solved, people will make time. If your boss is not giving you time to learn and implement, I would ask if this is really a priority project. Also keep in mind the type of time we are referring to is "uninterrupted time".
Key Takeaway: If you are not ready to change, don't. Take a careful look at the list above and be realistic about your answers. Not ready now does not mean not ready ever. Plan your change and your outcomes will be worth it.
Most physicians agree that anything to do with on-call stinks. But there are things that your practice can do to make it better or worse for your providers. If you really want to make it as bad as it can be, do these 10 things and you will see it go from bad to worse quickly.
- Don't compensate one of your doctors for creating and maintaining the call schedule, make them do it for free.
- Force your scheduler to do the work of creating, maintaining and publishing the call schedule on their own time at home.
- Allow each of the doctors the ability to have any rule or preference that they want.
- Negotiate next to impossible rules and scheduling accommodations for new providers that are joining the group.
- Allow all of your providers to decide when they are going to take days off and be on vacation after the oncall schedule is published.
- Try to balance your provider tallies monthly.
- Force your scheduler to "catch people up" when they take time off after the schedule has been created.
- Print out a paper copy of the schedule and give it to the providers.
- Allow your providers to make changes and swaps between themselves without any process or procedure.
- All of your providers to schedule themselves with or without software.
By following all 10 of the items listed above, you can create the worst-of-the-worst scenario for your providers. You can be sure that this will help you accomplish the following:
- Longer wait times for your patients in the ER
- The wrong doctor getting called in the middle of the night
- Unfair tallies and workload for some doctors
- Higher turnover rate of person creating the schedule
- Unhappy physicians
There is another approach to call scheduling, doing it the right way. In a recent blog post 3 Cost Effective Steps to a Modern Call Schedule you can learn about another approach. This one may give you, your providers and patients a better outcome.
According to website Wikipedia A center of excellence refers to a team, a shared facility or an entity that provides leadership, evangelization, best practices, research, support and/or training for a focus area.
A Center of Excellence (CoE) should, at a most basic level consist of: A team of people that promote collaboration and using best practices around a specific focus area to drive business results. This team could be staffed with full- or part-time members. There are 3 key words to the definition, "team", "collaboration" and "best practices" that are critical to the foundation of a CoE.
Centers for Excellence should serve 5 basic needs:
- Support: For their area of focus, CoE’s should offer support to the business lines. This may be through services needed, or providing subject matter experts.
- Guidance: Standards, methodologies, tools and knowledge repositories are typical approaches to filling this need.
- Shared Learning: Training and certifications, skill assessments, team building and formalized roles are all ways to encourage shared learning.
- Measurements: CoEs should be able to demonstrate they are delivering the valued results that justified their creation through the use of output metrics.
- Governance: Allocating limited resources (money, people, etc.) across all their possible use is an important function of CoEs. They should ensure organizations invest in the most valuable projects and create economies of scale for their service offering. In addition, coordination across other corporate interests is needed to enable the CoE to deliver value.
CoEs can really refer to any of the support processes within an organization that complement the line businesses. In the case of a Hospital "on-call management" here are some of the main elements of the process:
- Collecting specialty group call schedules
- Creating a daily call-log
- Publishing the oncall information for all to use
- Identifying who should be called
- Activating the on-call process for the proper provider
- Tracking how long it takes for the specialist to arrive
This entire process supports one of the main business lines at most every hospital, receiving a patient in the Emergency Department. A streamlined process in this case can do the following:
- Improve efficiency
- Enhance revenue
- Manage risk
- Enhance patient care
- Increase satisfaction
So to answer the question, can you create a "center of excellence" around on-call management at your hospital, the answer is yes. Should you? That will depend on where your organization is at today and if they see value from some of the benefits listed above.
What does Eli Manning and the New York Giants team have in common with you and your team at the clinic? You're probably saying, not much, but there is a lot more similarities in the two teams than you might think.
|Highly paid players
||Highly paid doctors
|Large up-front investment
||Large up-front investment
|Each player is a specialist
||Each doctor is a specialist
|Paid staff to support team
||Paid staff to support doctors
|Players want to be on a winning team
||Doctors want to be in a winning practice
|Highly paid coaching staff
||Highly paid management team
|Players can be traded
||Doctors can leave
One of the major differences is that football players listen to their coaching staff. Although the players make more money and have more status and influence, when they get together as a team, they listen to their leader and are all on the same page with the same goal in mind, WIN. Let’s compare that to a physician owned clinic. In that scenario, the Doctors run the show and although there is an administrator, I don't think that many groups look them as business experts.
In the game of Football, what is needed to win is points. You get points by scoring touchdown and field goals. You score touchdowns and field goals by working together as a team. Out on the field, everyone is important. In this past Super Bowl, if Eli Manning didn't have teammates defending him, he could not do his job. The team wouldn't be ready to play if there wasn't staff and facilities for practices. It also would not be possible without fans. Who wants to play in an empty stadium? Everyone is a star on the team. Although some stars are better than others, everyone’s contribution is key to success. A football team is a well oiled machine. When the machine works it is in its best position to win games.
In the business of Medicine, what is needed to win is profit. You earn profit by treating patients. You treat patients by working together as a team. In the clinic everyone is important. Without certain members of your team, for example, maintenance, physician on-call scheduler, accounting, you cannot effectively compete. When you compete without your staff, you are at a disadvantage and increase your chances of loosing. There are no stars on the team, everyone is equally as important. If you strive to provide the same level of quality and service each time, everyone’s contribution needs to count.
So when you ask yourself if the New York Giants are a better team than your management team, show me the rings.
Although I am not a big sports fan, I am always fascinated at how teams work together for a common goal, winning. I think that health care and independent clinics specifically can learn some valuable lessons from how these big-fancy teams win.
How much time do you currently spend creating, maintaining and publishing your physician oncall schedule? What tools do you use to assist you? If you are still creating the schedule by hand and then entering it into Excel or Outlook so that it is accessible to your Doctors online, you might be a good candidate to modernize your process.
The reasons for modernization are pretty simple to understand, the main features that most new users love are:
- The ability to program rules into the system
- A scheduling engine that will assist you in placing people in jobs
- Automatic tallies to prove fairness
- Easy way for providers to request and document time off
- Simple way to view the on-call information online
If your ready to take the next step and look at the "new way" here are a few tips that will assist you so that you do not waste your time.
1. Access your requirements. What are the top 3-5 things that you expect the software to assist you with. Put them into a priority list. Remember that software will not solve world hunger or all of your scheduling needs, make sure you know what is most important for you to get the most value.
2. Evaluate solutions. Go to www.google.com and search for call scheduling software or physician scheduling software. Check out a few of the top search results companies and see what they have to offer. Use the top 3-5 requirements that you discovered above and make sure the software has those features. Check out a demo. Look at the references page to see what their current customers think of the product. The best piece of advice I can give you for this step is to make a decision. Updating a software system in an office should be a fairly simple decision. Just make sure that you have an out if it turns out not to be the right choice.
3. 90-day-trial. I am a big advocate of trying before buying. Keep in mind that call scheduling software requires set-up and data entry to use the system, but it is worth the effort for a fair evaluation. As long as you have a full feature trial I would also suggest finding a paid trial. With a paid trial you will most likely have free training and support. These are critical services as a software newbie. I would pick a trial over a money back guarantee any day, why? Because in a “money back guarantee” you’re not the one who decides if you get your money back, the person that has your money is. Don't pay for services in advance and take that risk. All SaaS call scheduling software providers offer monthly, pay-as-you-go options.
Modernizing your on-call scheduling process with software is an easy investment that will become more valuable each time you use it.
Adjuvant and I have been actively involved with Kids Against Hunger of Central Minnesota since February 2005 just after the Tsunami in Indonesia. A small group of concerned Central MN citizens banded together to provide relief by way of "rice and soy" hunger packs. We raised nearly $30k and packaged over 285,000 meals with 1,000 local volunteers.
In 2010 the same group assembled to assist in the devastating earthquake that struck Haiti. We were so fortunate to have done an event like this before; we just needed money and volunteers. We assembled 3,000 volunteers, and almost $100,000 in a 2 day marathon packaging event in Central MN. We packaged and shipped 1 million meals to Haiti.
Kids Against Hunger most recently committed to sending 1 million meals to The Horn of Africa to help the starving women and children in leaving Somalia for a refugee camp in Daadab, Kenya. This event will take place on December 3, 2011 in Central MN.
Kids Against Hunger also holds bi-monthly packaging sessions at its local warehouse. I currently serve as Board Chairman of Kids Against Hunger because I believe in the mission of the organization and as a community leader, I and Adjuvant want to send a message. WE CARE!
The reason I share what I have done with this organization is to highlight Corporate America's responsibility to create social capital in and for their community. These events have not only feed the hungry throughout the world, but it has brought great volunteer opportunities for everyone from ages 6-80.
In the community where I live we have a very large Somali refugee population, volunteer efforts like Kids Against Hunger give members in our community a chance to meet and work side-by-side with someone new to the community. We see it as bridge building. Although it may be a slow process, it is forward moving and we accept that change takes time.
I am proud that Adjuvant, its employees and the Board of Directors support my/our involvement with this organization. I would not want to work for or own a company that does not share my passion for the community and building social capital.
If you are a customer of Adjuvant and use Call Scheduler or Call Communicator you can feel good that you have partnered with a socially responsible company. I would also encourage you to have this conversation at your clinic or organization. Ask yourself, how can you help make your community a better place.
PS: If you want to get involved helping the Horn of Africa please contact me. The famine and horror is like nothing you have seen before. Please help!
When the Apollo 13 mission ran into trouble in space, back up astronauts on the ground in Houston were able to help solve the problem and bring the crew safely back to Earth.
Now physician scheduling isn't exactly a mission to the moon, but having a trained back up scheduler can help avert any crisis large or small. And doctor scheduling is a mission-critical task in a medical office. The success — or failure — of a schedule or on-call schedule directly affects the success of a medical practice. Using physician scheduling software and training at least two people to use the software goes a long way toward making a medical practice run smoothly and avoid crash landings.
Benefits of Back Up
Just about any business or enterprise uses back-ups like back-up quarterbacks and substitute teachers. When it comes to physician scheduling, having a back up is just as crucial. If only one person in a medical practice understands the schedule, then what happens if that person falls ill, needs to take a vacation or simply isn't doing the job well? The schedule fails and chaos ensues.
Or, consider older models for physician schedules using pen and paper or spreadsheet applications. The scheduler often created a system just he or she could understand with special abbreviations and quirks specific to the one individual. When the scheduler needed to hand over scheduling duties, it became more work than it was worth or someone else would make up an entirely new system.
With physician scheduling software and a trained back up scheduler, the office can get on the same page. Everyone knows his or her own job and how to do it and the back-up scheduler can step in seamlessly when needed.
When a medical practice makes the decision to purchase physician scheduling software, the contract should include extensive training for those who will use it including training for a back up. To not use this training is to essentially waste money. A software provider should also provide ongoing training to staff members and offer support when those times arise that the primary scheduler needs to turn to back up.
Without a well-crafted schedule, medical practices simply can't run efficiently. The schedule drives the practice and it's the schedule that dictates the flow of patients, not the other way around. If you don't first have doctors and other employees worked into a schedule, you can't set appointments or meet the needs of patients. Think of the chaos if patients had appointments but no doctor was scheduled to be there. This scenario could easily occur without scheduling back up.
So while creating a schedule for a medical clinic doesn't necessarily compare with a mission to the moon, having a trained, back up scheduler proves mission-critical for any medical practice. The practice will run smoother, face less disruption from employee vacations and illnesses, and ultimately, serve patients more effectively.
President Barack Obama left on Thursday, Aug. 18 for a 10 day vacation to Martha's Vineyard recognizing that even the leader of the free world needs to take a break from time to time. If the president of the United States takes a vacation, shouldn't doctors take one too?
A full 34 percent of American adults don't use their vacation days, according to the annual vacation deprivation study conducted by Expedia. Doctors are among the group least likely to take vacations. Often, they feel a responsibility to their patients or feel concern about lost revenue from taking time off or find it difficult to schedule between on-call days. However, taking a vacation can stimulate creativity, make doctors more caring individuals, and improve a person's overall health, all of which make doctors better at what they do.
Taking a break from the everyday routine and the schedule people fall into when working full time can take its toll on the brain. When people get stuck in ruts, their brains go on a bit of auto pilot. Their ideas and practices stagnate. They may close off to new ideas and new ways of thinking or doing things. Vacations take doctors out of their regular schedule and routine and allow them time to reflect on themselves, their family and their practice. Vacation allows people to recapture the adventure of childhood and the excitement of trying new things. This free time to play and have fun allows the brain to roam and can stimulate creativity and new ideas.
Working nonstop without vacation can make doctors in any field resentful of their jobs, their patients and the many requirements and responsibilities they face each day. These doctors may seem tired, burnt out, uncaring and unresponsive to patient needs. They've essentially "checked out" of the office. This path to burn out creates resentment and a doctor who resents her job and patients will not provide the best care she can. Taking time away from a job can help doctors gain distance from work and stave off burnout. They can reconnect with family and friends, nurture themselves and their own relationships, and return to their practice renewed, refreshed and ready to provide top notch care once again.
Practice Good Health
Doctors advise patients all the time to remove stress from their lives. But unless doctors follow their own guidance and remove their own stress, they're not practicing a healthy lifestyle.
Numerous studies have touted the health benefits of vacation. A study by the State University of New York at Oswego found that men who take regular vacations each year reduced their risk of death by 20 percent and their risk of heart disease by 30 percent. Women benefit from vacation, as well. The Wisconsin Medical Journal found that women who did not take vacation were more at risk for depression, stress and marital strife.
Hardly anyone needs a study, though, to tell them how great a vacation can make someone feel. The chance to get away, relax and let go of the worries of everyday life can refresh and renew people from any profession. Doctors and others in the caring professions need the opportunity to relax and take care of themselves every year by taking a dedicated vacation.
A on-call medical scheduler's day is littered with distractions. In the fast paced world of medicine you have a ton of projects/duties going on at the same time. Not to mention a lot of distractions at any given moment. Here are a few tips or work-hacks as they say in the technology world (where I live) that you can use to save time, be more efficient and improve your physician scheduling productivity.