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

Four Drivers for On-Call Management Software Success

Posted by Justin Wampach on Wed, Jul 23, 2014 @ 02:42 PM

ID 10031660When was the last time that you or a family member needed to go to the Emergency Department at a hospital?  Whenever it was, it is very likely that you or someone in the next room or down the hall needed a consultation from a specialist.  Many non-medical people don’t realize that Emergency Room Physicians are trained to perform emergency resuscitation, start intravenous lines, or take other steps to stabilize the patient before transfer to another hospital department. Less serious injuries, such as lacerations or broken bones, can be treated in the ED.  Other patients that need to be admitted to the hospital will need to be seen by a specialist, such as a Cardiologist, Surgeon or Neurologist.  These highly specialized physicians are not just sitting around in a back-room somewhere in the hospital waiting for a patient to come-in.  Instead they are at their medical practice seeing patients or at home spending time with family and friends and take turns serving as “on-call resources” for Emergency Room Physicians.

Most hospitals mission statements are about patient care, staff and physician satisfaction, quality outcomes and perhaps something about being community oriented.  Yet when you look around an organization often you find areas where none of this has been considered for years.  How on-call works in a hospital or health system is a great example.  Where else do you find as much “old school” paper processes, Excel spreadsheets, 3-ring binders, fax copies and sticky notes as in the office of the person who manages the daily call roster.  Buying and implementing a new on-call management system seems pretty easy, Google some key-words, find some vendors, choose a vendor, get funding, create a contract, install the system and go-live.  If only it were that easy.

I would like to highlight four key areas that need to be carefully considered if you want a successful implementation of your new on-call management system.


Creating an on-call management system for a hospital or health system takes vision.  The reason for this is because on-call is one of the very rare items in a hospital or health system that affects almost every department and most every healthcare provider.  Because of this it is important to view this as a system wide issue, rather than department specific.  For example, if you look at this from a “telecommunications” perspective, you may solve the hospital operator’s problem, while creating a problem in the local medical groups or clinics.  Someone with vision needs to see and understand how each department uses on-call and buy a system that can reasonably accommodate everyone’s needs.  Don’t allow this project to be just about one department.

Commitment to change

Once you can visualize the big picture and have converted it into a vision then it needs to be translated into “why”.  The entire organization needs to clearly understand why accurate, live and accessible on-call information is imperative to meet the hospitals mission.  Why it’s important for providers and patients, and how it can change outcomes.  When your team understands why, if they agree, they will make a commitment to change.  If you can’t clearly articulate the “why” the project will not be successful because some people will choose not to participate in your project due to a number of reasons.  This would be like a department choosing not to use electronic medical records.  The “why” needs to be compelling enough that people who push back will be given an ultimatum for the good of the mission.

System wide view / Interoperability / Integration

Most on-call systems that are in place today are paper based.  Specialty Clinic call schedules do not communicate with the hospital.  Daily changes are a nightmare because of everyone who needs to be notified.  And there is a lot of double entry and transposition from paper schedules into Excel.  Clearly none of these systems talk to each other or integrate with each other.  When purchasing your new system be sure that you are solving all of the problems that exist, including how to create the physician on-call schedule in the first place.  When I hear about a Telecom Department installing a new on-call module that allows the operators to manually enter call schedules into a phone system so that doctors can be paged easily, I think to myself, wow, not only did they not solve the problem, but they did not understand or see the big picture.  I am willing to bet my Ipad that there is not a Hospital or Health System Administrator that would buy an on-call system to help operators by placing more workload on doctors and specialty clinics that provide most of the revenue to the hospital.  Never in a million years!  Be sure the hospital system talks to and passes information back and forth to the clinic system.  This will eliminate double entry and transposition of paper into a computer and truly give you an integrated system.


If you expect to go from a paper based on-call system that regularly fails to a new electronic on-call management system without an iterative approach, you’re in for a real treat.  That’s like going from a big-wheel today to a car tomorrow. It’s not a good idea and will increase your chances for people to say, “Let’s go back to the old way, this will never work”.  Plan on implementing your new on-call system one step at a time.  Each step will build on the success and failures of the steps before it.  Because this new system has so many users and uses, it will take some time to make everyone happy.  By being up front with your users and setting proper expectations about how the installation will take place you can install a great system and make everyone happy, just not all at once.

Key Takeaway:

If you thought that buying a new call management system was the hard part, I am sorry to tell you that that was the easy part.  The hard part is managing the 4 key areas that I have highlighted above to get your new software installed and useable for everyone.

Request A Live Demo

Interested in learning more check out this blog post "Budgeting for a Hospital On-Call Management System".


Image courtesy of Scottchan / FreeDigitalPhotos.net

Topics: call schedule management, adopting on-call software

Ready to Change your Hospital's On-Call Management System?

Posted by Justin Wampach on Thu, Apr 24, 2014 @ 02:49 PM

ID 100108574Change is hard.  Novelist Mark Twain said, “The only person who likes change is a wet baby.” 

Most hospitals in the United States still manage their on-call information using a series of 3-ring binders and Excel.  Most users of these systems will tell you that the current paper based on-call system is inherently broken and because of that patients, doctors and staff members suffer equally.  There are many reasons why hospitals have decided not yet to make the change.   Some are still wrestling with government mandates such as Electronic Medical Records, Meaningful use, and ICD-10.  Others are financially not in a position to invest in new technology.  I think the largest hurdle is that most organizations want to change and stay the same at the same time.  My goal is to change the way these organizations think about on-call.

In case this is your first time reading my blog, there are many reasons to adopt a new on-call management system, listed below are some of the top reasons.

Improve patient care 

  • Critical patients that require specialized care have better outcomes when unnecessary time is not spent trying to locate and contact the on-call physician.
  • Rapid access to on-call physicians for assistive consultation by ER Doctors can increase the throughput of the department.
  • Accurate information given to smaller hospitals in your area can lead to increased transfers to your facility.

Reduce Daily Expenses

  • Monthly collection and verification of on-call schedules from community specialty clinics is very time consuming.
  • Daily creation of the “daily call-roster” takes on average 2 hours each day to create and distribute.
  • Maintaining changes to the “daily call-roster” is a never ending job, and is often incorrect.

Manage Risk

  • Federal EMTALA Law mandates that your hospital maintain “accurate on-call” records, including changes that show the original provider and a change log.
  • On-call EMTALA violations are $50,000 per infraction.
  • Allowing physicians to manage their own schedules and changes can create EMTALA violations.

You would think that with all of the compelling reasons to make a change, it would be rather simple to adopt a new on-call system to benefit the doctors and patients.  Think again.  Healthcare can be very resistant and obstructive to improvements that are not directly related to revenue creation. 

In some cases even if the on-call project is approved via a budget, the implementation can be sabotaged due to people’s pushback and reluctance to change.   Managing this process is imperative to having a successful project.

According to author John Maxwell, there are better times to change than others, here is his checklist to help navigate the process.

  • Will this benefit the followers?
  • Is this change compatible with the purpose of the organization?
  • Is the change clear and specific?
  • Are the top 20% influencers in favor of the change?
  • Is it possible to test the change before making a total commitment to it?
  • Are physical, financial and human resources available to make this change?
  • Is the change reversible?
  • Is the change the next obvious step?
  • Does the change have both short and long range benefits?
  • Is the leadership capable of bringing about this change?
  • Does everything else indicate that the timing is right?

Changes in healthcare on-call technology are necessary.  It is also important to know why, when and how you are going to make the change happen and be sure that you have adequate support.   On-call management systems benefit the entire organization.  New systems that create and enhance communication between patients and providers is positive for everyone.  Just remember that the “change” will be the hardest part.

Key Takeaway:  Will the change get the best of you, or will you get the best of the change?

Image courtesy of stockimages / FreeDigitalPhotos.net

Topics: call schedule management, adopting on-call software

A Crisis in the Making: No One Owns On-Call at Your Hospital

Posted by Justin Wampach on Tue, Sep 03, 2013 @ 10:16 AM

ID 100177479Should 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:

  1. When there is an on-call problem or issue no one knows who to call
  2. Each department accesses on-call  information in a different way
  3. There is not two-way communication between the hospital and local clinics regarding daily schedule changes
  4. There is not a standard policy for how schedules are created
  5. There is not a standard policy for how schedules are communicated from clinic to hospital
  6. There is not a standard policy for how changes are made during business hours
  7. There is not a standard policy for how changes are made after hours and on weekends
  8. Individual schedule creation is not a concern
  9. Schedule fairness for physicians is not a concern
  10. How physicians access the schedule is not a concern
  11. 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.   

Key Takeaway:

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.

Image courtesy of xedos4 / FreeDigitalPhotos.net

Topics: call schedule management

What's the Difference Between Call Schedule Creation, On-Call Management and Telecom?

Posted by Justin Wampach on Wed, Jun 19, 2013 @ 04:41 PM

call schedule differencesIt's all software right, what's the big deal?  There are significant differences between software that a clinic or group of providers uses to create, maintain and communicate their work and on-call schedule and what a hospital will use to manage all of the on-call information they receive from clinics and the system used to activate the provider via a page or now a secure text message and track the results of that process.  Here are the top differences.

On-call scheduling software is specific software that was developed to accomplish one main function and several minor functions.  The main feature of a call scheduling software is the specific tools that assist someone in creating the doctors work and after hour’s on-call schedule.  Some of those tools may include the ability to create custom rules, a scheduling engine, availability notification, day-off tracker, and reports to prove fairness.  The minor features usually include calendar displays, smart phone integration, the ability to import and export schedules. 

On-call management software is integrated software that communicates with each of the on-call schedules that clinics within a medical community create, and selectively pulls certain jobs out and automatically displays them by service in a complete merged daily view, without having to manually enter individual schedule on-call information.  An on-call management tool will have robust schedule change features that allows for clinic call schedulers to make changes and have them automatically appear on the hospitals daily call sheet and authorized hospital users to make changes after hours and weekends to the daily call schedule while sending communications back to the clinic scheduler so that all of the information is in sync.  A good system will also have lock-out features that will prevent clinic schedulers from making changes to the call schedule within a certain period of time before the on-call shift starts to avoid a gap in coverage and a possible EMTALA violation.  An on-call management system may or may not include activation tools such as paging or secure text messaging the doctor.

A telecommunications on-call tool is typically a small module inside of a large phone system that allows for operators and/or clinic schedulers to manually enter only on-call jobs that are directly associated with the hospital.  Each change needs to be manually entered.  This is an extra step that some clinics are forced to do if their local hospital has a telecommunication tool as opposed to an integrated on-call management system.

When a hospital or health system wishes to truly eliminate the problems associated with the old 3-ring binder on-call system on the hospital side and Excel spreadsheets on the clinic side the only way to do so is to use call schedule creation software that is integrated into the on-call management system.  If you choose to solve the on-call problem with a telecommunication’s centered system the only problem you are solving is the one that exists within the hospital Telecom Department, which most often is inaccurate on-call information and having to use two systems, one to find who’s on-call and one to page the doctor.  In my experience on-call problems occur when there is not a direct connection between the people who actually physically creates the schedule from scratch.  Don’t confuse this with a person who is handed an excel sheet/schedule from a doctor who creates the schedule on the weekends and is asked to enter it into some system, that person is not a scheduler.  The call schedule creator is the person who reviews all of the doctors requests for time off, takes that and a lot of other information into consideration and then begins to make decisions on daily assignments and is accountable for the accuracy and fairness of that schedule for a group of doctors.

There are Telecom software companies that work directly with Telecommunication Departments within hospitals that claim that they have on-call scheduling software, when what they really have is a data entry system that will allow a user to manually enter certain on-call jobs into their system so that an Operator can page the correct doctor.  This software is not bad, and may be very useful in certain situations; it’s just not call scheduling software or even on-call management software.  It’s telecommunications software which has a place to manually enter daily on-call information so that the operator can see who is “on-call” and page the doctor without having to switch screens.

Key Takeaway:  When you are looking to make a change to your current on-call system the hospital leadership must consider what problem they are trying to solve and who needs to be helped the most, the physicians who generate much of the revenue and the clinics who refer patients to the hospital for large procedures or the telecommunications department.  By answering those questions you will be sure you are solving the right problem.

Image courtesy of Suvro Datta / FreeDigitalPhotos.net

Topics: call schedule management, adopting on-call software

Is Your Hospital Hiding On-Call Information From Doctors and Nurses?

Posted by Justin Wampach on Thu, May 02, 2013 @ 11:52 AM
ID 10070280If 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

Topics: call schedule management

Should Secure Text Messaging be Part of On-Call Management Software?

Posted by Justin Wampach on Mon, Apr 15, 2013 @ 10:58 AM

ID 100105627After 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:

  1. Texting for activation (paging the doctor) who is on-call
  2. Texting for communicating with other providers about a patient or case
  3. Texting for communicating with nursing staff about a patient
  4. Texting for patient “push” updates (change in status)
  5. 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

Topics: call schedule management

How IT Solves the Hospital On-Call Management Problem May be Wrong

Posted by Justin Wampach on Tue, Mar 26, 2013 @ 10:25 AM

hammerWhen 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

Topics: call schedule management

Implementing an On-Call Management System at your Hospital

Posted by Justin Wampach on Wed, Feb 27, 2013 @ 01:28 PM

ID 10088291This 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.

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. 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.
  8. 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. 
  9. 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.
  10. 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

Topics: call schedule management, adopting on-call software

Budgeting for a Hospital On-Call Management System

Posted by Justin Wampach on Tue, Feb 19, 2013 @ 02:43 PM

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.


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.


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.


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. 


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.

 ROI flowchart example

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.

Topics: call schedule management

Selecting the Best On-Call Management Software Vendor Partner

Posted by Justin Wampach on Thu, Feb 07, 2013 @ 11:01 AM

ID 10097469In 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.

  1. 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.
  2. Identify the decision making process in your Hospital for vendor selection
    1. Who needs to be involved
    2. Any special criteria that needs to be considered?
  3. 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.
  4. 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.
  5. 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*****
    1. Do not compare the price the vendor gives you with your annual salary
    2. Do not assume that anything is too expensive.  Your job is not to decide, but to gather facts, and present solutions.
  6. 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:
    1. You and the committee
    2. Potential users from each defined user group
    3. VP level person who’s budget this project will come out of
    4. Physician representative (VPMA or CMIO would be good candidates)
  7. 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

Topics: call schedule management