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