When the farmer was advised to build a fence in order to reduce the time he wasted chasing cows and focus on his business of farming, he replied “I don’t have time to build a fence, I’m too busy chasing the cows.” [This might be a Minnesota quote, cut us some slack, we're from the Midwest]

 Imagine it's 3:00 am and a patient arrives in the Emergency Department at a local small hospital with chest pains.  According to a June 2016 Harvard Medical School article When chest pain strikes: What to expect at the emergency room "Every 43 seconds, someone in the United States has a heart attack. " Once evaluated by a nurse and Emergency Department physician, many times a specialist is needed to further treat and/or perform advanced procedures.  When this happens, a call goes out to figure out who the on-call Cardiologist is that is covering the ED that evening.  Depending on the organization that process alone may take several minutes or much longer. 

 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 something relevant to their business that will save time?  Really? 

Perfection, the ultimate desire! Is the pursuit worth it? Is an physician on-call schedule "perfect" when everyone is satisfied? Is that even possible?

Automated physician on call scheduling software can do many things such as save you time, help you generate consistent results, and provide transparency of fair process. But software can never solved in-house political problems or replace the leadership of a seasoned on-call scheduler making an educated judgment call.

Some schedulers get so excited about the possibilities envisioned with their new scheduling software, they forget it's a tool, and it's not going to solve world peace.

Traps some eager schedulers, new to on-call software tend to fall into:

1. They assume the physician scheduling software is an artist that will automatically create the perfect masterpiece for them that they have in mind. They forget evaluation is a subjective judgment and therefore by definition imperfect. Even when on call scheduling software generates perfect tallies and even spread, beauty remains in the eye of the beholder.

2. They realize that there are exceptions to most rules they create. They create many complex rules often chained together with multiple levels of scheduling as conditions for filling the assignments. Sounds perfect, often it is, but remember that trying to fit your paper on-call creation process into software can lead to disappointment. Be reasonable and be open to reasonable change.

3. They begin to run scenarios looking to solve problems far beyond what they bought the software for. Scheduling with software is an iterative process. Having reasonable goals. You don't have to eat the elephant in one sitting, its often much better if you do it in smaller chunks. So I've heard.

4. Don't focus on what it can't do. There are limits to everything. If you're turned off by what it can't do, you're going to miss out on all that it can do. Keep an open mind.

Perfect is when “all the Doctors are happy”, really? This is the ultimate desire, and is often expressed. However, it is also often impractical. The irony is that while “perfect” may exist as a concept that keeps us trying to make the schedule better, anything we judge as “perfect” changes after a cooling off period. This is why we can judge something perfect one day, and flawed the next day without making a single change. The only thing that actually changed was our ability to judge the quality objectively.

A "good" on call schedule, created in a documented manner by a consistent scheduler, who understands why the schedule “looks like that” because he/she uses a repeatable process … may be more valuable than having a “perfect” on-call schedule one month out of the year, and disaster the rest.

Too many conditional rules chained together actually hinder getting the doctor's on call schedule out due to all of the various constraints. This is especially true if the rules are in flux or “designed by committee”.

Some rules may be in place to avoid “looking stupid” by forgetting something. These are fine for the most part, but when they are there to “cover your ass” for an outlier incident, they also limit flexibility. Document why a rule is being used. Where did it originate? Is the rule for on-call still pertinent? Are you letting Dr. Difficult dictate your scheduling process?

If the goal is to generate a reliable, justifiable schedule, then you need the right scheduler, using the proper scheduling software, following the correct process every time. The “correct process” and “every time” seem to be the most difficult pieces. Scope creep (solving a different problem), and a “scheduling team” made up of changing opinions are significant hazards not solved by on call scheduling software.

Key Takeaway: "Good" may be a better goal than absolute perfection for the physician on call schedule when using new on call scheduling software. The scheduler needs to avoid being trapped in a permanent state of dissatisfaction with every schedule created. He may not need to make it perfect, but make it better, and even better the next time.

You might be surprised to know how many times we get calls from Physicians and others that start out by saying, “I’m going to be taking over creating the on-call schedule for our providers, can you help me get started?”  Our answer is always of course, we’re happy to help.  I have heard this enough times that it now warrants its very own blog post.  This is primarily directed toward physicians and schedulers who are creating just the on-call portion of the schedule for the doctors.  In many practices, there is a physician that creates the “on-call” portion of the schedule, while someone does the office type assignments.  Today’s post is more focused on the on-call side of the schedule.

Sharing On Call responsibility between multiple small groups brings opportunity for less frequent Call duty for everyone.