When was the last time your physician group got together to discuss on-call? Was it to simply decide the Holiday coverage for the year, or did the discussion include several “by the way” comments and decisions? Were the results formally recorded and agreed upon or were some things assumed?
What happens with ass-u-me?
It’s always surprising to me how much information is not documented, and how often the “nitty gritty” only comes to light when something happens to the primary Scheduler, when there is a change in Provider staffing level, or an incident takes place.
Since discussion of the On-Call scheduling process involves collaboration among all the physicians to establish rules and expectations, this is a great chance for buy-in and better team compliance. Capturing and documenting the agreement of what is considered to be “fair” is crucial to figuring out a repeatable Process to attain “fair” and equitable future schedules.
This seems obvious, yet I frequently encounter frustrated Schedulers who have lost time and accountability within groups who do not have this “understanding” in writing and adhere to it. They keep reinventing the wheel, allowing so many exceptions that the rules are more “suggestions”, and the schedules become a series of scenarios. Ultimately not documenting and following a Process costs the group money, and possibly much more in Provider dissatisfaction and turnover.
What is an On Call Scheduling Process anyway? Plan beyond the Rules…
A Process defines what tasks need to be performed, by whom, when, why and in what sequence so the information gathered can be used to create a fair and timely On Call Schedule. It enables successful steps to be repeated, making the process manageable and predictable. By making sure nothing is missed, you can establish time-frames, sequencing and see the effects of delay and bottle-necks. Result? A Good Process represents what is currently being done, not what you think is being done.
Why document the Scheduling Process in the first place? Strive for repeatable consistency…
Even in a small scheduling group, certain activities always take place. Who will be approving or denying requests? What are the deadlines, and how will they be enforced? Who needs to see the schedule information when it is complete? How will it be “published” and will IT need to be involved? Delay and misunderstandings mean frustration and a “rush job” to get the schedule out later! Documenting a Great Process provides “guidance” for coordination, accountability and control of the tasks and personnel involved in generating/publishing the schedule.
Consider how these areas are influenced by using a Great Scheduling Process. It isn't just about the tallies.
- Authority: Identify your Scheduler(s), key personnel and backups involved in scheduling creation and maintenance. Document their roles, contact information and who has “sign-off” authority
- Continuity: Your Scheduler’s backup will be better prepared if they are trained where the Process is and how to use it before they need it! Unbroken, consistent results regardless of who is the Scheduler are only possible with using a documented, standardized Process
- Efficiency: Using repeatable steps simplifies getting things done, reduces “creation time” and the chance of error. The Scheduler can prepare the next On Call rotation in a timely manner and roll on to other things.
- Delegate! Others may now be empowered to help. Preliminary information gathering can be handed off to an Assistant or the Providers can submit requests themselves if on-line Call Scheduling software is used. Perhaps some of the daily maintenance/updating of the schedule could also be turned over once the difficult decisions are made as to who is on/off and the final schedule is released. You may even be able to outsource your scheduling.
- Predictability: Work-Life balance, “fairness”, less drama surrounding the On Call Schedule, a sense of control… all stem from having some predictability regarding when the schedule will come out and what it is likely to look like. Don’t forget reliable, easy access to the latest version from home or SmartPhones.
Are the benefits of documenting the On Call Scheduling Process worth the effort?
Expectations are out there in your group whether you document your Process or not! Once a Process is established, used and evaluated, a foundation is set. The On Call Schedule impacts so much of your colleagues’ business and family-life planning that compliance is easier if everyone knows there is a documented agreement to adhere to with the same “rules” for everyone. If changes to the Process are needed, scenarios for change can be tried based on a firm, known basis instead of trying various intellectual “what if” exercises from scratch. It’s all about meeting expectations, now and in the future. An established, documented On Call Scheduling Process is the best place to start.