How can you implement your new call schedule methodology without simply repeating the previous failure?
Recovering from disappointment and building towards “getting it right” is really all about change, how to attain it and how to make it stick.
FIRST, assemble your creative problem-solving team. To prevent “group think”, these individuals should represent the various stakeholders regarding the on-call schedule, and have authority to speak for those they represent. Beware of “we know what ___ wants”. Opinion may not truly represent their needs. The Physician On Call Scheduling problem is difficult because it is based on informal mutual cooperation (which is usually not documented), and also involves interdependence between multiple departments within the group. You may want to be sure physician recruitment/retention is represented, as well as scheduling admin, IT, nursing and after-hours communications.
SECOND, decide if you need absolute consensus or over all commitment. Healthcare is famously a culture of collaboration. Ordinarily, this is a great thing, but don’t let absolute consensus derail the project. Regardless of organization, there seems to be three segments of “readiness” regarding change: the “ready” segment (~20%), the “show me” middle (~60%), and the remaining “no way” segment (~20%). The trick is to focus your efforts on the enthusiastic supporters who can advocate and persuade the “show me” middle regarding the successful parts of implementation. The “no way” segment will come along after the call scheduling software change has been implemented.
NEXT, discuss, debate, and commit. Most people are more willing to commit to decision even if they don’t agree with it entirely, if they have been given the opportunity to present the facts, identify alternatives, and state their case.
HOW TO come up with realistic, actionable goals you can use to update your call scheduling process.
- It is essential the group is striving to accomplish the same goals. This is probably the single largest stumbling block I have run into. It’s hard to achieve a result your group can all live with if you are not all “on the same page”. Communications, time-lines, evaluation of on-call scheduling results, all flow from knowing the goal you are trying to achieve.
- On a scale of 1-10, how far did you get in your previous call scheduling change effort? Can you re-frame the project into something smaller, simpler… a more defined part of the whole? Can you sustain a smaller change with better control and success? Keep in mind, too small a focus on one aspect of “perfection” may mean less usefulness for the group overall
- What worked, in spite of the apparent failure? Keep the success in mind and expand on it towards the “show me “middle 60 percent. For example, if the MicroSite worked well for after-hour calls, remind Providers they can use it from home too. If a “Techie Provider” enjoys using the iCal subscription, encourage him to show his colleagues how he did it.
- What small change can you make right now to move towards your goal? Something as simple as allowing an assignment to be scheduled one day closer together than what the preferred “rule” states can make all the difference. Build familiarity with the software by allowing providers to make their Provider Requests on line if they are ready. This provides convenience for Providers when away from the office for requests, saves the scheduler time, provides tracking in a single location and builds momentum.
- Keep it simple, but not too simple. Focus on the essential to avoid analysis paralysis. Focus on what really matters. Picking “low hanging fruit” may not be the best strategy, since the group as a whole may not see benefits soon enough. The next smaller step doesn’t have be easy, but must be attainable, clear and sustained in order to build momentum for the entire scheduling software implementation. Most troublesome, next to having multiple (and not necessarily compatible goals) is trying to accomplish too much all at once.
- What can you stop doing? Change takes time. Building familiarity with the new process and software takes sustained effort to defeat sliding back into “the old way”. If you stop printing the on call schedules and posting them on the wall, users can go on line to view/print their own and will be able to do so whenever they like, knowing they have the most current calendar available. What else can you stop doing?
- What can you start doing? Encourage small changes of habit that also directly benefit the user and his/her family. Example: collecting and approving vacations early, so they can make family plans.
- Plan for internal support. There will need to be some room for flexibility, since different departments will absorb change at different rates. Know everyone goes through the “implementation dip” as they discover what scheduling software will really do vs what they thought it would do..
- Internal Leadership and Management. This cannot be “outsourced”. Be sure the lead person within the group has “big picture” vision of the entire call scheduling process and all the departments it “touches”, along with the influence and authorization to make decisions to keep the project moving forward. Don’t get bogged down in a small detail concerning one department to the detriment of the entire project, especially if it was already discussed in item #1. Implementation always involves some choices which may impact overall satisfaction
- Repeat for the next round. Focus on the essential. Avoid analysis paralysis. Determine what really matters. What worked? What is next most important? Break it down into small, achievable steps and start!
Key takeaway: Real change regarding your physician's call scheduling process involves risk of discomfort and “failure”. If you only do what you know, and what you are doing now, chances are you will not fail… you will stagnate.