How would you know if a Provider is "gaming the system", resulting in a schedule where the "odds are forever in their favor?"
How can you guarantee objectivity, fairness and transparency in your on-call schedules?
In the past, paper calendars and excel documents made "gaming" difficult to detect. Auditing was inaccurate and time consuming, since schedules were generally created by hand from scratch each time, requests came in via notes or phone, and tallies could be miss counted.
Using on-line scheduling software improves the situation, but you may need to take more preventive action.
- Standardization of rules makes assignment cause-and-effect clear and minimizes bias.
- Clarity of and agreement with limiting the number of requests "off" and / or the "cherry picking" of favorable assignments is a must.
Empowered, trained schedulers who are not "schedulees" are a key to fairness and objectivity.These individuals have less conflict of interest in creating the on call schedule and their authority in creating the on-call calander should not be influenced by the Providers they serve. They may still have some fear of stepping on toes when denying requests or making difficult choices to complete the schedule. But, that comes with the territory, and that is what a White-Knight Provider working with the Scheduler is for!
How to spot gaming?
There is a high degree of professionalism in healthcare, which means that you're likely to see less gaming than in some other professions. However, manipulating the system (technically following the rules and not the spirit) is a breach of Trust, hurting the faith of the group in the system. This where auditing comes in. It is a way to catch discrepancies and patterns of requests that skew the on call schedule, even if they come in sporatically.
Does the same Provider make requests to be off on a couple of Fridays or a few Mondays every so often throughout the year... which just so-happens to take them out of call for an undesirable weekend? When a Provider makes himself unavailable at certain times, it tips the scale so he will need to be scheduled more frequently elsewhere in the year to keep fair tallies. A few may be harmless, a few more... not so much. Such single requests may go unnoticed if they come in sporatically.
- A quick search of the Provider Request archive covering a year or two could reveal a pattern of such requests which went unnoticed in the short-haul rush to get a quarterly schedule out. Time-stamped on-line requests are much easier to search than emails, and they are on-file forever.
- An examination of the calendars in a year-view fashion, instead of a month-by-month view, also makes a pattern easier to spot. Highlighting the frequency and spread will further clarify the issue. Does it look innocent to you?
Does the same Provider volunteer to take a few Thursday's On-Call during a year? By itself, this sounds great... one less assignment to figure out. But is the consequence of this request the same as asking for the following weekend off? Is there some other premium that goes with taking assignments on Thursdays? When used in conjuntion with judicious day-off requests, a Provider can box in his availability to where there are only a hand full of weekends he is truely available.
- A quick search of the tallies for the individual's assignments, looking at specific days of the week, should show if certain day types are stacking in his favor instead of being spread out amongst all of the Providers. Automatic tallies do not lie!
- The "lopsided" schedule also may be the result of Swaps completed after the schedule was released. Since Swap Requests come in one-at-a-time, and may be approved that way... the Providers may have built have a "surprise" without realizing it.
Key Takaway: Detecting gaming is never a pleasant situation. You always struggle against trying to find and confront the blatant cases of it while hoping that you aren't incorrectly finding false-positives. These concepts are a starting point to finding and documenting the problem so having "the conversation" is easier.