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Rule Creep and On Call Scheduling: People, Tools and Process.

Posted by Amy Engebretson on Sun, Sep 29, 2013 @ 11:30 AM

all calculations wrong2It starts out so simply! A few rules, just simple common sense rules that all the Physicians agree with. Then something happens, a hard-to-court provider is added, or some snafu that “must never happen again” occurs, and a few tweaks are added to the rule set. Then the scheduling supervisor leaves and one of the Physicians gets saddled with the position and has a different vision. He uses the same rules, technically, but somehow his schedules seem a little skewed in his favor . . .
Signs of Rule Creep. Are these familiar issues?

    • Is some specific incident (or incidents) that occurred three years ago and may no longer be relevant, still driving your rules?
    • Are you having an increasingly difficult time scheduling dates due to Providers being excluded?
    • Do you know what problem a rule was supposed to solve, when and who proposed it?
    • Do you know who is authorized to “sign-off” on the schedule prior to release?
    • Do you have a process and accountability for handling Provider Requests for rule revision?

Rule creep can run rampant unless you take steps to control it. What can a Scheduler do about it?
Here are three areas to examine.


People, Tools and Process


1) People:
Do you have a stable on-call scheduling team? Who is in charge of your physician on-call schedule? A Physician Executive? A committee? An Executive Assistant? Has it been an ever-changing group of people over an extended period of time with an ever-increasing bureaucracy (for seemingly useful reasons) who are trying to achieve a predictable result? Perhaps your organization has recently merged with another one?

It may be time to trim back to a Master Scheduler and a backup assistant so you can have clarity in responsibility for executing the goals and vision of the on call schedule. For improved scheduling clarity:

    • Take a look at your “silos” and making sure the Scheduler is reporting to a person, not a chain of people from various departments causing a grid-lock of “chiefs”.
    • Limit access as to who gets to change/update the schedule.
    • Do not put the finished on-call schedule “out to vote” to everyone prior to release.
    • Have a reliable chain of authorization and a documented provider request process.

This is not to say the process of coming up with the rules shouldn’t involve a committee! It is important that all stakeholders be represented during this process, that the rules are thoroughly reviewed, discussed, weeded, and documented at least annually.


2) Tools:
How are you collecting, documenting, tracking, reviewing and archiving your rules?
In a fight, the person with the most notes wins . . .  unless you have a centralized “group” document regarding Rules.

    • Control innovation. Lack of rule documentation, combined with turn-over in Schedulers for your Physician after-hour on call calendar can cause a lot of headaches when deciding which rules you need to keep and which you have outgrown. It also means some innovator can arbitrarily add a new rule to make the schedule “better” from that person’s particular point of view.
    • Collect and track the Rules. One solution could be a tabbed excel file. One tab has the rules, another with description and who requested the rule, another when it should be implemented, and a last for change history with dates and reasons.  Then you will have everything you need, outside of a schedulers memory, to analyze the rules you have and take action.

      Another solution could be to have all of the current rules on-line where they can be viewed, amended and printed by authorized personnel as needed to share and discuss with others. Not only are the rules no longer “secret”, but they are no longer in only one, isolated location where they cannot be easily shared.

It’s not good enough to make rules and document where they came from. You have to revisit them at regular intervals and challenge their need. Rules should be reviewed at least annually, and any time there is a change in the makeup of the on-call Physician team. At minimum, rule changes and why they were made should be documented for reference next time.


3) Process: Rules vs Suggestions.

” The code is more what you'd call "guidelines" than actual rules. Welcome aboard the Black Pearl, Miss Turner”!
–Barbossa, Pirates of the Caribbean

Does that sound like your group? The bulk of your rules should be pretty concrete to achieve predictable results. Also, there will be less “interpretation” by the current Scheduler who may be doing it by hand, and fewer challenges by the Physicians being scheduled. That is why they are called rules, and not “suggestions”.

Use physician on-call scheduling software (such as Call Scheduler) to ensure consistency in the application of the rules when creating the calendar. Using the same software with the same ruels and process should yield a similar schedule each time, and a fair/equitable one will build over time.

Scheduling will always be a bit of an “art”, at least until true (and expensive) artificial intelligence can step in. There will always be judgment calls for complex situations. However, on call scheduling can be less painful if everyone can understand how the rules have come about and how they have been applied.

Key Takeaway: Control Rule Creep by keeping the on call scheduling Rules and updating process transparent instead of in someone’s’ head. People, tools and process are key areas to review to accomplish this.

Topics: on call scheduling tips, scheduling rule creation