Guest Column | August 4, 2016

Post Traumatic Scheduling Disorder

Patient Scheduling

How one hospitalist division’s physician shift scheduling broke and became something great.

By Romil Chadha, MD, MPH, FACP, FHM, hospitalist at University of Kentucky HealthCare

Physician heal thyself? How about physician try not to break yourself instead? We’ve all heard horror stories about how burnout is at a record high in our profession, EHR technology is trying to ruin our lives, and hospital management wants us to suffer with five-minute consults all day long. But is it possible we are part of the problem? If so, do we really have the power to heal ourselves?

I can say this was the case when it came to setting physician schedules during my past three years as the scheduling committee chair in hospital medicine at University of Kentucky HealthCare. Armed with good intentions, our team of administrators and physicians slowly, methodically, and completely broke our shift scheduling process in three years before discovering we had the power to rebuild it into something amazing. My aim is to provide a “grand rounds” of our particular journey into the heart of scheduling darkness and a treatment plan if your department might be suffering the way we were.

In this journey, I had two amazing bosses, colleagues, friends, and mentors — Dr. Charles “Chuck” Sargent and Dr. Zackary “Zack” Roy. Chuck has been a hospitalist since 2004 and is basically the founding director of our practice. Zack has been a hospitalist since 2006 and a partner to Chuck in this process for several years.

Year 1: With 20 hospitalists, we were part of the Division of General Internal Medicine. We had the scheduling problem nailed when I first joined in 2011. Our two physician schedulers — Chuck and Zack — would assemble a year’s worth of shifts at a time. It took a significant amount of time to build the schedule using a basic computer spreadsheet tool, but there were minimal errors and our system was decent at accommodating around 60 or so time-off requests, each a week long.

In addition to these, the schedule evolved throughout the year due to shift swap requests. Our process for swaps was not very user friendly as swap requests required both hospitalists to sign a paper request form and pass it through administrative support to the directors for approval. Even after approval, we required administrative support to disseminate it to the rest of the enterprise.

Year 2: In 2012, we started to grow and the administrative team was now only able to manually generate half-yearly schedules. Still, we produced very good schedules with few errors. Our physicians’ week-long time-off requests increased to around 66 a year and the process for balancing those was becoming strained. The shift swaps and last-minute changes were still difficult and required administrative support.

Year 3: Things really began to go wrong in 2013. We had grown to 27 hospitalists along with help from some primary care physicians (PCPs), plus a few advanced practice providers (APPs). Setting quarterly schedules by hand was now taking Chuck and Zach 20 to 30 hours each month (about 720 hours a year), plus 520 hours a year of additional administrative time managing shift swap requests via paper process. The scheduling team began making significant mistakes and stress was mounting on all sides.

Year 4: Our scheduling process was so broken by 2014 that we formed a special task force of six physicians to try to work out a treatment plan. Things got worse before they got better. Now at 34 hospitalists, some PCPs plus 10 APPs, it would take 20 hours with four to six physicians every month to generate the quarterly schedule. Our team was investing 920 physician hours a year in creating schedules, plus another 520 hours for Chuck and Zack managing shift swap requests.

Errors were rampant, we had resorted to scheduling the team on two-week direct care blocks, and our approval rate for shift changes was dropping. We realized we had to do something. Our task force started looking at three software options to treat our scheduling catastrophe: Lightning Bolt, QGenda, and Intrigma. Based on our assessment of the value each would bring as well as feedback from other facilities, we went with Lightning Bolt.

Year 5: In 2015, after investing about 200 hours in setting up the technology, the impact was immediate for our department. With 46 hospitalists and a few PCPs, plus 12 APPs, we were now spending just five to 10 hours a week to auto-schedule nine months in advance and zero time managing approximately 184 week-long time-off requests because the technology took care of it without administrative support.

We hit an approval rate of 99.7 percent for time-off requests including 100 percent approval for major holiday requests. No more two week blocks for direct care services, no night or swing shifts after a day shift, and vice versa. The schedule now fairly distributed jeopardy shifts according to physicians’ clinical FTEs and across weekends as well as equalized weekends working night or swing shifts.

Today, we’ve passed 50 hospitalists and 14 APPs with no additional help from PCPs. There are two married couples in the division now who are able to automatically work matching schedules. Our ability to recover our scheduling process has given them the time they deserve together. We have a workforce of physicians with actual work-life balance at a time when the division is also continuing to grow rapidly. Our scheduling process has dropped from a high of 1,480 hours per year to just 260 to 520 hours per year, an excellent return on our investment.

If your department might be suffering from a case of Post Traumatic Scheduling Disorder, apply treatment early before other systems begin to shut down. Create a task force to implement technology and build sophisticated shift rules. Leave the manual scheduling process behind.

We are physicians who did succeed at healing ourselves. With technology and a willingness to change, we created shift schedules that not only improved hospital operations but also gave us career freedom and satisfaction.

About The Author
Romil Chadha, MD, MPH, FACP, FHM, is a hospitalist at University of Kentucky HealthCare. Dr. Chadha received his medical degree from the University College of Medical Sciences, Delhi, India, and is board certified by the American Board of Internal Medicine.