Experts: Rethinking Provider Scheduling Alleviates Headaches, Turnover

Hectic schedules are a leading cause of burnout among physicians. Adding a dedicated coordinator or user-friendly software might be worthwhile investments.

Indigo Health Partners provides staff to six rural hospitals in Michigan, its satellite locations, and 25-plus nursing and assisted-living facilities in the state. The private medical group also offers services remotely through telemedicine.

It has more than 200 providers, about 70 percent of which are physicians and the rest nurse practitioners and physician assistants. Some of them are working in departments that require on-site staff around the clock.

All of that stands to create a scheduling nightmare: the different providers, staffing combinations needed for each hospital department, various hospital locations, vacations, adjusting for personal and sick days, and making sure any switches won’t botch the schedule a few days or weeks out.

“Can you imagine how difficult it is to manage all these agendas and schedules, trying to build one single schedule around the physicians who are working, for example, in the intensive care unit?” asks Rodrigo Deliberato, MD, PhD, a post-doctoral fellow at the Massachusetts Institute of Technology who researches physician scheduling.

Troy Ahlstrom

Before 2007, when Indigo was at least three times smaller, its scheduling fell on a single physician, who needed a full workweek to plan the next four months and would have to spend hours daily on emailed schedule requests, says Indigo principal Troy Ahlstrom, MD, SFHM.

But with so many patients to see, a physician arranging the schedule didn’t seem like an efficient use of time, Ahlstrom says, so Indigo hired a full-time schedule coordinator. Then, in 2008, it brought in another fix: contracting with a software developer to streamline all the pieces of the scheduling puzzle into a single program.

“It just got to the point with us — and I think that’s the case with most larger practices — where if you don’t have a dedicated person who also has the financial and computerized resources to work on [scheduling] every day, you’re in trouble,” Ahlstrom says.

Even so, moving away from rudimentary scheduling processes isn’t universal.

According to the latest data available, more than 45 percent of U.S. hospitals still do schedules manually, like on web-based spreadsheets or even on physical paper, says health care software company API Healthcare, citing market research from the Healthcare Information and Management Systems Society.

Ahlstrom says he thinks reluctance toward scheduling solutions is rooted in health care organizations tending “to move as slow as governments and nonprofits do.”

In the end, he says, it comes down to the budget: A dedicated scheduler and an additional software contract might not seem like deserving investments.

But in the eyes of Ahlstrom and Deliberato, the expense is worthwhile.

First, there’s the savings in employee pay: A scheduler might cost $30 an hour, including benefits, but that could be $100 to $200 for a physician, Ahlstrom says. Physicians’ time is valuable, so “having them do any part of the schedule at all makes no sense,” he says. “They should be seeing patients, where they can actually generate revenue and do what they’re supposed to do for a hospital.”

Then, Deliberato says, there’s mistake avoidance because all staff members’ schedules, requests and preferences are consolidated into one portal. This unification, for example, helps in avoiding one physician being double-scheduled in two departments and the need to pay a last-minute replacement to fill in, he says.

Also, Ahlstrom says, there’s lower burnout and thus turnover, which is a crucial consideration in hard-to-recruit rural areas, such as those served by Indigo. Hectic schedules are a leading cause of burnout among physicians, and software that accommodates scheduling preferences and organizes work calendars via a smartphone app or a computer can help with work-life flexibility.

At one point, after implementation of scheduling software by Lightning Bolt Solutions, Indigo reported a 97.6 percent staff retention rate — an 8.2 percent edge over the national average. During one five-year period with the software, Indigo reported a $38 million return on investment.

Still, scheduling software has a long way to go overall, especially in solving disconnects between developers and the many needs and wants of providers, Deliberato says. Three main software hurdles developers recently have wrangled with are:

Absence of regular notifications to department managers of shift swaps and changes based on personal preferences.

Lack of accommodation of regulations and individual hospital rules on number of hours and days continuously worked.

Shortcomings in mobile interfaces.

Among all the applications on the market trying to fill health care industry needs, choosing the best one can be difficult, Deliberato says. Scheduling software, though, is making headway and the decision to purchase it is rapidly becoming a smart choice, he adds. The right software would be user-friendly enough to eliminate the need for dedicated schedulers, he says.

Michael Stone is a freelance health care writer based in Tennessee.