“Any software can make a schedule, but Lightning Bolt’s software generates a schedule that’s optimized for the unique needs of each of the providers.”

–Dr. Kenneth Serio, Scheduling Physician
Scripps Medical Group, La Jolla, CA
 
  
Ernő Rubik, the Hungarian inventor who invented the famous Rubik’s cube puzzle, once said, “The problems of puzzles are very near the problems of life.” In both puzzles and in life, forethought and insight earlier avoids being cornered into limited, poor choices later. Anyone who has scheduled a medical group and has tried solving a Sudoku puzzle would merit this analogy. Lightning Bolt’s scheduler is an innovative system that solves the complex puzzle of scheduling.

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While alternative products available in the market only provide an electronic medium for viewing/entering scheduling data, Lightning Bolt produces the best schedule possible by thinking deeply, often millions of steps ahead, to meet both institutional and individual needs.

The scheduling needs of physician groups are unique. What they do have in common is that schedulers often find that the seemingly simple task of assigning providers to assignments or shifts can be overwhelmingly complex. The scheduling problem often starts out easy. Initially, when the schedule is blank, schedulers have a great deal of freedom in scheduling choices and the initial decisions are relatively easy. However, as you get towards the end of the schedule, schedulers find that they are backed up against a corner with limited and undesirable options. Often schedulers would realize that some of the earlier choices were, in retrospect, not the best. A simple change leads to a domino effect of changes and before you know it, you are back to square one! In Chaos theory, this is known as the “Butterfly Effect.” If you have ever scheduled a medical group, then you have experienced the Butterfly Effect.

Are not computers smart enough to produce good schedules? If people can eventually create satisfactory schedules, software systems should also produce equally good or better schedules, right? Until recently, the answer is emphatically and perhaps surprisingly, “No!!!” The methods used by software systems available in the market simply and poorly mimic what a human scheduler might do by hand. Systems available in the market create schedules very quickly, and also very poorly! At the end of a (long) day, they provide at best an electronic medium for what is done by hand. Certainly, an electronic medium offers advantages just as modern word processors offer efficiency over handwriting. We would also agree that centralized web applications enable collective modification and viewing of schedules. That’s useful and Lightning Bolt provides that.

However software systems, we feel, can and should do more. We can confidently say that Lightning Bolt is the first system that really solves the unique scheduling puzzle of medical groups. Lightning Bolt thinks deeply from the beginning, often looking millions of steps ahead, to avoid being cornered into poor choices at the tail end of the scheduling process. With Lightning Bolt, you can create the best schedule possible!
So what does this mean for your medical group? Below are some common problems faced in scheduling medical groups and how Lightning Bolt solves them.

Emergency Scheduling Sample Schedules

  • Emergency Medicine Scheduling Sample (by assignment)
  • Emergency Medicine Scheduling Sample (by personnel)
  • Request Calendar Sample
  • Emergency Medicine Report Sample

Emergency Medicine Scheduling Sample Rules/Requirements

Rule#

Description

Priority+
1 Track and equally distribute the total number of weekend calls, holiday weekend calls, holiday calls, and Thursday calls Very High
2 Maximize number of non-working weekends between weekend calls. Very High
3 Do not schedule Dr. Jones for more than X times for 7p-11pm shifts during any period consisting of Y days. Low
4 If no regular provider is available (because of day off, vacation, or worked previous weekend on call), schedule a contract provider or a moonlighter. Medium
More Rules
5 Each physician should be at outreaches two to three times a month. Medium
6 First call slot does the last available call slot, second call slot does next to last available call slot. Available number of call slots varies depending on the number of doctors on vacation. Maximum
7 If a provider works on a late shift, do not schedule that provider for early shift the next morning. Maximum
8 Providers who work OR prefer to work with different provider every week. Low
9 No consecutive days on primary call. High
10 At least ten doctors must staff the hospital daily. Medium
11 Look back two years in distributing the work assignments evenly. High
12 Dr. Smith only takes 50% of the calls. High
13 Only Dr. Smith and Dr. Jones can take Heart Calls. Very High
14 Dr. Jones is not available to start with the group until June 4th. Medium High
15 At least one of four doctors on call at any time must be a heart doctor. Maximum
16 Request Manager: At least 2 pain doctors must be available (not on Vacation). Medium
17 Request Manager: Providers can request up to 10 days in a row off. Maximum
18 Request Manager: Providers can only request 2 weekends off per month. Maximum
19 Request Manager: Only a total of 6 providers can request Vacation, CME, or PTO per day. Maximum
20 Request Manager: Each provider gets X number of CME, PTO per year. Maximum
21 Request Manager: Providers may only request 2 no-calls per month. Maximum

Emergency Medicine Scheduling Challenges

Schedule creation and maintenance is time consuming

Problem Generating schedules takes several hours to several days. Even creating one week of schedule for a small group of physicians can take anywhere from several hours to several days. The difficulty increases dramatically with more physicians and/or more tasks to be scheduled.
Solution Lightning Bolt saves time. After defining the scheduling policies in the initial setup, Lightning Bolt generates a new schedule on the click of a button. Once the system generates a schedule, users can modify it if desired. Lightning Bolt typically reduces the time to create and maintain schedules by approximately 90%. The software typically pays for itself within the first year by saving time on producing schedules.

Equitable distribution of work is not so easy

Problem Vacation requests, the need to cover sub-specialty tasks, and work preferences of individual providers make it difficult to distribute work evenly across providers with unique scheduling profiles.
Solution Lightning Bolt schedules fairly. It allows you to specify your group’s definition of equality based on FTE values or specific target numbers for each provider. It keeps separate counters internally for each area that you want to track. For example, you could specify that weekends and holidays need to be tracked separately. The system can be configured to produces schedules that converge to desired tallies over the long run based on past periods.

Is the schedule simply not possible mathematically?

Problem Is the schedule the way it is because I can’t find a good schedule or is it simply not possible mathematically? How many vacation days can each provider take per year? Can each provider work only two weekends per month? Do we have enough providers to cover all the outreaches and sites? How many locums do we need to cover shifts given the work preferences of regular staff? What’s the impact on the work schedule of existing providers if we add a certain sub-specialist? These are simple questions but the answers are not so simple because of the interaction of rules and how a small change brings large changes to schedules in chaotic systems.
Solution Lightning Bolt lets you explore the precise edge of what is possible. A schedule draws a line between individual needs and institutional need; between patient volume/quality of care and provider needs; between individual needs and collective needs. Lightning Bolt helps you analyze and explore the boundaries unique to your group. Can each provider be limited to two weekends per month? If yes, the system will produce a schedule with that limit. If not, it will let you know. Can the work shifts be covered by available staff? If yes, the system will produce a schedule covering all work shifts. If not, it will help you determine how many additional staff you will need. These are examples of questions and answers at the edge of what is mathematically possible, an edge that you can explore with Lightning Bolt.

Our Scheduler is no longer available

Problem The scheduler who has been doing our schedule for 15 years is no longer available. What do we do now? Because of the complexity of schedules, schedulers have often acquired much domain knowledge on the logic required to create a good schedule. They may have picked up many tricks, which might involve a sequence of complex steps in producing schedules. Often, schedulers would create schedules in layers. If the scheduler is suddenly no longer able to do the schedule, this poses an operational risk to the group especially if there was no time to plan the transition.
Solution Lightning Bolt offers a medium of transferring scheduling know-how. With Lightning Bolt, since the system is already configured to produce schedules automatically, a new scheduler only needs to learn to click the button to produce the schedule!!! As a result, the system continues to produce good schedules across this transitional period for the group.

Time-off requests cause coverage problems

Problem Time-off requests cause coverage problems. Schedulers would like to accommodate individual time-off needs to the extent possible. However when individual requests are unchecked, the collective requests causes coverage problems when too many providers are unavailable on the same day. When the group consists of sub-specialists that are not interchangeable, determining potential coverage requires a complicated calculation based not only on the number of absent providers but which combination of sub-specialists are absent. Not knowing which combination causes problems, the administrator faces a difficult choice in being overly conservative by denying requests that could be honored or being overly aggressive and face coverage problems when creating schedules later.
Solution Request Manager ensures coverage. With the optional Request Manager, users enter absence and other requests online, and the Request Manager approves or denies requests based on potential coverage problems and other user defined rules. Request Manager uses a sophisticated algorithm that determines whether a given sub-specialist can be absent based on the number of sub-specialists required and the current list of providers who have already been approved for absence on that day. This allows the maximum number of providers to be off on a given day while ensuring that there will be no coverage problems.

Why is the schedule the way it is?

Problem Why is the schedule the way it is? Physicians who live the schedule often seek an explanation as to why they are or are not scheduled on a particular day. Not knowing the collective rules and constraints, the choice of a particular schedule or a scheduling decision may seem random or biased.
Solution Lightning Bolt explains. The rationale behind a scheduling decision is particularly important when the schedule is automatically generated. Lightning Bolt offers detailed explanations of its decisions and displays violations of rules when they are unavoidable because of conflicts.

Only thing constant in our group is change

Problem Only thing constant in our group is change – changes due to changes in staffing levels and/or work demand. Schedules often need to adapt to changing events whether that event is due to a provider being unavailable due to illness, taking a leave of absence, or new providers joining the group. Just when the group is adapting to a period of change, a new schedule needs to be generated that takes the new events into account. Often, even a small change has large impact on the overall schedule.
Solution Lightning Bolt adapts. With Lightning Bolt, any portion of the schedule can be revised with the click of a button whether the portion needing revision is a day, a week, month or a year. When a new event occurs, you simply re-schedule the remaining period or a period specified by a start and a stop date.

Schedules can be misplaced or outdated

Problem Schedules can be misplaced or outdated. Where is the latest schedule? Modifications often need to be made after the distribution of the initial schedule. For example, physicians may need to swap shifts with each other. Maintaining the current and latest schedule can be difficult if it’s on a static piece of paper or on a spreadsheet on someone’s computer.
Solution Lightning Bolt has the latest schedule. With Lightning Bolt, there is a central place for the latest schedule. The schedule can also be published on a password protected website which can be viewed from anywhere you have internet connection. Users having sufficient access privileges can also swap shifts online, keeping the schedule current. These changes are not only reflected on the central website but also on any mobile device via calendar subscriptions which allows users to automatically sync their mobile device with the information on the Lightning Bolt web application.

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