“Lightning Bolt, in addition to saving countless hours in the scheduling process, helps us to individualize our schedules, which in turn helps us to recruit and retain new physicians ”Hospitalist Scheduling Software
–Autumn Moser, M.D., Scheduling Physician Providence Health System- The Evertt Clinic- Internal Medicine, Everett, WA
View Recording of Practice Management Session on Hospitalist Scheduling Held at HM14 ►
In scheduling hospitalist groups, schedulers struggle for a balance between the institutional requirements such as the need for continuity of patient care and the unique preferences of individual providers. With Lightning Bolt, hospitalist groups can produce schedules that honor individual provider’s preferences while at the same time meeting organizational requirements.
As the Hospitalist movement continues to grow rapidly, many hospitalist groups recognize the importance of ensuring that the individual preferences, strengths, and practice styles of their providers are taken into account while determining the work schedule for the practice. This is certainly true of any discipline but what makes it particularly difficult for hospitalist teams to achieve individualized schedules is the requirement that hospitalists must work for several consecutive days to achieve continuity of patient care. Often the vacation and downtime requirements of individual providers conflict with the patient census or acuity-based staffing. For example, the need to have a provider work seven or more consecutive days for continuity of care might conflict with a provider’s need for rest between shifts, vacation, or desired number of work shifts. Also, each individual provider’s needs must be balanced with the collective needs of all providers within the group. A schedule that does not achieve adequate balance results in poor continuity of care or compromises individual work-life balance, which in turn results in high burn-out rates and poor retention rates.
Lightning Bolt strikes this balance as uniquely defined for each hospitalist group. With Lightning Bolt’s Hospitalist scheduling software, you create profiles of individuals or groups of providers with preferences on the desired number of shifts or FTE percentages, the desired number of consecutive days worked followed by the desired number of days off, desired type of shifts, desired vacation days. The system thinks deeply, often looking at the implications of a scheduling choice several million steps ahead before it automatically produces the best schedule possible. During the configuration, end-users with the assistance of Lightning Bolt staff define the relative priority of requirements and rules so that in the likely situation that some rules conflict, the system uses the user-defined priority to resolve conflicting rules.
The result:
- Organizations do not need to rely on rigid templates that need to be tweaked or reinvented as the team size changes or the number of shifts change. Templates are rigid because they over-specify the group’s requirements. The reliance on rigid templates makes it difficult for growing hospitalist groups to adapt to changes due to growing staff or patient volume. With the Lightning Bolt, users minimally describe the institutional requirements and provider preferences allowing the system to flexibly produce schedules meeting those rules.
- With provider preferences and vacation requests already considered, schedules produced by the system are highly stable with fewer swaps needed between providers after the schedules have been finalized. With fewer changes in the schedule, the whole organization avoids the chaos that often results from the domino-effect of changes.
- Because provider schedules are important to providers, organizations rarely feel comfortable handing off the scheduling duty to administrative or IT staff. With Lightning Bolt, not only is delegation possible but if a provider does continue to oversee the schedule, his/her time on producing/maintaining schedules would typically be reduced by 90% over manual scheduling.
Hospitalist Scheduling Sample Schedules
Hospitalist Scheduling Sample Rules/Requirements
Rule# |
Description |
Priority+ |
|---|---|---|
| 1 | Providers that belong to group A prefer to be scheduled 6 day-shifts in a row followed by 4 days off | High |
| 2 | Maximum of 4 nights in a row for all providers | High |
| 3 | Providers that belong to group B should be scheduled 19-20 shifts per month | Medium |
| 4 | Dr. Jones works 80% FTE for day shifts and 20% FTE for night shifts | Medium |
More Rules
| 5 | No provider shall work a day shift after a night shift | Maximum |
| 6 | Providers that belong to group C prefer 10% of their night shifts to be swing shifts | Low |
| 7 | Each provider should work at least 1 weekend per schedule | Low |
| 8 | Providers in group D should get equal number of night shifts | Medium |
| 9 | No more than fifty percent of the staff change from one day to the next | High |
| 10 | Use moonlighters during weekends when sufficient staff is not available to cover shifts | High |
| 11 | Equalize distribution of holiday shifts | Very High |
| 12 | Schedule Dr. X and Dr. Y together whenever possible | Low |
| 13 | Dr. X works 60% of his shifts on nights at facility A | Medium High |
| 14 | Dr. Z cannot work the first or the third weekend of each month | Maximum |
| 15 | Providers should not be schedule for night prior to PTO or CME request | Medium |
| 16 | Providers belonging to group E should get no more than 3 weekends per month | 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, PTO per day | Maximum |
| 20 | Request Manager: Each provider gets X number of CME, PTO days per year | Maximum |
| 20 | Request Manager: Providers may only request 2 no-calls per month | Maximum |
Hospitalist Scheduling Challenges
| 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. |
| 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. |
| 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. |
| 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. |
| 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. |
| 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. |
| 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. |
| 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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