Control over work hours and schedule flexibility are important predictors of clinicians’ career satisfaction, work-life balance, and burnout, which are in turn linked to quality of patient care, recruitment, and retention. In our rapidly expanding academic hospital medicine group with over 60 providers, the scheduling process has grown increasingly complex, leading to high levels of dissatisfaction.
To use the Model for Improvement (MFI) to redesign the hospitalist scheduling process to improve clinician satisfaction in a patient- and learner-centered manner.
Using MFI methodology, we outlined a 4-step process to improve scheduling for our hospitalist group: 1) Needs assessment, 2) Measurement Plan, 3) Regular feedback mechanism, and 4) Innovation. We first formed a QI schedules work group comprised of both physicians and advanced practice providers with varying levels of seniority, protected time, and service line expertise. We then created a dashboard with key metrics capturing clinician satisfaction (e.g., schedule lead time) and patient and learner continuity (Figure 1). Using the work group as well as structured one-on-one interviews with clinicians, we developed a prioritized list of discussion topics around factors influencing and delaying the current scheduling process.
Based on this feedback, we created multiple Plan-Do-Study-Act (PDSA) cycles to implement interventions, including first streamlining shifts into either 7- or 14-day stretches to enable better automation by the scheduling software. Since beginning the continuous improvement process, schedule lead time has improved from 4.6 to 10.7 weeks, meaning that group members are now receiving their schedules 6.1 weeks earlier. Time from software automation to schedule release has decreased from 4.3 weeks to < 1 week, reflecting the need for fewer manual adjustments. Upcoming PDSA cycles will involve: 1) Setting a cap on the number of time-off requests to further improve schedule lead time and 2) Designing a separate scheduling process for highly versus non-highly clinical faculty to allow better coordination with administrative and teaching responsibilities. We will further assess provider satisfaction through surveys and monitoring the impact of schedule changes on quality metrics such as length of stay, 30-day readmissions, and discharge time.
There is a growing body of evidence suggesting that clinician work schedules are an important determinant of career satisfaction and burnout. We demonstrate that a complex process such as scheduling for a large academic hospitalist group can be approached using a rigorous continuous improvement process, with the potential for improved clinician satisfaction.
To cite this abstract:Patel, HP; Yirdaw, E; Anderson, M . IMPROVING HOSPITALIST SATISFACTION THROUGH CLINICAL SCHEDULE REDESIGN. Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev. Abstract 201. Journal of Hospital Medicine. 2017; 12 (suppl 2). https://www.shmabstracts.com/abstract/improving-hospitalist-satisfaction-through-clinical-schedule-redesign/. Accessed September 19, 2019.