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Opportunity for Improvement

All Health Systems rely on their Provider On-Call schedule to support vital patient care services.  This seemingly routine daily process is often taken for granted in busy health systems with bigger, more pressing priorities.  Yet the fact remains that the On-Call process impacts virtually every clinical service and clinical employee in the organization, is a significant driver of physician satisfaction and work-life balance, and – if poorly managed – can create ongoing inefficiency, wasted time, and potential delays to patient care.  At the extreme, the On-call process can even lead to liability as has been proven in several law suits over recent years.  In fact, in a study of over 23,000 malpractice suits poor communication contributed to 7,000 of them.

A cursory review of the on-call process at almost any health system will reveal challenges not only in schedule consumption but also in creation, publication, and change management.  From finding the right provider for any given service to escalation if required, the tools available to schedule consumers often do not support a rapid and efficient process.  Frequently users of the on-call schedule have to rely on a call center or other intermediary before reaching the colleague they require.  It is often hard to keep the schedule up-to-date given that publication often relies on static paper or intranet-based delivery.  This structure also makes accommodation of changes labor intensive and error prone.  The entire process often features waste and create frustration and lost productivity.  And yet attacking this problem holistically requires a coordinated effort across departments and teams – something health systems have often found challenging especially related to clinical processes.

Creating an Enterprise Framework for On-Call Services

Health systems can dramatically improve the On-Call process for all clinical team members by focusing on the development of an enterprise framework coupled with streamlined access and communication protocols.  The first step is to engage schedule management technology to act as a centralized On-Call hub that clinicians can access directly from their mobile devices.  Since all on-call schedules would be created within that “single source of truth”, the providers can access the right resource quickly and call, text, or securely message their colleague directly without having to check in with any intermediary or call center team.  Further, the system should manage assignment changes in real-time so team members can trust that the information available is accurate and up-to-date.  Schedule consumers, including nursing staff and call center workers, can access the schedule too, but the key is to establish a single source for on-call information and allow departments to “opt-in” to further capability (full departmental staff scheduling, time and attendance, or compensation management) if they choose over time.

This approach does require a focus on change management across the organization since the on-call schedule remains an emotional and personal situation for many providers.  Key stakeholder identification and communication is, therefore, a key to success.  This level of change will undoubtedly expose some long-held negative behavior and health systems must be ready to combat those situations firmly and effectively.

This consolidated, technology driven approach will yield significant benefit for the health system and its clinicians:

  • Health Systems should dramatically reduce the call volume to their call centers creating opportunity to reduce cost and strengthen their focus in other areas.
  • We would expect an improvement in clinician satisfaction as well as a reduction in the delays associated with peer communication and thus patient care.
  • Since the On-Call schedules would be created in a central repository or system, health systems can also gain efficiency in the processes to create, publish and manage changes to those schedules. This will yield a positive impact for every department.

With a central repository for On-Call schedule information, the health system can accumulate data associated with the on-call work effort and make that readily available for reporting and visible to the physician team.

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