Nobody is average. No day is average.
A statistician drowned walking across a river with an average depth of 2 feet.
Average harms patients.
When emergency departments are understaffed, patients wait. When departments are overstaffed, costs go up.
This post touches on material in Step 5 from No More Lethal Waits: 10 Steps to Transform Canada’s Emergency Departments
In Step 2, we said to Close the Waiting Room; bring everybody inside. If EDs do this, staff will feel every surge in patient volumes.
It will create chaos, if you do not match physician scheduling to hourly changes in patient volumes. Staffing levels need to swing up and down with changes in patient volume.
High-end restaurants solved this long ago. If an evening gets busy, restaurants call in more staff. If it is slow, waiters go home early. Restaurants schedule staff based on how fast each waiter works.
To use this thinking in the ED, schedulers have to tackle clinical speed and the traditional LEGO block approach to scheduling. Check out Schedule 4 Patient Flow and Efficiency to see how.
Schedule Trilemma
Scheduling frustrates some of the smartest people, when they ignore the schedule trilemma.
A trilemma offers 3 options such that only 2 of the 3 can be true at the same time.
One classic trilemma asks you to pick 2 of the following 3 options: better, faster, cheaper. If you want better and faster, then it won’t be cheaper. If you want faster and cheaper, then it won’t be better. And so on…
A humourous Soviet era trilemma asks you to pick 2 of the following 3: communist, honest, smart. You can be communist and honest, but you won’t be smart. And so on….
The schedule trilemma asks us to pick 2 of the following: efficiency/MD productivity, short patient waits, rigid shifts.
If you want to keep physicians productive and have rigid start and stop times for your shifts, then patients must always be waiting so that physicians are never idle.
If you want short wait times and rigid shifts, then you need to over-staff your department so that there’s always an MD ready to see patients, even during the biggest surge in patient volumes.
But if you want efficiency and short patient waits, then you must not have rigid shifts; you need flexible start and stop times.
We need flexible shifts to maximize efficiency and decrease patient waits.
Scheduling to Meet Patient Needs
- Determine the speed each physician works
- Estimate total volumes
- Let physicians pick their shifts
- Each MD should choose 50% more shifts than they want to work
- Use number 1 – 3 to create the schedule
- Assign approximate start and stop times
We’ll look at how to operationalize this in the next post.
Check out this interview with Dr. Marko Duic, the brains behind this scheduling approach. The interview touches on the mechanics which we will expand in the next post: Step 6 – Give MDs Responsibility for Flow and Hire Patient Navigators.
I hope this gives you a little taste of the process advice from the book. Check out No More Lethal Waits