The black hole of clinical scheduling

Want a colorful response from someone on the management side of our healthcare system? Ask them about clinical scheduling.

A few choice quotes from folks I talked to for this piece: “When I was in charge of the cardiology call schedule, I’d have to block off a whole afternoon to do it!”. “It’s simply crazy how much time my unit managers spend on scheduling.” "It's basically 3-D chess with lots of interruptions"

Nursing managers spend 40% of their time creating and updating schedules

In hospital nursing, the figures are striking. Let's quickly levelset on how scheduling actually works. Hospitals typically are arranged into units: med/surg, cardio/tele, ICU, and so on. Each unit has a manager (a nurse themselves) responsible for, among other things—but often mainly—the shift schedule.

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From a recent survey of nursing leaders, the average total time a unit manager spends on scheduling is 15.6 hours in a 40-hour workweek (i.e., ~40%). This is time NOT spent on employee well-being, retention, quality, safety, and the many other responsibilities they have.

Few think that 40% of a highly-trained unit managers’ time going to scheduling is ideal or appropriate - to put it mildly. Yes, some is unavoidable: there are pieces of the puzzle, like adjusting for team dynamics or specific experience that are hard to automate with technology.

Scheduling systems often do not optimize self-scheduling and essentially guarantee manual rework

That said, there is a LOT that is addressable with better tech + process. As one example, many platforms do not fully regulate self-scheduling, creating inefficiency from the first moment. A typical example: eight nurses sign up for a popular shift (typically M-W daytime), when most of the time the shift requires six. So from the start, the shift is not set up properly. The result? Unit manager will have to manually re-schedule two nurses per shift, while factoring in skill and training balance. Some weeks later, the cycle will repeat.

Another example is from a (medically) advanced academic medical center. At the AMC, units do shift swaps via email, outside of the (industry-standard) scheduling platform. Because of management overload, most of the time the emails go unreviewed, and the switched nurse will simply show up to the shift despite not actually having been "approved".

Poor scheduling practices also hurt hospital profits through inefficient allocation of staff

Scheduling struggles worsen not just the experience of unit managers, frustrated with manual process, and direct care nurses, for whom the process creates unpredictability. They also hit the bottom line. As my co-founder and our CNO, Sergey Vasilenko, points out, when the future is hard to predict and unit managers are busy, they may “pad” the schedule with an intention to adjust it later, but are not always able to do so given the fast pace of their workday and competing demands.

In this, at In-House Health we see an opportunity: clinical schedules overall, and nursing in particular, deserve attention from the perspective of time spent and resource allocation that matches clinical demand. Getting our nurse managers out of endless scanning of the EMR and shift schedule and hours spent dragging & dropping is a no-brainer to ease the burden on modern nursing teams.