FOR THE HOSPITALISTS at the University of New Mexico Hospital in Albuquerque, scheduling software has helped them achieve targeted flexibility with different kinds of shifts.
Christopher Smith, MD, section chief of hospital medicine, says that historically, the academic hospitalists rounded with residents seven-on/seven-off. But “over time, the hospital has asked more and more of us, each resulting in new and different roles,” Dr. Smith says. Those different roles, as well as the fact that the group just kept getting bigger, “drove a natural process to need different kinds of shifts.”
But “over time, the hospital has asked more and more of us, each resulting in new and different roles,” Dr. Smith says. Those different roles, as well as the fact that the group just kept getting bigger, “drove a natural process to need different kinds of shifts.”
“The main reason we pursued flexibility was to make people happier with their schedules.”
Christopher Smith, MD
University of New Mexico Hospital
In addition to having resident teams, the hospitalists now have nonresident teams as well as triage shifts—where they work in the ED, admitting patients—and a swing shift to increase the number of admitters during afternoons and evenings.
After the group experimented with the length (and times) of both the triage and swing shifts, both shifts are now eight hours, with the swing shift just recently moved to 1 p.m.-9 p.m. (It used to be 3 p.m.-11 p.m.) Was the rationale behind eight-hour shifts to right-size staff to demand?
“We did it to improve job satisfaction,” Dr. Smith notes. “The main reason we pursued flexibility was to make people happier with their schedules.”
That was the case years before the pandemic, when a scheduler used to hand-make the schedule using Excel. A couple of years ago, the group adopted scheduling software. (They went with QGenda.)
“That,” says Dr. Smith, “was the impetus to make a lot of decisions. That was an opportunity for us to really figure out how to maximize flexibility in our scheduling process.”
Weighing shift preferences
Having moved away from a hand-crafted schedule, the hospitalists started to survey group members about their schedule preferences. For each type of shift (rounding, triage, swing), the survey asks, do individual doctors want to work the normal allotment? Only half, or double, or even three times the number of that particular shift?
The least popular shift is the swing, Dr. Smith points out, and hospitalists aren’t allowed to opt out of doing those completely. “Some find that shift to be very disruptive to things like family time. But others find that it’s great for their lifestyle.”
Same with the triage shift: “Some of our faculty, if given the opportunity, would do nothing but that shift.” The “more experienced and seasoned” hospitalists tend to gravitate to the triage shift, which for newer faculty “can be very stressful to navigate all the interpersonal, interprofessional dynamics” of spending an entire shift in the ED.
It takes a scheduler up to 15 hours every six months (that’s how often the schedule is made) to weigh individual doctors’ survey responses and craft a schedule that hews as closely as possible to their preferences.
“That gets us the maximum amount of flexibility we could,” Dr. Smith notes. “We really have had very few complaints.” Doctors can also choose their block size of days, including 14 or even 21 days in a row. At the other end of the spectrum, doctors on at least one nonresident team can also opt to work only three- or five-day blocks.
Another plus of the scheduling software: It’s now much easier to arrange one- and two-way shift swaps. Instead of pressuring a scheduler to find someone to swap with, “swap requests just sit there on the software, and we let doctors submit swaps on their own,” Dr. Smith says.” That gives people more control to change their own schedule.”
Attendings on the teaching services still need to do seven-on/seven-off.
“We feel it’s critical to have that continuity to be able to evaluate residents and give meaningful feedback,” he says. But for the nonresident service, the doctors on one of those rounding teams can already work less than seven-day stretches.
The group is debating whether to extend that flexibility to more teams. “Some people feel very strongly that there’s a patient care element to maintaining seven-day continuity,” Dr. Smith points out, adding that younger physicians may also choose seven-on/seven-off because they can more easily arrange childcare. “But others feel the flexibility of offering shorter stretches is more important. That’s the big tweak we are wrestling with now.”
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Phyllis Maguire is Executive Editor of Today’s Hospitalist.
