Background: 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. Additionally, several recent editorials questioned the “7-on/7-off scheduling.” In a rapidly expanding academic hospital medicine group with 63 physicians, the scheduling process is cumbersome, particularly when trying to accommodate variable service stretch lengths and numerous time-off requests.
Purpose: Identify the impact of scheduling process changes on provider satisfaction and scheduling metrics.
Description: From January 2017 through October 2018, our academic hospital medicine group undertook a scheduling redesign process using improvement methodology in combination with purchased scheduling software. Prior to January 2017, service stretches ranged from 5-9 days, and there were few limits on time-off requests. Despite having a scheduling software, this resulted in significant scheduling complexity requiring many hours of manual scheduling and average schedule release lead times of less than 7.5 weeks.
Through sequential interventions, we standardized service stretches to seven days (Tuesday-Monday), introduced a limited number of guaranteed 7-day time-off requests (Tuesday-Monday), and added a limited number of non-guaranteed 3-day flexible time-off requests. With these interventions, we reduced the complexity of the scheduling process: the total number of schedule requests for the group decreased from an average of 201 days to an average of 145 days per 4-week block while maintaining request fulfillment at 100%. This simplification improved the automation of the scheduling software which increased the schedule release lead time to an average of 16 weeks. Further, despite standardizing service stretches to seven days and limiting time-off requests, physicians surveyed reported improved satisfaction with both their scheduling process (34% of participants “satisfied” in 2017 to 67% “satisfied” in 2018) and their overall clinical schedules (50% of participants “satisfied” in 2017 to 75% “satisfied” in 2018).
Conclusions: We have demonstrated that simplifying the clinical scheduling process can result in improved schedule release lead times, less administrative burden, and higher provider satisfaction with the scheduling process and clinical schedules.