Recently, behavioral health physicians at a Phoenix Department of Veterans Affairs (VA) Hospital have stirred up criticism for blocking off open time slots in their schedules.
It's a move being portrayed as selfish doctors trying to game the system for easier schedules - and one that has also increased wait time for veterans. Some veterans at the facility have waited over 400 days for an appointment. At a time when the VA medical system is already facing scrutiny, negative media coverage of this staffing dispute is just one more blow to the program.
Staff scheduling at this VA hospital is obviously not working for anyone. In truth, it seems to be catastrophically broken. From the physician's perspective at the facility, they may have taken what they see as necessary measures to build workable schedules with time for meetings and other administrative tasks. From the patient view, it appears that the physicians and hospitals don't care and that has triggered "whistle blowing" to the media and Congress about the issue. From the hospital operations side, there are apparently broken shift scheduling rules in place that lack oversight and things have spun out of control.
How close is your own hospital to facing this same kind of miscommunication and hospital scheduling muddle? In today's open media world, everyone may be just a few angry doctors and patients away from bad press and even funding fall-out.
Transparency is the solution. As the old saying goes, "Sunlight is said to be the best of disinfectants." Working with hospitals around the country, I've seen this kind of tangled scheduling crisis in many different settings. Lack of scheduling transparency can easily create major conflict in hospital operations and that story can spill out far beyond the hospital doors. It may be that doctors and administrators in this VA facility are trying to achieve the same goal. With no data to tell an accurate story, feelings and politics get involved instead.
Open collaboration between healthcare organization leadership, physicians and patients is essential in any effort to improve quality and cost of medical treatment. These scheduling challenges can be overcome with the right technology and organization processes. There are several practical solutions for hospitals facing their own scheduling and physician time block issues:
o Look at the data first before jumping to conclusions. Run reports on distribution of different types of work events - such as number of blocked hours vs. appointments scheduled without blocked hours, and compare that with other clinicians is one way to bring transparency without controversy.
o Get more specific on time block policies. Some hospitals require doctors to enter special codes to indicate how exactly they need to block hours - administrative time, meetings, personal appointments - or to get approval by a chief before changes can be made. This additional detail also helps to boost data transparency in operations.
o Using scheduling tools and data analysis to track and report hours can help hospitals "crack down" on unreported hours or what is often called "extra compensation" for additional hours reported and create a fair solution with physicians.
The Department of Veterans Affairs is reportedly in the process of adopting new patient scheduling technology into their systems - but there doesn't appear to be an incorporated program of physician staff scheduling systems with that move. In the meantime, a program that should be working in unity toward a single goal - providing the best possible care to our nation's military veterans - is distracted by scandal over a dispute between operations and physicians.
A more transparent physician scheduling system would help Arizona's VA Hospital not only avoid negative press and possible congressional scrutiny but could also help retain and boost physician morale, increase hospital capacity and most-importantly serve the behavioral health needs of its veteran patients. It's a lesson the VA is learning the hard way, but also hopefully one that every hospital can learn from.
Suvas Vajracharya is founder and CEO of Lightning Bolt Solutions, which automatically generates 3 million hours of balanced physician shift schedules for hospitals each month. Prior to founding the company, he worked as a staff scientist at the Los Alamos National Labs scheduling massively parallel supercomputers.
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