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Posts tagged ‘healthcare information systems’

Staff Self-Scheduling: Ownership and Investment by the Professional Worker

The following guest blog post is provided by our board member Dr. Tim Porter-O’Grady.  In it, he argues for the benefits of employee self-scheduling in the healthcare environment.  In addition to the citations he includes below, readers can also learn more about self-scheduling best practices in our recent publication “Elements of Successful Organizations”.

As viable as staffing self-scheduling can be, it is surprising that it is still a minority choice for scheduling professional workers. Perhaps much of the problem relates to the need for a positive understanding of the characteristics of professional workers and the unique need they have to control their time and their practice. This delineation of the knowledge worker’s need for control over life and professional practice is the relatively recent product of professional staffing research (1). As a result, it may not have reached full exposure in the management techniques and methodologies of contemporary clinical managers. Even though virtually no one should be able to claim they’ve not heard of self-scheduling, it still has not caught on as the majority work scheduling vehicle for most clinical settings. We might do well to advance the argument representing some of the basic elements and characteristics of effective professional worker self-scheduling as the foundation for advancing interest in its utility.

Variations in self-scheduling have been around since the 1960s and hospitals and health systems have used it since that time with varying degrees of consistency and success. Benefit claims include ownership, engagement, consistent compliance, cost savings, high levels of staff satisfaction, and potential reduction in staff turnover. Self-scheduling is especially useful for round-the-clock workers who must address the needs for schedules 24 hours a day seven days a week. The inclusion of weekend scheduling implications makes self-scheduling especially useful in so far as it balances and regulates the use of weekend work time more equitably across the service or departmental workforce. In addition, compressed workweek schedules (three to four 12 hour shifts per week or seven day/12 hour work weeks one week on/one week off schedules) and Baylor Plan schedules (two 12 hour weekend work shifts counted as a full week schedule), all serve to add creativity and flexibility to round-the-clock professional worker scheduling (2).

Self-scheduling processes involves engaging the staff and assuming primary responsibility for the planning and constructing of their own staffing schedules. Usually large worksheets or computer programs cover all available staff over a period of 4 to 6 weeks. Schedules are made available two weeks to a month in advance via specific protocols and guidelines agreed to by management and staff establishing the essential staffing rules and processes that must be applied to scheduling all persons. Often, rotations are suggested by software programs designed to fit the particular staffing modality of an individual unit or service, thus allowing the schedule to present as complete so that staff can see the objective array of scheduled shifts and rotations before adjustments and modifications can be addressed to apply the unique and particular needs of staff in a way that adjusts the originating schedule. In many healthcare organizations, shift patterns have been long well established and individuals have frequently been slotted into those patterns for long periods of time factors reflecting tenure, role, patient characteristics, intensity, acuity, individual professional skill set, and a range of other factors can often influence the routine foundations for self-scheduling. Having a fully developed and visual staffing schedule helps individual staff see the complexity, vagaries, and impact of shifts or changes each might seek to apply to the existing potential schedule. It helps the individual identified complexities and impact of changes across the scheduling array, deepening individual understanding of the vagaries and challenges associated with making changes in one place and its significant impact on other components of the schedule. This increased awareness accelerates the sense of engagement and impact, challenging individuals to caution regarding choices, carefully justifying their choices and the adjustments they make and their impact on the schedule and lives of colleagues and peers.

While accountability for appropriateness and balance in the schedule now emerges between peers and the affected staff in self-scheduling, the role of the manager also changes. From the more directive, parental, and controlling agency, the manager now must become proctor of the terms of engagement, the consistent requisites of the protocols and processes regarding fairness and equity agreed to by all stakeholders, and assure that the final schedule product represents balance, fairness and equity, sufficiency and adequacy, and meets the general staffing requirements of the service or department. In the role of “agent of accountability”, the increasing obligation on the role of the manager emphasizes the need for the manager to develop the more adult to adult capacity in the staff for quid pro quo, negotiating particulars, trade-offs, time bartering, and value exchange. These techniques require a higher skill set than simply evidenced in the manager’s traditional ability to unilaterally manage the mathematics flow of shifting numbers and persons on a paper grid. Secondarily, the development of these “agency” management skills yields parallel results in resolving personal conflicts, mediating issues, negotiating outcomes, and interest-based problem resolution on a broad range of nonrelated but important human dynamics issues (3).

There are a range of positive results that arise is the product of self-scheduling in most professional organizations. For the manager, less time is spent in the parental role of directing and managing others requests for time shifts, days off, schedule adjustments, and shift changes. Two outcomes result from this shifting accountability: more time is provided for the manager to develop in others the skills necessary to negotiate relationships and choices and, secondly, peer ownership and investment in the work schedule accelerates, moving the locus of control for related issues to staff at the point-of-service. Predictably, personal ownership and life self-management of individual staff accelerates simply because engagement and predictability joined to allow the professional more personal control over choices that affect his or her life and the use of time. In addition, the acceleration in the degree of interaction between members of the professional staff around the balance and distribution of time and schedule increases the intensity of communication, interaction, interpersonal capacity, and agreement with secondary benefits of increased ownership, increasing interaction, staff satisfaction, and a more professional context for the work (4).

In self-scheduling, when problems do occur they become more readily apparent and more visible to all stakeholders. Issues related to absenteeism, chronic violations of time and schedule, and the pattern of sick time use generally decreases because the schedule more clearly represents the needs and wants of staff and the personally negotiated parameters which more clearly define agreements around the use and distribution of work time. Suggestions also indicate that greater shift in scheduling satisfaction leads to reduction in turnover and accelerates the potential for positive recruitment (5). Academic programs now suggest that as staff seek employment one of the questions they raise relates to the presence of staff-driven self-scheduling approaches.

As a concluding point, questions abound as to the sustainability and viability of self-scheduling over the long term. Major concerns exist whether staff is continuously able to negotiate and construct viable and satisfactory schedules over the long term. Increasingly, current data suggests that staff increasingly demonstrated expectations for models of self-scheduling as a foundational expectation and the positive influence for making potential employment choices (3). The initial flurry of reactive “noise” and struggled in transferring the locus-of-control for scheduling to staff is more than compensated for increasing effectiveness engagement, ownership, and process efficiency for both organization and staff. As the self-scheduling process becomes an increasing normative way of doing business in more clinical services, the negative challenges apparent in the transition to such systems can be significantly diminished. In the final analysis, the evidence increasingly suggests that self-scheduling is not only an effective method of managing workload and professional worker time but is the most efficient and engaging method of time management for the contemporary workforce and for sustaining positive staff investment and ownership and reducing problems in a critical area of effective workload management.


  1. Kerzner, H. (2009). Project management: A systems approach to planning scheduling and controlling. New York; Wiley.
  2. Talier, P. (2008). Nursing staffing ratios and patient outcomes. New York; VDM Verlag.
  3. Amoldussen, B. (2009). First-year nurse: Wisdom, warnings, and what I wish I’d known my first hundred days on the job. Chicago; Kaplan Publishing.
  4. Meisel, M. (2010). For ideas to improve staff management. Health Management Technology 31:4, pp 10-11.
  5. Robb, E.; Determan, A.; Lampat, L.; Scherbring, M. (2003). Self-scheduling: Satisfaction guaranteed. Nursing Management. 34:7, pp16-18.

Healthcare Information Management: Means Not Ends

The following guest blog post comes from our newest board member, Dr.Tim Porter-O’Grady.  Given the historical vote in Congress last night, coupled with the rising call for evidence-based medicine, Tim’s perspective from the trenches is very timely.  You can also read Tim’s recent article in Nurse Leader magazine on the case for clinical nurse leaders in the 21st century.

One of the big challenges with leaders and clinicians these days is the overwhelming amount of data that must be collected, codified, generated, and analyzed. A big temptation in this necessary effort is to watch data management convert from means to ends. As I travel around the country working with a wide variety of health care agencies, I see clinicians overwhelmed with trying to balance the collection and management of data with the demands of patient care. While data is important, leaders must remember that clinical and management data should be directed to supporting, improving, and advancing patient care not simply a nonaligned means of the measure of process.

When the demand for measurement becomes overwhelming, it moves from tool to goal. When data becomes a goal it moves from facilitator of practice to an impediment to work. In fact, it begins to undo its very purpose and itself become a “workaround” and just another barrier to effective patient care. For many clinical leaders the demand for information and the urge to collect and provide it becomes more important than the real sustainable achievement of value or outcome. One wonders how many clinicians are now working to instrumentation measures, making those measures their performance goals, losing focus on their patient in the process. While the collection of this data is certainly essential to the methods and techniques essential to measuring the presence of effective process, they are indicators, not results.

It must be remembered, in the midst of all this data collection, that clinicians are providing a service deeply embedded in the context for caring to persons experiencing one of the most significantly vulnerable points in their life’s journey. These patients are expecting that the focus, attention, and center of clinical activity are directed to helping them cope, respond, and accommodate their healing journey. The real value-driven measures are those that well articulate a goodness-of-fit between the needs for caring and the resources necessary to assure that it occurs efficiently and effectively.

The best measure of the utility of data is that which assures that mission, purpose, resources and care interface in a mosaic where the patient expresses exuberance with their experience, the clinician expresses satisfaction with her or his impact and management recognizes value in the efficiencies leading to sustainable outcomes. The achievement of these ends is reflected in the essential dance between the stakeholders and the organization and the music is the information that demonstrates their convergence.

So, finally, it is important for each stakeholder to both recognize and enumerate value in the collection and analysis of data related to the dynamic of caring for patients. Equally important is to acknowledge that data is reflective of value and action, it is not, however, itself value and action. Measurement of the meaningful delivery of service is not the service itself but, rather, is indication of the effectiveness and efficacy of the service. There are three things that must continuously be kept in mind when interfacing data management with clinical care:

  • The ownership for the output of care is always the clinician at the point of service. Transferring that ownership to other points in the organization does not increase personal accountability and does nothing to either facilitate or advance the outcomes and impact of that service. In fact, shifting this locus-of-control from the point of service only impedes the achievement of sustainable value.
  • Data collection and analysis can only serve to inform work and effort; information is not itself the work — it remains forever means not ends. When information becomes the point of work, the real value of that work is lost and its purposes becomes skewed, making it increasingly difficult to recalibrate people and organizations toward who and what they are and do.
  • Clinical leaders must increase both their acceptance and their use of data in the determination of objective and meaningful value in the critical clinical work they do. The meaningful use of information should relate directly back to the point of service and the creation of real value. Through the good use of the means of data collection and analysis, clinicians are empowered to demonstrate genuine value and impact and to make their contribution clear and evident to all.

In the final analysis, sound relationships are the best indicators of both efficacy and meaning. The relationships between health organizations and their clinicians, between clinicians and those they serve, and between health organizations and their communities are the clearest indicators of effectiveness. Data and measurement devices are the lenses through which the value and impact of these relationships can be assessed for both their quality and effectiveness. If all stakeholders in this dynamic keep focused on the ends of advancing the health of those we serve, the data means we use will provide the evidence we need for the validation we seek in fulfilling the central purpose of the caring we provide. Quite frankly, that is why we are here.