Friday, December 28, 2007

Not So Happy Holidays

November and December have been lean months from the point of view of getting rid of our backlog. As we noted during the summer months, when several physicians are away, it’s difficult to find extra office capacity for the remaining physicians.

As holidays are a recurring reason for reduced clinic capacity, we need to consider if we can manage them more effectively.

The first thing I’d like to implement is a more effective way of requesting and tracking holiday requests. Our traditional method is to write the request on a scrap of paper and attach it to the paper “master calendar”. I then mark my initials on the days I want off. If there are already x number of urologists away at that time, I’m not supposed to request that time off. Special circumstances may be negotiated individually.

I need to see the actual calendar in order to check available dates. It usually lives in the holiday coordinator’s office, but it may occasionally go missing for a few days. It’s usually our office manager or the call-scheduler who have it, but it’s still a nuisance when I want to book holidays and can’t find the calendar.

The solution: Google Calendar. I love Google’s online applications.  We use Google Calendar at home to coordinate 6 people’s work, school and play time. It’s easy to use, gives multiple views (day, week, month) of appointments, and (most importantly) is Internet-based. This means I (or any of my partners or staff) could view it simultaneously and from any location. No more chasing around the office to find the calendar’s hiding place!

Here’s my plan for the New Year:  I’ll set up a separate calendar for each physician. Google Calendar can mash them all together into a master calendar. Each calendar will be color-coded for easy identification. There are pre-made templates that indicate Canadian and Saskatchewan holidays.

Because calendars can also be displayed individually, it will be easy for the holiday coordinator to tally the number of holidays each doctor has used during the year, by selecting only that doctor’s calendar.

I’m going to suggest that holiday requests be made by email. This creates a more reliable record of requests than our current Post-it notes/back of a prescription sheet/scrap paper method. It also automatically records the date when the request is made in case of first-come, first-served disputes. Finally, it’s easier to notify all the necessary people (holiday coordinator, office manager) by copying a single email to them.

So far, so good. But so far, this is just an anal-retentive e-tweak of our current system. The important changes will be much more challenging (naturally!).  We need to decide if we should change the limit on number of physicians away at a time. At present, we have 9 urologists, but only 7.5 FTEs. We arrange holidays so at least 4 of us are working. That’s bare-bones coverage of OR time and other essential services. Perhaps we need to try a minimum of 5 working at any time. That may be a tough sell, as it restricts holiday availability.

Maybe we need to restructure our work schedules when several people are on vacation. The working urologists could book more late offices (5-6 pm) to guard against the backlog creeping up.

Or maybe, once we get our current backlog worked down, we’ll find that holiday times aren’t quite the villain I’m painting them to be. Perhaps we’ll only see minor fluctuations in wait times related to holidays, once we get our wait times down to target levels.

There’s always room for wishful thinking.

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