Re: CLD Feb 2013 article “On-Call Scheduling – Trying for Equity”

To: MarshallRitchey@hotmail.com

Subject: Call Schedule

Hello Mr. Ritchey,

My name is Rose Winfrey, RCIS. One of our techs read your article on the call schedule grid. We were wondering if you could help us out with a few questions.

1. How do you assign holiday call?
2. How do you complete the grid with vacation time?
3. How do you work new employees into the grid?

Thank you! Rose Winfrey, RCIS

From: Marshall Ritchey 

To: Rose Winfrey

Subject: RE: Call schedule

Dear Ms. Winfrey,

Greetings and salutations! I hope this e-mail finds you both happy and healthy.

I will try to answer your questions, but you and your team will have to craft a workable schedule that you feel is fair!

At Piedmont Medical Center, we have our rotation set on seniority. There are three major holidays (Thanksgiving, Christmas, and New Year’s Eve) and three minor holidays (Memorial Day, Fourth of July, and Labor Day) in our system. Each year, the most senior staff member gets the first pick. The caveat being that if you pick Christmas this year, you may not pick Christmas next year. There are still some problems with this system as junior members don’t have a choice and there is not a quick advancement to become the senior member.

If you look at the table “Operating Status and Schedule, Cardiac Cath Labs: Who will be on-call?” (bottom), you will notice that you may plan for on-call until 2020. My recommendation is to make a grid (see top table, below) and list who has covered the holidays for the last five years. Based on your past record, plan a rotational call for the next five years. Then your staff will know what their future holds and may plan accordingly.

Vacation grids are tough unless you have plenty of warning. My recommendation is to plan your vacation by October the previous year. I like having my yearly schedule completed by October 1st. When you have a monthly or a six-week schedule, there is a constant drama. An annual schedule still has drama, but most likely once a year.

Make guidelines for requesting vacations and avoid too many staff out to run the lab safely. If you don’t have sufficient staff to rotate vacations through safely, then you will need to schedule travelers or PRN staff to cover the holes. The smaller the number of your staff, the more critical adequate staffing becomes. Your need for call coverage makes advance planning all the more important.  

With sufficient staff, you would have a vacation rotation through the grid. Usually only one or two staff may take a vacation without major problems. We have sufficient staff for only one person to vacation at a time without me working in the room, too! So I am the relief valve when unexpected vacancies occur. I hope you have a Plan B, too!

Ben Franklin is noted as saying, “Those who fail to plan; plan to fail!” I think planning is a great idea. You have to have more than one plan or guideline. You cannot control life outside the cardiac cath lab. Sickness, injury, and even death occur. Staff must deal with these problems of life and thus have unexpected absences. You need depth in your team to deal with these situations. Make sure your administrators are aware of the challenges and limitations without PRN plans.

Worse-case scenario is when staff leaves and you have a position open. First, you have to orient and sometimes train the new person to work in the cardiac cath lab. A totally new person in the cardiac cath lab will take up to a year to learn 70% of the techniques, duties, inventory, doctor preferences, terminology, skills, and knowledge to be proficient in the cardiac cath lab. The worst problem is low-use, high-risk equipment and procedures. It can take three to six months to have a new staff member competent to cover call.

So when they are ready to pull call on their own (not shadow call) the easiest way is to just have them fill the open position that has left the grid. Don’t try to make a whole new grid. If you are using seniority for the grid, then you have no choice but to make major changes to the schedule. 

When you add additional staff or lose staff (full-time equivalents [FTEs]), it will change your grid as well. Avoid, as much as possible, a rebuild of the whole grid until the next schedule is rolled out. I encourage you to patch and fill in the gaps until the new schedule is released. The idea here is to keep things calm. When you mess with the schedule, you mess with the staff’s life.  

The real key to this scheduling is teamwork: staff willing to help their co-workers. To cover if someone needs a day off for a sick child, to switch calls when there is a death in the family, and yes, even when the hair appointment got confused and they need that day off! You are all in the same boat together. You need to work together to make the schedule work. It is only a plan, and the circumstances are quite fluid and change daily with supply and demand.

I hope these recommendations have been helpful for you and your staff.  If I may be of further assistance, feel free to contact me.

Respectfully yours,

Marshall W. Ritchey, Manager, Cardiac Cath Lab, Piedmont Medical Center, Rock Hill, South Carolina 

From: Rose Winfrey 

To: Marshall Ritchey 

Subject: RE: call schedule

Dear Mr. Ritchey,

Thank you so much for the additional information. We have created a sample grid for 11 staff members and most of our staff really like it. It really gives you the opportunity to plan a life. Keep up the good work.

Happy cathing! 

Rose Winfrey, RCIS