September 13, 2018

The Road to Operational Excellence

8 min read

Written by: Rich Miller  |  Share:

Physician scheduling, staff scheduling, and workforce analytics are core components of the road to operational excellence - and it's time to take action.


Hospital departments and physician practices have never been more challenged to perform and universally, they are scrambling to improve. This is new ground and the expectations that departments and practices are trying to live up to are poorly defined, anecdotal, and often seemingly unattainable. We are witnessing our clients struggle to meet these expectations and demands. It can feel like trying to eat well, get enough rest, balance work & life and get to the gym... It's overwhelming and frustrating.

Changing to Improve

To approach this problem, it's important to adopt new behaviors and habits that will keep you on track toward your goals. Most importantly, it is critical to understand where your practice is on the path to operational excellence and to have clarity about the milestones for success that will help you achieve operational excellence.

We developed a program to define what this journey looks like in four stages. Designed to help a practice leader identify where they are on the road to operational excellence, and what they have to do to get to the next step, these stages outline the challenges and the steps to incrementally achieve operational excellence. Furthermore, business conditions will change, staff will turn over and organizations (just like individuals) will backslide.   Any plan must be resilient enough to stop the regression, build a plan to get back on track and come back strong with greater resolution than before.


Watch the video:



What Does Operational Excellence Look Like-2

Manual Stage - What does it look like?

A department or practice that is in the manual stage meets the general expectations for how they should run 'today'. They get the job done and support the status quo operations of their organization.

They employ moderate amounts of automation, but still support many deeply-entrenched manual processes.

Their staff retention is reasonably good, perhaps in part because their leadership does an effective job of tactically addressing issues as they arise.


Details of the Manual Stage Practices

  • Moderately good alignment, but there continues to be factions and politics at play.
  • Leadership is benevolent but more concerned with maintaining the status quo and keeping people content.
  • Members of the team are primarily focused on their immediate work at hand and don't spend much time thinking about improvement
  • Policies and rules may be documented, but many rules exist 'off the books'


The Processes of the Manual Stage

  • Core revenue and clinical systems are in place and stable but there are many manual internal processes.
  • Physician scheduling and staff scheduling may be partially automated or not automated at all, and consuming significant time because of manual effort and oversight.
  • Access to physician schedule is available online.
  • Requests for changes, time-away and swaps are either managed directly by scheduling through person-person communications or via email.
  • Processes like tracking incentive pay, overtime and call balance are in place, but tracked in spreadsheets.


The Tactical Stage - What does it look like?

A Department or Practice that is in the Tactical Stage has become somewhat automated. They have supplemented manual paper processes with electronic processes. Staff are engaged although processes have yet to be re-engineered to take full advantage of the deployed systems.


Details of the Tactical Stage Practices

  • The staff is fully engaged in the goal of improving systems.
  • While people are eager to improve they may not have the tools they need to get to the next level.
  • Staff have embraced the thoughtful use of technology and have developed confidence to explore and consider deepening implementations of current systems or replacing systems that have reached a functional plateau.


The Processes of the Tactical Stage

  • Core revenue and clinical systems are in place and stable.
  • Schedules are generated electronically but require a significant amount of manual override. Staff believe that schedules are fair and balanced and that the organization's scheduling policies are respected and applied fairly.
  • Access to departmental schedules are available electronically and in real-time across the organization.
  • Requests are submitted electronically including time-away, call, shifts and CME, as well as swaps and exchanges but require manual intervention to ensure no coverage rules or policies are broken.
  • Time and effort tracking may be done electronically but not interfaced to the physician scheduling application.
  • Premium time and incentive pay are calculated manually.
  • The organization manually generates reporting using raw data from its systems to do periodic analysis of practice performance.



The Automated Stage - What does it look like?

A Department or Practice that is in the Automated Stage is almost fully automated and the staff is largely engaged and trained with all electronic processes. Staff are comfortable with the implemented systems and processes have been re-engineered to leverage technology. Practices are beginning to realize the benefits of being a data-driven organization, are streamlining the work, and increasing productivity.

  • Tools are in place to allow staff to improve and reach the next level.
  • The thoughtful use of technology is standard in the practice and staff continue to learn and increase their knowledge and utilization of current and new systems.
  • Core revenue cycle and core clinical systems are in place
  • Physician call and staff schedules created electronically, swaps and time away requests are done electronically and require minimal manual intervention.
  • Scheduling rules and policies are proactively reviewed and refreshed in the physician scheduling application.
  • Time tracking is done electronically within the physician scheduling system or interfaced into scheduling.
  • Premium time and incentive pay calculated manually.
  • The organization has integrated the physician schedule to clinical systems like the OR’s EMR and patient scheduling. OR schedules and daily schedules are managed in the physician scheduling application.
  • We have inconsistent visibility into where, when, and why overtime occurs. Organization is creating meaningful reports but gathering the data is still a challenge.


The Processes of the Automated Stage

  • Core revenue cycle and core clinical systems are in place.
  • Schedules are almost completely automated. Physician schedules are created electronically, swaps and requests are done electronically creating greater physician and staff satisfaction, and a sense of equity.
  • The organization is tracking incentive pay electronically and, in some cases, using time tracking data to support the calculation of pay.
  • Time tracking is done electronically and interfaced into scheduling while premium time is calculated manually.
  • Overtime is managed by combining multiple data sources however there is still Inconsistent visibility into where, when, and why overtime occurs.
  • The organization is focused on creating meaningful reports but gathering the data is a challenge. 



The Strategic Stage - What is Operational Excellence?

A department or practice that has achieved operational excellence' is committed to proactive change management and focused on identifying opportunities to leverage technology to improve performance. They have automated every process they can and they are receptive and eager to uncover further opportunities to automate and re-engineer processes. They are able to lead their organization with strategies based on access to analysis and reporting. 

The systems this organization depends on are universally embraced by staff and communicated within and outside of their organization. Furthermore, this organization is motivated to look hard at their behaviors and performance through the lens of analytics and through a process of continuous improvement.


Details of Operational Excellence 

  • Poor performance is not tolerated and staff are eager to continuously improve their own performance
  • Mistakes and failures are celebrated as opportunities to learn. Bad news is welcomed and transformed into opportunities to transform.
  • Staff are confident that their openness to change and improvement will not be used against them or punitively. As a result, people are unafraid to dig deeper, take criticism and take risks.
  • People are eager to join this organization as it is efficiently run, concerns are thoughtfully addressed, and the opportunities for learning and improvement are ongoing.
  • The organization is universally recognized as a leader in their domain and they have the numbers to prove it.


The Processes of Operational Excellence

  • The entire organization, has consolidated systems and re-engineered processes to the greatest degree possible.
  • Physician schedules and call assignments are well organized and uniformly available in real time, to all staff. The call center has become a quiet and lonely place to work.
  • All physician schedules are created automatically, all swaps and time away requests are done electronically and time tracking is fully integrated.
  • The practice has complete control of the scheduling rules and policies and proactively manage them directly in the physician scheduling application with minimal support from the vendor.
  • Premium time and incentive pay rules are stored and managed in the physician scheduling system. Incentive pay is calculated automatically by combining assignment, time data, and pay rules and sent electronically to payroll.
  • Data is automatically transformed and processed so that performance metrics are always up to date.
  • Analytics are employed across the organization. Processes are measured consistently and root-cause analysis is in place when results don't match expectations.
  • Continuous improvement is not episodic, but rather something that is built into the organization's processes



Where is your practice on the road to operational excellence? Where do you want to be? What do you need to do next? How can you lead your practice through this transformative process to operational excellence? What does this look like from a leadership and operational perspective? Implementing software systems that uncover hidden dynamics and automate the illumination process will help organizations experience this transformation. Bring the challenges facing your organization to light so you can resolve them.




Topics: Physician Scheduling, Operational Excellence