About the University of Texas Southwestern Medical Center (UTSW) Department of Anesthesiology
As the third largest Anesthesiology and Pain Management residency program in the nation, UTSW’s mission extends well beyond excellent patient care to education, research, and innovation. UTSW’s Department of Anesthesiology and Pain Management is renown for the depth and breadth of practice it supports and for offering its student a unique experience across the full spectrum of Anesthesia subspecialties. With over 200 faculty physicians, the department services across both in-patient and ambulatory settings throughout the Dallas-Fort Worth area including at Parkland Hospital and Health System, University Hospitals (with the state-of-the-art William P. Clements University Hospital), Texas Scottish Rite Hospital, Dallas Children’s Medical Center, and the VA North Texas Health Care System.
“As the nation’s third largest academic anesthesia practice, we have to perform exceptionally today while also evolving our department to anticipate the challenges we expect to face in the future. This means proactively managing our clinical staffing practices ahead of the growing patient care and financial demands we have to meet.”
Chair, Department of Anesthesiology and Pain Management
With aggressive growth plans and, like most health systems, substantive cost management targets, UTSW faced the reality of “doing more with the same” resources and having to manage their clinical staff members more effectively. This evolving clinical productivity mandate also required proactively balancing the organization’s exceptional commitment to teaching, research, innovation, and discovery. The Department of Anesthesiology and Pain Management, led by Charles Whitten M.D., exemplified the challenge facing the Medical Center. Renown for outstanding care and compassion as well as academic excellence, Dr. Whitten and his team faced the need to expand their services to match increasing volume while maintaining the national reputation of their residency and fellowship programs.
Unfortunately, management of the department’s most important resource – its 400+ clinical team members including faculty, residents, and CRNAs - remained a largely manual, inefficient process:
- The department managed the schedules for each area via daily, paper-based processes. Four administrative staff prepared the various schedules for operating room coverage, call coverage, and other assignments every day for the next working day. One member of the team spent six hours each day gathering, adjusting, and formatting schedule information for approval and distribution. Once the Chief Residents and lead faculty members had reviewed, changed, and approved the assignments, staff emailed the schedule for the next day by 3pm to the team and entered the assignments manually into UTSW’s electronic health record system. Any changes from that point required re-approval and further manual adjustments in multiple locations. Staff also submitted all PTO and vacation requests on paper, and the processes were not standardized across locations. This often resulted in inefficient allocation of resources, errors in scheduling that could impact patient care, and a high level of dissatisfaction from the team.
- Given the manual nature of the process, the department had limited data to support the balance of work for its team members. Specifically, it was challenging to account for clinical time set against academic or research work. It was also difficult to demonstrate fairness and balance in call assignments, vacation distribution, holiday work, and other areas that impact clinical team engagement and satisfaction.
- The process also had downstream impacts especially associated with the calculation of incremental pay for clinical team members over and above their salary. UTSW’s pay structure rewards clinical team members for taking on additional assignments or for certain more stressful clinical work. With only paper and Excel or Word files to reference, the effort to validate this work contribution and associated compensation was laborious.
Despite these challenges, the department still produced strong clinical and academic results. However, those outmoded workforce management processes inhibited efficient deployment of team members, created a sense of unfairness and a lack of trust, and ultimately failed to match clinical labor expense to work effort effectively.
The Solution: Developing Scheduling Discipline
Dr. Whitten and the team identified the need to centralize and automate scheduling practices as a core tenet of their growth plan for the Department. Despite the broader organization’s commitment to another provider scheduling tool, Dr. Whitten successfully built the case to implement OpenTempo’s advanced scheduling platform given its unique capabilities for Anesthesia and Pain Management practice. Further, Dr, Whitten and team saw the implementation as an opportunity to standardize their approach and drive long-overdue change in the department. So while OpenTempo provided powerful tools to support the improved staff management the team sought, their success stemmed predominantly from their disciplined and well-orchestrated approach to change management. Their best practices included:
Focusing first on the value for clinical team members:
The team recognized the disruptive nature of the planned change especially given the projected impact on physician work patterns and time away. Fortunately, they also understood the overwhelmingly positive implications of the conversion to an automated scheduling approach particularly for the faculty. With those in mind, the team set about building the case for change with the department:
- They took the time to develop a communication plan built around the positive impacts of the new approach to scheduling. They focused on the benefits to the faculty including greater transparency, fairness, and control over the schedule to support the needed change. And while there were enormous potential benefits for the department and the organization, they took secondary billing in the “what’s in it for me?” message for the physicians and other clinicians.
- The team appointed several clinicians to help lead the change with their colleagues. This ensured that decisions around policies, rules, and conventions focused on providing value for the physicians and other clinicians first and the organization second or as a by-product of those actions. Dr. Whitten also appointed a physician leader, Gloria Cheng, M.D., to become the central point of focus and accountability for schedule development supported by a strong, IT-savvy administrator, Norma Hendershot. Rather than scattering that responsibility across multiple individuals, Dr. Cheng and Norma consolidated scheduling processes and helped to develop a much more efficient and streamlined approach.
- Whitten spent a substantial amount of time talking through the case for change both with individual team members and with the whole group. He invested his personal time and energy as well as his considerable influence to build strong momentum for improving the scheduling process. By taking that responsibility and not delegating it down the organization, Dr. Whitten built a platform of credibility from which he could later enforce policies and rules much more effectively.
Emphasizing transparency, fairness, and control:
The focus on value for clinicians also lead the team to understand the pressing issues they needed to resolve to drive the change most effectively. This lead them to emphasize several areas of the program to improve utilization of the system and adherence with new processes:
- The team underlined that the system would provide a single “source of truth” for scheduled work assignments taking away the guess work and, as team members described it, the “game playing”. Dr. Cheng reinforced the point: “We have one central source of information, updated in real-time. The subjectivity has gone.”
- The team turned the opportunity to schedule over longer periods into a positive for the clinicians. They moved to a 60-day cycle and away from the day-to-day process, but helped the team understand the benefit of that shift. They described that team members would have the opportunity to request time away or PTO in a more controlled and transparent way, and that the system would help to balance assignments (especially call assignments and holiday work).
- They leveraged the mobile version of the system to create further value for the clinical team. They reinforced the “self-service” mode and helped team members learn quickly how to see their schedules including their case assignments in their Outlook calendar, and to make requests and even to swap assignments with each other via the mobile app. This improved the sense of control and visibility.
Enforcing changes to process and policy:
Given the opportunity to enforce positive change on the department, Dr. Whitten and the team recognized the need to establish firm rules, guidelines, and standards across teams and facilities:
- By establishing centralized control over scheduling processes, the team was much better able to ensure consistency and objectivity. And while clinical leaders still had the opportunity to change schedules and assign resources to meet clinical needs, the central process eliminated subjectivity and made sure that resources were assigned based on need and not preference.
- The centralized processes also helped to expose potentially negative behavior or local rules that contravened the overall policies the team had put in the place. Fortunately, the team anticipated this outcome and was prepared to address such situations quickly and fairly.
- Whitten’s continued executive involvement earned him the right to enforce agreed-to policies and practices and actively support the team as the program rolled out. He acted as a tie-breaker for specific decisions across the process without undermining the team’s approach. His sponsorship and active engagement reinforced consistency and standardization to concentrate on maximizing value for the entire department not just specific individuals or teams.
This disciplined and thoughtful approach to change management in the context of an IT system implementation yielded both short-term operational gains as well as longer-term strategic value. As the program continues to grow, the department and the team have recognized valuable changes in several key areas:
- “We can now see what’s going on. We can easily move resources from one area to another to support patient care. We are much closer to the clinical need,” points out Dr. Cheng. The centralized and standardized nature of the program enables the team to flex resources much more effectively especially with the continued growth and expansion of the health system and its surgical needs.
- The department has removed the scheduling burden from its administrative staff freeing those team members to provide much more proactive support to their physicians and staff. They feel much more focused and able to contribute to the department’s mission. The financial impact of this change is also significant. The Anesthesiology department has the lowest ratio of administrative staff to physicians in the entire system. This means they have not had to hire or backfill administrative positions as the department has grown and the level of service has increased.
- OpenTempo provides a single source of truth not only for schedule information but also for team member contact information. Previously, the department published a 6-page phone list that quickly became outdated and was often inaccessible. With OpenTempo, the department now has a central source for all contact information with permission-based access aligned to who is working when and where. This means team members can access the correct information about their colleagues quickly and easily minimizing any delays or patient care impacts.
- The effectiveness of the program has created much greater objectivity and transparency around assignments – especially call assignments. Each member of the clinical team sees the number and type of assignments each person works making the distribution of work fair, balanced, and more importantly very objective.
- From a financial perspective, having the ability to manage resources more proactively has allowed the department to absorb continued volume growth without a commensurate growth in staffing and associated labor expense. The team has also managed to decrease controllable attrition of clinical team members despite the growth in volume and in the greater pull on the department’s resources. The combination of these factors aligned to other clinical program improvements have allowed Dr. Whitten and the team to meet and exceed budgetary targets while continually improving the quality of the services they provide and the academic output of the department.
Continued Growth: Analytics to Support Clinical Capacity Planning
Like any good leader, Dr. Whitten still challenges the team to improve. That ongoing drive for better outcomes has lead the department to explore new tools to pinpoint areas of opportunity. Another advantage of the move to an automated scheduling approach is the resulting data generated from the OpenTempo system. The team is now combining that data with information from UTSW’s electronic health record and time tracking systems to explore clinician productivity using OpenTempo’s InsightsTM Clinical Workforce Analytics platform. They are now combining schedule data with case information and billing output to assess workforce optimization more accurately and to drive true activity-based costing. The team sees opportunity to gain further improvement in resource utilization while at the same time preserving and accounting for non-clinical time more effectively.
Visit OpenTempo solutions to learn more about how are physician scheduling and staff scheduling software can help your department, practice, or health system.