Can’t get the time of day from your scheduler?
Tips for higher productivity, less stress
A private duty operation with an ineffective scheduler is like a car with a bad starter. It’s not worth having. Not being able to count on filled shifts, loyal staff, and happy clients can make you want to ditch the tin lizzie and take up walking.
Wringing more productivity from a scheduler is only part of the equation. The scheduling function in a private duty agency is "one of the most difficult jobs that ever was," says Darien Zimmerman, RN, director of Bayada Willow Grove Pediatrics in Willow Grove, PA.
Walking the fine line of balancing an admittedly tough workload without unduly stressing the scheduler can have far-reaching consequences for the organization.
"Schedulers are the lifeline to the office. They can make or break your operation," says Lauri Snow, RN, LPN, patient care coordinator for the Daytona Beach, FL, office of Pediatric Services of America.
Making scheduling easier
You can create a smooth-running scheduling function, however, by using these tips:
• Find the right person.
Not every one is cut out to be a private duty scheduler. The person must be a self-motivated, organized, critical-thinking-cheerleader-mother superior-diplomat all rolled into one.
"You’ve got to have someone who’s outgoing with an upbeat personality who can switch gears at the moment’s notice and doesn’t get upset. And if she needs to discuss a problem with a nurse, she’s got to use finesse to get the point across and not cause the nurse to cancel her next five shifts," Snow explains.
"It’s not a job for everyone," Zimmerman agrees. "The person has to be tenacious, totally comfortable on the phone, and not afraid to ask someone to drive 25 miles further than they usually go. The pressure is intense, but they have to be nice no matter what."
Although computerized scheduling programs can match client needs with nursing availability and skill levels, effective schedulers also envision a complicated puzzle beyond the system, according to Tina Shivar, RN, location director for the Greenville, SC, and Augusta, GA, offices of Pediatric Services of America.
"They’ve got to maneuver people around and sometimes do three-way swaps to fill shifts. They must have critical thinking and organizational skills," she says.
Finding a person with such a variety of talents is not easy. While Shivar wouldn’t consider someone without prior scheduling experience, both Zimmerman and Snow would.
Former field staff can also make great schedulers. That’s the case at Fayetteville, NC-based Home Health Services of Cumberland County Inc., according to Elizabeth Hudspeth, RN, MSN, executive director. The company’s private duty scheduler is a former home health aide who previously worked in its health and hospice divisions.
• Don’t mix private duty and visit scheduling.
Combining the scheduling function for shifts and visits is like mixing oil and water. Although it’s possible for one person to do both, especially on a small scale, it’s better to keep the two areas separate. Visit scheduling necessarily involves lots of paperwork tracking, and extensive communication with physicians, insurance case managers, patients, and professional field staff. Integrating those activities with the often-urgent nature of private duty scheduling may set a person up for failure.
"It’s really two different mindsets," says Kathleen Bailey, president of Lancaster, PA-based Private Duty Solutions, a private duty consulting firm.
• Set realistic productivity and staffing standards.
It’s better to establish private duty scheduling standards based on the number of hours rather than cases, according to Shivar. "I’m responsible for two offices; one with 21 patients, and one with eight, but they both have the same hours," she explains.
Although it depends on the relative stability of your cases, number of available field staff, and average shift length per case, most schedulers should be able to handle about 1,000 hours per week. Bailey recommends a 1,200-hours-per-week standard as a starting point.
"It really varies for each agency. If you have three 24-hour cases that run themselves, the scheduler can probably do more. But if you have a lot of cases with two or four hours, it might be less. You also have to consider what else the scheduler does, such as interviewing and orientation," she explains.
The scheduler at Home Health Services of Cumberland County arranges between 8,000 and 9,000 hours per month, according to Hudspeth. The caseload has several 24-hour cases, as well as many three and four hours and involves mostly CNAs and companions. The scheduler is also responsible for filing the daily case records.
• Schedule as far in advance as possible.
The longer out your schedules go, the better, according to Zimmerman. She prefers two-month cycles. "If you’re really good at it, you can get the nurses to commit that far in advance. Two weeks ahead is really last minute," she says.
• Require daily updates.
Shivar requires schedulers to maintain a Microsoft Excel spreadsheet that shows the daily openings for all cases. She reviews those with the schedulers, along with records of field staff called and the overall staff roster.
When reviewing a call list with the scheduler, look closely to see that she is efficiently making phone calls, Bailey advises. "It’s not just making the phone calls. Does she narrow the possibilities before calling? It saves a lot of time and frustration on the part of the staff."
In addition to the number of phone calls that she makes, other productivity and performance measures include the amount of overtime paid to field staff, the percentage of shifts filled for each case, and the level of staff and patient satisfaction. "If you have too much overtime it’s because the same people are doing all the work and the scheduler is not finding other people," Snow advises.
Good schedulers manage to keep patient complaints to a minimum, and not only have shifts covered, but have the best of the staff working. They also intimately know each case and remember which staff aren’t acceptable to which patients, as well as a good sense about ones who shouldn’t be tried on certain cases, she adds.
• Emphasize teamwork.
If your operation is large enough to support two schedulers, put systems in place to ensure that they work together.
"Have them in the same room so they can see each other and talk back and forth. Put a board on a wall and post all the unfilled shifts so each one can offer anything available to a staff member who wants to work," Bailey advises.
With more than one scheduler, "don’t divide the caseload. It can fail if you separate the cases by territory. Have masterbooks and have one put out calls on open shifts and the other do the monthly maintenance work," Snow recommends.
Zimmerman disagrees. "If you don’t assign cases, you don’t have accountability. It may work to have one do openings and the other maintenance, but I wouldn’t want to be the one to have to fill the openings."
Another benefit of assigning cases is that instead of having two people who each know a little about 40 cases, for example, each will instead know everything about 20, she adds.
When assigning cases, evenly divide both the hours and the proportion of easy and difficult-to-staff cases, Bailey recommends. "Give both a percent of ongoing, easy-running cases. Don’t have one with all the problems."
Whether you have one or five schedulers, it is important to have other staff members cross-trained and ready to pinch hit in their absence. At Home Health Services of Cumberland County, the private duty biller, nurse manager, and the person who handles orientation can all substitute for the scheduler.
It’s important that those filling in are well-trained. "The director must instill teamwork. No one wants to return from a vacation and find their cases trashed," Zimmerman says.
Teamwork that helps keep the scheduler on board also extends to the field staff. "Our staff are really educated in orientation about the importance of showing up or calling in when they can’t. They know it’s really an offense if they don’t show up," says Hudspeth.
• Consider an on-call scheduler.
In some agencies, any after-hours phone calls go to the nurse on call. She handles everything from referrals to patient complaints to staff call-outs. With so much on her plate, and perhaps not that familiar with all the cases and staff members, she may not be able to do justice to unfilled shifts or next-day call-outs.
To combat this problem, Home Health Services of Cumberland County now has a private duty scheduler on call with the on-call nurse providing backup. "It’s an added expense, but it works really well and the scheduler likes it because she gets extra pay," says Hudspeth.
• Don’t accept cases you can’t fill.
It’s impossible to fill every shift every day on every case. But how many shifts need to be filled at the start of a case when you expect to continue recruiting and ultimately fill more shifts?
"Don’t accept a case if you can’t fill at least 80% of the hours," Bailey advises.
"You should have the first week fully staffed. That’s a critical time. If you have more open than filled shifts, communicate with the family and referral source and discuss what they’d like to do," Snow says.
It helps to have a long lead time to staff a new case, such as four weeks for complicated cases involving hi-tech care, according to Zimmerman. And avoid opening a case on weekends and holidays at all costs, she recommends.
To determine the number of staff ultimately needed for a case, Snow doubles the number required with no overtime. For example, a 24 hour case involves 168 hours per week. Assuming a 40-hour week, the case would require 4.5 people. To staff it on a day-in, day-out basis, you’d need at least 10 nurses available and trained.
• Recognize and respond to signs of burnout.
If call-outs that normally wouldn’t cause your scheduler to bat an eye send her over the edge, or she seems less willing to make just one more call to fill an open shift, she may be on the verge of becoming a casualty to the scheduling grind. Other indicators include taking longer to complete scheduling-related functions, such as time reports for payroll, and increasing overtime and open shifts.
Intervene immediately when you notice signs of scheduler burnout, and take steps now to prevent it from happening. If your operation is experiencing a temporary crunch — taking on a complex new case, for example — do your part to help ease tensions. Zimmerman buys lunch for the entire office at such times; Snow recommends that managers roll up their sleeves and work side-by-side with employees.
It also helps to require the scheduler to take vacations and holidays and send her home early on occasion.
• Give flexibility and freedom.
Of course, certain things need to be done a certain way, but when possible, give the scheduler the freedom to do things her way. "Don’t be stuck on rules. You have to be creative in doing what works and give staff the ability to do the job in their own way as long as it works," Zimmerman advises.
It also helps to make clear your expectations about how the job is to be done. Along with that, set high, but realistic performance goals. Doing so will give the scheduler a sense of empowerment and ultimately more job satisfaction when she achieves them, Zimmerman says. n