How to Create Fair Provider Schedules

Clinician schedules carry a lot of weight when it comes to provider satisfaction, burnout levels, and the overall efficiency of a healthcare organization. 

Due to the cumbersome, inaccurate, and manual way many schedules are put together, it’s not unusual for one provider or another to get the short end of the stick by feeling like they’re shouldering more of the load than their colleagues. This isn’t intentional—it’s just difficult to put a complex schedule together by hand. 

What happens when healthcare schedules aren’t fair? 

• Clinicians begin to feel the weight of imbalanced shifts, limited time off, and a workplace that doesn’t do enough to accommodate their schedule preferences.
• Department and contract requirements, credentialing, research needs, and other factors all complicate the scheduling process.
• In some cases, physicians can be left with too many or not enough shifts at the end of the month or year.

Schedulers often feel the burden just as much. They want to build the best schedule possible, but balancing shifts while attempting to accommodate every individual provider’s preferences from memory is both time consuming and exceedingly difficult. 

Balancing schedules is right up our alley, so we’ve outlined some best practices schedulers can employ to ensure across-the-board schedule fairness for clinicians. 

Use Rules to Build Healthcare Shifts

Rule-based scheduling is the process of using “rules” to build schedules that align with the unique makeup and requirements of your organization. This process empowers schedulers to:  

• Incorporate provider preferences and requests 
• Balance shift loads equally across providers
• Meet unique organizational requirements and needs
• Ensure accreditation requirements are met (I.e. making sure residents work an appropriate number of hours for their program)
• Optimize provider supply with patient demand
• Confirm pay is accurate

Here are a few examples of rules that can be used to build better clinician schedules: 

Ranking Shifts  

Not all shifts are equally desirable. For example, many providers may prefer a Sunday morning call shift over a Friday night call shift, as the latter could be considered harder or more taxing. If you were to rank these shifts in terms of difficulty and desirability, it’s safe to say that Sunday morning and Friday night would probably hold different slots. 

With the help of rule-based scheduling technology, schedulers can easily account for these shift ranks to ensure that everyone shares the workload as equally as possible, meaning no one provider will be overburdened with less desirable shifts. 

Holiday Shifts  

Understandably, working over the holidays isn’t the most exciting part of a clinician’s role, but sometimes it’s just part of the gig. If you try to track which clinicians worked a holiday shift over the last two years, when would it become too difficult to count? What if one clinician has already worked a holiday this year, but they’re the only provider available for the next holiday call shift? 

With rule-based schedule optimization that can help alleviate physician burnout, you’ll have all of your holiday bases covered. This advanced technology can accurately track who worked every holiday over the past year (or more) and build schedules for upcoming holidays with that information in mind. 

It’s also true that not all holidays are created equal. If some providers value Thanksgiving more than July 4th, for example, it’s easy to build a rule that deprioritizes them for work on the former while prioritizing them for work on the latter. 

Spacing  

A spacing rule allows specific shift types to be spaced out and/or separated from one another. Similar to ranking, this avoids giving providers successive shifts with highly demanding work.  

For example, if a provider is working the ICU—which is often taxing and involves high-stakes work—a spacing rule can prevent them from having any additional on-call operating room shifts until at least a week after the ICU assignment.  

By spacing difficult shifts apart, providers are less likely to experience burnout. Each provider can rest assured knowing that, when they do have to work a tough shift, they won’t need to worry about working that demanding shift the very next day. They’ll know far in advance when those shifts are coming and how much time they’ll have in between.  

Equalization 

How many types of shifts are there, and how many should each provider be working in a month? In a year?

Equalizing shifts ensures the workload is evenly distributed among all providers. This rule can be adjusted to any timeframe, so if a scheduler wants the schedule to be built based on all shifts worked since 2022, an optimized scheduling solution can account for all providers and shifts worked to schedule them accordingly in the next iteration of the schedule.

This kind of built-in automation ensures everyone is scheduled fairly year over year. And when a new provider is added to the schedule, the technology can “prorate” their shifts to make sure they aren’t over-scheduled because they haven’t been included in previous schedules. This can be applied to clinicians who work at multiple locations as well. 

Here’s a concrete example: Before they started using smarter scheduling technology, AnMed Pediatric Hospitalists had to deal with a major hiccup involving an over-scheduled provider. By the end of the year, this provider was so far over their shift target that they had to be completely removed from the schedule for an entire month, leaving other providers to fill the gaps. With an equalizing rule (along with better tracking and reporting capabilities), this would never be a problem! 

How to Foster Transparency in Healthcare Scheduling 

A fair schedule is only truly fair if it’s also transparent. Transparency doesn’t just mean accessible—it also means there should be clear insight into how the schedule is built. Providers don’t always know the nitty-gritty details of the scheduling process, but they do deserve to know it’s equitable.  

As is too often the case, feelings of favoritism with shift assignments can become a point of contention among care teams. If a clinician works their preferred shift or gets their time-off requests approved more often than others, even if it happens unintentionally, other clinicians are probably going to notice.

Thankfully, there’s a way to make the schedule development process more transparent and equitable with optimized scheduling software: 

• For starters, knowing from the start that rules are in place to equalize shifts can help to dispel the notion that schedules are being put together unfairly. 
• Another element is schedule access. No matter how powerful your software is, it’s never going to live up to its potential unless it provides ready access to the schedule for all users from any location and any device. Universal availability is key to transparency.
• The term “real-time schedule” holds greater meaning when providers know the schedule is always up to date and accommodates their shift swaps and time-off requests as much as possible.
• Visibility into other schedules is also important. Knowing when you’re working is helpful, but understanding the whole “universe” of schedules at your organization helps to paint a more complete picture. 

How to Accommodate Provider Preferences in Schedules 

Providers need personal time and work-life balance just like anyone else. Clinicians without children may feel they aren’t given the same preferential treatment on holiday shifts as those with children, but they deserve just as much autonomy and choice as anyone else on the care team. It’s essential to talk with your providers to understand what holidays and other shift preferences are important to them. 

Accommodating provider preferences becomes much easier when you can bake them into the back end of the system as rules. No more referencing hand-written notes and months-old emails to remember so many details! Preferences, shift swaps, and time-off requests become simplified and, in many cases, can be fully automated. 

Not only does this save time and stress on the part of the scheduler, but it fosters a sense of autonomy and control for clinicians. If Dr. Jeffers prefers to take call during morning and weekend shifts because she prefers to have weekday afternoons open to be with her children, rules-based scheduling can accommodate this as much as possible while still accounting for fairness with other providers. If Dr. Ramirez needs to swap a shift next week for an event she wants to attend with her husband, she can offer this swap up for all other available clinicians on the team. Dr. Lee sees it, selects the available shift and the schedule adjusts accordingly so everyone can see the change.

How to Replace Manual Healthcare Scheduling Workflows 

Building fair schedules by hand can feel like an impossible feat for schedulers. Even with the best intentions, the schedules produced are often unbalanced, and ensuring schedules meet department and contract requirements only adds to the complexity of the process. Though manual workflows are still the norm for many organizations, solutions exist that can help you create the most fair, accurate, and transparent schedules possible. 

Armed with powerful rules that can account for individual preferences while increasing schedule equity, your manual schedule woes can be a thing of the past. If you’re facing challenges with your manual scheduling workflows, consider a healthcare scheduling tool that puts the power of automation and optimization at your fingertips.