Many lab managers find that scheduling by committee can engage employees in the process and alleviate many of the headaches associate with this dreaded task.

By Kerri Penno

One of the biggest complaints in laboratory work, and in healthcare in general, is work schedules. The constant need for the services of the laboratorian leaves no room for a break in coverage, regardless of holidays, summer vacations or the hour. While 24-hour facilities can disrupt employees' lifestyles with night shifts, required holiday work or rotating schedules that make personal planning difficult, no one is more acutely aware of the coverage nightmare than the person responsible for scheduling, often, the lab manager.

To see if this challenge can be overcome, ADVANCE spoke with laboratorians from facilities that use team scheduling in an effort to share the burden and increase staff input.

Rewarding Seniority

Danville (VA) Regional Medical Center has been using a team scheduling approach since 1995, when separate departments were merged into one large pool of techs from which each discipline drew. Originally, the Danville scheduling team was comprised of the technical specialists, coordinators and the team leader as the tech representative. Over the years, the team has evolved to include other techs and eventually emerged as a team of three members.

Through trial and error, the team developed a system for scheduling that works for their staff and keeps the peace. After testing out a commercial scheduling system, Danville's team deemed it inadequate, as it failed to accommodate staff versatility, recalled Pamela Coates, MT(ASCP), SM, technical specialist, microbiology. Now, the team uses Excel^® spreadsheets with templates for schedules and vacations. Instead of the "first come, first served" method, days off are awarded by looking at everyone's first choices, based on seniority, then moving to second choices. The result? "Everyone can get a little time off and no one gets penalized for being the new kid," Coates explained. "And the seasoned techs get a perk as well."

At Coates's hand, the schedule begins to take shape about 6 weeks prior to its due date. The schedule is then reviewed by other team members and released to the staff, who are then free to request trades or submit paid time off (PTO) forms. The scheduling team meets as needed and generally reviews all PTO requests by quarter, 6 months in advance. Additional requests can be met after this time before the final schedule comes out, as long as enough employees are available to work the requested dates.

Staying Flexible

For the lab staff at Regional Medical Center at Bayonet Point, Hudson, FL, team scheduling is a new approach. Prior to the change, a little more than 2 years ago, each supervisor crafted an individual schedule for their particular section of the lab, and then compared notes to check the level of coverage. "It was very difficult and confusing to be sure that changes on one schedule were reflected on all the other schedules," Jacque Loveall, MT(ASCP), hematology supervisor, said.

The confusion—as well as the drive to better use technologists' skills throughout the lab and improve the scheduling process to optimize coverage—led to the formation of a scheduling team. The team originated from staff members who had invested time and thought to improving the process. Currently, two technologists and one supervisor comprise the team.

When the group first formed, the members met often until a system emerged that seemed to work, Loveall noted. Although scheduling is a constantly changing process, the team only finds it necessary to meet now on a quarterly basis to discuss problems or new ideas. The schedule is created 4 weeks at a time in an Excel document that Loveall said facilitates easy changes. All vacation requests are due 6 weeks in advance and are granted on a first come, first served basis; Overlapping requests are granted only if staffing permits in all sections. Once the schedule is posted, the team does not grant time off for more than a 2-day duration, except in emergency situations. "The schedule sometimes changes day to day, but it is now easier to switch people to the area where the need appears," Loveall added.

Including Everyone

At Dartmouth Hitchcock Medical Center, in Lebanon, NH, every one of the 22 staff technologists takes part in scheduling. "We all make up the team," stressed Tammara A. Wood, MT, microbiologist. Though the supervisor maintains the master schedule, no one person is in charge of deciding the weekday schedule.

Weekend scheduling has been a team effort for 8 years. "Too much effort was going into making the schedule without the input of the techs," Wood said. Once the schedule was posted, staff members invariably spent the first few weeks trying to switch their weekends with coworkers. Now, the supervisor places a weekend "wish list" in staff mailboxes to be filled out with desired weekends off (five first choices and five second choices out of 16 weekends).

A couple of years ago, the Dartmouth Hitchcock staff realized that a similar approach would work for the weekday schedule, and began taking on the task a week at a time. The staff then took team scheduling a step further, and began meeting daily to allocate daily tasks and section assignments. Before, bench assignments were dispensed in 3-week blocks, leaving staff members feeling stuck in a particular section, Wood revealed. Now, anyone who would like a say in the next day's assignments gathers each day at 3 p.m. to fill in a blank schedule. Anyone who can't attend the meeting can leave requests on a note for the team's consideration. Though the hands-on approach may seem like a recipe for disaster, Wood said conflict is rare. If two people want the same assignment, one person simply chooses something else.

The daily scheduling allows flexibility to deal with personal commitments or for parents with young children, Wood explained. She provided an example where a tech finds out she needs to pick up her daughter from school early on a particular day. She could go to the person making the daily schedule the day before and ask to be put at a bench that would afford her the opportunity to leave early.

As at Regional Medical Center, vacations are awarded on a first come, first served basis, without seniority playing a part. Staffing requirements mean only two techs can take off on any given weekday. Tech-to-tech switches are allowed and if someone needs a coworker to pick up her shift, she sends out an e-mail asking for volunteers. "It always works out that someone is willing to swap or simply take the time from the person," Wood said. The master schedule is updated (in red) to reflect the change. If too many people request the same week off, such as the Fourth of July holiday, then techs who have had that holiday off in the past year are expected to defer to coworkers who worked during that time the preceding year.

Measuring Outcomes

All three facilities faced a few bumps along the road to team scheduling, including resistance. Though the initiative is designed to encourage input and accommodate the wishes of more staff members, Regional Medical Center still experienced some staff resistance to team scheduling that eventually dissipated. "The staff had to experience the value for themselves, and that is always the proof that something is working," Loveall noted.

The biggest ongoing challenge is ensuring that everyone gets enough time in all areas to maintain competence and confidence, while allowing staff to take time off as requested. Another concern is keeping measures in place to ensure maintenance procedures are completed while staff is floating from section to section.

A challenge unique to Dartmouth Hitchcock, with its open scheduling team, is making sure the same person doesn't take over scheduling duties every day.

Though implementing team scheduling had its challenges, each staff that took this step reported an overall boost in morale. At the Danville Regional Medical Center, team scheduling has provided a larger pool of techs to provide coverage and has led to what the staff feels is a more fair approach to doling out vacation time. Team scheduling has "dramatically" increased positive attitudes at Dartmouth Hitchcock, Wood said, especially in the microbiology lab. The new method allows the staff to see clear opportunities for training; has reduced tension by giving employees a daily voice; has alleviated feelings of being stuck by giving staffers a choice in daily duties; and has given employees the freedom to adjust work around their lives, instead of the other way around.

As for Regional Medical Center, the staff was able to condense four schedules into one, providing more uniformity of coverage, and more camaraderie and teamwork between sections of the lab, Loveall told ADVANCE. The new schedule makes it easier to find obvious solutions to staffing shortages and has encouraged more buy in to scheduling changes.

Ten Tips for Success

Still not convinced team scheduling can solve your staffing woes? The following tips should help you ease the transition and develop a system that works for your staff.

1. Include every single person with a vested interest in the schedule. No one person or persons should be solely responsible for a "team" schedule.

2. Scheduling meetings should be open to anyone able to attend and minutes should be passed out to those who were unable to attend.

3. When building a scheduling team, choose people who have positive attitudes and a true interest in improving the scheduling process. Pick people who see beyond themselves and their specialized area.

4. Be patient with everyone else. The schedule is always a work in progress, always changing. Be prepared to see the situation from another's point of view.

5. Allow staff members to switch shifts or help find solutions to coverage problems. They will be happy to help each other out if they know that the favor might be returned in the future.

6. You don't know until you ask. One of your techs may prefer having the same two days off in the middle of the week to coincide with their spouse's time off, instead of fighting for weekend days off.

7. Train employees in multiple areas. The more skills your techs have, the easier it will be to find someone to fill in in a particular section of the lab.

8. Rules will not work if you consistently make an exception. Treat everyone fairly and put your foot down if someone abuses time off.

9. Be flexible. Many staffs have tried multiple scheduling solutions before they found the method that worked best in their lab. Change is good, if it leads to better patient care and a happier staff.

10. Recognize your staff's unique needs. Each of the three examples of team scheduling differ in vacation policy, team size, timeline and scheduling process, yet each team was able to satisfy the majority of their techs.

Remember, it can take some time to make the move to team scheduling; this is not an overnight solution. The teams we spoke with met frequently in the early stages of group scheduling and gradually fell into a groove that worked for them. If your staff spends their free time grumbling about the latest schedule, put that time to good use and get a team together to make some changes. Hopefully, your efforts, and those of your new scheduling team, will be appreciated.

Kerri Penno is an assistant editor at ADVANCE. She can be reached at kpenno@merion.com.