The following guest blog post is provided by our board member Dr. Tim Porter-O'Grady. In it, he argues for the benefits of employee self-scheduling in the healthcare environment. In addition to the citations he includes below, readers can also learn more about self-scheduling best practices in our recent publication "Elements of Successful Organizations".
As viable as staffing self-scheduling can be, it is surprising that it is still a minority choice for scheduling professional workers. Perhaps much of the problem relates to the need for a positive understanding of the characteristics of professional workers and the unique need they have to control their time and their practice. This delineation of the knowledge worker's need for control over life and professional practice is the relatively recent product of professional staffing research (1). As a result, it may not have reached full exposure in the management techniques and methodologies of contemporary clinical managers. Even though virtually no one should be able to claim they've not heard of self-scheduling, it still has not caught on as the majority work scheduling vehicle for most clinical settings. We might do well to advance the argument representing some of the basic elements and characteristics of effective professional worker self-scheduling as the foundation for advancing interest in its utility.
Variations in self-scheduling have been around since the 1960s and hospitals and health systems have used it since that time with varying degrees of consistency and success. Benefit claims include ownership, engagement, consistent compliance, cost savings, high levels of staff satisfaction, and potential reduction in staff turnover. Self-scheduling is especially useful for round-the-clock workers who must address the needs for schedules 24 hours a day seven days a week. The inclusion of weekend scheduling implications makes self-scheduling especially useful in so far as it balances and regulates the use of weekend work time more equitably across the service or departmental workforce. In addition, compressed workweek schedules (three to four 12 hour shifts per week or seven day/12 hour work weeks one week on/one week off schedules) and Baylor Plan schedules (two 12 hour weekend work shifts counted as a full week schedule), all serve to add creativity and flexibility to round-the-clock professional worker scheduling (2).
Self-scheduling processes involves engaging the staff and assuming primary responsibility for the planning and constructing of their own staffing schedules. Usually large worksheets or computer programs cover all available staff over a period of 4 to 6 weeks. Schedules are made available two weeks to a month in advance via specific protocols and guidelines agreed to by management and staff establishing the essential staffing rules and processes that must be applied to scheduling all persons. Often, rotations are suggested by software programs designed to fit the particular staffing modality of an individual unit or service, thus allowing the schedule to present as complete so that staff can see the objective array of scheduled shifts and rotations before adjustments and modifications can be addressed to apply the unique and particular needs of staff in a way that adjusts the originating schedule. In many healthcare organizations, shift patterns have been long well established and individuals have frequently been slotted into those patterns for long periods of time factors reflecting tenure, role, patient characteristics, intensity, acuity, individual professional skill set, and a range of other factors can often influence the routine foundations for self-scheduling. Having a fully developed and visual staffing schedule helps individual staff see the complexity, vagaries, and impact of shifts or changes each might seek to apply to the existing potential schedule. It helps the individual identified complexities and impact of changes across the scheduling array, deepening individual understanding of the vagaries and challenges associated with making changes in one place and its significant impact on other components of the schedule. This increased awareness accelerates the sense of engagement and impact, challenging individuals to caution regarding choices, carefully justifying their choices and the adjustments they make and their impact on the schedule and lives of colleagues and peers.
While accountability for appropriateness and balance in the schedule now emerges between peers and the affected staff in self-scheduling, the role of the manager also changes. From the more directive, parental, and controlling agency, the manager now must become proctor of the terms of engagement, the consistent requisites of the protocols and processes regarding fairness and equity agreed to by all stakeholders, and assure that the final schedule product represents balance, fairness and equity, sufficiency and adequacy, and meets the general staffing requirements of the service or department. In the role of "agent of accountability", the increasing obligation on the role of the manager emphasizes the need for the manager to develop the more adult to adult capacity in the staff for quid pro quo, negotiating particulars, trade-offs, time bartering, and value exchange. These techniques require a higher skill set than simply evidenced in the manager's traditional ability to unilaterally manage the mathematics flow of shifting numbers and persons on a paper grid. Secondarily, the development of these "agency" management skills yields parallel results in resolving personal conflicts, mediating issues, negotiating outcomes, and interest-based problem resolution on a broad range of nonrelated but important human dynamics issues (3).
There are a range of positive results that arise is the product of self-scheduling in most professional organizations. For the manager, less time is spent in the parental role of directing and managing others requests for time shifts, days off, schedule adjustments, and shift changes. Two outcomes result from this shifting accountability: more time is provided for the manager to develop in others the skills necessary to negotiate relationships and choices and, secondly, peer ownership and investment in the work schedule accelerates, moving the locus of control for related issues to staff at the point-of-service. Predictably, personal ownership and life self-management of individual staff accelerates simply because engagement and predictability joined to allow the professional more personal control over choices that affect his or her life and the use of time. In addition, the acceleration in the degree of interaction between members of the professional staff around the balance and distribution of time and schedule increases the intensity of communication, interaction, interpersonal capacity, and agreement with secondary benefits of increased ownership, increasing interaction, staff satisfaction, and a more professional context for the work (4).
In self-scheduling, when problems do occur they become more readily apparent and more visible to all stakeholders. Issues related to absenteeism, chronic violations of time and schedule, and the pattern of sick time use generally decreases because the schedule more clearly represents the needs and wants of staff and the personally negotiated parameters which more clearly define agreements around the use and distribution of work time. Suggestions also indicate that greater shift in scheduling satisfaction leads to reduction in turnover and accelerates the potential for positive recruitment (5). Academic programs now suggest that as staff seek employment one of the questions they raise relates to the presence of staff-driven self-scheduling approaches.
As a concluding point, questions abound as to the sustainability and viability of self-scheduling over the long term. Major concerns exist whether staff is continuously able to negotiate and construct viable and satisfactory schedules over the long term. Increasingly, current data suggests that staff increasingly demonstrated expectations for models of self-scheduling as a foundational expectation and the positive influence for making potential employment choices (3). The initial flurry of reactive "noise" and struggled in transferring the locus-of-control for scheduling to staff is more than compensated for increasing effectiveness engagement, ownership, and process efficiency for both organization and staff. As the self-scheduling process becomes an increasing normative way of doing business in more clinical services, the negative challenges apparent in the transition to such systems can be significantly diminished. In the final analysis, the evidence increasingly suggests that self-scheduling is not only an effective method of managing workload and professional worker time but is the most efficient and engaging method of time management for the contemporary workforce and for sustaining positive staff investment and ownership and reducing problems in a critical area of effective workload management.
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