The phrase most often heard during a recent on-site consultations was "We're so short staffed." That had become the justification for the pace of work. After reviewing the schedule and the percentage of income spent on staff salaries and benefits, it was obvious that the hospital was not really short-staffed, but it is mis-staffed. There were times when the workload was more than the staff can handle while there were other times when the staff was doing "busy work" to make sure they didn't appear to be immobile. Many veterinary practices have hired mostly part-time workers to gain flexibility in scheduling, but often the workers' availability drive the schedule instead of the workload. For instance, in one practice, all the part-time people work in the afternoon because they were students at a local college and some only had a two or three hour shift because that's all the time they were available. Normally, flexibility in scheduling is a good thing, but in cases like these, the flexibility can adversely impacting on the rest of the staff.

As in medicine, sometimes the problem isn't really the problem but merely a symptom of other problems. Sometimes, staff disharmony or perceived staff shortages are some of those issues. We in the management arena, address the need for "defining the systems" as a core of the practice, but it becomes very difficult to do this when folks just don't get along or when it seems there is too much work to do.

Reasons

One reason for these symptoms can be a imbalance in the "mechanism" we use to deliver our service. There is sometimes a strong perception among the staff that the doctors have a disregard for the needs of the staff; the ignoring of the basic human needs like meal and rest breaks are the best example. In most practices, the "busy or hectic" pace of operations can not continue if you are to have a staff that continues to care about quality patient care. The schedule must be controlled so that the staff's need for structure is satisfied. The Practice Manager and ultimately the Hospital Director MUST be the staff's advocate in these issues. Most often, that will mean just controlling the appointment book and scheduling appropriately.

Another reason for these problems can be a violation of the principle, Form Follows Function. We have all heard this phrase as it applies to architecture, but we don't realize that it applies to many other aspects of a business. Before a staff schedule can be made, there needs to be a staffing plan. The first step in staffing is to understand the needs of the practice. In a balanced staffing plan, the workload determines what people are on duty at a given time. If the leadership of the practice can't use "institutional memory" to start the process, then look to the appointment book or day sheet. Simply by ensuring all events are written down (including walk-ins and drop-offs) with a time of arrival and a time of departure/completion, it will only take about a week to see the "trend of the practice."

The graphic below is an example of a practice's staffing program. In this representation, the practice can function efficiently and effectively with a given number of people. Each person on the staff picks or is assigned a "shift" to work instead of the multi-tiered, multi-faceted schedule in place at most practices now. If a person is not available to work the needed shifts, then it is obvious that the needs of the practice and the person are not compatible or synergistic. In this example, there are no blocks larger than 4 hours - that's the flexibility the practices are looking for but rarely find with a haphazard collection of "part-timers." The schedule must be controlled so that the staff's need for structure is satisfied. The Practice Manager and ultimately the Hospital Director MUST be the staff's advocate in these issues. Most often, that will mean just controlling the appointment book and scheduling appropriately.

Conclusion

By shifting the focus from the problem (short staffed) to the solution (scheduling based on staffing needs) the leadership team can become problem solvers quickly while having a neutral effect on the budget.