Part One: The Past, The Present, & The Problem(s)

     I love puzzles: jigsaw puzzles, logic puzzles, day-to-day what-are-we-going-to-do-now puzzles. Once the initial shock of starting a new job wore off and I started to settle into life on the PPCU (pediatric progressive care unit) I began to pay attention to the very interesting puzzle that is the schedule. Suzan, a gem of a nurse, had done the schedule for years; and she had done such a good job of navigating unit needs and staff wants, everyone still loved her. I was intrigued, wondering if I would be able to figure out the complexities it required.  Hesitantly, I asked if she needed help. Once she knew I was serious she welcomed me on board. I have been doing the schedule every other month for 3 years now. I love it. 

THE PAST

    When I started working on the PPCU there had been a management implemented, short-lived, supremely unsuccessful, much hated attempt to out-source and computerize the scheduling system. Nobody was happy and before I was off orientation it had been scrapped. The scheduling reverted to the paper, pencil, Suzan version that had worked for decades. 

THE PRESENT

Still in place, this system works as follows:

• Approximately 2 months ahead of time a four week skeleton is placed in the schedule book.
• Staff fill out their requested shifts based on their availability and preference.
• After 2 - 3 weeks the skeleton is pulled and the penciled in requests are in-putted into a spreadsheet and the puzzle begins.
• Once we have moved people around in order to have the necessary numbers for each shift (a process where we both add the all important human element because we know home situations, preferences, and personalities), and it has been approved by our unit manager, the schedule is emailed to staff and a hard copy is placed in the schedule book  

An example of the 'skeleton' for staff to fill out.

(Note: This is 1 of 4 sheets; between RNs, PCTs, & secretaries we have ~80 staff.)

THE PROBLEM(S)

    Like I said, I love the challenge of doing the schedule. What I don't love is transferring all the As (day shift) and Ps (night shift) from the paper skeleton into the spreadsheet. It is time consuming and prone to transcribing errors. Is there a system where staff can enter their requests directly into a spreadsheet to eliminate this step in the process? Unfortunately, I am afraid the trauma caused by the previous computerized disaster has made staff resistant to any computer involvement in scheduling, however minimal. Additionally, I would like to add formatting features to the spreadsheet so it automatically tallies the number of Mondays & Fridays, and nights each person works for reference as I move people around.

    What options are out there for entering scheduling requests? What program would be user friendly enough for a traumatized staff? How do you introduce a change which is not only new, but has a negative experience associated with it? Can technology make a difference in this situation?  

Join me on the journey...

Part two: The Proposal, The Potential, & The Process

THE PROPOSAL

    I already use google sheets as my spreadsheet of choice. I wanted to keep using google but needed to be sure it would meet all the needs. After some research I discovered the following information that makes google sheets a good option for this.

Consideration	Solution
Limit changes needed on the part of staff in terms of new accounts or apps.	You do not need a gmail account to access google sheets as long as you have the link.
Limit chance of staff accidentally (or otherwise!) changing another person’s requests or the skeleton cells.	Google sheets allows for ‘locking’ of selected rows and columns which can be done before posting. By selecting this option only I can make changes on the locked rows/columns. Through ‘version history’ it is possible to see who made what changes and when.  Periodically through the two weeks that staff are adding shifts, a day’s version can be ‘named’ which stores the most recent additions in an easily retrievable file. Google sheets saves all changes so it is always possible to go back and see what changes were made.
Ease of access is important. Some other units in our hospital have one dedicated computer for scheduling. The PPCU has multiple wings so a central computer is not a realistic option. Multiple users may need to access the file at the same time.	Google sheets allows access from any computer as well as from home for those staff who work more infrequently. Everyone has equal access to filling out the schedule. Up to 100 editors can simultaneously be on google sheets.
Automatically counting the number of Mondays and Fridays each RN is working to ensure compliance with guidelines.	Our scheduling guidelines require staff to sign up for certain shifts. Having these automatically tallied will be another time saver. I can use the “=counta” function to tabulate this data for easy viewing.*

*Understanding this possibility with function formatting is a direct result of the course and the required reading in Informatics and Nursing: Opportunities and Challenges (Sewell, 2019).

THE POTENTIAL

    There are two main benefits of having staff enter their requests directly into the spreadsheet. First, it reduces the potential for transcribing errors. With almost 80 staff, the four weeks of shifts, the day-off requests, the switches, and the vacation days translate to over 1000 pieces of data to be entered; which means 1000 possibilities for error. While it is not a life or death error, it can be a source of frustration to staff - which impacts job satisfaction. Secondly, it would save money. It takes several hours to transcribe all the data, hours I am paid for. I estimate it would save the unit between $1500 and $3500 a year. 

The schedule immediately after inputting all the requests - note the uneven distribution of numbers.

The schedule as I am working on it (I color coded switches as I make them.) 

    Unfortunately, as mentioned in my previous posting, staff are reluctant to try any computerization of the schedule. And, as it has for us all, COVID has made this a stressful year with tough working conditions and numerous changes to policies and procedures. In addition to the necessary changes for COVID, hospital leadership have implemented a new benefits policy that has not been popular! Morale is at an all time low. 

    If the benefits of the change are to be realized, implementation needs to be done well. Multiple studies have shown that how staff feel about their job impacts patient safety (da Silva Batalha, Melleiro, & das Neves Borges, 2019; Fitzpatrick, Bloore, & Blake, 2019). With morale already low it will be even more important to understand change theory and implement any changes well. As much as this change may seem removed from patient care, anything that impacts how staff feel about their job has the potential to impact the patient. 

THE PROCESS

    There are a number of change theories but most are a variation on Levin's 1951 unfreezing-change-refreezing model (as cited in Udod & Wagner, 2018). However, in this case I think a focus on the three tactics described by Weiss and Tappen (as cited in Udod & Wagner, 2018) to unfreeze staff will be most important. The tactics are:

1. Sharing information: I need to communicate this change is for them; it ensures that the shifts they sign up for are the ones considered in making the schedule.
2. Disconfirming currently held beliefs: I need to be super clear that this will NOT be a computer making the schedule. Suzan and I will do the manual manipulation of the shifts. The issues experienced last time are not even potential problems.
3. Providing psychological safety: I need to make myself available to staff to help them navigate the new system. I can let them know they can always text or call me if they can't figure out how to fill it out. This can take away some of the fear of "did I (or will I) do it wrong?"

    Focusing on these strategies will ensure that the fear of technology, the resistance to change, and the natural push back to 'lets do it the old way' is minimized. 

Part Three: The PostScript & The Particulars

THE POSTSCRIPT

    Introducing a new system for collecting shift preferences will save time and money, and will reduce the chance of errors. Increased access - being available from home or work and being available to multiple staff at the same time - will be an advantage to the staff. Despite these advantages staff are likely to be resistant to change. Unfreezing staff by using good communication tactics - sharing information, disconfirming currently held beliefs, & providing psychological safety - will help overcome this resistance. 

    Google sheets meets the needs of the scheduling team, addresses the concerns of the staff, and has the tools needed to manage the data. Additionally, new functions can be included in the spreadsheet to aid the scheduling process, ensuring equity in assigning shifts and further reducing the time needed to create the schedule. Implementing the use of technology in this way allows technology to work for us - for the staff and for the unit - while still allowing for the all important human element that technology can never replace.

A FINISHED SCHEDULE!

THE PARTICULARS

COMMENTS FOR CLASSMATES
I commented on the blog posts of Peter Vath (Dec 3, 9:30pm) and Alisa Asif (Dec 3, 10:33pm).