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How Hawkesbury and District General Hospital Improved Its Efficiency by Digitizing Its Schedules

How Hawkesbury and District General Hospital Improved Its Efficiency by Digitizing Its Schedules

There we go. You can all hear me okay? So
the Hawkesbury General Hospital is a medium-sized rural community hospital
just towards the border of Quebec, so it’s within Ontario. We are a hospital
under expansion we currently have 69 beds but shortly we will have 104.
We have over 140 physicians and almost 800 employees. I’m the Chief of staff at
the hospital since 2013 but I’ve been working there since 2005. I’m a family
physician by training. I still do have a private office where I take care of my
practice but I also do work in the hospital as a hospitalist, doing
obstetrics, doing a little bit of emerg. Basically a good old fashioned country
doc. I’ve also been the IT Lead for the Lower Outaouais Family Health Organization. Actually where FIT now, so the family health team. We’re in 2009 we
went from being completely paper to completely paperless in integrating a
full EMR. Prior to my work in Hawkesbury, I was in Toronto. I was the Program
Director for the Family Medicine Program at the University Health Network and I
worked at Mount Sinai on the Toronto Western. So i’ma start with a real
example of how I think scheduling software such as PetalMD can help. So
we’ve been with PetalMD at Hawkesbury for a little while now and in this past
year I was wandering around and got a phone call saying we have a Code Orange.
A Code Orange is an external disaster. So Boston Marathon that’s a Code Orange.
For us, it meant a school bus. So we’re a small emerge we see actually quite a bit,
we see almost 50,000 patients a year, but we have two doc’s on at a time and we
got a call that a school bus was hit in the morning and that we had 25 injured
children showing up in the next 15 minutes. So what did I do,
I pulled out my phone, went holy cow I gotta find some doctors now! So I went to
my PetalMD Console I said okay, who do I have here in the
hospital and right away I started looking. We have it broken down by Clinic
by OR, by endoscopy, by On-Call. So I scrolled through and I found okay I’ve
got an ENT guy in the OR, call him right away. I said: Hey Brent I need you no
problem hold the next case I’m with you. I’m in the emerg. I checked in endoscopy
the guy giving sedation in endoscopy GP anesthesia
also does emerg. I said: George I need you. He came straight to emerg. I only
had to call in one extra doctor from outside because just by using my console (my dashboard) I was able to mobilize about 20 doctors to be in that emergency
department within 20 minutes and we had a real command center going. We had a docin triage greeting the ambulances. We had waiting rooms set up for families for
patients. It went super smoothly and I sat there in shock thinking oh my god
what would I have done before Petal. Prior to Petal we had a lot of
challenges with our scheduling and we had been through a couple of, like Peter
says, the the low the lowing the low-cost versions out there and had significant
challenges. Part of the challenges we had is that because we’re a Regional
Hospital we rely a lot on primary care. So we have a lot of family
physicians that wear multiple hats. So there’s family physicians doing a
emerg, doing hospitalist, is doing obstetrics doing anesthesia, doing community work,
doing palliative care. So their schedules are all intermingled. It’s not like you
have six cardiologists and they do cardiology and that’s it. It’s very rare
in our area to have person that does one thing. So it was extremely complicated
and waiting on one person to do a schedule to then do the next one, to then
do the next one had a domino effect that could drag on and on and on and it
resulted in us getting call schedules out at the very last minute. The other
struggle we had is last-minute changes. So as you can imagine with a paper-based
system or even a very basic electronic system, a last-minute change can be
missed. In fact, we have had it past where the wrong person was being
called and patients incidents did occur because we just couldn’t figure out who
was on call. Sharing these lists, where do we deliver them to? There’s an
administrative assistant who’s walking around half the day updating paper lists
in all the departments. A doctor makes a last-minute change, they’re calling
reception, they’re calling East, they’re calling north, they’re calling all over
the place to update them. This eliminates that. The other thing that we were able
to get advantage of is seeing the whole picture, seeing the coverage of the
entire Hospital. So you might be on the surgical ward and you might be seeing
the surgical call schedule but it doesn’t tell you who’s in radiology, it
doesn’t tell you who’s an emerge, it doesn’t tell you who’s in the ambulatory
clinics. So by having the console we get to have the big picture of who’s in the
hospital at any one time. I’ve even used it to my own benefit
as I walk through a department or through an care I’ll see all who’s
working today and I’ll go: oh I haven’t seen them in a while I’m gonna go
schmooze and then they think I’m so smart for knowing they were working that
day but really I’m just using Petal for my own social skills. Physician
coordinates. So that’s the other huge advantage that we we found was solved by
having this online system is that people’s phone numbers changed. They
change constantly. It’s very hard to keep track of my administrative assistant was
constantly updating lists everywhere. Another real example, I got a text from a
doctor just two weeks ago and he said oh hi Julie just want to let you know I
changed my cell phone number and I went oh, okay what do we do and I went into Petal he had already done it say oh yes I’m so proud of my team. So it was seamless and
then the this winter I wanted to go to a cottage nearby I was on-call for hospitalist
and not the end of the world I can be within thirty minutes plus I’m the boss
so who’s gonna get me in trouble. So I went to the cottage for the night and
all I did was I went into Petal put in the phone number for the cottage and I
knew that they were going to be able to find me for that evening and then the
next morning I deleted it. So super easy and then finally the roles of the Chiefs
I know we all have hospitals with Department Chiefs and they have all
sorts of jobs they’re supposed to be taken care of, they have a role
description that is bigger than the amount of time and funding allotted to
them. So in the past whenever I was trying to bring on a new chief they
would say to me well Julie what is it I’m supposed to do. I say well basically
you make the call schedule that’s your job. Well not anymore because this has
eliminated so much of that work that really when they say to me well what am
I supposed to do I’m like well you’re gonna be dealing with performance, you’re
gonna be dealing with complaints, you’re gonna be looking at quality improvement,
you’re gonna be looking at how can we make our department run run better and
so the focus has completely changed for these Chiefs from being the guy that
makes the schedule to being the guy or the girl that is making the department
work better. So for us right now we’re very pleased with the service that we have. We have schedules that are centralized in the dashboard. We no
longer have to look all over the place for information. It’s accurate, it’s
completely live and up to date, it’s accessible on the mobile and we’re very
very reliant on our mobiles at this point. Little perk is that a lot of the
hospital physicians are also community physicians. So as a family doctor in the
community if I’m sitting in my office and I see something that needs attention
or a question to let’s say a gynecologist so I’m in the office and I
someone with a missed abortion I don’t need to call reception and figure out
who’s on-call for “genie ” today. I pull it right up. I see it’s doctor Puckett. I
called her right away I say hey Steph I have a question. Problem solved. It used
to take an hour two hours to have that problem solved in the past. And then the
on-call lists are automatically generated from the physician schedules
it’s so much easier to match the complicated complex world we live in
right now and the reality of a small rural hospital is not only that we have
doctors wearing many hats but we also have doctors that work in many locations.
So we’re matching our schedule with Cornwall’s, with Montfort, with TOH. So we
have all sorts of blend merging schedules that has to occur and
this has certainly made it way easier. So I’m happy to take any questions and give
you guys the real lowdown on how it works for us in a small Ontario Hospital. So the question was about implementation
and change management. At the time, we did have some struggles
I think getting people used to their mobile phones particularly some of the
older physicians was a learning curve. They’re all used to it now. We did have
some issues with who’s updating what info in the system and we worked those
up with PetalMD because there was some blockage as to you know they want well
my secretary will fix that well the secretary wasn’t allowed to fix that
right. So we’ve had some issues with that that all got sorted. I would say at this
point were maybe two or three years out. There’s been not a peep it’s been
completely integrated into the culture and there haven’t been any issues. The
secure messaging I’d say is slow to pick up. We’re not used to that but we did
recently have an online chat go on because we had a patient that was video
recording us in emerg and it caused a lot of distress to the doctors. So they
all started chatting about that within on the secure messaging. So it’s
right now I can say it’s really good at the time though, I will say that when we
did have some questions and concerns Petal did come out and did webinars with
us, came to our medical staff association meetings, did some education. So the
support levels from the company has been really ideal. Excellent questions. So the
question the first one was who’s managing the platform and who’s putting
in the schedules and the second question is about funding. So for the first
question, initially we had as chief of staff I had two administrative
assistants. I had one dealing with credentialing and blah blah blah and
then I had another one that was really solely working on schedules and assisting the Chiefs working on the schedules. By using petal
what we were able to do is whittle down the amount of time that the
administrative assistant was doing that and really whittle down the time that
the Chiefs had to do that. Such that that one main administrative assistant was
able to take over the job because it’s really not a lot to ask of her. So I was
able to actually reduce the resources required at the hospital for me in the
end we ended up using her for something else. So it’s not like we fired anybody. We used her for a patient experience and to be a liaison with outside offices
but it did streamline certainly the amount of extra work that I had. But yes,
so my administrative assistant is the manager and liaises regularly with PetalMD. As far as the funding so yes a hospital paid for this the physicians
are paying nothing. I think there’s some mixed models out there. But being once
again a rural Hospital where retention and recruitment is a huge issue, this was
one of the perks that we could offer to try and bring in doctors. So we put it
into our Hospital budget. I mean otherwise we’re spending money on
recruitment and retention so this is one way we looked at it and now when I
interview new doctors to come to Hawkesbury I tell them oh we are on Petal I
often get things like oh that’s great, yes I use them at so-and-so and I use
them over here. So it has become a positive tool that helps us with the
recruitment. So I’m not gonna share the names of the other solutions that we
tried. And adoption is a hundred percent 140 doctors it’s not like we’re the
Ottawa Hospital with you know two thousand doctors so it is a little bit
of a manageable size where we do know each other face to face. There’s not a
single doctor that I don’t know to say hi to so we have been able to get a
hundred percent and the whole so the family health team being already on an
EMR means they’re fairly tech savvy we actually go live in four days with EPIC so the whole hospital is you know it’s getting there. But yeah we have a
really good bunch of doctors and they they the buy-in is the advantage to
themselves right so they see how easy it is for them they see oh am I on-call or
not they just look at their phone so it’s it’s a no-brainer that one’s not
hard. For the secure messaging. Yes, so I think it’s a it’s a younger generation
thing it’s the texting. What I’d like to see is there’s still a lot of texting
going on and sometimes with patient information in it so you know privacy
officers block your ears but that’s reality. So what I’d like to see is this
more and more encouraged and less and less of the texting and it’s easy I’ve
used it myself from the phone it’s super easy so it’s just a question of shifting
that culture and getting people used to it and you know the more the privacy
officer crunches down on us the more we’re going to learn our lessons, right.
So the ones that got caught they learn their lesson. Yes, so when you’re using
the scheduling software yes you can create your own business rules and you
can edit them as you go along but what’s fun with it is the because it’s so
visible and everybody sees what everybody’s doing it’s easy to trade
shifts and it’s easy to offer to the marketplace. So we actually did have an
incident a couple weeks ago where one of the emerg Doc’s got into a big fight
with the radiologist because the radiologist was refusing to do the scan
and then it became a whole personal thing. So then that emerg doc saw in
two weeks it’s that radiologist on call again he
traded his shift. Right, so it’s so easy to be able to manage that when you see
the big picture and I don’t care if he trades a shift with somebody else and
somebody else takes it fine, you know, they’re grown-ups they can work it out.
But so that that was a nice little advantage you can look ahead and plan.

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