The document discusses issues with the current scheduling system including too many changes and vague requests. It proposes implementing scheduled cesarean sections on call days to improve efficiency by ensuring the primary surgeon performs the surgery and eliminating wasted time. This could add 30 hours of clinic access per month. Some providers argue they are too busy, but deliveries have decreased so scheduling cesareans this way could help protect staffing levels. No more than 2 cesareans would be scheduled per provider per call day.

3. Issues we are facing
 Many schedule changes
 Vague requests
 Too many unexpected staff changes
 Managing flexible scheduling
 Improve access
 Satellite clinics
 Improve access without shuffling people
 Reduce waste

4. Too many schedule changes
 A number of them have been out of our control.
 One physician left the group and 5 providers our on
sick leave.
 But how can we improve the current system

5. Things to consider when
submitting your request
 BE AS SPECIFIC AS POSSIBLE
 If you need a day off request a VACATION on the
schedule
 Order of preference
 SICK LEAVE>VACATION>EDUCATTIONAL LEAVE
 6/10, 8/10/9/10 comp off days are flexible
 If requesting Friday or Monday vacation then let me
know what you would like for the weekend.
 Don’t be as one of the extremes

6. Things to consider when
submitting your request
 Don’t use symbols such as X or O or blank space since they
lead to mistakes and misunderstandings.
 Use the following terminology
VACATION
NO CALL
CALL
SICK LEAVE
6/10, 8/10, 9/10 OFF (These requests are flexible)
AT or IW with committee meeting detail
More detailed you are easier it is

7. Steps we are implementing
 When the schedule is completed It will be submitted
for your review and you can request changes at that
time.
 When the schedule is published then changes will be
done only on case by case
 Will start the self scheduling module on AMION.COM

8. Do more with much less

35. What is the fiscal cliff
 During dept ceiling negotiations congress set up a
bipartisan committee, the supercommittee, to address
the budget deficit and cut the deficit by 1.2 trillion in
10 years.
 If they did not agree on a compromised plan then
nother part of the Budget Control Act directs
automatic across-the-board cuts (known as
"sequestrations")

38. Why should I care?
 Mandatory 300 billion dollar cut from the medicare
and medicaid fund
 More taxes
40 K/year $ 3000
100 $ 8000
200 $ 12000
300 $ 16000

40. Very inefficient system
 One area of waste in our department has been
scheduled cesarean sections.
 We perform 50-60 scheduled cesarean sections per
month
 5-10 deliver at other facilities and the patient delivers
prior to the scheduled cesarean section and the
schedule is not modified and goes to waste.

41. we are witnessing history as it happens.

42. Current system
 We devote ½ W per cesarean section and one hour of
traveling time if provider travels from the satellite
clinic
 30% of the cases are bumped and do not go on time
 Great source of frustration on providers and patients
 Problem with the lack of providers and access issue.

43. Solution
 Arrange the call schedule around the schedule
cesarean section que.
 The primary surgeon will do the surgery
 It is a patient satisfier
 Eliminates the need for other providers to perform the
cesarean section
 Potentially can add 30 W of clinic access per month to
the schedule

44. Rational against it
 We are busy
 Not true: 2 years ago we used to deliver about 350
babies per month and now we are down to 240 per
month
 Due to shortfall of deliveries we might lose our CNM 2
spot and by scheduling Cesareans on call we can
protect the above.

45. What to expect?
 1-2 scheduled cesarean section per call day.
 If more than 2 per provider then will arrange a per
diem physician to cover the labor and delivery for that
period.

46. What to do?
 try to do the cesareans with the CNM staff on call that
day
 Delay the case as needed depending on the volume on
the labor and delivery