Feature Story

Mix and match: Powerful software takes the hassle out of scheduling

December 2000
Mark Uehling

Suppose your lab runs 20 workstations and employs 25 employees to operate them. How many possible schedules could properly match up the people to the machines?

The answer will be obvious only to a math wizard: 1023 possible schedules. Put another way, there are countless ways to fill the 20 slots in the lab from a list of 25 techs. Given the complexity of the job, it’s amazing mere mortals have managed scheduling as well as they have.

Of course, no math wizard would know that Bob works nights or that Susan is the lead technologist doing coagulation. Any good laboratory supervisor would know that and draw up a schedule accordingly, taking still more time to tinker with the lineup when someone calls in with a soccer game to attend or a sick cat to take to the vet.

Now there’s a better way. It combines raw computational power and nuanced human insight into a lab’s workforce. The program is called Lab Scheduler. It’s Windows software that knows most of what any supervisor does about the strengths of each technologist and technician on the roster. Lab Scheduler scans tens or hundreds of thousands of so-so schedules. In a few minutes, all but one of the theoretically possible schedules have been cast aside.

That one remaining schedule has survived a literally Darwinian selection process inside the computer. The software was designed by an academic pathologist and crack programmer at the University of Virginia. Then it was licensed and retooled by a small Virginia company called Medical Automation Systems, or MAS.

Judging from a few testimonials, the silicon-based schedules are uncannily good. Perhaps Lab Scheduler’s most appealing trick is that it automatically rotates staff through their workstations often enough to maintain their competencies-but not so fast they are not in their most crucial spot when they need to be.

For people like Ed Bush, chief operating officer of Medex Regional Laboratories, Bristol, Tenn., the Lab Scheduler package has been a lifesaver. He guesses it will save half an FTE, or between $15,000 and $25,000 annually, once it’s fully implemented. "I’m convinced it’s the slickest thing since sliced bread," he says. "I get excited about it because it will help us save significant time not only in scheduling but in staff utilization."

Scheduling is always hard, he concedes, but it has become especially difficult in the era of TN-Care, a statewide managed care plan, which decimated his head count. "We lost 16 FTEs in two weeks, affecting 25 people. We reduced staffing from 84 to 59. It was awful," Bush recalls of the period in 1994. Today, as a newly formed consolidated reference lab with more than 300 employees, "the software will become even more important," Bush says.

In rotating technologists to maintain their competencies, Bush and other Lab Scheduler customers quickly see a double payoff. They no longer have to think so hard about scheduling issues. And the software’s record-keeping and report-generating functions can help create the paperwork to expedite inspections and accreditations that are related to maintaining employee competencies.

Some of the other benefits are less tangible but equally intriguing. Lab Scheduler’s output can be tweaked to reflect Susan’s and Bob’s departmental preferences. But the larger idea is that the software can put an end to some of the bickering or complaining about one employee getting preferential treatment over another.

Says Bush: "It is almost impossible to be fair during the scheduling process. The program improves efficiencies and lets us treat everyone equally unfairly. It removes favoritism: ’I like Susie so I’ll work her here and I’ll give the odd shifts to this other person.’ Some of that [personal chemistry] may go back 20 to 25 years."

Indirectly, Bush says, Lab Scheduler addresses his concern about the demographic trends in laboratories: "We’re all getting older. It’s frightening to look at where we’re going as an industry. Our applicant pool is drying up. We have to use the available resources in the most efficient way."

The story at the Mayo Clinic is similar. More than 70 technologists and technicians are being scheduled by Lab Scheduler in Rochester. Most of the lab workers are scheduled by a few lead techs, one of whom is Janice Krahn, lead technician at the Mayo Clinic’s hospital clinic laboratory.

Krahn is as pleased as Bush. The software knows which techs prefer to work at which of four geographical locations, and which techs rotate through all of the sites. "A one-month schedule is posted at all times, so everyone can check on their lab assignment well in advance, which avoids a drive across town at the last minute," says Krahn.

"I like it a lot," she says of the software. "I think it’s better [than a human scheduler]. You don’t have the factor of people coming to me and complaining that ’I’m always over there.’" Krahn’s computer skills may not be robust enough to qualify her for a job at IBM, but she says that doesn’t matter: With one click of her mouse, using Lab Scheduler’s AutoLink function, she can generate a schedule. Then when her practiced eye discerns a few minor problems, she can just as easily improve on it. "We’re big on our head count. Our minimum on the day shift is 12. If we’re down to 11, I get a flag. It’ll be a different color and tell me what area needs a different person."

Soon, Krahn reports, the software will also be connected to the payroll system. That means administrators will be able to verify overtime, time off, and hours worked. "Our management staff will be able to verify employee timecards. It will be a lot faster for them," Krahn says, "as far as total hours worked and so on, as long as the leads keep it updated."

Her only complaint-and she’s not alone-is that while the schedule on the screen is in color, the printed versions are not. Lab Scheduler’s product manager, Kathryn Kelly, says color printing is something that MAS programmers are working on.

The Charlottesville, Va., company, founded in 1994 and probably best known for RALS, its point-of-care product, has been assiduously incorporating suggestions from the real world. A newcomer to the lab scene, Kelly has personally demonstrated or sent Lab Scheduler to some 700 laboratories.

First impressions are positive. "Most reactions are incredible," says Kelly. She notes "people tend to think that I have been doing laboratory scheduling myself for many years." Sample reactions from potential customers: "I have been looking for this product for over 10 years" and "I can breathe again."

As with any innovation, however, there can be resistance to closing the sale. So far, 10 separate laboratory sites have purchased Lab Scheduler. Twenty-nine users have been trained to operate the program at those sites. An additional 20 labs are evaluating the program as part of trials in which the company sets up Lab Scheduler using phone lines or the Internet. At least 1,200 techs nationwide are being scheduled with the program.

For all the power of Lab Scheduler, Kelly graciously points out that the Internet has any number of do-it-yourself scheduling Web sites. Such inexpensive choices may well suffice for small labs with 10 or fewer techs, Kelly says. But she notes that the plain-vanilla online schedulers are not designed for laboratories.

Her product’s ability to rotate employees to maintain their competencies is far beyond some hypothetical Web site like any.old.calendar.com. "Maintaining the proficiencies alone points you toward Lab Scheduler rather than a generic scheduling program," says Kelly. "It’s maintaining the skills, it’s taking the bias out of the schedule, it’s the best fit for the laboratory, it’s the reporting features."

One of the big selling points, it turns out, is the variety of documents the program can generate. Says Kelly: "Some people want to know more about the reports than about the scheduling." Some customers, she reports, tell her "’all of the information I want is right there on the screen. Make it print out.’ You can do it for an individual, for a department, for the whole lab. Or just totals. By workstation, by employee."

With half a dozen staffers working on Lab Scheduler, Kelly reports, MAS has been able to mine the experiences of early customers to improve the program. As an example, she cites phlebotomy routes. In the early days Lab Scheduler would send someone who returned at 4:00 PM back out the door to do another route until 6:00 PM. "We decided there must be a way for us to ensure there is only one physical location per employee per day." Done.

Another feature in the works is the ability to run the program over the Internet. That could be a payoff for laboratories because the software could be updated automatically. And it might reduce informational technology costs, since MAS would be maintaining a lab’s scheduling data on its own computers in Virginia.

By the first day of 2001, several customers will operate Lab Scheduler over the Internet. These labs’ schedules will not be stored on site but on Lab Scheduler’s well-protected, backed-up computers. Many new customers, like Walter Reed Army Medical Center, will access their schedules over long distances-and be spared the hassle of maintaining a computer for scheduling. That should allow MAS to troubleshoot the schedule more quickly.

As for security or privacy risks? Few customers worry about that. The company takes all the standard precautions. "Once they realize there is no patient data, people tend to relax quite a bit," Kelly says of the Web-enabled version of Lab Scheduler.

In general, Kelly says, the company’s goal has been to let the program adapt to the customer-not the other way around. At one sales call in a northerly U.S. location, she asked those assembled for a reason that a technologist might not show up for work. Someone shouted: "Ice fishing."

No problem, said Kelly. "We put that in the program as a reason people were out. It shows up on the report as ’ice fishing.’ Lab Scheduler is user definable and people love that. We don’t want people to have to change how they run their laboratory. We just want to enhance what they’ve got."

The company spends a fair amount of time examining detailed setup information supplied by the laboratory. That includes basic personnel information about the competencies of each technologist, technician, and supervisor, and the types of workstations and existing rotations. Almost every item in the program-every person, skill, and machine-gets an easily changed numerical value, a weighting of its urgency or priority, that helps the computer create the schedule.

MAS then tries to examine the information for minor conflicts or illogic that might make Lab Scheduler’s output less than perfect. "We try to figure out-hey, what’s this about," says Kelly. "Do you really want that weekend workstation to be operating on a Tuesday?"

After the basic issues are ironed out, MAS sends out a team to instruct the laboratory in question. The length of the training varies, but typically one to three people need to be taught the program over a period of four days.

For all its technical complexity, much of the program’s attraction has to do with its ability to handle the softer side of scheduling. "The human chemistry is a big part of it," Kelly concedes. "That’s why we need these human resources features in the program. The program will optimize the schedule for the laboratory. But when Susie complains to Ann that she’s near Bob again, you can manually change anything. You’re not stuck with this automated outcome." As time passes, Kelly says she’s more aware of the importance of keeping not only technologists and technicians but also supervisors as stress-free as possible. She recounts a lab that calculated the cost of finding a new supervisor at $7,000 before the first paycheck is ever cut. Which brings up the cost of Lab Scheduler.

There are two bills. The first covers entering the right information into the program’s database and training key employees. Those setup fees are $3,500-$6,000.

The second Lab Scheduler fee is an annual licensing fee. That number is based on the total number of warm bodies (full time, part time, per diem, supervisory) being scheduled. The annual fee is calculated in tiers, with bigger labs paying a lower fee per scheduled employee than smaller labs.

The company might charge $500 a year for a lab with 10 techs, or $7,000 for a laboratory of 100 techs. To schedule 250 people, MAS might charge $9,000 annually. As steep as those numbers might seem, Kelly says they are half of the cost of doing a schedule manually.

As Kelly tallies it up, a laboratory that schedules 30 techs may spend $3,456 annually if the time of a scheduler is valued at $24 per hour and the task takes 144 hours a year, or 12 hours a month. In contrast, Kelly notes, MAS might charge $1,800 to use Lab Scheduler for a lab with 30 employees.

One unanticipated bonus is that the program can provide just as much data about nonbiological resources in the labs. That’s because the program also monitors workstations, the lapses of which can be tracked as exhaustively as that of any human.

As Kelly explains: "If you have a workstation that is going down quite a bit, you can track that. You can print out a report and show every hour that it’s been down. It’s about managing resources." It’s a tool, then, to be used when negotiating with vendors in the future.

What Lab Scheduler is intended to bring to the party, basically, is a reduction in the daily level of frustration that accompanies scheduling. Says Kelly: "Most of it is saving time, saving money, but a lot of it is saving frustration. It’s ’take this bull’s eye off my chest.’ Let the computer do it."

The man who figured out how to let the computer do it is pathologist James Boyd, MD, of the University of Virginia. Dr. Boyd is associate professor, director of laboratory, systems engineering, and specimen support services, and associate director of clinical chemistry and toxicology.

One of his quasi-official roles in his department is to advise colleagues on statistical and technology concerns. He majored in applied mathematics, which may explain why-upon hearing of the scheduling complexities-he took it upon himself to write a program to resolve them.

"I do a lot of programming in SAS, statistical analysis system programming language," he says, "and do a fair number of statistical analyses for various colleagues. It’s always been a big part of what I do." So when colleague John Savory, PhD, briefed him on the Virginia lab’s scheduling headaches, Dr. Boyd was intrigued. He toyed with simple schedulers, but none could properly rotate the techs to maintain their competencies. As Dr. Boyd recounts, he was briefly stymied.

But then he attended a medical conference and learned about genetic algorithms. These computational engines randomly generate potential "legal" solutions to a problem like how to minimize the distance a sales executive must travel on his or her rounds. Each such solution, in a metaphorical sense, can be thought of as an "offspring" or "organism." Then, generating new offspring, the program uses mathematic analogs of Darwinian selection principles to pit the organisms against each other.

After untold eons of evolution inside the computer, only the fittest-like hardy rats or humble bacteria-survive. Rather than duplicate a previous schedule, Dr. Boyd realized, he could tell the computer to slog through tens or hundreds of thousands of possible schedules for the same lab and-using a numerical score built into each schedule-pick the most highly rated organism.

Genetic algorithms, Dr. Boyd points out, are available commercially. His contribution was realizing that he could create a skill- and tech-rating scheme that would solve the problem of when to take a particular tech off a particular workstation. The computer does that automatically.

But by tinkering with the numerical values for a particular person or workstation, the human operator of Lab Scheduler can also ensure that if Mary is learning to do CBCs she will stay at that station long enough to master them-but not so long that she loses proficiency in anything else.

Though he seems to have made several novel conceptual and mathematical leaps, Dr. Boyd is ever the programmer: resolutely modest. "I’m not saying my work is all that unique," he insists. "I’m sure this scheduling problem has been solved elsewhere, in industry. It’s just not commercially available for some reason."

But Dr. Boyd goes on to explain that the program does not pick the supremely, certifiably best of the trillions of possible schedules. It does not have to. It uses tens of thousands of iterations, gadzillions of years of simulated evolution, to do the choosing for him. Thus Lab Scheduler just chooses an extremely good schedule, one better than all the others it evaluates.

"The schedules that get developed are sometimes not perfect," Dr. Boyd concedes. "But the technologist can immediately see that ’if I just swap this person for this person,’ that would fix it up and make it better. Minor tweaks often will make a schedule that is good nearly perfect. The techs have found that they can spot these readily and can fix them very easily."

Dr. Boyd knows that firsthand, because an early precursor to Lab Scheduler was used at his own institution, the University of Virginia.

When Dr. Boyd realized he did not have the time to be a one-man technical support operation for the product, he had the campus lawyers license it to MAS. The program was then overhauled to make it easier to use for those less mathematically inclined than Dr. Boyd. The first commercial version of Lab Scheduler was released in mid-1999.

The company keeps him informed on the development of his brainchild, and Dr. Boyd does seem to take a small amount of pleasure in seeing his idea loosed upon the world. "My general impression is that people are happy with it," he says. "The technologists felt the scheduling was fairer when it was done by the computer. It was less biased. The fact that we can take schedules out far in advance does give them notice about when they can take vacation. Those things are valuable to people-they give them more sense of control in their lives."

Some of those lives are in South Bend, Ind., where the South Bend Medical Foundation, a large regional lab, is using Lab Scheduler. Carola Cummings, manager of centralized transfusion services, is scheduling the day shift for two hospital labs, a stat lab, and a transfusion service, with as many as 60 people in the program at one time. "I really like how I don’t have to handle my vacation requests several times,"Cummings says. "The minute I get the request, I can log it into the computer."

Cummings also admires the built-in head count feature, which allows her to check the staffing for a particular day and learn who’s scheduled to work and at which workstation. But she hasn’t yet decided whether to recommend that her administrators buy the software. Using the old-fashioned method, she could do six weeks of scheduling on paper. Now, with Lab Scheduler, though she can schedule for longer periods, she can print out at one time no more than a two-week schedule.

Cummings makes clear that, because of turnover within her department, adding each new employee’s skills, days off, vacation time, and other personal data has proved time-consuming. She says it’s hardly fair to judge the program given those circumstances. But she also sounds hesitant about whether to give it an unqualified recommendation. She needs more time. The underlying database of employee skills and rotations, for starters, was somewhat cumbersome to set up. Beyond that, "there’s a little more interaction at the end after the AutoLink than I thought," Cummings adds, referring to the software function that matches techs and workstations. She’s hoping to train a clerk to run the day-to-day schedule adjustments, subject to supervisory approval, once the program has all the basic information it needs.

Her purchasing recommendation is riding on whether the program will be too difficult for the clerk to use. "If the clerk can handle it, then I would think definitely it would be a time-savings for everybody," says Cummings.

One reservation about the software, Cummings says, is the way it awkwardly accommodates her techs’ staggered starting times. "The computer likes definite start and stop times. But our staff comes in anytime from 3, 4, 5, 6, 7, 7:30 in the morning. I have a whole bunch of random start times. That leaves little bits and pieces all over on the computer program; when I print out the schedule, I go in and delete some of those half-hour periods."

In its early days in Indiana at least, Lab Scheduler also had difficulty assigning a particular tech to one of four physical locations. That problem was solved by the ace programmers at MAS company headquarters in Virginia. But the software still needs her eye for now. "It still requires that last check by a human, and some of the combinations may not be correct. You move people around at the end."

As it turns out, they do the same thing in the labs at the University of Virginia, but there the experience has been uniformly positive. Carolyn Smith-Lee, operations supervisor for the clinical labs at University of Virginia Medical Center, is not going back to pencil and paper scheduling. For her and the other shift supervisors, scheduling 60 people or so typically ate up 90 minutes every day. "We could never forecast," she laments of the pre-Lab Scheduler era. "We could never plan. We could never predict."

Now she’s done with scheduling in 20 minutes or so per day. And with Lab Scheduler, negotiating staff time off, even months into the future, is possible. "I can see my numbers," she says. "I can move people and talk to that employee if necessary. I can say, ’Next March, what about Thursday instead of Friday?’ People are more apt to work with you because they don’t have any plans yet."

Smith-Lee has discovered another use for Lab Scheduler: to figure out the best time to install new equipment, since every apparatus seems to be replaced on a two- to three-year cycle. "You are able to look at your grid and say, ’These are good times. Not this time.’"

For technologists and technicians in high-pressure situations, Smith-Lee says, the program is more likely to ensure that no one gets worked to the bone. "With trauma," she says, "before you get it they already wanted it. It’s good that I can give technologists the ability not to be in that environment three days in a row, or a week at a time. They’d be a puddle of water on the floor. A little intensity can go a long way."

Do laboratorians understand the mammoth Darwinian selectivity under the hood of Lab Scheduler? Probably not, says Smith-Lee. But they do appreciate its objectivity. "They understand it in the sense of ’my God, I’m not on urine and fluids three days in a row.’ I have fewer people saying ’I’m on that bench all the time.’"

Lab Scheduler can even shed light on broader hiring and training needs. Smith-Lee suspects, for example, that she would be able to identify training needs on her own. But she says the program shows her visually-in color-where she needs to beef up the skills of her team. Such questions as "Do you need more individual technologists?" or "Do you need more technologists trained in a particular area?" would get answered under the old scheduling system, but not as fast as they are with Lab Scheduler. The Einsteinian program makes her day a bit more, well, Boydian.

Mark Uehling is a freelance writer in Chicago.