{"id":21246,"date":"2024-02-07T12:11:43","date_gmt":"2024-02-07T18:11:43","guid":{"rendered":"https:\/\/www.lightning-bolt.com\/?post_type=case-study&#038;p=21246"},"modified":"2025-09-23T09:58:54","modified_gmt":"2025-09-23T14:58:54","slug":"st-michaels-balance-provider-shifts","status":"publish","type":"case-study","link":"https:\/\/www.lightning-bolt.com\/case-study\/st-michaels-balance-provider-shifts\/","title":{"rendered":"How To Balance Clinical Assignments and Provider Preferences with Rule-Based Scheduling"},"content":{"rendered":"\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:100%\">\n<p>St. Michael\u2019s Hospital is an urban, quaternary care trauma center located in downtown Toronto, Canada. St. Michael\u2019s is renowned for its teaching and research and is fully affiliated with the University of Toronto. The hospital was founded in 1892 and became part of the Unity Health Toronto hospital network in 2017.<\/p>\n\n\n\n<div style=\"height:30px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 class=\"wp-block-heading\">Challenges<\/h2>\n\n\n\n<p>Since 2003, St. Michael\u2019s Department of Anesthesia has been using Excel spreadsheets to build schedules for a group of around 30 anesthesiologists. This was a complicated process that averaged 100 hours of scheduling work each quarter, and there was often trouble equalizing shift types among providers and keeping track of their clinical assignments. There wasn\u2019t a quick or easy way to equally distribute weekend work, clinical assignments, and on-call shifts\u2014such as overnight and late calls among providers\u2014and there was limited insight into how equitable the schedules were. As the department grew from 30 to 100 providers, the strain of using a manual scheduling process to build, track, and fairly manage shifts became overwhelming.<\/p>\n\n\n\n<p>Because St. Michael\u2019s is a teaching hospital, schedulers also needed to pair learners with specific assignments and\/or staff to ensure they met their educational requirements. This added complexity, and coupled with attendings\u2019 own complex intensive care schedules and protected research time requirements, led to significant frustration whenever any of these intersecting schedules needed adjustment. Each schedule required thousands of manual assignments and dozens of work hours before a feasible schedule could be produced.<\/p>\n\n\n\n<p>When Dr. Nick Lo, current Deputy Chief of Anesthesia, took over scheduling in 2016, he felt it was vital that a solution be implemented to create fair and feasible schedules while supporting quick and easy<br>adjustments. His ideal solution would foster wellness for schedulers and providers by building optimized schedules that prioritize coverage, ensure operational requirements are met, protect educational and research time, and account for personal preferences as much as possible.<\/p>\n<\/div>\n<\/div>\n\n\n\t<section class=\"video-promo-block\" id=\"\" style=\"background-color: \">\r\n\t\t<div class=\"inner-container\">\r\n            \t\t\t<div class=\"video-container\">\r\n\t\t\t\t<iframe src=\"https:\/\/player.vimeo.com\/video\/940913848?h=f20b141cb9&amp;badge=0&amp;autopause=0&amp;player_id=0&amp;app_id=58479\" frameborder=\"0\" allow=\"autoplay; fullscreen; picture-in-picture; clipboard-write\" style=\"position:absolute;top:0;left:0;width:100%;height:100%;\" title=\"Limitations of Scheduling in Excel\"><\/iframe>\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t<\/section>\r\n\t\n\n\n<h2 class=\"wp-block-heading\">Solution<\/h2>\n\n\n\n<p>Dr. Lo and his colleagues knew the Excel-centric process for creating schedules was ripe for improvement. After researching available technology that could help their group build and distribute optimized schedules with significantly less manual intervention, they decided to implement PerfectServe&#8217;s Lightning Bolt Scheduling within the St. Michael\u2019s anesthesia department. With Lightning Bolt\u2019s rule-based scheduling capabilities in place, Dr. Lo would be able to:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Distribute shifts fairly among providers<\/li>\n\n\n\n<li>Allow time off between clinical assignments<\/li>\n\n\n\n<li>Classify weekend shifts differently than weekday shifts<\/li>\n\n\n\n<li>Accommodate individual scheduling preferences<\/li>\n\n\n\n<li>Pair appropriate providers to specific assignments and trainees (fellows and residents)<\/li>\n\n\n\n<li>Access detailed analytics about shift allocation to inform future decision-making<\/li>\n<\/ul>\n\n\n\n<p>After implementing Lightning Bolt, Dr. Lo can now use specific schedule-building rules to create an optimized, equitable schedule for his attendings, fellows, and residents. Lightning Bolt uses <a href=\"https:\/\/www.lightning-bolt.com\/blog\/combinatorial-optimization-provider-scheduling\/\" target=\"_blank\" rel=\"noreferrer noopener\">combinatorial optimization<\/a> to build schedules, which means it can produce an optimal schedule within the constraints of the rules that have been set. This mathematical process allows Lightning Bolt to build the schedule in thousands of different ways to land on the most ideal solution. Other systems employ a heuristic model, which constructs the schedule in a more linear, step-by-step fashion. This frequently leads to non-optimized schedules.<\/p>\n\n\n\n<p>Because rules can be designed around any equalization time frame, providers know that their shift types, vacation time, and working weekend time will be equalized based on one\u2019s own local rules. For St. Michael\u2019s Anesthesia Department, this means that attendings\u2019 calls are equalized in perpetuity, while fellows\u2019 calls are equalized within the academic year. Dr. Lo has also seen significant improvements related to provider wellness, schedule analytics, and time required to build and distribute schedules.<\/p>\n\n\n\n<div style=\"height:30px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\t<section class=\"video-promo-block\" id=\"\" style=\"background-color: \">\r\n\t\t<div class=\"inner-container\">\r\n            \t\t\t<div class=\"video-container\">\r\n\t\t\t\t<iframe src=\"https:\/\/player.vimeo.com\/video\/940913859?h=279aff51b3&amp;badge=0&amp;autopause=0&amp;player_id=0&amp;app_id=58479\" frameborder=\"0\" allow=\"autoplay; fullscreen; picture-in-picture; clipboard-write\" style=\"position:absolute;top:0;left:0;width:100%;height:100%;\" title=\"Balancing Call Shifts with Automation\"><\/iframe>\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t<\/section>\r\n\t\n\n\n<h2 class=\"wp-block-heading\">Results<\/h2>\n\n\n\t<div class=\"numbered-block\">\r\n\t\t<div class=\"inner-container\">\r\n                                        <!-- loop through repeater -->\r\n                                    <div class=\"single\">\r\n                        <div class=\"number\">\r\n                            <p>1<\/p>\r\n                        <\/div>\r\n                        <div class=\"text\">\r\n                            <p><strong>Schedule Development Time Reduced by 75%<\/strong><br \/>\nBefore Lightning Bolt, manual schedule creation was an arduous task involving the entry of thousands of assignments. During periods of minimal staff availability, such as summer holidays, scheduling assignments became increasingly difficult, as previous decisions would limit downstream workable assignment combinations. This added many hours to the schedule-building process.<\/p>\n<p>Today, Lightning Bolt does all the heavy lifting by presenting a complete schedule with the computed best result. Previous hand-built schedules sometimes went through hundreds of hours of building, with many hours of edits. Thanks to Lightning Bolt\u2019s ability to keep track of provider on-call preferences and worked shifts, Dr. Lo can now build equitable schedules that allocate shift types equally among providers in a quarter of the time.<\/p>\n                        <\/div>\r\n                    <\/div>\r\n                                                        <div class=\"single\">\r\n                        <div class=\"number\">\r\n                            <p>2<\/p>\r\n                        <\/div>\r\n                        <div class=\"text\">\r\n                            <p><strong>More Time for Non-Clinical and Academic Activities<\/strong><br \/>\nBecause St. Michael\u2019s is a teaching and research hospital, they used Lightning Bolt to balance provider availability and clinical demand.\u00a0 This allowed them to grant providers more non-clinical days for educational and research activities, as well as more time for other work-related activities and administrative tasks. Results post-Lightning Bolt implementation included:<\/p>\n<ul>\n<li><strong>45% increase<\/strong>\u00a0in the total time allocated for non-clinical and academic time<\/li>\n<li><strong>268% increase<\/strong>\u00a0in time allocated to education<\/li>\n<li><strong>7% increase<\/strong>\u00a0in time allotted for administrative\/non-clinical activities<\/li>\n<li>The number of successful University Merit Awards rose from\u00a0<strong>3 in 2016 to 8 in 2023<\/strong><\/li>\n<li>The number of peer reviewed publications rose from\u00a0<strong>43 per year to 75 per year<\/strong><\/li>\n<\/ul>\n                        <\/div>\r\n                    <\/div>\r\n                                                        <div class=\"single\">\r\n                        <div class=\"number\">\r\n                            <p>3<\/p>\r\n                        <\/div>\r\n                        <div class=\"text\">\r\n                            <p><strong>More Transparency, No Bias<\/strong><br \/>\nBecause Lightning Bolt is preprogrammed with all of the group\u2019s unique rules and requirements, providers know that schedules are built as fairly as possible and without human bias. Schedulers like Dr. Lo who work painstakingly to create schedules always have the best of intentions, but oversights or minor mistakes\u2014which are understandable given the complexity involved\u2014can lead to unbalanced shifts and dissatisfied providers.<\/p>\n<p>Because Lightning Bolt makes schedules accessible everywhere via desktop or mobile app, providers always have real-time, instant access to the most up-to-date schedule. With the mobile app, users receive updates and can make requests and changes instantly. This combination of greater transparency and the elimination of perceived scheduling bias greatly benefits provider satisfaction.<\/p>\n                        <\/div>\r\n                    <\/div>\r\n                                                        <div class=\"single\">\r\n                        <div class=\"number\">\r\n                            <p>4<\/p>\r\n                        <\/div>\r\n                        <div class=\"text\">\r\n                            <p><strong>Detailed Reports and Analytics<\/strong><br \/>\nDr. Lo uses Lightning Bolt to glean insights about shift allocation, resource utilization, payroll accuracy, and future scheduling decisions. Published on-call stats allow greater visibility into shift distribution and equity, and users can review monthly reports within Lightning Bolt to confirm their working days before they\u2019re passed on to the accounting department. This allows provider to validate their shifts to ensure they\u2019re being paid accurately.<\/p>\n<p>Lightning Bolt can also break down shift types to ensure every provider is being scheduled fairly. Because St. Michael\u2019s is a teaching and research hospital affiliated with the University of Toronto, many fellows and residents are there to study and continue the educational portion of their medical careers. Lightning Bolt ensures that appropriate providers get the required number of academic hours. In fact, after implementing Lightning Bolt, providers have seen a higher balance of academic time than ever before.<\/p>\n                        <\/div>\r\n                    <\/div>\r\n                                                        <div class=\"single\">\r\n                        <div class=\"number\">\r\n                            <p>5<\/p>\r\n                        <\/div>\r\n                        <div class=\"text\">\r\n                            <p><strong>Detailed, Unique Rules for Optimized Schedules<\/strong><br \/>\nThough many solutions exist on the market that can automate schedules, Lightning Bolt\u2019s rule-based scheduling is what allowed Dr. Lo to program the solution to meet St. Michael\u2019s distinct set of needs. When searching for the right solution, Dr. Lo chose Lightning Bolt because of its unique ability to equalize various scheduling parameters, balance clinical schedules with research\/academic schedules, and meet anticipated OR demand.<\/p>\n<p>The following examples highlight rules specific to Lightning Bolt that put true schedule optimization into Dr. Lo\u2019s toolbox:<\/p>\n                        <\/div>\r\n                    <\/div>\r\n                                                \t\t<\/div>\r\n\t<\/div>\r\n\t\n\n\n<div style=\"height:30px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\t<section class=\"video-promo-block\" id=\"\" style=\"background-color: \">\r\n\t\t<div class=\"inner-container\">\r\n            \t\t\t<div class=\"video-container\">\r\n\t\t\t\t<iframe src=\"https:\/\/player.vimeo.com\/video\/940913866?h=4f824763c4&amp;badge=0&amp;autopause=0&amp;player_id=0&amp;app_id=58479\" frameborder=\"0\" allow=\"autoplay; fullscreen; picture-in-picture; clipboard-write\" style=\"position:absolute;top:0;left:0;width:100%;height:100%;\" title=\"Better Scheduling Better Physician Retention\"><\/iframe>\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t<\/section>\r\n\t\n\n\n<div class=\"wp-block-group border-left\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<div style=\"height:30px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<p><strong>Equalizing<\/strong><br>This rule allows shift types to be equally distributed among providers within any specified time frame. If the scheduler asks Lightning Bolt to equalize shifts based on input since 2021, Lightning Bolt will take into account how providers have been scheduled through the previous years to ensure everyone is scheduled as equally as possible year over year. When a new provider is added to the system, Lightning Bolt will \u201cprorate\u201d their shifts to ensure they aren\u2019t overscheduled.<\/p>\n\n\n\n<div style=\"height:15px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<p><strong>Spacing<\/strong><br>The spacing rule allows specific shift types to be spaced out or separated from one another to avoid giving providers successive shifts with highly demanding work. For example, if a provider is working in the ICU, they will not have any additional on-call operating room duties until at least a week after the ICU assignment. In this way, Lightning Bolt keeps providers from being scheduled for back-to-back demanding shifts.<\/p>\n\n\n\n<div style=\"height:15px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<p><strong>Weekend Classification&nbsp;<\/strong><br>This rule distinguishes between assignments that occur on weekdays versus weekends or holidays. Dr. Lo uses this feature in conjunction with the spacing rules to ensure that personnel never work two weekends in a row.<\/p>\n\n\n\n<p>Lightning Bolt gives Dr. Lo more control by allowing him to schedule providers according to the difficulty of their previous shift type.<\/p>\n\n\n\n<div style=\"height:15px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<p><strong>Linking (If\/Then)<\/strong><br>Linking is a scheduling rule that follows logic: \u201cIf<em>&nbsp;<\/em>scenario X occurs, then<em>&nbsp;<\/em>action Y should follow.\u201d Dr. Lo uses this functionality to link call shifts with post-call shifts. If a provider is scheduled to work a more stressful shift like the ICU, they are not scheduled for any on-call shifts for the following week.<\/p>\n\n\n\n<div style=\"height:15px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<p><strong>Advanced Conditional<br><\/strong>This rule gives Dr. Lo extra control over the nuances in scheduling, such as pairing a senior resident with a junior resident on a specific assignment at a specific time. With control over more granular scheduling details, Dr. Lo can further prioritize provider wellness, shift equity, and organizational needs.<\/p>\n\n\n\n<div style=\"height:15px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<p><strong>Targets<\/strong><br>With a focus on resource optimization, Dr. Lo uses the target rule to count or \u201ctally\u201d the scheduled personnel for each date and shift. Lightning Bolt allows him to see, in detail, how many providers are needed for a certain shift versus how many are actually scheduled. Dr. Lo is given the OR schedule three months in advance, which includes OR room types and available nurses. The rule allows Dr. Lo to match the hospital\u2019s clinical demand with the correct number of anesthesiologists. Lightning Bolt helps him forecast staffing and demand mismatches well in advance in order to have the correct number of providers for every shift. If there are too many providers scheduled for a shift, Dr. Lo can offer vacation days to people who want them. If any future shifts will be short-staffed, Lightning Bolt grants preliminary visibility into the future to ensure any gaps in coverage are filled. Dr. Lo says this allows his department to provide consistent and dependable anesthesia service for St. Michael\u2019s Hospital, and avoids case cancellation from lack of anesthesia availability.<\/p>\n\n\n\n<p>\u201cWe use Lightning Bolt software to efficiently schedule all clinical and academic activities in our department,\u201d Dr. Lo said. \u201cUtilizing the Lightning Bolt system allowed us to more than double our commitment to supported education time, greatly enhance the limited time for business activities, and protect our researchers\u2019 time to ensure their continued academic productivity.\u201d<\/p>\n<\/div><\/div>\n\n\n\n<div style=\"height:30px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 class=\"wp-block-heading\">Conclusion<\/h2>\n\n\n\n<p>St. Michael\u2019s Hospital isn\u2019t the first\u2014and certainly won\u2019t be the last\u2014hospital to experience the distress of building schedules by hand. All too often, health systems are unable to build and edit shift and call schedules that meet provider schedule requests and keep payroll accurate through Excel workflows. Though it may feel like a \u201cnecessary\u201d burden to schedulers and something that is \u201cjust part of the job,\u201d solutions do exist to drastically reduce the time it takes to build and optimize new and existing schedules while simultaneously allowing providers to allocate more time to patient care.<\/p>\n\n\n\n<p>Just as Dr. Lo experienced, Lightning Bolt has the necessary capabilities to improve the schedule building process for departments across the organization. Through advanced combinatorial optimization, Lightning Bolt improves the scheduling process from start to finish, and it offers notable improvements in provider wellness and resource optimization as a byproduct.<\/p>\n\n\n\n<div style=\"height:30px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<div class=\"wp-block-buttons is-content-justification-center is-layout-flex wp-container-core-buttons-is-layout-16018d1d wp-block-buttons-is-layout-flex\">\n<div class=\"wp-block-button\"><a class=\"wp-block-button__link wp-element-button\" href=\"https:\/\/visit.perfectserve.com\/University_of_Toronto_Rule_Based_Scheduling\" target=\"_blank\" rel=\"noreferrer noopener\">Download Case Study<\/a><\/div>\n<\/div>\n","protected":false},"featured_media":21249,"template":"","meta":{"_acf_changed":true,"footnotes":""},"case-study-category":[49],"class_list":["post-21246","case-study","type-case-study","status-publish","has-post-thumbnail","hentry","case-study-category-hospitals-and-health-systems"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>How To Balance Clinical Assignments and Provider Preferences with Rule-Based Scheduling<\/title>\n<meta name=\"description\" content=\"Learn how St. Michael\u2019s improved clinical and academic shift balance and boosted provider satisfaction with rule-based scheduling.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.lightning-bolt.com\/case-study\/st-michaels-balance-provider-shifts\/\" \/>\n<meta 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