Optimization of Self-Scheduling to Enhance Respiratory Therapist Skill Mix

Background: The aim of this study was to develop a self-scheduling system to optimize skill mix on a day-to-day basis, thereby enhancing clinical competency and employee satisfaction. The study sought to determine if creating a skill-based schedule could address competency concerns and reduce employee absenteeism. Methods: The scheduling system was designed by first allocating shifts to highly skilled team members to ensure the minimum staffing requirements for each unit/day were met. Subsequently, additional shifts were assigned to less experienced team members who could benefit from mentorship. This approach facilitated self-scheduling and self-balancing, promoting work-life balance for employees, and reducing managerial burden. The creation of a skill-mixed schedule aimed to strengthen team dynamics, provide robust support, enhance employee satisfaction, and lower absenteeism rates. The study posited that employees who felt supported in their learning and work-life balance would be more likely to take ownership of their assigned patient care unit. Results: Initially, the scheduling system required 46 adjustments (pulls) for the first schedule. After iterative refinements and considering vacancies, paid time off requests, holidays, and other off requests, the system evolved. This optimization process reduced the number of pulls to 46, then to 26, 21, 11, 8, and eventually only 3. The results showed a significant decrease in absenteeism and punitive action, along with improved retention rates (< 5%) and employee satisfaction (above benchmark). Conclusions: Implementing a skill-based scheduling system ensures that the right skills are available in the right units at the right times. This system supports mentorship and skill development, leading to better clinical outcomes, such as reduced safety events, length of stay, and readmissions. While also improving patient satisfaction. The study demonstrates that a well-designed self-scheduling system can enhance team performance, reduce absenteeism, and improve overall employee satisfaction.