Shifts in La La Land: nuclear meltdowns, Oscar awards…and HosPortal design

Posted By on 25 November 2019

HosPortal loves to listen to good podcasts. And about 21 minutes and 50 seconds into a recent episode of the Cautionary Tales podcast we saw some insight into the parallels between good design of nuclear reactors, Oscar award envelope logistics, and HosPortal’s shift-swap and shift-splitting features.

We are often asked whether we have a mechanism for roster administrators or someone receiving a swapped shift to approve the change. Our quick answer is ‘no’. A more complete answer is ‘it is not hard to do, and we would be happy to enable such a feature if you believe it will work better than the system we have today.’ So far, no one has asked for us to make that change.

At the moment, people can only swap shifts if:

  1. Both parties are eligible to do the shifts in question, and
  2. They are of the appropriate seniority and skill-set, and
  3. Their hospital has allowed shift swaps at all

But if they then swap a shift, it happens the instant that one party enters it into HosPortal. Even if it is 2am on a public holiday. It is immediately visible to all users so they can contact the right on-call doctor. As a protection, the two swapping parties get an immediate confirmatory email, any administrators who need to know get an email, and the public audit log is updated.

A bit like carrying duplicate briefcases of Oscar award cards, or having 700 warning lights on a nuclear reactor control room, having a person approve a swap or split can add potentially damaging complexity, and create a perception of safety while actually making the system less safe and reliable:

  1. The administrator has to be at work, or the other person has to be logged in, to process the change. So the shift can sit in limbo (shift La La Land, if you will) for a while.
  2. The accountability for the shift is lost: if the person receiving the shift does not want it they can ignore the swap rather than have any incentive to consciously address it.

Instead, our system provides clear accountability. If the person allocated the shift does not want it they know immediately, and they know that they are responsible for that shift until they take action. Possibly by contacting the other party directly, or getting help from an administrator. So far – with over 4,000 users at 30 hospitals and thousands of shift swaps – we have not heard of any deliberate abuse of the system.

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