Micah Krempasky, MD, chief medical officer of mental health at WakeMed in Raleigh, N.C., has seen firsthand how flexible scheduling rooted in clinician autonomy can improve workforce satisfaction without compromising patient care.
“It’s really important to have work-life balance. And if we’re not happy at home, then that comes into the work, and you can’t give your patients your best,” she said. “The thing that irritates me as a clinician is people who’ve never done the work telling me what my schedule should be.”
After spending 11 years at the bedside, Dr. Krempasky understands that clinicians move through different phases of life and that responsibility can shift. Now in a leadership role, she said part of the workforce strategy is giving her team similar options by offering flexible scheduling, including a seven-days-on, seven-days-off model.
“Telling people what they have to do, and only letting the numbers dictate, I don’t think leads to good workforce happiness,” she said. “If you tell clinicians to do something that works well for your patients, they will. But if you dictate to them, their sense of self kicks in. It’s finding this balance of motivating them to do what’s right for the patients, and it can be done.”
Dr. Krempasky said her clinical experience showed that under a traditional Monday-through-Friday model, hospitals often need weekend coverage staff members who function largely as placeholders. Because treatment is not typically furthered during that time, fewer discharges occur, slowing throughput, she said. If weekend staff are part time, health systems also may pay benefits and invest additional resources in recruiting and retaining those workers.
Under the seven-on, seven-off model, Dr. Krempasky said WakeMed does not need weekend coverage, eliminating those burdens entirely. She created paired teams that receive a schedule and have full autonomy to fill the calendar and determine staffing. The approach also reduces handoffs, which can be a dangerous point in the patient care journey.
“I only have one handoff every seven days; my throughput looks better. We discharge seven days a week 100% and you get consistency on the unit, which I think reduces your seclusion and restraint,” she said. “My providers are happy.”
