‘Tis the season for twinkling Christmas lights, warm hot cocoa, and endless Hallmark Christmas movies. For those in the healthcare industry, ’tis also the season for holiday scheduling discussions. This is my first holiday season in a management position, and I’ve finally seen how the sausage, I mean schedule, is made. Creating a holiday schedule that works for our urgent care clinics while keeping our providers happy has been no small feat.
Let’s get the obvious thing out of the way first – no one wants to work on or around the holidays. But since illness and injury don’t take days off, ERs and Urgent Cares must remain open. This dichotomy can lead to antagonism between an employer and their employees. Adding to the problem is that part-time employees tend to disappear during the holiday season. Any medical business should have a holiday scheduling policy for full-time and part-time employees. Your expectations must be made clear during your hiring and onboarding process.
I have been through holiday scheduling as a provider at a couple of different places, each with its own unique methods for dealing with this problem. Now that I’m responsible for my company’s schedule, I wanted to research options we may not have thought of that could make this time less stressful and more harmonious for our employees. Let’s explore some ideas and perspectives in crafting a holiday schedule.

Emergency Room Holiday Scheduling Challenges

During the past three holiday seasons, my world revolved around the ER- where the doors never close and the shifts must be covered. Amid the chaos, the ER scheduling team had their techniques for fairness and efficiency.
Technique number one is ranking your preferences. This method gives a measure of control to the employees as they name the holiday they would most like to have off. You might think everyone would want Christmas off, and it is the most popular, but not everyone celebrates it. Additionally, some people prefer to be off on New Year’s Eve. With enough variance in requests, everyone can get off their first choice. If not, another system must be in place as a backup.
Technique number two involves working a required number of major and minor holidays. For example, you must work two major holidays and one minor holiday. Honestly, there were no complaints about these methods when I worked in the ER. It was expected that you would have to work around the holidays – it’s the nature of the job. However, we did not see pushback because they enabled the providers to pick which they preferred to work.

Urgent Care Holiday Scheduling Challenges

My decision to leave the ER and switch to urgent care came with benefits, including being closed on major holidays: Easter, July 4th, Thanksgiving Day, the day after Thanksgiving, Christmas Eve, Christmas Day, and New Year’s Day. My four-year-old son noticed this, recently telling me, “Mom, I’m glad you work at the place that closes now.” Although this seems like it would make scheduling easier, it actually presents a different challenge. Since they have the holiday off, employees want to have days off around the holidays as well in order to travel.
My current urgent care allows providers to pick if they want to work the 2 days before or the 2 days after a major holiday (such as Thanksgiving or Christmas). The goal? Ensuring everyone enjoys four consecutive days off before or after the holiday. It seems like a balancing act to make the schedule fit with their preferences, but when it does work, everyone gets a well-deserved break.

Curious about other methods

While I don’t find fault with the approaches used by my previous employers, stepping into the scheduler role has prompted me to explore alternative methods. While I acknowledge that the intricacies of scheduling may not interest everyone, I believe it is important for those of us in the healthcare profession. So, let’s look at this together and try to sprinkle a bit of magic on the art of holiday scheduling.

Exploring Alternative Approaches to Holiday Scheduling

Rotation shift work

A rotational schedule prevents the annual conundrum of individual providers being pinned to the same holiday shifts. This system would manifest as a series of rotating blocks in the urgent care. We could expand our tradition of two-day blocks to four, allowing a generous six-day break before or after the holiday. This approach safeguards against the monotony of working the same block each year.
Unfortunately, this method removes provider choice, which forces them to plan their festivities around their work schedule. Although they probably should do this anyway, the reality is that people have traditions that may not align with a rotating block schedule. Another downside is that the scheduler must maintain a record of the blocks. Turnover also affects this system as you must work new providers into the established blocks.
Perhaps this model works best in the Emergency Room setting, where there is less provider turnover and an understanding that shifts must be covered 24/7/365. Here, a mandatory rotation ensures that everyone takes a turn working Christmas Day- arguably the least desirable shift. The aim is to strike a balance that honors the provider’s need for time off with patient care demands.

Time-Off Accrual

We do not have accrued time off in our urgent care because we have over half of the month off. However, another scheduling method is to permit the use of accrued time off during the holiday season. This begs the question, is this a benefit of seniority, or would it be first come, first served?
While we are not using this method, we have discussed it as a team. The prevailing sentiment from team members was to allow the use of accrued time off during the holidays on a first-come, first-serve basis. The downside of this method is that it benefits those who plan farther ahead. Someone will always turn in their request for the following Christmas on January 1st.

Half Day Options

At my old ER, they would shuffle their traditional 10-hour shifts, trimming hours during the holidays. For instance, instead of staffing 4 x 10-hour shifts, they might use a 3 x 12-hour alternative, allowing one more person to be off on the holiday.
Conversely, shorter shifts can give everyone some time off on the holidays. Allowing days to be split between providers would not help the people who need to travel. Still, it would give those staying local more time at home.
This method isn’t a one-size-fits-all solution but could be a tailor-made fix for some. This approach offers a compromise for providers who need to balance their holiday time without being tethered to full shifts. It allows them to contribute to coverage during busy holiday hours and still savor special moments with family.

Reverse scheduling

We use this model for routine scheduling in our urgent care clinics. Providers have the autonomy to handpick their preferred workdays, indifferent days, and those they’d rather avoid. I saw this method recommended for holiday scheduling as well. The concept is the same- providers can submit their preferences, explicitly indicating the days they prefer not to work or simply cannot work during the holiday season. The schedule is built around the constraints of individuals and can use seniority if everyone has the same preferences.
Providers can shape their holiday commitments to their individual needs when this works. Unfortunately, this type of scheduling can quickly devolve into a seniority-based system if we believe that no one wants to work on or around the holidays.

holiday scheduling with preferences

Patient-Centric Holiday Season

One of our company’s core values is to be patient-centered. During the busiest season of the year for healthcare, it can be easy to lose sight of this. We recognize the difficulty of managing high patient volumes and the sacrifice of spending more time away from family, particularly during a time when being together is cherished. While we can’t alter these realities, we can shift the narrative and find appreciation in the chaos. Healthcare is a cyclical business. We can learn to appreciate the busy season, which keeps everyone employed when volumes slow down in the summer. By flipping the script, we cover all the shifts and create an environment where we’re there for our patients when they need us (and most other places are closed), diverting unnecessary traffic from the ER.
I don’t want to dread the chaos. I want to foster an atmosphere where our providers, too, learn to appreciate the demand of the holiday schedule and the associated increased patient volume. We can balance this with a genuine appreciation for our providers and healthcare workers. Hold a potluck around the holidays, send your employees cookies, buy them coffee, or anything to show them that you appreciate them working hard and having a great attitude. Because let’s face it, everything’s better with food, desserts, and coffee!

Overall view

My takeaway is that there are pros and cons to each holiday scheduling method. No system is perfect. As a provider and scheduler, what matters most to me is fostering an environment where suggestions and preferences are welcomed and heard. Acknowledging that every method has limitations, the emphasis becomes picking a system that is understood and followed by your organization.
I aim to enjoy the holiday spirit at work this holiday season, encourage others to do the same, and cherish time at home with my family. Please let me know if you have other suggestions on holiday scheduling that might make my job easier next year.