Chris’s Ramblings: Core Schedule’s medical adventure

Every quarter Punakaiki Fund principal Chris Humphreys does a deep dive into the backstory of one of their founders. Last quarter, it was our very own Founder and CEO, Stephen Pools turn. The following article was published to the Punakaiki Fund website late last year:

Let me introduce to you Stephen C. Pool: entrepreneur, Alaskan Malamute owner and the founder of Core Schedule. But that’s not all, Dr Pool is also an Emergency Medicine Specialist. You know – the guy that patches you up when you have an accident, or in my case, when your oldest son accidentally guillotines the end of your youngest sons finger in a door (I won’t go into the gory detail, but we did need a helicopter ride to the hospital).

It’s not a job that I could ever do – I have a thing about needles. Apparently, you also need some type of qualification and apparently a finance degree just won’t cut it.

But let me take you back to the start of the Core Schedule story. To do that we need to go back to late nineties New York, a place of crime, grime, and bulletproof glass in taxis. It was in this setting that a fresh-faced Stephen had just come out of New York University and started his emergency medicine residency at Bellevue Hospital.

Sleep is Optional 

We’ve all seen the TV shows – residency is gruelling work. Long shifts, 100+ hour weeks and being at the bottom of the pecking order are all part of the job. Most people in that situation would usually just put their head down, focus on the job at hand and get on with it. But not Stephen. With an interest in computers and programming that can be traced back to his childhood in Mobile, Alabama, Stephen continued to tinker and learn new programming languages, and was continuously on the lookout for ways to apply his knowledge. In the end, he decided that it would be a good idea to set up an internet start-up partway through his residency.

It sounds like sleep was obviously an optional nice-to-have for Stephen back then! Medical Web Solutions specialised in developing websites for GP offices. Back then the World Wide Web was still in its infancy, so there was plenty of opportunity to grow and Stephen made the most of it. It started with basic websites for friends and colleagues who were willing to pay for it, and then got more sophisticated and attracted new customers. The company’s software got better too, and Stephen started looking to building in billing functionality, where he saw a lot of potential. The business was growing really well, even to the point where Stephen was having advanced discussed with US venture capital funds about raising money to expand the business. Then it happened.

Bubbles Always Burst

For those of you that are old enough, you will remember the terms like “dot-com bubble” and “tech wreck” that were in common usage at the turn of the millennium. They refer to a period when there was a lot of speculation in internet-related businesses and those companies’ valuations were sky-high. In 2000, those valuations crashed and sent those businesses out of business. For Stephen it meant a double whammy of no venture capital funding and sales drying up. Medical Web Solutions was dead in the water. That hurt. Stephen had been funding the business up to that point out of his own pocket and found himself in a serious hole. Stephen took stock and decided that it was time to refocus purely on medicine. He completed his residency and then worked in a number of hospitals around New York.

Things We Love to Hate

It was at one of these earlier jobs that the painfulness of hospital rostering was made clear to Stephen. He wanted to take leave and when he asked how to go about it, he was handed a transparency (that’s a clear plastic piece of paper used for overhead projectors, for those born more recently than Lance) that had a bunch of red lines on it and then another form which had some sort of calendar on it, along with a two-page list of instructions. It worked by holding the calendar up to a window and moving the transparency across it in a certain way until you find a spot on the calendar that lines up with a certain line on the transparency. This represented the days when you could actually take leave. So Stephen took it home and it took him and his husband 30 minutes to figure out how it was supposed to work. Not much later at work there was a discussion about their leave system and Stephen mentioned that the current system was really embarrassing. Their response was “well, if you think you can do better, have at it…”

Oh… It’s On!

That single comment made eleven years ago was a red rag to a bull. The system was about to be computerised and Stephen had the right programming skills and the medical experience to do the job. This overhaul started as an online system to request leave, which was followed (after requests) with work scheduling outputs so staff could see more easily when they were rostered on to work. Over the next two years, Stephen built the first iteration of what would become the Core Schedule software. Stephen treated this as a hobby project in the early days. Initially the software was only used in his department, but pretty soon the doctors that were using it at his hospital would ask Stephen about building a system for other hospitals where they also worked.

With organic demand increasing, the amount of time that Core Schedule required became too much for Stephen to manage alone, so he engaged a developer from a firm in India to do a lot of the basic programming and software updating. By this point Core Schedule was being used by single departments across a dozen hospitals.

A Year of Big Decisions

2013 was a pivotal year for Stephen. He had just married long-time partner Neil and they were deciding where to go for their honeymoon when they saw an ad the weekend after the wedding for a South Island action adventure/white-water rafting tour. It was an easy decision to come to New Zealand for a holiday and when they arrived they fell in love with the country. They had no thoughts of living here at that point, thinking that it wouldn’t be possible. After the honeymoon, Stephen went back to work in New York and was raving to a colleague about like how much he loved New Zealand, how much fun they had and how great the people were. His colleague responded that it is actually really easy for American doctors to go and practice in New Zealand. Stephen’s immediate response was that he was too old to re-sit his medical exams again, but his colleague said that wasn’t an issue. New Zealand would recognise his American certification as being equivalent to the New Zealand certification, and all he would need to do is pay the fees and jump through a lot of administrative hoops.

That was news to Stephen, and he later found out that of all the other countries in the world, only New Zealand and Australia has this recognition arrangement for American doctors in place. He looked into it and found there were a lot jobs available in emergency rooms in New Zealand, with many of them for six month terms. So a plan was hatched to come to New Zealand – a sort of a six month working vacation. A position in Wellington became available and once the decision was made to take it up, they had 32 days to sell all of their stuff in New York and make the move.

Stephen didn’t really know what he was getting himself into with the New Zealand health system. He wasn’t expecting it to be as modern as the US system, but he what he actually found was actually on a par. He was shocked by his first day working in the Wellington Emergency Department. He recalls that apart from the accents, you wouldn’t be able to tell the difference between Wellington Hospital and any other ER in the US – the skills and the training were probably better and we have all the equipment you would expect to see in a US emergency room. The set up was also very similar in terms of how it was equipped and how it was operated – right down to the staff rostering system.

The only things that were different was the lack belligerent patients on PCP, the heroin overdoses and the people threatening to shoot you, which was a daily occurrence in New York.

It’s All Good

The six months in Wellington was a great experience. So good in fact, that Stephen and his partner pondered why they ever would go back to the US. Sure, the pay was about 50% lower in New Zealand, and the cost of living was about the same, but Stephen had long paid off his student debt in the States, so didn’t need to earn a whole lot. And Stephen was ready for a change. The constant stress, lower staffing levels and the sicker patients in the US weren’t worth thinking about (not to mentioned that he would be up to his eye-balls in COVID-19 patients if he had stayed). So as you do, they bought a house, got dogs and went through the immigration process. This raised a question of what to do with Core Schedule.

By that point, the ER department at Wellington Hospital was their only non-American customer (Stephen was in charge of the roster there and said if he couldn’t use Core Schedule, he wouldn’t do the rostering). Up to then, Stephen had never marketed Core Schedule, so they decided that they should go to a medical conference as a vendor to do so. So Stephen and his husband went to Australasian Emergency Medicine Doctors conference, got a table, and handed out flyers that they had made up the night before.

All In

In that single conference, they doubled the size of the business overnight and started thinking, wow, we actually might be on to something here. They went to that same conference the following year and the exact same thing happened. It was at this stage that Stephen realised that Core Schedule was now too big and running too fast to operate as a hobby business anymore. Eight years in, Stephen knew that he needed to decide what to do with the business. It wasn’t going to work to put a manager in the business, so it was either sell it or fully commit himself.

Realising that he was having more fun doing Core Schedule than clinical medicine, it was time to go into pure start-up mode. Their first New Zealand hire was software developer Richard, who Stephen’s husband had first met in a bar. When they worked out that Richard had php programming experience, he was invited in for an interview. Richard wasn’t sure what he was turning up for – he thought maybe some casual or contracting work. Immediately after the interview he was offered a permanent full-time job on the spot and has been with Core Schedule ever since.

The Build Up

At this stage Stephen was spending most of his time on sales. The next two hires for the business where Vaughan, a business development manager, and Nicole, a finance manager. They found Vaughan through a friend of a friend. And they knew a partner of a doctor that Stephen worked with that had a finance background – that was Nicole. The company had that team for the next year as the business continued to grow. Soon after, they hired a fulltime support person and another software developer. At that stage, there were seven people in total, all working out of Stephen’s home, which kept the costs down. That arrangement lasted for a year before they bit the bullet and moved into their current office. That was two years ago, a time when the company was generating around $200,000 in annual revenues. Since then revenues have more than doubled and in June Core Schedule took its first round of external funding, lead by Punakaiki Fund, along with investment from K1W1 and the Aspire NZ Seed Fund (part of the Government’s NZ Growth Capital Partners). In these COVID times, the company has a unique opportunity to help manage health workers through these stressful times. While selling the Core Schedule software has become harder in the short-term (because of travel restrictions), the future is looking bright for this ex-US start-up.

ACEM Winter Symposium July 2021

The team here at Core Schedule are looking forward to the opportunity to start travelling again and seeing our clients face to face. We are planning to attend a number of conferences this year. The ACEM Winter Symposium is a fixture on our annual conference calendar. Core Schedule was developed by an Emergency Physician, also a FACEM and originally designed specifically for emergency departments. So we really enjoy this conference and catching up with new people and familiar faces.

A hybrid symposium
 
ACEM and the Local Organising Committee will be offering a hybrid Symposium model, which will consist of a face-to-face Symposium in Cairns coupled with an online program so that both in-person and remote delegates can attend. Both options will provide delegates with keynote and invited speakers, oral presentations, workshops, panel discussions, networking opportunities as well as a physical and virtual exhibition.

#acemws21

https://eecw.eventsair.com/acemws21/

NextCare Health Conference 22/23 April 2021

The Australian team at Core Schedule will be attending next months NextCare Health Conference at the Brisbane Convention and Exhibition Centre.

Rescheduled from June 2020, the #NextCare Health Conference will now be held on the 22 & 23 April 2021. The #NextCare Health Conference will combine world-class keynote speakers with engaging concurrent session speakers for two days of extraordinary development and learning for healthcare leaders.

Come and see us at the Core Schedule stand and say hi to the team! We will be running demonstrations of the latest staff scheduling for healthcare as well as giving away some prizes.

Thank you to our customers!

It’s been a huge week here at Core Schedule we have so much to update you all on. Next week we will be publishing our next Newsletter, so stay tuned. But for now, we want to say a huge THANK YOU to our customers. In the last couple of weeks, we have had several enquiries come through from people that has heard about us either on social media, health forums or word of mouth. Hearing this gives us all the warm fuzzies, and while it’s too early to say what it will lead to, it’s certainly made us reflect on a couple of things.
First, great products win. Product design and customer experience are hands down the best tools in the marketing toolkit. No amount of advertising hype will overcome a crappy experience. Core Schedule is a great product and is the most adaptable to suit our client’s needs.
Second, we’re in a long game and patience is our secret weapon. Core Schedule’s sales cycle is long and complex. We try busting down doors but in the end, our customers will make decisions on their own time and probably rely on their peers before they contact us.

If you have ended up on our website or social pages because one of our customers told you to check us out, then WELCOME. If you are already a Core Schedule customer we wan to say it again, THANK YOU!

To find out more or book in a demo, just click on the button above. Also check out our social pages to stay up to date.

Budget & Risk Management in Healthcare Rostering

We all know that the health system is under pressure from all directions and a significant part of that comes down to finding ways to deliver healthcare to meet the expectations of the communities they serve within the very real budget constraints and the prescribed frameworks of compliance and safety. 

With unlimited money and an unlimited supply of staff, it would be way easier, but that’s not how it works. Everyone in healthcare knows that things are tight.

Who does it impact?

Most people working in healthcare see and experience the impact of the problem, but the underlying drivers and solutions are not always as obvious because they are complex and require a system-wide understanding and plan to address them. 

This is an incredibly difficult thing to achieve with the diversity of perspectives and priorities that co-exist with functional divisions and structures within hospitals and the internal competition for scarce resources.

Often what happens when there is a lack of cohesion is that someone makes an executive decision to implement a process or a system that on the surface may seem to make a difference but in reality, does not address the underlying challenges so the problems persist. 

And here is why:

The biggest cost in healthcare is the people. 

The ongoing operational budgets are not blown out in big chunks of thousands or millions of dollars like they could be in a Capital project.

The healthcare budget is blown in tiny increments hour by hour, call-back by call-back and shift by shift. 

The ability to reduce annual leave balances that sit on the balance sheet and eat into operating budgets will stay big while there are no meaningful plans, tools and resources to manage them. And the tool to do that is not an expensive piece of reporting and tracking software dressed up as a leave management solution

Whether the hospital is compliant with the Awards or not has very little to with the HRIS or HR Department.

The ability to meet the obligations regarding patient experience and outcomes in contracts with funders has very little to do with what the contract says and more to do with the number of people and the mix of skills they have when a patient turns up.  

The person actually spending the money, managing the leave, ensuring compliance, and managing the resources to meet patient demand is the person managing the rosters. And they do not get given the right tools to help them do it. 

And what happens, in reality, is that these people carry the burden of budget, risk, compliance, patient outcome and all of the staff related issues from fatigue to training requirements. 

And no matter what the memo says about budget constraints or reduction of leave balances, they have to make the choices and address the priorities with the professional diligence that puts staff and patients first.

The memos about budgets and leave reduction do not come with written permission and instruction to reduce staff levels and increase waiting times for patients, stress levels for staff or permission to override the Awards.

A Timetable is not a Roster

That’s a lot of responsibility for the NUM, Doctor, unit administrator or Medical Workforce Unit to manage on an excel spreadsheet, whiteboard or with a timetable programme mistakenly called a roster system. 

Just to be clear what I mean by that, what most people think of as a roster is actually nothing more than a timetable.  A roster system is something that takes into account all of the variables (skills, finance, compliance, availability, risk, rules, workflows etc) and a timetable is just a report that says who should be at work.  One is a system, the other is a report

SLIDE 8- Transformation

The ability to transform the healthcare system sits in the hands of the people managing the roster at the frontline and the power to enable it to happen sits at the top end of management. 


So if the people with the ability have no power and the people with the power have no ability then the wider system is in a perpetual stalemate situation with very little meaningful progress. The massive filter of “translators” in the middle called the hospital or health system is often so encultured with entrenched beliefs and behaviours that it makes it difficult to get traction. It’s nobody’s fault because everyone is in healthcare shares the same purpose, it’s just difficult to see how to change it when you’re in the middle of it and it feels like a labyrinth. 

The most amazing thing is that you already have all of the ingredients you need to make a difference and you do not need to change your underlying drivers, people, processes, or systems. 

And you already have really smart staff with the desire and ability to make it happen if they have the right tools to help them do it. Everyone is on the same page and wants the same thing. 

You just need Core Schedule to bring it together seamlessly and unlock the data to enable transparent and appropriate rostering that frees up resources and improves performance at all levels.

Streamlining the process 

You don’t need always need a complicated answer to a complicated problem. Sometimes you just need people to understand exactly how complicated it is and see a clear path through it without diminishing it.

There are very few real roster systems on the market and there are plenty of timetables in drag pretending to be, but no other system does or can do what Core Schedule does.

It is because we understand the complexity of the whole health system that we built a tool that is easily tailored to be completely fit for purpose for each individual roster in any unit, no matter how different they are from each other. 

Breaking down silos (Big Picture)

At the same time, we also ensure the needs of others are met – such as the Finance Manager who needs to run forecasts and identify trends, or the HR department ensuring overall Award compliance, or Switchboard knowing who is on call at any given moment in any department.

The reality is with Core Schedule you can transform your healthcare system without disrupting it. 

You can make a massive difference to really big challenges in your organisation if you have the tools to manage the details. As the old saying goes – “look after the pennies and the dollars will take care of themselves”. 

Free rostering software to support Australia & New Zealand COVID-19 Vaccine rollout hubs

Core Schedule is committed to keeping our countries safe and we want to support our public health services in any way we can to help manage the COVID-19 Vaccine programme in a meaningful way. For that reason, we are making our standard Vaccine Clinic Rostering Module available at no charge to help teams manage the public COVID-19 vaccination hubs.

This comprehensive yet uncomplicated system includes many features that provide assistance to administrators and managers of our essential healthcare specialists involved in COVID-19 vaccination clinics. These key features include, but are not limited to:

  • the ability for people in your wider team to self register and indicate their availability
  • confirming team members have the appropriate training,
  • organizing shifts based on people’s credentials and availability,
  • team members being able to view their personal roster in one place while operating across multiple clinics within your vaccination hub.

Further information on this initiative available here:

Roster vs. Timetable

What most people think of as a Roster is really only a Timetable. It is why so many people invest endless hours of processing, juggling, and double-checking everything to ‘run the roster’ to make sure the timetable is right.

Many people who manage the roster to build the timetable have ended up with the responsibility for everything from compliance, to finance, to human resource management and don’t have the right tools to help them do it. It has been a very slow unintentional migration of responsibility in an environment of increased pressure and competition for resources that has for one reason or another not been recognised.

That’s where Core Schedule comes in.

In this webinar we discuss this and share a little of our approach.

Attributes – anything you need and everything you want.

The latest update to Core Schedule Attributes means you have the ability to include any relevant information for your unit and team members. There is no limit to the number of data points, format, the kinds of information you need or the way it can be used in the system.

There are multiple ways attributes are used and appear in the system. For example, they can be shown in the roster, applied to rules, used for reporting, inform contingency plans, track call balances, identify compliance set or exceptions, automate process, place icons, inform unit and organisational risk analysis, or be combined with other data and used for calculations or projections with our advanced analytics tools, to name just a few.

Whether you need to track credential expiry, record every qualification and sub-specialty for every person, need to implement a leave reduction program, capture personal roster preferences, record and manage contract KPIs, or perhaps you want just to want to keep track of the birthday of the pets of the people on the team who have brown eyes and can pilot a helicopter. If you need it, we can include it to any level of detail or hierarchy across any category.

When used in conjunction with our rules, alerts, templates, safety scan, dashboards, reports, analytics and workflows, this information then helps with everything from identifying the person with the exact skill you need to SMS right now, forecasting the cost of your next roster, or knowing who needs to have their Working with Children Certificate renewed in the next 2 months.

Every roster, person, and team are different, and so is Core Schedule. We believe that people should determine what matters to them, not software. It’s essential.

“Why I have a thing for New Zealanders”

“Why I have a thing for New Zealanders… In particular, 9 reasons why I think New Zealand based companies are great to work with”.

I love working for Core Schedule. They are an NZ based company, founded by a New York expat living in Wellington. Now, it’s not the first time I have worked for a successful NZ start-up. A few years back I worked at Xero, a little Accounting SaaS company you might have heard of. Ok, not that little, in fact, Xero has gone on to be one of the most successful Startups of all time and with over 2 million subscribers globally there are no signs of it slowing down. Legend has it that Xero, which was founded by Rod Drury, was done so in an apartment with a dodgy solution for accessing wifi from a nearby café. Running his own business gave Rod insight into just how clunky traditional accounting software was, and after his money arrived from the sale of AfterMail the founding Xero team set out to develop a cloud accounting platform with the first multi-perspective general ledger. And the rest is history.

Core Schedule tackles the challenging and complex areas of healthcare rostering to improve the lives of people working at all levels in the sector. It is another successful company to come out of the thriving New Zealand tech industry. So it got me thinking, why is it thriving? AND why is it that I get drawn into working for NZ tech companies? Well, it probably comes down to aligning to my own personal values of Creativity, Innovation, Love (Care/People First), Adventure and Fun.

So based on that, here is a list of 9 reasons why it is awesome to work with Kiwis:

  1. People First- Well this starts from the top. With a leader like Jacinda Ardern who actually can combine the qualities of empathy and leadership into her role and was also the first world leader to actually take maternity leave whilst in office just proves that people come first in New Zealand.  
  2. Pride stems from culture and community rather than from the self, for Kiwis. Culture is respected and honoured in every gathering so there is a distinct sense of collective responsibility.
  3. I am one of those Aussies who follows Jacinda Ardern on Facebook and I think it is partly because I feel like I am part of a tribe with a tribe leader that is approachable, and that I am part of the family. “Evening everyone, thought I would jump online and just check in with everyone as we all prepare to hunker down for a few weeks,” said the New Zealand leader via Facebook Live as the country prepared for its month-long Covid-19 shutdown. She pointed to her grubby sweatshirt. “It can be a messy business putting a toddler to bed.” There certainly is less ego in the hierarchy and I have felt that across both companies. 
  4. Everyone plays in the band, especially leaders. Singing and dancing are part of life. Both are proven to have positive impacts on mental health and well-being. Xero even had a band for many years and at Core Schedule I have lost count how many times I’ve been asked if I do Karaoke.  
  5. Companies care about purpose. The ‘Why’ factor over profit. Which I believe has much better long term effects for business. 
  6. There is a balance between having fun and being productive. Which leads to even more creativity. 
  7. The country is crazy beautiful, like almost unreal, a work of art perhaps. This seems to flow through into everything. Quirky, colourful, creative people and places. 
  8. Emotion is celebrated in New Zealand. Feelings have value and you are not discouraged to share. I have had several male leaders across both companies get quite emotional at times which once again just highlighted true compassion, empathy and love. 
  9. New Zealand is progressive. As a member of the Aussie LGBTQI+ community, this is something that I have watched with envy from afar. Keep leading the way NZ!

So there you have it, with a list like that why wouldn’t I want to get amongst it. You should too! You don’t need to quit your job or book a flight. There are a bunch of NZ tech companies already doing great things here in Australia and you should definitely consider them in your tech stack.

Jasmin Kelly

Healthcare Roster Specialist

December, 2020.