At the Transform Virtual Hospital Operations Summit in December 2022, Andrew Graham DNP, RN, PCCN-K, Director – Outpatient Oncology and Infusion, NewYork-Presbyterian Brooklyn Methodist Hospital, and Adam Neiberger, MPH, Quality & Performance Improvement Manager, University of Kansas Cancer Center, each discussed their organization’s deployment of Queue for Infusion Centers to achieve cancer center optimization.
When AI is the answer: streamlining infusion operations in a growing community site and across a statewide academic cancer center
Park Slope-based Brooklyn Methodist Hospital (Methodist) is newly integrated within the NewYork-Presbyterian system. In 2021, to expand its footprint of quality patient care in the community, Methodist opened a new 35-chair infusion center to supplement its original 16-chair site. Leaders and staff had to rapidly redefine success in a much larger space, and transform their day-to-day work to support level loaded schedules and safe nurse-patient ratios – in the midst of the Omicron variant of COVID.
Located in the Kansas City metropolitan area, The University of Kansas Cancer Center (KU Cancer Center) has an annual patient caseload of 6,300. KU Cancer Center adopted a lean methodology in 2015 and maintains this approach to continually expand its scope and quality toward full cancer center optimization. In 2019, KU Cancer Center focused its lean principles on optimizing its large infusion value stream, which performs an annual 120,000 visits in 160 chairs and beds throughout seven locations.
Both organizations, despite their very different scopes, deployed the AI solution iQueue for Infusion Centers to support their growth and efficiency goals, and both achieved similar success. Brooklyn Methodist’s Andrew Graham, who oversaw implementation on his site in 2021, and KU Cancer Center’s Adam Neiberger, who led go-lives in infusion sites throughout his cancer center from 2019 to 2022, shared key learnings from their journeys socializing iQueue among their stakeholders and fulfilling the potential of AI in infusion operations.
Change management lessons from adopting iQueue for Infusion Centers for cancer center optimization
1. When deploying iQueue, involve all levels of infusion staff as collaborators and build the foundation for success
Graham: Setting up standardization and best practices as early as you can is key. As we adopt new technology, we’re making sure our schedulers have the support, the training, the understanding, the oversight to ensure we’re doing everything right in the first place…It’s all about making small changes, getting takeaways using your pilot program, and listening to the staff about what that impact has been.
At Methodist, we developed cheat sheets and ground rules. We met with our staff, and had clear and consistent messages from them about what we needed to run most efficiently. We want to listen to the staff and collaborate with them. We can all agree that working in healthcare the last couple years has not been the most fun. We want to embody the “you talk, we listen” mentality, and celebrate the small wins. We’ll start small, get feedback and see what we can do to continue moving in the right direction. We won’t make big wins overnight. We have to make sure we’re doing things right now in order to do things right in the long run.
Neiberger: We were at an advantage, as many individuals in our institution were frustrated with our current process and looking for a change. But my experience in change management is that first and foremost, you should assess what and who will be impacted, then invite them to the table. Work with them to help them better understand the ask or the impact.
We partnered with the nurse manager, the charge nurses, the frontline staff, or our medical assistants. We also made sure our physician leaders were aware of the changes that were relevant to them. Although we were all hungry for change, we wanted to be mindful and tactful about our changes and understand their ripple effect.
We always want to emphasize that patient care is of primary importance. From the frontline staff’s perspective we want to build in as much mistake-proofing as we can, making it as simple as possible to adhere to the process that we put in place, walking through standard work on how we schedule an appointment and making sure we’re scheduling it right the first time, and trying to avoid those mistakes so that there’s less re-correction on the backend.
2. To get buy-in from leadership, both in the infusion space and across the cancer center, leverage iQueue’s ability to deliver accurate, consistent, and relevant data
Graham: For hospital administrators or other non-oncology nursing leaders, an infusion center can seem a little abstract. They might look at a schedule and assume a patient should only have a half hour slot, but not realize added needs like inserting an IV, doing hydration, or post meds. A solution like iQueue, and a partner like LeanTaaS helps you speak to that information, adding those cushions or factoring in for lunch breaks, which to achieve results like recruiting and retaining nursing staff is key right now.
As we’re expanding, iQueue helps leadership better understand the phase in process, as well as the target numbers, completed infusions appointments and their types, and granular information like chair turnover and wait times. Now, rather than applying anecdotal data, leadership has that overall data to help us move in the right direction or advocate for additional resources, whatever can speak to wait times or patient dissatisfaction. Having that within the iQueue dashboard is tremendously helpful.
Neiberger: Leadership were some of the original adopters who bought into iQueue. Then it was a matter of cascading our metrics, regularly discussing not just schedule template compliance, but template utilization, all the way up to the senior executive leadership level. This helps us make the case for additional resources, for example, construction or additional nurses for certain sites.
The capacity analysis really helps demonstrate that not only is this frontline work of scheduling and adhering to that template, but we are increasing that capacity and volume. We can show leadership we’re seeing these additional patients, and we need those additional resources for even more patients as our clinics grow.
3. Execute the change management through an ongoing, people-driven process that maintains input of both staff and leadership
Graham: When we partnered with iQueue, we did a lot of huddles. We looked at ways we could improve our templates, apply actual and anecdotal data, and listen to the staff about progress. We asked, “Are we getting lunch breaks? Are today’s schedules less choppy? Are the mornings less busy?” We also used the daily huddle aspects within our dashboard to give out nurses assignments, which was a positive factor at that time.
To help the scheduling and nursing teams adapt to the new scheduling guidelines, we provided frequent support in the form of meetings and check-ins, making sure everyone was on the same page and relaying best practices we’d found. It took a lot of patience, partnership, and collaboration. Numerous times I would go sit next to the check-in staff and work with them, partner with them, and then work very close to the charge nurses and understand how the day went.
Where did we find log jams? Did everyone take their lunches? What’s some of the anecdotal feedback we can take back to the iQueue team? It’s a little bit about being boots on the ground, being visible, a lot of collaboration, and it was kind of fun. That’s what I would say, is to really immerse yourself into the day-to-day, the granular, being in the weeds. That’s the only way you’ll get a true, valuable experience.
Neiberger: At the core of our lean principles are both our daily huddles and the visibility to those huddles across the leadership structures in the health system…making performance visible to the sponsors, process owners, frontline leaders, clinicians and staff. In this way, we can continually test our “Plan, Do, Check, Act,” plan, or PDCA, to see whether certain interventions are successful at getting us closer to achieving our goals.
Respect for people is perhaps the most important key tenet. We emphasize being always hard on the process, easy on the people. Very little of the value to the patient comes from the meeting rooms and boardroom, so it’s important for us to get to the floor and observe the work people are doing. Throughout the implementation of iQueue for Infusion Centers, it was critical to sit with our schedulers, nurses, and patients, and observe the challenges faced during the implementation.
We also like to emphasize coaching and specifically a coaching kata, kata being a Japanese term from martial arts that roughly translates to muscle memory, practicing a move over and over until it becomes automatic thinking. For our coaching kata, we try to emphasize and repeat four specific questions:
- What is our goal?
- What is the current condition?
- What are our next steps to get closer to achieving our goal?
- When can we observe that the next step has been successful?
There were different concerns at different community sites, different experiences with the patients, and different needs with patients from our clinical research center vs. our small community sites. We sat with the schedulers and asked about the challenges they were facing, what they were hearing from the patients, providers, and nursing teams. I can’t emphasize enough how going, observing, sitting, and seeing the work being done is an important part of the implementation process.
Results: Brooklyn Methodist’s sustainable growth and KU Cancer Center’s optimization
At Methodist, deploying technology to support the first steps of schedule optimization resulted in improved patient satisfaction and nurse-patient ratios, despite the adjustment to the infusion center’s expansion. This clear impact encouraged leadership and staff to continue utilizing the solution to achieve further positive results. Methodist performed 1,100 infusions in October 2022, compared to 823 in January 2022, and continues to maintain its increased appointment loads.
KU Cancer Center’s adherence to lean principles yielded value from iQueue in a short timeline. When the implementation began in 2019, leadership’s goals for iQueue infusion schedule template compliance across all sites were 80 to 85%. By the time iQueue was live in all seven sites in 2022, the average compliance rate was 95%. An average template utilization rate of 90%, meaning schedule templates were almost completely filled by completed patient visits, showed a clearly efficient use of resources to support full cancer center optimization.
For the complete conversations on how each organization implemented iQueue for Infusion Centers successfully and more on their day-to-day methods, view Graham’s session on New York Presbyterian Brooklyn Methodist’s expansion here and Neiberger’s session on KU Cancer Center’s optimization here.
