A growing demand, a strained process
City of Hope Corona‘s outpatient infusion center serves a wide and diverse patient population, many traveling long distances for cancer care, hematology treatments, and supportive therapies. As one of the more geographically accessible sites in the City of Hope network, demand for services continues to grow.
But with that growth came operational challenges.
Previously, patient assignments were made manually the prior afternoon. Charge nurses would review the schedule, calculate patient acuity, and divide assignments as evenly as possible across the team. While thoughtful in design, the reality of the day rarely matched the plan.
Patients arrived early or late. Treatments took longer than expected. Reactions occurred. And when even one variable changed, the entire system became difficult to manage.
For nurses, this often meant juggling multiple competing priorities at once, caring for a current patient while anticipating others already waiting. Breaks were harder to coordinate, and workloads could quickly become uneven.
As a result, stress levels increased and flexibility decreased. Nurses had limited control over their day, even though they were the ones closest to the patient experience.
Rethinking the model: Introducing Nurse Pull
IIn March of 2025, the team decided to try something different. Instead of continuing with a fully pre-assigned model, the center implemented the Nurse Pull approach using LeanTaaS’ iQueue for Infusion Centers. While they were initially hesitant – especially given tight staffing – the team quickly saw the potential for a more flexible, team-driven workflow.
Today, the process is a hybrid model:
- Each nurse is assigned an initial patient to start the day
- Certain complex treatments (like first-cycle therapies) are pre-assigned
- After that, nurses “pull” their next patient when they are ready
As patients check in, they appear in iQueue. Nurses can see how long it has been since each team member last pulled a patient, helping ensure fairness. From there, the next available nurse selects the patient based on their current workload and readiness.
This shift reduced the need for charge nurses to step in and adjust assignments as the day changed. Instead, decision-making moved closer to the point of care.
Empowering nurses at the frontline
One of the most meaningful changes has been the increase in nurse autonomy, but one notable outcome was how quickly the team embraced it.
One early concern was whether nurses would hesitate to take on patients without being assigned. In practice, the opposite proved true. Nurses were often eager to pull their next patient as soon as they were ready – what staff informally described as a kind of “feeding frenzy.” Rather than waiting to be told what to do, nurses actively stepped up, assessed their capacity in real time, and kept the day moving.
That behavior is rooted in autonomy. Instead of being assigned patients regardless of their current workload, nurses now determine when they are ready to take on the next patient. This allows them to plan their time based on the complexity of care in front of them.
For example, a nurse managing a patient with multiple pre-medications may need more time before taking another patient, while another nurse in a lighter moment can step in more quickly. According to staff feedback, this flexibility reduced the pressure of “what’s next” and created a greater sense of control.
At the same time, accountability across the team has increased. Because everyone can see the flow of patients and who is pulling, nurses are more aware of each other’s workload and step in accordingly. The result is a stronger sense of shared responsibility, one where autonomy and teamwork go hand in hand.
A new role for charge nurses
Importantly, the Nurse Pull approach has also shifted the role of the charge nurse.
Instead of focusing on constant assignment decisions, charge nurses now have greater visibility into real-time operations and more capacity to support the team directly.
They can quickly identify when a nurse hasn’t pulled in a while, check in to see if support is needed, and step in to help when necessary.
This shift has allowed charge nurses to spend more time on the floor supporting patient care, troubleshooting issues, and ensuring smooth operations, rather than managing assignments from behind a desk.
Smoother days for nurses and patients
The operational impact has been noticeable.
Staff reported lower stress levels and improved ability to manage their time, including taking breaks more consistently. Because they are no longer locked into a fixed assignment, they can adapt in real time when patients arrive late, require additional care, or experience reactions.
The changes also affected the patient experience.
Instead of waiting for a specific assigned nurse to become available, any available nurse can bring them back. Staff observed shorter wait times and a more seamless experience from check-in to treatment.
In fact, even during periods of sudden patient surges – like when a nursing strike at neighboring infusion center drove a significant influx of new patients to Corona – the workflow continued to function effectively, allowing them to absorb higher volumes without sacrificing efficiency or experience.
Supporting the transition
Implementing a new workflow required coordination between operational leaders, frontline staff, and the LeanTaaS team supporting the rollout.
During implementation, the teams collaborated through regular check-ins, workflow discussions, and go-live support to adapt the process to City of Hope Corona’s specific environment.
Rather than applying a fixed model, the approach evolved over time based on staff feedback and operational needs, ultimately resulting in the hybrid workflow used today.
Within several weeks, the team had refined the process and established a sustainable approach to managing patient assignments.
Building a stronger, more collaborative team
Perhaps most importantly, Nurse Pull has strengthened the team dynamic.
Rather than working in silos, nurses now have greater visibility into each other’s workload and actively support one another throughout the day. Decisions are made in the moment, based on what’s best for both the patient and the team.
Staff described a more collaborative environment with greater shared visibility and accountability across the team.
Lessons from the experience
The City of Hope Corona team found that introducing a Nurse Pull workflow required adjustment, particularly in a fast-paced clinical environment where staff were accustomed to pre-assigned patient loads.
Starting with a limited trial period and incorporating ongoing staff feedback helped support adoption and refine the process over time. What began as a short-term pilot ultimately became part of the center’s ongoing operational approach as the team worked to balance growing demand, staff workload, and patient flow.
As demand for infusion services continues to grow, this new staffing model enhances City of Hope Corona’s goals to deliver high-quality care more efficiently and more collaboratively well into the future.
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Are you a customer interested in bringing the Nurse Pull method of assigning patients to your center? Contact your Customer Success liason!
