Infusion centers endure notoriously chaotic days; it only takes one delayed patient, one negative drug reaction, or one missing staff member to throw the entire schedule into disarray. Every morning, as members of the operational and nursing teams walk into an infusion center, the common prevailing thought is: What can we do to make today run smoothly? The scheduling team has already completed the schedule; the book is set and the center is facing what it’s facing, and the emphasis is on the day’s flow.
But of course, improvement in how the day runs isn’t needed just today. What can be done to ensure both today and future days run as smoothly as possible in the infusion center? Beyond optimizing the schedule, the most effective answers are found in establishing improved and consistent communication processes to empower operational and nursing teams, scheduling teams and patients.
3 common problems for infusion centers
Regardless of the healthcare system or where it sits in the country, infusion centers face three relatively common challenges:
- Patients tend to wait a long time for their infusion appointments – especially in the middle of the day
- Chair utilization typically starts out low and ends low, but has a midday peak that is often at or above full chair capacity virtually every weekday
- Infusion nurses often miss their lunch and breaks several times each week, have high levels of overtime, and frequently receive emergency callbacks during their time off
Solving for these common problems is a difficult juggling act, requiring a balance between patient demand, nursing and pharmacy resources, and infusion chair capacity, all within the context of highly-variable oncology clinic appointments and other services patients need, like labs and radiology.
Before looking to the future, let’s talk about how we can address the challenges of the present.
Ensuring the present day runs smoothly
Ensuring the current day runs smoothly requires accepting the fact that one variable has been firmly set and cannot be adjusted, and that’s the schedule on the calendar. Appointment scheduling – so fundamental to the operational health of an infusion center – is no longer an input lever to adjust, but rather the framework for the way the rest of the variables have to be managed for the day.
Like in many service industries, a key best practice is to conduct a brief huddle with the staff at the very start of the shift. This isn’t a 15- or 30-minute meeting that will set everyone behind for the rest of the day. Rather, it is a quick, concise 2-3 minute joint briefing to talk through how the day is likely to unfold and allow for the formulation and coordination of preliminary plans to manage it. Daily huddles should cover the following:
- Identifying the best times to take lunches and other breaks
- Calling out times that it will be most possible to take add-on appointments, as well as times when it will be more difficult
- Identifying pockets of time when it will likely be either helpful or detrimental to bring patients back early
- Communicating any staffing concerns or known issues to the nursing team
There are tools, like iQueue for Infusion Centers, that provide a snapshot of the day’s scheduled appointments and prove helpful as resources in guiding the morning huddle. With regards to the schedule, the impact of seating patients early often produces somewhat counterintuitive results, as resources get used when they’ll be needed later for other patients and add-on cases. When a schedule looks good, don’t seat patients early. However, if there are peaks and valleys anticipated throughout the day and you can bring forward part of one peak to help fill a valley, then it’s possible to smooth out the day. Be clear in the huddle on what times of day will be beneficial to bring patients back early.
In addition to the nursing and pharmacy staff, it’s important to proactively bridge the communication gap between the nurses and the clinic team, highlighting the identified times in the day where it is more feasible to absorb last-minute, add-on treatments to the scheduling team. Finally, communicate with the front desk staff if it appears likely a bottleneck will occur at certain times of the day, thus empowering the entire organization to communicate with patients as appropriate, whether at check-in at the front desk or through other patient communication tools and processes.
Setting expectations for all stakeholders – staff and patients, allows all parties to feel as though they have some degree of control. And, once the current day is set to run on a relatively smooth course, the infusion center can then look ahead to smoothing out future dates on its near-term calendar.
Proactively planning for smoother operations
In planning for future days, there realistically isn’t much wiggle room in the very next day’s schedule. There might be a little ability to influence where the last few appointments will be slotted, but for the most part, the book is set.
Bigger opportunities to push and pull upon scheduling levers lie two-plus days into the future, and include:
- Identifying days coming up soon where all chairs are planned to be full or beyond full for more than 30-40 minutes at a time
- Rescheduling a modest number of patients to different times or locations to prevent bottlenecks from forming
- Closing scheduling for parts of days, or perhaps entire days, when chair utilization is especially high
- Identifying future days where planned utilization is heavier than expected, and monitor closely as the day approaches
When hotspots where high chair utilization are seen on the horizon, and the decision has been made that it’s worth the effort to attempt to move some patients, start with patients who might be flexible and try to reschedule a modest number. For example, if patients don’t have a clinic visit or other activities on the same day of their infusion, attempt to move a couple of them from high utilization times to lower utilization times, influencing the operational and patient care efficiency of your future day before arriving at it.
Alternatively, if it’s not worth the effort to reschedule patients or if no easily moved patients are identified, close down scheduling for the parts of the day that are already at or over capacity, diverting demand toward times when resources are more readily available.
Lastly, of course, based on the scheduled patient demand, consider flexible scheduling of staff to best accommodate expected fluctuations in utilization. Pull some shifts forward while pushing other shifts back, but ensure there is common overlap and a full staff available for those high-utilization peak hours.
Mid-range operational planning for smooth days
Just as effective communication is necessary for the schedule grooming efforts reviewed above, it is equally as important in operationally planning for smooth days far in advance, and that begins at the scheduling desk, with both physicians and patients. An important best practice to integrate is to ensure consistent messaging over time, eliminating the occurrences where patients hear one thing from a particular scheduler and quite the other from another scheduler. Provide specific scripting recommendations or guidance to maintain on-point messaging and deliver consistent patient experiences.
Additional best practices for fine-tuning the scheduling function to better schedule smoothly running days include the following:
- Training the scheduling team to start patient conversations by offering up a set of appointment options, rather than asking what times work best for the patient
- Initially offer options that tend to be the most difficult to fill
- Aim to book non-linked appointments toward the edges of the day, either early or late
- Scripting for likely scenarios that schedulers will encounter
- Reduce heat-of-the-moment pressure to balance patient-centricity with good booking practices
- Build an environment where patients receive consistent messaging
Schedulers often face trade-offs when attempting to select the optimal time for appointments linked and coordinated with other services, like clinic appointments. If the infusion appointment is too early, the patient may arrive late and contribute to a bottleneck in the infusion center. On the other hand, if the infusion time is scheduled too late, the patient may need to wait for an extended period.
Then, of course, delays from clinic visits or labs vary from provider to provider, across days of the week, and by the time of time of day. Thus, another best practice is to develop appropriate guidelines for how much time to leave between clinic and infusion visits, and clearly define the acceptable range across the entire portfolio of patients – a single fixed window is usually the wrong answer.
Finally, tightly define the process for overbooking, and don’t leave it to chance. Either provide specific guidance to schedulers on how to overbook when needed, or establish specific protocols around when to escalate to managers; for example, every time an open spot can’t be found right away, or when the schedule reaches a predetermined level of fullness.
Communication best practices for infusion centers
Effectively smoothing out today’s schedule, grooming the short-term schedule and planning the mid-range schedule requires a convergence of people, processes and technology tools.
Ensuring each time period – today, the next week, and the next month – runs smoothly requires a strong foundation across all three structural pillars.
Engage the power of the organization’s people in problem-solving and building the optimal service delivery model that works for both patients and staff. Create processes to increase the frequency and improve the communication throughout the entire organization, both intra-team and across teams, and train associates with the necessary communication skills as necessary. Provide access to the data and tools required for staff members to make a maximum impact.
With essential tools and processes in hand, infusion center personnel are empowered and enabled to optimize operations to increase patient access, decrease wait times, improve overall staff satisfaction, and reduce healthcare delivery cost.
For additional information on how to make the most of your infusion center resources while managing through a minimal set of challenges and obstacles, be sure to watch the recorded webinar on demand, “The Daily Huddle: Best Practices for Ensuring a Smooth Day with Regular Communications.”