The Winter 2021 LeanTaaS Transform Hospital Operations Virtual Summit featured a conversation between Emily McCambridge Kowalski, Patient Access Operations Manager — Infusion, Fred Hutchinson “Fred Hutch” Cancer Center, and Armand Indra, Product Implementation and Customer Success Manager at LeanTaaS, on Fred Hutch Cancer Center’s ongoing success in infusion center scheduling optimization to the benefit of nurses, staff, and patients. Results have included 3 to 4 hours saved for staff on scheduling per day, and an 80% reduction in the patient appointment waitlist.
Missed the event? We’ve got the details below, or view the full session here.
The context:
Fred Hutchinson “Fred Hutch” Cancer Center is a unified adult cancer research and care center that is clinically integrated with University of Washington (UW) Medicine and UW Medicine’s cancer program. It serves a diverse patient population with a heavy focus on clinical trials, including conducting Phase One through Four clinical trials on its main campus.
As Patient Access Operations Manager, Emily McCambridge Kowalski, MHA, oversees Infusion scheduling and works closely with the patient access staff and nursing team to support the Infusion and Clinical Trials operations.
One of Fred Hutch Cancer Center’s biggest pain points pre-COVID was its nursing assignment process. This was entirely manual, handwritten in pencil the afternoon before, and took on average four hours to complete. Changes and cancellations were not easy to manage. Patient names had to be erased and redistributed, with morning sick calls taking additional time for the morning charge nurse.
Subsequent challenges included long wait times for patients, midday peaks in scheduling, and staff burnout. During peak COVID-19, the challenges grew to encompass staffing limitations, relocation of administrative staff off-site, and expanding hours and services to deal with the surge.
Fred Hutch Cancer Center’s infusion scheduling optimization:
At the start of COVID-19 in March 2020, Fred Hutch Cancer Center implemented the nurse allocation feature then offered by iQueue for Infusion Centers. iQueue auto-distributed patients across available nurses. Then the charge nurse could look at specialty skills and acuity distribution, making any final adjustments needed to the schedule. The change in the assignment process freed up three to five hours of nursing time, which could be redistributed to other uses.
As a downstream result of the pandemic, the Fred Hutch Cancer Center’s infusion team extended operating hours and added new services to help decamp patients from the ER and the hospital. They also implemented a COVID hotline and testing center. All these changes were made with no additional staff. To be more equitable and agile with their staffing, Fred Hutch Cancer Center further used iQueue’s nurse allocation feature to divide nurses into pods. Due to different scheduling practices, the schedule was split between hematology BMT patients and general oncology patients.
By pooling these resources together using the nursing allocation feature, they were able to mix infusion and hydration patients more evenly with heavier chemo regimens without needing to alter their scheduling practice. It also led to a more balanced workload for support staff.
Fred Hutch Cancer Center also worked with their LeanTaaS partners to improve capacity management and infusion scheduling optimization to alleviate a growing patient volume. LeanTaaS identified Tuesdays as an area of optimization for scheduling. Fred Hutch Cancer Center also implemented different scripting to align with best practices. Historically, schedulers asked patients what time they prefer to come in. If that time was not available, they would add them to a waitlist. Now they are offering patients a choice of different available appointments to avoid the waitlist process entirely. After this scripting change, it took Fred Hutch Cancer Center’s waitlist from an average of 500 patients within a three-month period to a low of under 100.
Fred Hutch Cancer Center also participated in LeanTaaS’ customer advisory board, which allowed them to provide feedback and gain insights into new features.
The results:
Since March 2020, Fred Hutch Cancer Center Infusion Center has seen:
- Level loading resulting in an 80% reduction of waitlist
- A more even distribution of acuity and treatment types
- Better utilization of resources and space
- 3-4 hours saved every day on nursing assignment scheduling
- Balanced workload across the week, especially on Tuesday
- Improved chair utilization, flattening the peak between 10am – 2pm
- A more accurate view of nursing availability with added or canceled treatment thanks to real time data
What others can learn from Fred Hutch Cancer Center’s:
- Long wait times, midday peaks with low chair utilization early and late in the day, and staff burnout are common challenges for infusion centers — with common solutions.
- Fred Hutch Cancer Center worked closely with LeanTaaS to solve for these challenges, using a three-step approach:
- Optimize algorithms to deploy a better scheduling template
- Use forward-looking analytics to solve problems before they happen
- Monitor actual vs. expected performance to pinpoint opportunities for improvements in templates.
- Identifying and addressing the actual problems can lead to improved patient access, a better nurse workload across the week, and improved utilization of resources overall.
