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Improving Nurse Satisfaction Requires Root Cause Solutions

Pamela Tobias, MS, RHIA, CHDA

Head of Customer Success, iQueue for Infusion Centers

Cancer centers are known to experience midday peaks that can feel chaotic. Most centers schedule patients on a first-come, first-served basis — like taking a reservation — with no insights into the relationship of visits before, during and after this patient, and the many other factors that make an infusion appointment non-deterministic such as how likely other visits are to run short or long, add ons and cancellations.

Under the noble goal of patient satisfaction, schedulers/charge nurses let patients dictate their appointment time. Since most patients want to receive treatment between 10 a.m. and 2 p.m. and chairs are a finite resource, exceeding capacity in the middle of the day is common. This puts unnecessary pressure on your nurses and drives up patient wait times.

For cancer center nurses, it often means slow mornings, “hair on fire” during the middle of the day, and then slow afternoons, punctuated by more-than-occasional overtime. With such a randomized arrangement of appointments in addition the predictable unpredictability of patients arriving late, reactions, patients needing additional supportive care, nurses calling in sick, the pharmacy or lab back ups or the clinics running late, it doesn’t take much to completely blow up the day’s schedule … only to have it happen all over again the next day.

Under such unrelenting odds, it’s easy to understand how, as one oncology nurse put it, “I wake up every morning wondering if today is the day something terrible happens to a patient because I was too busy to do my job right.” Since most nurses enter the profession because they have a passion for caregiving and enjoy spending time with their patients, it’s easy to empathize with nurses on this point and want to find a way to make it better.

The key to improving nurse satisfaction in an infusion center rests not so much in recognizing their efforts (though it’s also a good idea!), but in changing the conditions in which those efforts are undertaken. Instead of just showing appreciation for nurses who routinely miss their lunch breaks, cancer centers can do more to change the working conditions that cause them to miss lunch in the first place.

Applying predictive analytics and machine learning to data from the EHR can create schedules that flatten chair utilization throughout the day to eliminate the “10 a.m.-2 p.m.” chaos just about every center experiences. Flatting the utilization, results in a smooth and manageable flow for your patients and your nurses. Gathering the nursing staff first thing in the morning to preview the day’s workload helps predict and counteract bottlenecks, know where to steer add-ons, anticipate no-shows, and makes each day a little less crazy. Sharing visualizations with the team makes it easier to reliably plan for patient peak times, overcome delays, and let nurses know when to expect time for breaks and lunches. Sure, there will still be days when things go awry, but making those the exception rather than the rule will do more for nurse satisfaction than anything else.

At UCHealth’s 10 infusion centers, LeanTaaS iQueue for Infusion Centers was deployed to improve nurse satisfaction and level-load the workday for a manageable pace. As a result, UCHealth has decreased patient wait times by 33 percent at the peak of the day, accommodated a 14 percent increase in patient volume, and reduced overtime hours by 28 percent.

Utilization Curve Before

uch curve before
  • Frequent “mid-day” peaks and slow mornings and evenings
  • Frequent overflow in waiting rooms – long patient waiting times

Utilization Curve After

uch curve before
  • Even workload throughout the day allows for more predictable schedules
  • Unlock capacity to help deal with unexpected delays and add-ons


The following results were calculated by comparing the six month period post-iQueue launch to the analogous six months in the previous calendar year.

LOWER Waiting Times at Peak Hours
LOWER Average Waiting Time
HIGHER Patient Volumes
LOWER Overtime Hours
See how iQueue for Infusion Centers helps you optimize operations
Download the 5-Step guide to flattening daily chair utilization

Find out how your peers are alleviating the nurse burnout issue

UC Health

Resource optimization at UCHealth Cancer Center was failing, leaving nurses to work extended and overtime hours on a regular basis:

After iQueue:


Reduction in overtime hours

Patient volume increases at Huntsman Cancer Institute meant peak time capacity was regularly exceeded, which negatively impacted wait times and nurse satisfaction.

After iQueue:


Days over capacity

Stanford partnered with LeanTaaS to jointly develop iQueue for Infusion Centers and deployed it at one of its 60 chair centers to create optimized infusion scheduling templates.

After iQueue:


Higher percentile points in Nursing Satisfaction

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