BRIDGETT ROELL: Hi, there. This is Bridget Roell. I’m one of the Senior Product managers on the iQueue for Infusion Centers product.
LEAH SELIGMAN: I’m Leah Seligman, I’m a product manager on the iQueue for Infusion Centers Product.
BRIDGETT ROELL: OK. Today, we’ll be discussing how to manage your infusion demand across your physical spaces. So whether you’re infusion centers are physically isolated from each other, or you’re managing one large space by trying to divide it up into pods or some sort of segments, we’ll be talking t the [? stuff ?] side consideration for making a long term plan as well as strategies for managing your operations day to day. So before we dive in to today’s topic, a little bit more about us. My name again is Bridget Roell.
LEAH SELIGMAN: And. I’m Leah Seligman.
BRIDGETT ROELL: And we’re both product managers on the iQueue for Infusion Centers Product. A big part of our role is working with customers throughout the implementation process as well as providing ongoing support once everything is up and running. Both of us have worked with a wide variety of health systems and infusion centers, many of whom have faced this issue of managing segmentation efficiently. So let’s jump in. The patient supply demand problem for infusion centers is essentially making sure that your patient demand can fit within your infusion center resources, which includes both nurses and chairs. The way this starts to become especially complicated is when there’s a division in any of these populations. So let’s start with a pretty basic example, where your infusion chairs are physically divided. Now this might be two different floors in the same building, separate buildings altogether, or them distinct areas on the same floor that are separated by some sort of physical barrier, whether it’s a pharmacy or a break room or something else that kind of divides the two areas.
In any of these situations, there is a pretty obvious need to divide your nurses across the areas as well. So it’s clearly not feasible to have the same nurse running from one floor to– or building to another to treat their patients. So now that we’ve kind established we have two separate distinct areas, we also need to divide the patient demand across these two spaces. So if we assume that both spaces are equally capable of handling any patient, you can simply divide your patient population as you schedule them, really aiming to balance the overall demand across the two spaces as the schedule [INAUDIBLE] that. In some cases, the division isn’t typical, maybe it’s based on the skill set of your staff. So maybe you have one infusion area and a set of nurses, but one of your staff members is an LPN or MA that can only work with a subset of your population.
So in this situation, you might feel the need to dedicate some of your care resources for the staff member, and you need to decide if it makes sense for them to have one or two chairs to work with. Here, evaluating the size of your patient demand is really key to ensuring that your physical resources are well utilized. You might even find that the answer requires you to be a bit flexible, where you might dedicate two chairs throughout the morning and just one in the afternoon. Now this example can also be applied to other virtual segmentation beyond some form of abstract area like this one. For example, if your patients and staff are divided by disease groups but are still treated within the same physical space. In many cases, infusion centers say some combination of these scenarios where there is a need to evaluate how to divide your virtual groupings into the physical spaces. So let’s say your patient population can be divided into three segments– medical oncology, hematology, and clinical trials. Now maybe your staff is also divided into these specializations, and on top of that, you have two distinct infusion areas where you can treat patients.
Here evaluating your patient demand across each segmentation can help you decide what is the best way to group your patients into each area so that the supply of infusion chairs and nurses is well matched with that demand. Before we dive into a more specific example, let’s talk a bit about the general pros and cons of segmentation. So one obvious benefit to segmenting your patient population is specialization. It can really allow nurses to become especially familiar with a specific disease groups or treatments and not as obviously helpful for them. However, it’s important to consider the trade-off and efficiency when there’s too much segmentation. So dividing your patient population into very small groups often results in the demands from each segment becoming extremely variable, which in turn makes the regular allocation of resources more difficult. Ideally, you can strike the right balance between the two by only grouping as much as is truly necessary. This means pooling your resources where possible, and potentially frustrating your nurses in order to build more flexibility into the system, which can in turn increase your overall operational efficiency. Now let’s talk through an example. So the first step in finding the right match between the supply of your infusion center resources and the demand of your patient population is quantifying your supply. Here we have two infusion units. One is slightly larger than the other. Both open at 8:00 AM.
They ramp up throughout the morning. They fall for most of the day, and ramp down at the end of the day it’s close at 6:00 PM. We’ve roughly calculated the number of daily patient hours that can fit within each unit here with the total supply being about 280 hours. The next step is to understand the possible segments of your demand. So in this example, we’ve divided by cheap and tight. And we could quantify the typical demand for each group in patient hours. As you can see the upper end of the total demand here is about 270 hours, so it’s a pretty good notch for that supply. Now that we’ve quantified both the supply and the demand, we can decide on the best way to group the treatment types to fit within each unit. Here we can see that grouping either clinical trials or blood products with the chemotherapy treatments would fit nicely within unit 1. In which case you can decide which one makes more sense from a broader perspective.
We’ve decided to group effort two together in unit 1, keeping the clinical trials with the chemotherapies since that will likely be more feasible from a cross training perspective. And that leaves us with blood products and non-oncology which also fit nicely into unit 2. Now obviously, not all cases will be as clearly cut. Here, we’ve adjusted the number of chairs in each unit slightly, but the total available patient hours remains the same at about 280. So what we find here is that we can still group the first two treatments types together– the chemotherapy and the clinical trials, and put them into unit 1. We have a little bit more space left in there, and we’ll talk about how we want to use that in a moment.
Now if we look at the blood products and the non-oncology treatments on the lower days, we have about 90 patient hours, which could feasibly fit within unit 2. However, there would be some days where the total demand across these two segments would be too high for unit 2 alone. In this case, it would likely make sense to prioritize keeping the non-oncology treatments in unit 2 but being a little bit flexible with where the blood products are scheduled based on the overall demand each day. This flexibility will allow you to ensure that those units flow smoothly and are well utilized. So now that you’ve made your plan, how can you effectively manage it on a day to day basis? I’m going to talk things over to Leah so that she can walk us through it.
LEAH SELIGMAN: So the first approach to implementing or segmentation strategy is merely looking according to your plan. So we all know that increasing demand can be variable. It would be inefficient to have one of your treatment areas have idle chairs or nurses while the other has an extremely high workload. There are a few ways to adjust for this variable demand to make sure that your operations are running as smoothly as possible. So two ways to do that include reshaping your demand ahead of time before the day of treatment as well as managing your schedules on the day-of. So we’ll start with making adjustments ahead of time in order to manage your plan. In order to reshape your demand ahead of time, it’s important to see the big picture of how your schedules are filling up. You can look ahead to see if your treatment areas are filling up again in an unbalanced way.
One way to do that in the iQueue application is with a multi unit called a calendar which is pictured here. You can see one week as your schedule of care utilization across multiple areas making it easy to visualize when certain schedules are filling up faster than others. So in this case of pictured here, it looks like. Thursday and Friday are filling up a bit faster in the treatment unit 1 in the first row rather than treatment area 2, where Tuesday looks like it’s actually the opposite. So when you identified the day where one schedule is filling up faster than another, are you finding that your schedulers are needing to overbook frequently, it might be time to start scheduling patients not strictly according to your segmentation plan. Even if there are clinical factors and patient preferences factoring into where you would initially try to schedule the patients, remember that putting a patient onto an empty your schedule may lead to a significant reduction in wait times, which is also an important factor in patient satisfaction. It might also affect the wait times of other patients scheduled in this area around this time. So scheduling a patient in a slightly less preferable area might actually lead to more optimal outcomes. Another way to reshape your demand is to clear your schedule which involves moving patients across treatment areas even after their appointments and schedules.
You need to evaluate which patients will have the biggest impact on your day if they were to be treated elsewhere so that you only contact and disrupt the plan for a few patients as is necessary. You want to target patients that are scheduled for the largest portion of the busiest part of your day in order to have the biggest impact, which in this case and treatment unit 1 looks like a mid-morning. In this case, moving a three-hour appointment as scheduled right at 10. AM in treatment unit 1 from treatment unit 2 will help reduce the schedule chair utilization during this entire busy period, and it looks like there is capacity in the other unit to treat these patients. One way I can help you do this is what the schedule shifter, which is shown here. The schedule shifter identifies which appointments are good candidates to shift and ranks them according to the impact that moving this appointment would have on your day as you can see on this list you’re on the right.
This way, you can move a few patients to have a large impact on your day. I recommend reshaping your demand ahead of time, it’s also possible to strategically manage your demands on your day-off. If you’re segmentation strategy involves physical spaces, if you can wait until the patient actually arrives since you have to decide if they should be moved to an alternating treatment area, at this point, you can make the most informed decision to match your current supply with your actual demand based on how the day is unfolding. Perhaps a no show or a same day cancellation has even opened up the capacity needed to treat this patient in their preferred treatment area. There are different factors that could prevent this from being feasible and for treatment area are served by separate pharmacies, or a further apart from each other so that your patients would need to know where to go right ahead of time, or maybe the physician needs to know ahead of time where the patient will be treated in infusion. If this is the case, try to see if there is a process you can implement to allow you to adjust a patient’s treatment area once they arrive.
Perhaps in separate pharmacies or pharmacy the present processes are your limiting factor, perhaps you can utilize a pharmacy runner to deliver the medication to the patients correct treatment area. If the patient needs to know where to arrive ahead of time, perhaps utilizing a shared check-in process between treatment areas, or increasing communications between the checking staff, or the check in fact can instruct the patient to go to a close by alternate treatment area that would have lower wait time. If your segmentation strategy involves virtual grouping, you might even have the flexibility to flex your resources to respond to current demand, and maybe even just buy part of the day.
For example, using this similar segmentation strategy that Bridgett shared earlier, perhaps you have more long– if one day you have more long treatments in the hematology population than usual, and you don’t have enough chair capacity to accommodate these many patient hours, perhaps you can use one of the chairs from a close by treatment area for this population. You can even have the same nurses ever initially planned to treat this patient to see the patient in this case if the chairs are close by. In the case that you have more patients or higher acuity patients that require more nursing hours, perhaps you can utilize the float nurse for this population or even one of the nurses from an inpatient treatment area being able to hop over and help out during the busiest part of the day. This way, you can adjust on the day-of to variable demand and execute the plan that will best accommodate both your demand and your supply as your day unfolds.
BRIDGETT ROELL: Great. So that’s it. We talked today about strategies for segmenting your patient population across your additional resources and how to effectively manage these divisions on a day to day basis. If you have questions after this webinar, do you feel free to reach out to our team. We’d be more than happy to start a dialogue with you. We’ll also take the next few minutes to answer any questions you want to submit to the chat box.
HOST: So it looks like we have a couple of questions that have already come in. And as Bridgett just mentioned, take advantage of our. Q&;A widget to submit any questions you may have. This is a perfect time you get to interact with them live. The first question is what do you recommend if a patient refuses to be booked or treated in an alternative treatment area?
BRIDGETT ROELL: That’s a great question. So in this case, we wouldn’t recommend pushing too hard, but definitely communicate that you said what the benefits are for going to an alternative area. So really highlighting that the area that they would normally be scheduled in to is expecting to have significantly higher wait times. That can sometimes encourage the patient to go to the alternate area, but sometimes it doesn’t work. In which case we say, fair enough. If a patient really would prefer to go to their regular area, schedule them in there if you can, or leave them on the schedule and try to identify other opportunities for moving patients. Most of the time, it’ll be a matter of moving just a few patients from one area to another. So you don’t necessarily need to convince every patient that they should shift to the other area.
HOST: One other question. Does it make sense to segment by length of treatment?
BRIDGETT ROELL: So this is a question that comes up quite a bit and generally the answer that we give is probably not. And the reason is that if you’re talking about balancing the nurse workload over the whole course of the day, it’s really important to make sure that you can give them a mix of both short and long treatments in order to make sure that the number of ongoing patients they have at any given time is manageable, and the number of patients that they get over the whole course of the day is manageable. So what often happens if you try to segment the population with a specific duration cutoff is that you might run into the case where your short treatment area has nurses that are seeing a really high number of patients, and they are really quite busy all day long with getting patients started. And your long treatment area ends up having a much lower number of patients per nurse, and the nurses find that maybe they have some capacity to get patients started in their workload, but they don’t have a place to actually seat any more patients.
And so that by kind of allowing yourself to pool by duration, you enable yourself to balance that out a little bit better, so that the nurses can see an even number of patients. And also not have too many patients going on at the same time. So in some cases we do find that having a fast track area of some sort is helpful, but the key to making that work is making sure that the acuity truly are on the lower side, where having many back to back patients is still going to be manageable for a nurse. So if the acuity is on the higher side, it’s pretty comparable to the longer treatments then having a nurse see many, many short treatments is going to be a lot of work. But it’s pretty quick and easy treatments, and you’re able to manage that in a back to back the way with those nurses, then that can be a feasible way to separate out a segment of your volume based on the duration. Sometimes it can also help you utilize some physical space that maybe you wouldn’t be able to utilize for longer treatments. So if you have an area, for example, that just isn’t ideal for having patients with long infusions, then you can better utilize that space by dedicating it to some of those quick treatments and that allows you to use that space that you otherwise might not be able to use very well.
HOST: So again, thanks to all of you for joining us today. Thanks to Bridgett and Leah for presenting today’s webinar. Thanks again for joining us.