Infusion Center Communication 101 Webinar transcript
DAN HOFF: Welcome to Lean TaaS’s monthly webinar on efficiency in our operations. Today, we’ll be discussing best practices for your team’s daily communications with each other and with patients. With iQueue now live at over 125 infusion centers, we’ve seen a wide variety of operations, whether it be a large hospital system spread out across a metropolitan area, or a smaller rural hospital. I think we can all agree being able to communicate effectively and efficiently is universally important. In the next 30 minutes, we’ll share some of the tactics that we’ve learned from serving as a partner to infusion centers across the country. We also have a robust supporting materials to help bolster those tactics, some of which will show during today’s discussion in which we’re happy to share if you send us an email.
LOUKYA GARLAPATI:. One thing we have seen while helping launch iQueue at many different centers is that there are often two sets of conversations among communications. One, during the initial implementation, and then another several months out once the infusion team has gotten comfortable with iQueue and wants to continue in building their operations. Whether they are already an iQueue customer or just interested in improving how your team communicates, today’s webinar is designed to be relevant to all infusion centers. So with that, let’s jump in.
Broadly speaking, with the three main sets of interactions that infusions and us work through. The first is communications between nurses and schedulers. The second is communication with patients. And the final is communications with providers and with pharmacists. While some of these interactions could be more frequent than the others, we believe effective communication across all the groups would help smooth out the operations in the center. One of the most frequent interactions we see is between nurses and schedulers, whether it is about finding the right time for an add on patient or trying to find appointment times on a busy day. Nurses and schedulers work collaboratively to achieve the common goal of optimizing the infusion schedule.
Most of the infusion centers have very few patients booked in the mornings and evenings, but have a high number of appointments in the middle of the day, which makes it difficult for the nurses to take in patients. And this in turn increases the patient rate times. So it’s very important to level load the schedule and ensure that the staff and the patient’s satisfaction levels are high. One way to achieve this would be for the nurses and the schedulers to think of daily in the morning or on the previous day so that they can plan for the upcoming days.
During these headers they can discuss the current day and also look at the futures to make sure they have a plan in place. When the nurses and schedulers are discussing the current days, they should look for the busy times or the red zones where there are no chairs or nurses available. Once identified, the staff can then take extreme measures, such as bringing in the charge nurse to work for a short amount of time. Or bringing in a float nurse to make sure that the patients in the busy times don’t wait for longer periods of times.
They should also be careful not to book any same day add-ons at the busy times, but rather look for underutilized times to book the same day add-on. one easy way to identify these over utilized and underutilized times is by visualizing the patient flow. That would give the staff the opportunity to easily focus on the busy times. And also identify those underutilized times. And once the staff expectations for the current day have been set, d the next step is to look at the future days. When you’re looking at the next couple of weeks, it would have to dig deeper into the days with uneven schedules.
Since the appointments are in the future and there is some lead time, we have time to plan where the next few appointments should be booked. Or if there is an opportunity to move some of the existing appointments to create availability for a new one. We often see that there are a few infusion patients without any provider visits booked in the big banks of the days. And it would help to move these guys to move these patients to late evenings or early mornings. So that there is space for the linked appointments or patients with other constraints, such as travel constraints. In addition to thinking daily and preparing for the current or the future days, having a few specific guidelines so that the scheduling and the nursing team follow the same set of rules will keep everyone on the same page.
These guidelines should be created based on the operational workflow and should aim to avoid the extremely busy times in a day to have an optimized schedule. We usually see a set of guidelines that are important for most of the centers. It could be decided on– it could be something like deciding on a sufficient gap between the provider and infusion visit, so that there is enough flexibility to find the appointment options and not just in the team. This gap would also set the expectations for the patients and they would have time for a short break between the provider and infusion visits.
It’s also critical to discuss about how to handle peak time appointments, whether it is deciding on a maximum number of appointments during peak times by busy time or by linked appointment status. We also know that for many centers there would be days where the volumes are extremely high. This could be due to it being a holiday week or maybe because of some provider burdens. So it’s important to have an overbooked process and trying to stay within the available number of chairs. We see that establishing an approval process for each unavoidable overbooking situation to capture that specific reason we create a fact base for the set of recurring reasons. This would have the team understand how to plan for the future busy days, or to find ways to resolve the root cause of the underlying concern. While it’s important to have general guidelines, it could also have to go a step further and decide on numerical limits.
For example, you can decide on the number of chemo appointments by time of the day to level-load the pharmacy workload. Or you can also decide on the number of appointments per time slot to level-load the MA workload by taking in the patients. This would remind the team to check before overbooking at any time during the day and to spread the appointments toward the day. Here, we have a sample scheduling guideline sheet which includes information about booking at peak times, or booking for linked appointments or for overbookings. The next step in the nurse and scheduler interaction would be to look into the data and the scheduling patterns to modify the templates. While the nurses and schedulers discuss the trends and patterns that they’re seeing, it would also help to dig deeper into the data and find patterns by appointment type, or visit type, or maybe the providers.
You would then be able to figure out if there are any particular trends to keep in mind while booking appointments or if it’s necessary to change the scheduling guidelines to incorporate distance. Nurses and schedulers often discuss if there are any restrictions based on those capabilities, such as item restrictions or LPM restrictions, and so on. They could also discuss about the pharmacy constraints to make sure that patients aren’t waiting long periods of time to get their drug. Understanding these restrictions and constraints among different groups of stakeholders would help in creating a better set of templates. You can also look into the scheduling in lead them patterns which would be looking into the lead time for scheduling an appointment and making sure that we are not scheduling too far out in the future. We usually see that appointment schedule too far into the future end up being rescheduled or canceled. And they’re just risking the other appointments that are being booked.
So it’s important to determine how far we can book into the future. And for these we have seen some centers use reserved slots or block some of the slots in a few cases, just to make sure that there is space for the appointments that are being booked within the last two days for within the last few weeks– last week. It’s important to analyze these volumes and figure out if we have provided the right amount of slots and keep reviewing them from time to time. To create an optimized schedule and a level-load appointment, it’s necessary to have a plan about the peak times and linked appointments. While letting we know which others or which appointments are being requested for the most, it’s also necessary to have a set of rules around them so they don’t end up overloading the nurses, or the pharmacists, or face log situations. Through these reviews and discussions the nurses and schedulers should be modifying the templates and scheduling guidelines to reach an ideal stage.
DAN HOFF: Once you have your nurse and scheduler team coordinate with one another, the next big item to consider is the team’s interaction with patients. There are a couple tactics that we’ll describe shortly on how to better engage your patients. But what it essentially boils down to is opening the lines of communication and giving patients a clear and consistent insight into the decision making process in your infusion center.
The first item that can go a long way towards improving the patient experience and making the team feel more comfortable in their interactions with patients is to provide scripting on the key questions that patients might ask. Generating a frequently asked questions document and providing the corresponding answers can be a fruitful team exercise. On the nursing scheduler side, it also allows for sharing of best practices and developing a consistent team view, as well as helps to identify and workshop functions that nurses and schedulers might have had to previously respond to.
This exercise is also beneficial for patients. We all recognize that infusion, especially chemotherapy treatments, are inherently a stressful process for both patients and the families. By making sure that the whole team provides consistent answers and displays confidence in their replies, the patients will notice that and in turn feel greater peace of mind that they are being well looked after. While this is important during daily operations, it can be especially critical during implementation of new initiatives. These changes may affect patients when they aren’t expecting changes in their schedules which can create frustration. By being proactive in your center’s response to these changes and equipping the team with the right language, you can minimize these risks by getting a head start on explaining the changes to patients and preempting any potential frustrations.
Displayed on the screen currently are a few examples of scripted dialogue that we have shared with our customers in the past. Each of these examples features the patient’s question in green, with the team members responses in gray. As seen here, you can give responses for nearly all types of patient facing staff. Whether the questions be about scheduling changes, new guidelines, or purely addressing patients dissatisfaction, scripts form a powerful tool to nail interactions with patients on the first try. One item worth calling out here before moving on is that these scripted responses need not be for our patient interactions only.
If you find that there are frequently asked questions or scenarios that your nurses, or schedulers find themselves in with other hospital stakeholders, for example, clinic providers, pharmacists, emergency room staff, you can also script responses for those interactions as well. While the answers might seem straightforward to most team members, they can prove invaluable in confirming that everyone knows the correct response. And also provides a great resource for new staff that need to get up to speed quickly. Another tool in your patient communication tool box should be flyers. While scripted responses are inherently a reactive approach, flyers allow the team to be more proactive. These flyers can be placed in waiting rooms or included in the patient’s discharge materials.
They can also serve to support existing conversations or initiate new ones. Depending on the information being communicated, they can also serve as a starting point for conversations. For example, you could say something along the lines of– did you get a chance to see the new flyers while you’re in the waiting room? If not, we’re just letting people know that items A, B, and C are changing because of reasons– 1, 2, and 3. The one key item to remember is that it takes most people several touch points to remember a new piece of information.
So bringing it all together, you might provide patients with flyers advertising a change in infusion center operations, then have the nursing and frontline staff bring up the topic again as the patient is being brought back to a chair bed. And then supporting those same staff with scripting to answer patient questions related to the flyers information. Similar to how scripting can be adapted beyond patient interactions, flyers can also be adjusted for different audiences. Returning to the example where you’re making significant changes to your infusion operations, adapting the language from explaining the benefits to patients, to reminding providers of the change can help to avoid future scheduling or workflow conflicts.
In many cases, providers will want to know that the changes help their patients. So much of the information can be repurposed between multiple sets of related flyers. Your marketing department may also be able to help you in the creation of these. In particular, one item that is often a priority and common piece of feedback is ensuring patient which is origin of the appropriate reading level to ensure maximum accessibility. While the exact level varies from location to location, the average level have a average recommendation hovers around it having things read at a fifth to sixth grade reading level. Internal use of flyers fires for providers and pharmacists likely don’t have the same reading level constraints, but as an origin materials it’s critical to consider your readers.
As highlighted in the past two items, there are plenty of resources that infusion centers, schedulers, and nurses can use to work more closely with their counterparts in pharmacy and the clinics. Focusing in on the scheduling aspect for a moment, updating scheduling guidelines to reflect the preferences and constraints of your pharmacy and clinic providers can not only buils trust but also improve operations across the board. If we take pharmacy for example, with some coordination you can find a few ways to potentially decrease turnaround times for meds and free meds. And subsequently pass those time savings onto patients in the form of shorter wait times. These conversations can flow in both directions between pharmacy and the infusion center.
On the one hand, reviewing appointment data to determine how often certain drugs are administered per day can help advise the pharmacy on when and what to batch or pre mix. On the other hand, adding to your scheduling guidelines is just an appointment towards particular times that either align with the internal delivery of materials, such as propmts. Or that better level-load the demand on pharmacy can help you to limit the extent to which infusion center scheduling creates pharmacy bottlenecks that later then get passed back to the infusion center. Similarly with providers, identifying clinic demand patterns and providing guidelines to schedulers to balance those volume demans and other appointments can lead to more level appointment for across the day.
To be more precise, take for example a center with a majority of infusion center appointments that have linked same day clinic visits. Let’s also imagine now that that center happens to run out of chairs routinely as well. By moving the non-linked appointments that have fewer constraints out of the peak hours of the day, you open up room for the more constrained linked appointments and put yourself in a better position to level-load your day. You might have noticed on the provider side that most of the suggestions require not only coordination amongst multiple stakeholders, but also involve some data analysis. Well, it probably shouldn’t be surprising that we’re constantly thinking about new ways to use data LeanTaaS.
Bringing data to conversations with providers and pharmacies really does help support the conversations you’re trying to have. Starting with historical data, you can both troubleshoot existing problems, as well as call days that have gone particularly well. Focusing on the latter point for a second, this very much falls under the Benjamin Franklin axiom that an ounce of prevention is worth a pound of cure. Whether you’re in the midst of trying to solve an existing operational problem and see a few days that have done well, or it’s this random day that’s gone much longer– much better than expected.
Calling these out and sending a note on the metrics that show it’s going well can go a long way. Nearly everyone likes to be complimented. So a quick call out to those good moments on recent days can not only turn around but also lead people to reflect on what they’re doing and find ways to more consistently repeat those positive behaviors. Similarly when troubleshooting, polling data on specific points, or specific patients rather, allows you to be more precise in identifying what went wrong in a particular day. Pulling several patients, for example, and studying their timestamps can help to pinpoint parts of the workflow that might have adversely affected their stay.
At the end of the day, everyone here is working together because we care about improving the well-being of patients. So being able to pull up specific patients in the data and quantify how much they’re impacted by a given issue strengthens your case when requesting a change in workflow or operations. Beyond using data for hindsight, data can also be used to aid in foresight. In particular, a review of scheduling data can provide useful in planning for the future. By watching what the next couple of weeks of appointments are shaping up to be, schedules can work with the nursing team to understand where to steer additional volume or recommend additional nursing resources be recruited. Furthermore, infusion centers schedulers can reach out to their counterparts in clinic offices and try to shape the incoming demand of linked infusion appointments.
This can be accomplished by suggesting clinics consider preferences certain dates for infusions over others. Or sometimes the constraints of clinics or a specific regimen limit the flexibility on making changes here. Reviewing the data about what their demand pattern looks like ahead of time can really help to build confidence in the requests being made. On the pharmacy side, looking into the upcoming patterns of certain regimens can give you a sense for whether to suggest to pharmacy about promoting drugs to help with turnover times. Similarly, or similar to making suggestions about scheduling clinic appointment demand, the answer might still be that no request changes can be made.
However, doing the analysis will help you gain more even footing in your discussions with the pharmacy team. Following up on the concept from the prior slide about shaping the demand of infusion appointments with a link to same day clinic visit, there are often quite a few constraints already in place that might act as a barrier to making adjustments. In our experience, however, there is actually one particular time that does present an opportunity to make such request. And that is during provider staffing changes. One of new provider joined. Their natural question is about what that provider’s clinic hours will be. By engaging the clinic’s team on what their current hours are and presenting data that highlights the options that best left alone their schedule, both you and them will benefit.
Beyond the clinics being able to offer a more consistent appointment times across the days of the week, the incoming flow of linked infusion appointments will also be more evenly spread. If your infusion center runs out of chairs frequently, this level-loading of incoming linked appointment demand makes it much easier to level out all of infusion appointments, and subsequently, reduces your risk of chair walk. So in summary, we’ve talked about three sets of communication tactics today. One between nursing and scheduling, another between the infusion team and patients, and a final set between the infusion team and their affiliated providers in pharmacy.
Between nurses and schedulers, we learned how to structure daily checking conversations, set up guidelines for schedulers to follow, and review booking patterns. Between the infusion team and patients, we learned about the value of scripted responses and promotional flyers, and how the two can work in tandem. And finally, between the infusion team and providers and pharmacy, we discussed additional options to add discussion guidelines, as well as learned about the importance of bringing data to both forward-looking and retrospective conversations. To close, we hope that these tactics serve as helpful inspiration for you and your teams. Please feel free to reach out to me, Loukya, or any of our other product managers about the materials or tactics mentioned today. And with that, I’ll turnover to Loukya for questions.
LOUKYA GARLAPATI: OK. It looks like we have one question here. So I’m reading out the question. It says, “Our center has a lot of same-day cancellations and no-shows. How do we communicate with the patients and providers to decrease this number, and to make sure we’re being completely utilized?” That’s a great question. So we can plan ahead for the no-shows and same-day cancellations and help in making sure that the center and the staff are not under utilized.
One way to do that is having a meeting with the physicians to look at the upcoming week, and determining if there are any patients who are too sick to get the treatment or if there are any patients who might not come. With this way, we can plan ahead and see if there are any patients that can be rescheduled. And we can call them up and find out which days would work for them. We can also look at the data and provide guidelines to make sure that the schedulers can overbook by a certain amount. For example, we can let them know that they can overbook in the mornings, between 8:00 AM and 12:00 PM, by one chair. But we should also be careful not to overbook too much as we might not have that many overbooks on some of the days. So it’s about finding the right balance between overbooking, but at the same time, making sure that we haven’t been canceled on them with the number of overbookings.
We can also remind the patients of their appointments, either early in the morning or the day before, to make sure that they would come for their appointment. And if they’re not well, we can find that out and we would then be able to reschedule those patients. So doing these sort of things could help decrease our number of no-shows and same-day cancels, and also make sure that the center is being completely utilized and the staff is being completely utilized as well. Looks like we have another question here. The question reads, “Some of our providers are late while some of them are early in treating their patients. How do we work with them to make sure that patients coming in for infusion appointments after their provider visits are on time?” We’re so sorry to hear that but we have seen this at a few other centers as well. These are just digging into the data to check which providers are late and which providers are early, and by how much time.
So like Dan said, data is a very important part for us. So looking at the data can give us additional information into the provider and the patient information. So communicating this lateness or the early information to the providers so they know the time by which their patients are late or early could let them know how to manage their schedules. For the providers who are late, make sure that the providers are not overbooked, which could be the reason for this delay. Spread out the provider template evenly across the date to make sure that the provider would have time to look at the patient.
We can also provide guidelines to the schedulers to have a gap between provider and the intrusion visit based on the provider. For example, this gap could be longer for the late providers. So it could be sometime around 90 minutes to 120 minutes. Or it could be shorter for early providers, so sometime around 60 minutes or 45 minutes. So again, looking at the data and communicating with those particular providers and also communicating the guidelines to the schedulers would help us in taking the patients in time and making sure that the patients are on time. OK.
We have one more question here. “We have a lot of schedulers that book appointments onto the infusion templates. How do we train them and communicate the guidelines effectively with everyone? We have seen this case at most of our customers. So where there are several schedulers, and each scheduler has a different way of looking into the availability. Scheduling is a very difficult job, and it’s definitely important to have everyone on the same page. When we have multiple schedulers, we can have different training sessions with different sets of schedulers separately so that they know there are complete set of guidelines.
But we also know that it’s difficult to gather all the schedulers, whether it’s at the same time or at different times. So we could record one of the training sessions, which would include a demo with detailed instructions, and distribute this recording among the schedulers. We have also seen some of the centers print out the tip sheet of the guidelines, and distribute them among schedulers so that they can have it at their desk and they can just look at it if they need any quick suggestions.
We also recommend frequent check-in for the schedulers to remind them of the guidelines, and also communicating with them of the good days. So like we have discussed before, there could be many days where the schedule is uneven but it’s important to communicate with the schedulers when you have positive days. So like Dan said, positivity and reinforcement helps keep the spirits up. So it looks like we are running out of time.
WOMAN: You are correct. Unfortunately, we’ve run out of time. I see that there are a few more questions in our queue. We apologize but we’re out of time today. We will reach out to you post-webinar and answer any inquiries that you submitted. But thank you to all of you for joining us.
A big thanks to our infusion product team for doing a stellar job today. Couple of reminders. The link to this webinar recording will be sent to you via email within 24 hours, that will include the slide deck. And again, for those of you viewing this for CE credit, you will need to complete a survey. And that link will also be emailed to you. So today’s action item is keep an eye peeled for your inbox. Thanks again for joining us.