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The Daily Huddle: Best Practices for Ensuring a Smooth Day with Regular Communications Webinar transcript


With regular data driven communication another way to find out is what can you do today to ensure a better day today for future days. So tomorrow, next week, four weeks from now. And also, how can you equip the scheduling team to consistently make decisions that help produce excellent operational outcomes. So quick schematic of how we think about this. This is you here today. And the question is, what can you do to make today run great. And to influence the future to run as well as possible. So we’re thinking about running the operation for today and for the future. When you’re talking about today, which is where the book is already set. You’ve got what you’ve got. And the idea is how to manage that the best you can. 


So a couple of points on that we’ll talk about conducting a daily huddle we’ll talk about communications with clinic staff and with patients. And then for the future. There are a couple of important pieces here. One is what you can do as members of the operational and nursing team. Those are largely around influencing the demand pattern in the future and also influencing how you’ve staff, your nurse team into the future. So if you think of a demand and a supply side of getting it right. And then from a scheduling standpoint, it’s, of course, about the scheduling. So two major pieces there. One is aiming for calculus that really do give you a level look. And the other is guiding patients in appropriate flux and those templates helping do that matchmaking in a world of many constraints to get patients where you need them just a little bit more background here. 


You’re all familiar with these problems since you’re all involved closely with the infusion center operations. These are the big 3 to having work. Now with many, many cancer centers across the country. We keep hearing time and time again. So this is life and an infusion center. Long wait times for patients typically, especially in the middle of the day is a major challenge to have a smooth enough flow and the right balance of demand and resources to reduce wait times chair utilization getting this right is really tough. So the typical thing you get is low utilization in the morning and the afternoon later afternoon. And then a lot of activity in the middle of the day. So decreasing that midday rush, especially in the tended to chunk of time is a difficult problem and often one that you find yourselves grappling with day over day. And then from a nursing standpoint, very much related to that busy middle of the day period. 


It’s tough to get lunch breaks and other breaks that folks should be having. So getting the balance of patients demand right with what you have going on your nursing team in order that people can actually take the breaks and have a reasonable schedule during the day is a tough one. And all of that is in a world where every patient has their own unique flow many parts through the infusion center lots of constraints related to the oncology appointments. What’s going on in the pharmacy. Other things that the patient is therefore such as needing to get their labs done. Even visiting vidic visiting rad on all of that makes it very tough for schedulers to kind of get this right every day. So that’s the set of problems. Now what are the best practices for running this the best you can. 


First of all we’ll talk about today. So again today your book is set. The scheduling is done. Now what can you do to help make sure the day runs as well as possible. The first piece is the daily huddle itself. So this is something that’s like a 2 to 3 minute touch base at the start of the day. Nobody has time for a 15 minute meeting or a 30 minute meeting with all of your nurses at the start of the day. But something like a 2 to 3 minute touch base can help a lot. So the goal is to get together and talk through how the day is likely to unfold and then make quick coordination plans around that time, even just that visibility of saying, what is going to happen today. 


What are we expecting even that is very helpful for teams just to feel like they know what’s coming and each new thing is not a surprise. But there are a couple of specific questions you can answer to help get the team prepared for the day. So that’s down the list over here, looking at what your book has for the current day. If you can identify the best time to take lunches and any other breaks that folks might need to take doing that upfront is very helpful based on what the book of patients looks like you can call out the times that is most possible to take add on appointments and also the times that it’s most difficult.. That’s a helpful thing to do. And then similarly identify pockets of time that it’s helpful to bring patients back early in times that it’s really not. 


So in general, if the day has been planned very well. It’s actually not helpful to take patients back early because essentially, you’re using up resources that will soon be needed for other patients. So if the schedule looks really good. You usually don’t want to take patients back early. But if you have a little bit of peaks and valleys going on then if you see that a peak is coming if you can bring that a little bit forward into a valley then you’re smoothing out the day. So being clear about what times of day will help you to bring patients back early versus actually hurt you is a great thing to communicate to the team. And then the final point on this to communicate any staffing concerns or known issues to the nurse team. 


OK this next point here is about communication with clinic staff and patients throughout the day. So again, we’re talking about the day of service itself. All of your preparation. It’s great to bring the communication back to the clinic team in terms of those times of days that those times of day that you identified it will be more difficult or more feasible to absorb last minute, add it on treatments so that they know that. And then also on the patient side of things to be proactive about letting patients know what to expect. So if you know that a bottleneck is likely at a certain time of day to have resources available to communicate that to patients, whether that’s at your check in desk or if you have other dedicated resources to do that kind of work and setting expectations both up to clinic and out to your patients really helps folks feel like they’ve got control. 


Even if the outcome is similar and it is a big mindset shift that helps a lot. We’re going to give a direct impact in influencing behavior there as well. I think to the extent that they’re able to make decisions about when to send patients last minute to engage in that they should be aware of what’s going on there. And then hopefully I can add a little bit of real world application in how we use these strategies in operational clinical setting for today. So that’s been something that I manage. We have different chemotherapy units that are located on multiple floors of one building in the morning. Our team that consists of the infusion nurses some administrative staff and our nurse leadership. They conduct this brief 2 to 3 minute huddle just as the day’s beginning where they’re evaluating any staffing changes due to unexpected absences or any other changes. And what this group does is they pull up the ICU huddled out. 


So assess patient volume for the day and how many of these unanticipated changes may affect patient flow. And actually, the throughput in our individual units. The nursing and admin team who will do that. Good So you said and start to plan their lunches and really start to begin to formulate their own expectations for the day with respect to anticipated busy times and any pockets of opportunity where you know the day may be slower. And there’s an opportunity to make an impact if some of these same day staffing changes for us are significant. These groups during the study will make the decision to send nurses between the infusion units in response to changing treatment ratios or on occasion even redistributing a small portion of patients to help avoid any of those potential bottlenecks for the day. 


These units will also communicate with one another after their individual huddles what opportunities they have to help out the other units. If things like hypersensitivity reactions or a high volume of changes in treatment or same. They add-ons occur they communicate when the best times would be for that assistance. So that they can play off of opportunities for one another during the morning our administrative staff also used the ICU huddle and they familiarize themselves. And then look to do exactly what you mentioned with the opportunity to make decisions where it may be helpful for patient for the they notice that volume is reaching our chair capacity sometime later in the day. 


The look for those patients with appropriate infusion durations to bring back in advance to give themselves a little bit of additional breathing room during those peak times or for anything really to benefit the schedule for that day. Or I mean staff are also in constant communication with our outpatient clinical teams that are seeing those coordinated patients who will be treated in the units later and also our front desk staff that are greet patients as they arrive. They’re proactively communicating any delays in clinic. So that the teams they can keep the patients informed of any changes to their schedule for the day, and also to the front desk and communicate expectations to the patients as soon as they arrive. 


And lastly with iQueue huddle features that are really helpful for our nursing and the admin team to really quickly assess what are the constraints that they’re feeling in that moment are like soon to pass or if those delays are expected to continue or worsen just with understanding the scheduling of patients and the really nice illustrative tool that the huddle is they then can base their assessment of delays and also their communication to staff off of that information that I can provide. And this really helps them to give more informed and accurate estimations to patients right. Let’s have a look at what that panel looks like. So this is something that many of you on the line are familiar with and perhaps some of you not that we’ll just have a quick look at it to give a real example of some of the things we were just talking about or planning on the day. 


This is what the daily huddle picture looks like that when you’re using ICU you’ve got email to you every day or that you can see in the web app that comes to your email, you can view it on a smartphone or log in and see it. And what it’s showing is mapping out the expected utilization for the day. So we talked about trying to see where you see an advance where are good places to schedule breaks versus not where are places that it’s most feasible to absorb add on versus where it will be most difficult.. And then communicating that information back to the nurse team to the clinic team and even to patients in terms of setting expectations about delays. So looking at the appointment book is a great starting point. Looking at the projected utilization is probably the most helpful thing in being able to identify kind of hotspots in the day. 


So if we look at just this example here, you can see that the day ramps up as most days should. But it’s ramping up a little bit fast between 9 and 10. So this is the kind of thing that the nurse team might want to know. Hey, guys between 9 and 10 you are going to feel like it’s a little bit busy. But then right around 10 10 10 30 things lighten up a little bit. So setting that expectation in advance is a helpful thing. And here again, you can see there’s a little bit of a hot spot that is starting just before 2 o’clock. So in this case, it might be helpful for the team to make sure that most of the staff has had a chance to take lunch before 2 o’clock because at 2 o’clock things are going to be just a little bit busy. And then there is some open time in the afternoon here. So if there’s an opportunity to take any out on later in the day. That’s a very doable thing. 


So we’re talking about the last mile coordination on the day of and really communicating back to everyone involved in running the day so that everyone has their expectations that and knows how to best coordinate in order to have things run smoothly. OK with that, let’s move on to preparing for today. So this is under the category of what can I do today that will help me tomorrow or next week. And four weeks from now. So the first thing here is to look ahead. This is something that it’s helpful to do every day. I look forward to what’s happening in the next few days and even beyond that. So that you can decide if there are things you can do to help influence your demand patterns in the future in a way that will be operationally beneficial. 


So the basic things you can do on the demand side, meaning what is your patient demand going to be like in the future are to limit scheduling or start to move appointments basically amounts to that. So if you look look forward. It’s really two plus days you can look at tomorrow, likely you won’t be able to do much in terms of changing your demand pattern for tomorrow, maybe you can limit where you’re scheduling those last few appointments of the day. But look forward two plus days to identify days coming soon where you are risking being out of chairs. So all terrorists planned to be full or even beyond full for more than 10 to 20 minutes or so with the variability that’s there and infusion, you can probably live with it. 


If you’re kind of at a higher utilization level than you would like for a very brief period of time or a couple of brief periods of time. That’s the kind of thing where the pain of moving patient appointments is probably more than what it will take for you to live through those 20 minutes of the day. But when it starts to be longer than that if it’s looking like 30, 40 a longer period of time that you’re truly planning to be out of chairs or at a utilization level that’s too high. That’s where it might be beneficial to start looking for a specific schedule. 


Grooming opportunities. So if you can see that you’ve got some of those hot spots on the horizon and you’ve made the decision that, yes, it’s worth it given the amount of utilization I see. Yes it’s worth it to try to move some people. The recommendation would be to identify patients that seem like they might be flexible and try to reschedule a modest number of them. So again, it’s not for freeze rescheduling patients doesn’t come for free. It can be a patient dissatisfied as well. But it’s a trade. So if you can reschedule a small number of people and make a big difference in how the day will flow that could be a good thing for those specific patients as well. And that’s something you can use to kind of sell it to them if necessary. 


So if you identify patients that, for example, don’t have a clinic visit on the same day or don’t have other activities in the cancer center that have specific dependent timing related to their infusion appointments and try to see if you can move a couple of those in order to decrease the hot spots, then that’s a great way to influence your future before it happens. The flip side of that, if you can do or it’s not worth it to reschedule patients in a particular time of day is you can close down scheduling or close it down for part of the day. So if you’ve identified days in advance that are overfull you can try as much as possible to divert demands to other days or closed down specific times of day. So if you know that the middle of the day is absolutely Chock a block full for next Tuesday, then you can give that guidance back to the scheduling team and say, hey, no more patients at this time at last point on here is to monitor. 


So if you know that a day looks like it’s building up in a way that doesn’t look great. Then to keep a close watch on that if you identify it in advance and you can see as the day approaches if you need to start taking the steps above of grooming the schedule moving a few patients around and potentially closing down or giving specific guidance to the scheduling team on where you can’t fit any more patients. So that’s, again, on the patient demand side of things. You can also, in some cases influence the supply. So I’m sure you all have a few fewer nurses than you would like available in your infusion centers. But if you are on top of what’s coming up tomorrow, the next day and the days in the future that arm view to make decisions about your staffing. So if you look at a day and see that the morning is heavier than typical maybe you can ask a couple of people to come in a little bit early or in the opposite. 


If you haven’t filled up the morning, then it’s not helpful to you to have more nurses available than you have patients for them to treat. So trying to align your staffing to your patient demand pattern as closely as possible is a helpful thing to do. Now oftentimes nurse schedules are made long in advance. So you may not be able to suddenly get three more nurses or suddenly say, actually, there are two nurses that we don’t need today. But small changes sometimes can be made. So it’s worth looking to see if the overall counts and ratios are what you want them to be. And also specifically by time of day if the demand pattern and your nursing availability are well aligned or they’re a bit off. So it’s really up to them. I One is our your overall ratios kind of aligned with what you want. And the other is by time of day you have your supply and your demand well-matched for us at Memorial Sloan Kettering I think using the iQueue tools to really help with future day scheduling has been really exciting. 


And I think that actionable information that it provides in advance of the day of the treatment really helps us make better decisions aimed at impute improving the flow in our infusion units and ultimately, the patient experience here we’ve utilized a daily 4 PM meeting for as long as I can remember for where we’ve had the nursing group and administrative teams assess the infusion unit volume for the next day during this need. They really look to make any of those last minute like nursing changes that he had mentioned or on occasion, they’re looking for opportunities to move patients in an effort to better distribute volume resources across the units during the available times of the day. 


But with the iQueue huddle and some of the other information on the dashboard. It’s been really helpful for our teams to visualize how the treatment durations and the distribution of visit times play into the flow for the day. And it helped us to make more informed and better decisions about our resource utilization for the following day, whereas previously, we had really relied on volume as one of the only metrics to dictate how we allocated resources. And I think we’ve been finding that we’re moving now significantly fewer nurses and also fewer patients during these last minute 4 PM meetings since we’ve incorporated iQueue tools. Additionally, our administrative supervisor team has also incorporated using these tools in their daily workflows at our outpatient setting. 


Each of the infusion units have a different supervisor who oversees the operations for that unit among other responsibilities and they’ve all been really creative in the way that they find opportunities to make a positive impact on the schedule for their unit. They look out well in advance to try to identify days that have either a disproportionate volume of patients or are days where the distributions look worrisome with heavy peaks in the middle of the day. Then they’re proactively looking to reserve space on the schedule like. Sylvia mentioned knowing that the volume is only going to increase as those days approach for us by placing those slots on hold during peak times it limits the availability for our frontline scheduling staff to find solutions through auto scheduling during non ideal times. And it’s really helped to drive appointments to the early and late hours where utilization is always a challenge. 


This also gives the unit and the supervisors, the needed flexibility during the peak hours to accommodate patients looking to coordinate their chemotherapy visits with other appointments. They also use the tool to look far out in advance. And it really has helped them to catch days that were even a month or so out that wouldn’t have originally been on our radar or flagged us as problematic before we would have potentially missed opportunities to influence scheduling these days since they were so far away or if it was a situation where the overall volume of patients was low. But the treatment mix included a significantly higher number of long patients just utilizing the tool to look forward has been very helpful and iQueue even has a really helpful future a feature that flags users of potentially problematic days that could benefit from scheduling grooming that our supervisor staff have been using. 


And then in addition to really looking out in advance regularly for their individual units our supervisor group has also established a daily meeting where they focus in on the next five business days as group and they work to discuss potential opportunities to smooth out the schedule. Collectively they compare the individual iQueue huddles across the units and they really bounce ideas off of each other and offer advice to one another. They look at all the infusion units as a group in together as a building as a whole and they also try to identify opportunities to move patients from one unit to another and they’re in regular communication with our nurse leaders as well just to keep them in the loop of any changes in volume or any adjustments that they can adjust their nursing schedules accordingly. 


And I feel like this has been very helpful for our operations on multiple levels. It really gives our staff more lead time to take action on improving patient distribution. It’s helped shorten the duration of the daily 4 PM meeting that we have because there’s less people to move and it significantly decreases the amount of last minute moves for both our patients and nurses. And then also seeing the previous day’s visit and having easy access to daily wait times has been very helpful for us to look back on the scheduling decisions that we’ve made leading up to the day of treatment and confirm for ourselves best practices and really build our unit’s confidence and our scheduling OK. 


A bunch of points that are really worth highlighting I think. One question for you, Dylan. Sure you mentioned you mentioned the next five days versus the future. It’s not like you guys have a slightly separate process for looking at both of those. Can you say a little bit more on that. For the daily 4 PM is the focus on the next five days. Yes So our 4:00 PM our daily 4:00 PM meeting is really just looking at the next day. And I think that meeting is really to kind of solve any like last minute moves last minute nursing reallocation that we can do to solve what’s going on the next day our staff the supervisors themselves are using the iQueue tool daily to look far for out in advance like weeks, a month or so to really get ahead of any potential scheduling concerns and that our supervisors collectively have a meeting in the morning where they’re looking like five business days ahead to try to catch anything that they can in an effort to make those last minute decisions like fewer. 


Yes, it’s a great point. The more you can get schedule to look the way you needed to in advance the less of a last minute dash is going to be either trying to make last minute changes or just live through the day that has been created. That’s a great point especially related to linked appointments. I think. So we’ll get to your questions. All at the end here. But one question just from the side of my eye I can see here is about length appointments and how that plays into being able to move patients around. Absolutely many of you will be dealing with a high percentage of linked appointments during that an infusion. So linked to clinic to infusion visits that makes it a challenge. 


That’s all the more reason that looking out for word beyond the next two days. But even into the coming weeks and making sure the schedule is building up the way you need it to is a helpful thing to do because once it gets to a point where you feel schedule grooming is needed of actually moving around appointments you’ll have to go down and see which patients are potentially flexible enough to move. And so basically, you’re most almost all of your linked visits are not going to be qualified for that. Right those patients aren’t going to be flexible. So you certainly have a limited number of patients that are even potentially eligible to be moved, which is why the more you can do the farther away from the date of service the better. OK, we’ll just have a quick look at what the huddle looks like for future planning. 


So Dylan mentioned this in the iQueue tool. There is a little bit of a future horizon that shows each day. So when you’re looking at the current day, you can see what the volumes are coming up for the next week. And there is some flagging that we do in here as well to highlight days that you might want to go and take a look at in advance. So this is kind of a process related thing as a tool and process related thing where if each day you want to look forward how far should you look forward. Do you need to spend a lot of time kind of looking through every single day. That’s coming up for the entire next month. That’s probably not going to work for many of you, but we help with that a little bit by showing the future horizon here, both in terms of volume and flags that highlight days where the utilization is not quite ideal. 


So as the volumes are a great starting point. It’s good to track your volumes to make sure that they’re on track to see what aligns with your nursing ratios that you’re targeting. So see if the volumes are too high or not high enough out in the future and trying to influence the demand accordingly. But the utilization picture is also really important. So at times you may have days where the volume isn’t abnormally high but because of the mix of patients maybe that day in the future has a lot of long treatments more than usual or because of the specific spacing of the treatments you might end up with a utilization pattern that’s a little bit challenging. So the trick is to be on top of both of those the volume and the utilization in terms of the specific times of day that you are more and less utilize. 


So the volume numbers have to be in a feasible range, which means if they’re too high, you might need to think about bulking up your staffing for that day if they’re too low, you can think about either trying to guide more demand to that particular day or trying to call off some nurses. So getting the volumes aligned with your demand and your nursing availability is important, but also the specific utilization by time of day has to be feasible and ideally as a pattern that’s pretty smooth so that you don’t get delays at certain times. So both of those are important. And in the iQueue tool you can look ahead a little bit to see what’s coming. OK, moving on then there is a schedule shift or piece as well in the iQueue app, which can recommend to you which appointments ideally, you would be able to shift to a different time of day in order to help the utilization flatten out for a day in the future. Now that’s very much to the linked appointment question we’re giving a list here. 


And the iQueue tool of the appointments a ranked list of the appointments that we would most like we’d like you to shift in order to get the utilization to flatten out. And it may be that several of those are not eligible to be moved. But if you go down the list. You might find a couple of patients who are. So if you’re talking about a period of time where you’re plan to be out of chairs maybe your plans to have three patients more than you actually have chairs to treat them in three patients. And then moving three patients will make a big difference to the day. So in a world where there are a lot of constraints many patients will not be flexible sometimes finding even just a small number that could be can swing it for you in terms of not running out of chairs. We’ll go now into the last piece here, which is what you can do at the point of scheduling and this is largely focused on communication. 


So there’s an upfront piece here where if you’re starting with a template that does help you level load the day. That’s, of course, going to be the right starting point. So the more the template can do for you and helping you build out a flat, level loaded day the better. But let’s talk about the communications side of things today. So the first one is to really provide specific guidance to your scheduling team on how to communicate with patients. One thing that we’ve heard from a lot of folks is that having a consistent message helps a lot. So that patients don’t hear one thing from 1 Scheduler and then another thing from another scheduler. So by providing specific scripting recommendations or guidance you can help make sure that patients are getting a consistent experience and also make sure that the messaging is what you want it to be. 


At first point here is about training schedulers to offer up a set of appointment options, rather than start by asking when would you like to come in or what works best for you. And this is something that we all deal with in many walks of life. So if we need to schedule a haircut or something like that, usually the stylist doesn’t say, hey come whenever you want. Or when would you like to come. Usually they say I have availability two or three that kind of a strategy can work well, because you’re not agnostic to what time the patient comes. So if you can start by offering up the options that are most helpful to you then you’ve got a better chance of getting the patients into those options. 


Of course, it still may not work out and you might have to put that out a different time. But it’s a great starting point. So that means start by offering the options that you know will be most difficult to fill and also really target those patients that could be potentially more flexible. So if you know that a patient does not have a linked appointment that day really try to get that patient toward the edges of the day. Don’t put a lot of people in that primetime tended to chunk that don’t truly need to be there for real. Can constraint based reasons. So do. Do what you can to arm the scheduler on that front. And if you give them specific guidelines for the scheduling in terms of starting by offering up the least popular options and also specifically trying to protect the middle of the day. 


That’s very helpful. And the second piece here is coming back to the scripting. So again, it’s much easier if you have consistent messaging if you’ve given specific guidance on that. So if you give you come up with a set of likely scenarios that you’re scheduling team will face and then give them a couple of notes on how to respond to those it can be a very effective thing. It takes the pressure off the scheduler a little bit, because a it kind of takes them out of the heat of the moment of needing to respond to a patient on the spot potentially even a dissatisfied patient time and again, it also helps you with delivering a consistent message all the time. 


The second piece here is about, again about giving specific guidance to the scheduling team and kind of not leaving things up to chance. So here we’re talking about the link between clinic visits and infusion visits. Very popular topic. It’s really the source of a lot of the scheduling challenges. So in one way to help control this and get to an answer that’s reasonable for each individual patient, but also that works well across your portfolio of patients is to give schedulers specific guidelines on what the gap between clinic and infusion visits ought to be. So there is a trade that schedulers are facing if they schedule the infusion appointment too close to the clinic visit, then patients could be late to infusion causing bottlenecks there. 


On the flip side, if they schedule this the infusion visit to far from the clinic visit, then the patient may be waiting unnecessarily or more time than necessary. So rather than leaving that up to kind of each schedulers individual best guess at what will work well if you give specific guidance you’ll get a more consistent set of behaviors. And what tends to work well is say, OK, this is what we’re aiming for. And then this is the amount of time by which we’re able to let that wiggle. So leave it a little bit discretionary. But within a pretty firm set of guidelines. So just as an example, it’ll be the right answer will be a little bit different for each of you, depending on your demand and your flows. But an example could be we’re going to aim for one hour between the start of the clinic visit and the start of the infusion visit. 


But we’re willing to let that wiggle by 30 minutes in either direction. That’ll put us in the range where we’re likely to be able to deliver on the promise without risking a lot of bottlenecks and infusion. So those two pieces to start with a specific guideline about what the window ought to be. And then also defined by how much it’s OK to let that wiggle so that you can get answers that are OK for your individual patients and also make sense for the whole portfolio. It’s not a helpful thing to stick to a very, very tight window. So that you feel like it’s a patient centric thing to do while you’re scheduling each patient doesn’t need to wait at all. Between clinic and infusion and then create a situation for yourself where you have too many patients coming to infusion at the same time and you’re not able to deliver on their scheduled appointment time. 


One thing about that window is that at times it’s a different right answer for different service lines or specific providers or by time of day. So when you’re giving that guidance that’s something that’s worth looking at in your own data if it makes sense to give one particular one specific guidelines as universally applicable or if it makes more sense to segment that a little bit whether it be by disease group by time of day or individual provider. The final piece here is about overbooking. So with this. Again, based on the template you’re starting with the better the template is, the better the outcomes are likely to be. But regardless, you probably have whatever template you’re using you probably have some kind of limit on the number of patients you’re allowing schedulers to book throughout the day and at times schedulers will come we’ll be in a situation where they might need to overbook or think they need to overbook. 


So the guidance there is not to leave that up to chance either. If you provide specific guidance to schedulers on how to overbook when needed that can be an effective thing to do if you’re scheduling team is fairly limited in size. So provide the training on if you need to overbook. This is how you do it. Here’s your final top limit or these are the times of days where most OK to overbook. The second way to handle it is by giving specific guidelines on when to escalate to manager. And sometimes a combination of both can work as well. So for example, at MSA they use the auto search functionality. So every time you don’t find Dylan. Correct me if I’m wrong, but I think that we are you guys every time a scheduler doesn’t find a solution in the auto search back escalated automatically. Yes, that’s correct. 


We have enterprise wide scheduling with hundreds of schedulers who have the ability to book into these units. And then if they’re unable to find a solution. There’s basically a supervisor designee that they’re able to reach out to for guidance on schedule and that appointment. Right So that’s one way to say the guideline is anytime you’re not able to find a perfect match with a template it needs to get escalated and that’s good. That’s one way or you could have a different guideline on when it is. But whatever your answer is, it’s great to be clear about that. So that, again, it’s not a one off decision being made differently by different folks. But you’ve got a consistent way of handling it. So that it’s clear to the scheduling team when they need to reach out and kind of kick that up to somebody else to make the decision whether that be somebody in operations or a nurse manager who can make the final call on whether or not it’s OK to schedule a patient at a certain time. Day So with all of that. 


What does it take to execute on this meaning run the day. Well, today and prepare for future days. It’s a combination of people, process, and tools. So on the people side of things you’ve got your training and communication basically. So the schedule or training that we just spoke about now. And educating nurse managers and infusion staff about what to expect for the day. And this was a great point about building the scheduling confidence by saying we are seeing how the schedules build up. We’re talking about what we expect to happen. And then once the day is actually run. And we see what our historical numbers look like then circling back to that and saying yes it played out the way we expected it to. And here’s what we can learn from that, and then, of course, the communication with clinic teams and with patients on the process side. We spoke about a daily huddle. 


So a morning huddle very quick in the morning to get everybody on the same page at MSA. They’re using also at 4:00 PM huddle to look at the next day. And then the processes of consistently looking out in the future to see if there are opportunities for schedule grooming and nurse schedule adjustments that might be a little bit farther out. Finally, on the tools and technology. These are here to support the decisions and the processes. And so huddle information that you can see on a daily basis. It’s really good to look at what’s on the books for today, both in terms of total counts and utilization patterns. And then a little bit of a forward looking prediction as well. So that you can see in advance what’s coming tomorrow. What’s coming next week. What’s coming four weeks from now. And finally optimal scheduling templates. 


So again, the more you can set things up in advance to build you a flat and level loaded schedule, the last minute correction you have to do with that. I think we can go ahead and open it up to questions here. So it’s 947 Pacific time and we’ll just stay on the line for about 13 minutes here and see what questions we can get through. OK So starting kind of the beginning, we had a question from. Josh at Fox Chase. What are some strategies to proactively let patients know when there are delays and feeling. Do you want to take that one. Yeah Yeah. I think it can even start before the actual day of treatment when we’re reaching out to potentially move patients like there’s a piece of education that we try to provide when discussing moving patients appointments about what to expect for that day. 


So I think sometimes that’ll help them understand if they’re unable or uninterested in moving their appointment at least a little bit of a heads up about what to expect for that day. And I think our biggest strategy is to just communicate as early and create as often as we can both what we expect the delay to be if there is a delay. And then any changes in that information as we become more aware of different things that maybe affect the unit. So I think communicating to the front desk. So that when the patients arrive they’re aware of exactly what’s going on for that day. So that they understand how their appointment may be affected. And also that they are open to come get updates as often as they like. And also communicating to clinics so that as like the nurse sees them as the physician sees them. 


They can reaffirm any of those changes to the delays that may be the second unit that day has been really helpful for us asking right. And I think that’s one more question to you. Dylan again franchise and advocacy. The question is, is. Nsa decouple most clinic appointments and infusion appointments absence there. They have difficulty changing patients and getting appointments on the day and treatment as many are attached in clinic appointments. If we don’t really intentionally decouple any we probably have in sous. You may know our numbers better than I do. Like roughly like 70 or so percent I think across all of our units of patients that are seeing the physician, the same day that they’re getting treatments for us. I think all the work that we’re doing for future days and the work that we’re doing leading up helps us to hopefully drive some of those uncouple those uncouple those uncoordinated treatments to either the morning or the afternoon and trying to reserve as much of that space and plan as much of that space in the bulk of the day for and during the peak of the day for those couple visits. 


And then to the scheduling shifter piece that Sylvia was describing. That’s definitely a main driver for the patients that we target moving appointments. We definitely try to target those patients that have maybe only achieved visit that day. And then we from there move on to maybe patients who have a couple of appointments. But the physician maybe has availability earlier or later to help coordinate their. M.D. visit at least closely with their infusion. That’s a great question from. Tom at Seattle cancer Care Alliance and an Ms. MSH6 and scheduler Rampart confusion. Are they in a separate reporting structure. 


They report up like our administrative group who ultimately has some oversight over the infusion unit. So they’re not reporting directly to like our nurse leaders or employees to an administrative group. But kind of collectively and with a team approach that admin group as well as nurse leadership oversees the operations of the Houston unit here right. Putting therapy chatterbox here to see if we’ve got any other questions that we can address just got a question from Nicole so the question from Nicole here is this can help with finding a good time to pair our infusion visits with clinic visits and suggest an appointment time to put on hold for such visits. So with that, the approach is to look at your demand pattern in aggregate for coming out of clinic. This is back to the challenge of how do you get it right for each individual as well as for the whole portfolio of patients. 


Because if you were to say we’re going to start with a clinic appointment and then we’re going to tightly link every infusion appointment to the clinic appointment with something like a 30 minute gap or some really tight linkage then you wouldn’t have any ability to wiggle the demand profile and infusion into something that you can actually deliver on. So what we do is look at the aggregate patterns of all of the demand coming out of clinics and try to build infusion templates that accommodate that demand pretty well. So give you slots that will be there and accommodate the set of appointments you need to schedule. But not in a way that’s tightly linked one by one. So with that there will be times where you can’t get exactly the perfect window for every patient. But then that again, goes back to what is the right window. Have you defined that specifically by service line or in some cases, even by provider or by time of day. 


And then by how much do you think it’s OK to change that window for an individual patient. So as you said, the guideline is an hour, which we can then wiggle by 30 minutes in either direction, then that’s kind of the line in the sand where you say if there isn’t a way to book into the template we have that lets us be within an hour and a half of the clinic appointment for every patient then that would point to a time to overbook your patients a little bit. So that’s what we recommend in terms of template compliance is to do it within reason. So that you try to get pretty close to meeting all of the needs of your individual patients. You don’t get too far out for any patient or you don’t miss by too much with any individual patient. But stick to the template. It’s close enough that over your whole portfolio you still do get to a smooth level loaded day. OK 


So a couple of other questions coming out about ethics. Can the iQueue templates work in conjunction with ethics, specifically. Yes, they can. So that’s what they’re using in MSA and at many others. And each hour when there’s really no each are that you can’t plug. IQ templates into because we’re just talking about recommending the math behind the scenes is very complicated. But when it comes to the template themselves. We’re just talking about a recommendation of how many appointments to schedule at what times of what length. So that kind of basic functionality is there. And every year jar does work with epic and the others. And then a question about urgent add-ons is the next one here. So how do you have. This is from Ann. Sullivan at USC. And how do you handle urgent add-ons on a very busy day. Don’t know how to clinics communicate with the infusion center regarding holding or stopping treatment don’t you think. Yes Yes. 


So for scheduling urgent add-ons are chemotherapy. Administrative team is in constant communication with the clinics that feed patients basically into that respective unit and they help advise. When are those good times to accept add-ons and when those other times may be more of a challenge. And I think they’re offering to those clinics, the best scenario. So they’re saying like 4 o’clock we may be able to take this patient right away. If they’re willing to maybe step out and come back or if they want to say. Here we work to kind of like help them understand what that wait time may be before we can take them. So they’re also managing the same day cancellations and looking to kind of best match any add-ons with those cancellations in an effort to kind of smooth the move hopefully add them to our schedule. And then communication regarding same day cancellations. The infusion units work in close proximity with our clinics. 


And that is a piece of information that’s communicated for our outpatient physician clinics to the treating nurses in the unit. Any cancellations or any changes in treatment that kind of thing. The clinician a clinician OK. And here’s another and then the big question is from Wendy and Ms. Kay. How do you scheduling your nurses to patients on the daily schedule. So we don’t match individual patients to nurses daily. And if some infusion sites will kind of say this nurse will take this patient especially this patient. This patient for us, it’s more of like as they arrive. Different nurses will communicate and pick the patients that they’ll be treating. It’s kind of like availability and acuity for that day they’re using in their assessments of like who will take the next patient that arrived OK. So when that kind of on the fly assignment and does that become the charge nurse’s responsibility. Exactly Yep. 


The charge nurse helps oversee that step aside. Great So we’ve seen lots of different strategies on that and working with lots of different centers. And that’s actually our favorite one. So in some places. There is a strong need to build assignments in advance. But when you can manage it doing it kind of on the fly assignment like that has a lot of advantages because in infusion nothing ever runs exactly as planned. And so if you’re able to do that. And dedicate charge nurse time to making sure that patients are paired appropriately with nurses it really is a good way to make sure that in a world where patients don’t always arrive on time or sometimes the treatment they need is a little bit different than what you were expecting. Maybe they may need to have a unit of blood added on or maybe the patient is too sick to treat or maybe you get some no shows. 


Maybe you’ve got some urgent add on a world of that amount of variability. Being flexible on the assignment can actually be the most effective way to make sure that you get you stay in a situation where the workload is manageable for each nurse’s individual. So we like that a lot. OK a couple of other questions in here. And I’ll just say it’s 10:00 now. So we should finish up and let you all go. But there are a couple of questions that we didn’t quite get to some specifics around the scheduling. So do you see all of the chairs and one screen. Do you see all of the nurses in one screen. What is your scheduling into different providers. 


We would be happy at least talks to talk to you about any of those specific scheduling questions as it relates to how you’re doing things today. And you can see we’ve got can reach out to me at the email here on the screen. And Dylan graciously agreed to answer some follow up questions. If you have specific operational questions for him. So with that, we’ll call it a wrap for today. He’s saying this to CNN Dolan and of course, all of you for participating today. Keep an eye on your inbox citylink to the recording of the session as well as analysis about teacher of the nurse. There’s also a survey that will pop up on your screen as soon as you leave the session. It takes about 15 seconds. So they fill it out. So you can sit back and they can. So they say thank you. And feel free to reach out to me addressed. I think you’re going.

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