The Impact of Seasonality on Your Infusion Center Webinar Transcript

CAITLIN ISOBE: Hi, everyone. Thanks again for attending our webinar. With the seasons changing, not only is it getting colder and wetter outside. However, you may be feeling changes within your infusion center. Join us today, as we delve a little deeper into the seasonality changes infusions in this space, and see how iQueue can help you combat these changes. Today’s webinar is great for potential customers and customers already using iQueue. Once again, my name is Caitlin Isobe, and I’m an Operations Analyst for iQueue for Infusion Centers. Feel free to email me after this presentation if you have any questions. Let’s get started right away. Here’s our agenda for today’s webinar. 

We will first define and better understand what seasonality is, and what seasonality isn’t within your infusion center. We will talk about common types of seasonality trends you are likely to see, and less common types of seasonality, and the impact it may have on your operation. 

We will then talk about which areas are more likely to see seasonality, and what the changes may look like in this area. 

We will then define the 14 types of infusion changes, infusions in our space, and see what changes are seasonality related, and which are not. 

After we understand what seasonality is, we’ll give you some quick questions you can use to determine if these trends are related to changes in season, or other changes in your operation. 

We will then walk through how you can use iQueue to assess the seasonality is impacting your center and your operation. 

Lastly, we will discuss ways iQueue can help you lessen the effects of seasonality on your infusion center. We will walk through examples that show how iQueue uses helpful analytics and templates to benefit and optimize operations, as well as how you can communicate these seasonality changes best to your staff and patients. 

We will end by having a Q&A session where you can ask any questions you have relating to seasonality. So what is seasonality? We probably all feel the changes in the weather. But let’s get a little more technical about our definition of seasonality. Here is how we define seasonality. It is a characteristic of a time series in which the data experiences regular and predictable changes that recur every calendar year. Any predictable fluctuation or pattern that recurs or repeats over a one year period is said to be seasonality. Let us describe an example of a seasonality that an infusion center may feel. They often see increases in volume or decrease in volume, correlated with certain points of the year every year. 

Why is it important to note that this is seasonality versus another change? Because these changes are regular and predictable. This means these changes will not come at you by surprise. We can use your past data that we have received, and predict future trends in seasonality. Using our algorithms and application, we’re able to help you prepare for these changes year over year due to seasonality. Whether it is volume increases which change your templates or different patient arrival, we see trends in seasonality, we know it is easier to solve the problem, and how we can solve it. It is important to be aware of seasonality because it can affect your infusion centers in various ways. 

Let’s delve a little deeper into where seasonality is likely to occur within the US. Centers that are currently experiencing big effects of seasonality oftentimes know they are experiencing these changes due to changes in season. But other centers with smaller impacts of seasonal changes may not realize that many changes in their operations could be linked to changes in season. As in real estate, seasonality is often linked to your location. Where you are located can make a big difference in how you feel about the seasons. But it can also determine how your infusion center feels the differences as well. Since we are in winter, we chose a diagram of the US that reflects winter temperatures. 

Changes in the volume can often be seen with changes in the temperature. Let’s take Florida for example. Since Florida seems warmer than most of the rest of the country, oftentimes individuals will flock here during the winter time. These people are often referred to as snowbirds, and are likely to come in during the winter months. This uptick in the number of people traveling to Florida is large. According to the. University of Florida, the elderly population can grow by about 20% during the winter months. With over 800,000 people coming to Florida during these months alone, during summer, these folks may return to their home. Also an additional 300,000 people are likely to leave during the same summer period. This can mean changes in the summer are heading to other areas to receive treatment. The areas likely to feel the most of seasonality are the areas with the most extreme changes. In the map, these are noticed by the changes in color. The dark blue representing the states with the coldest weather. 

And the darker red offering the states with the warmest temperatures. People who are experiencing cold temperatures are likely to see shrinkage in their volumes instead of growth. Regardless of where you are located, you can use data to predict the coming weeks and months. Let’s delve a little more into the seasonality changes you may be experiencing in your center. The first type of change we will talk about is seasonality. In order to better understand your operations, it is good to understand the difference between the changes you may see. Each of these changes may have different effects and different outcomes other than seasonality. In order to understand what you need to do for your infusion center, it’s important to sit back and ask yourself some questions to understand what type of changes your center is experiencing. We have defined these four different types of changes you may feel in your center. 

These changes may affect your volume, your amount of patients, your wait time, your arrival time, and your overall operation. Seasonality, as we define seasonality, it is predictable and regular changes that happen year over year for multiple months. That is what we’re focusing today’s presentation on. The next type of change we see is the change around holidays. Although holidays may seem similar to seasonality, they are predictable and happen year over year. There are many ways they are different. Holidays are often for just one day, and only affect a few days before or after the holiday. They may have pre-existing changes that need to happen, and trying to figure out the cause is already determined, it is the holiday. We will go over some suggestions about ways to help your center deal with holidays before and after. Acute events. These events include natural disasters, such as hurricanes, tornadoes, earthquakes. 

One of the main differences is that these are not predictable. Unlike seasonality and holidays, you can predict it, and know when it will happen. With our iQueue testing, we take into account event changes and variation, and have a buffer built in to help you accommodate for these changes. Many times closures may coincide with different patient arrival. And many times, the buffers and templates will take care of any effects that these acute events may have had on your centers. Other changes. Other changes include volume changes. A decrease in injuries and the number of patients managed, such as the example we gave for Florida. However, for these changes with other changes, they are not predictable and are unknown. The amount of time they are unknown is not predicted, and will not be returning back after the end of the season. It’s important to distinguish these four different types of changes.

 During our presentation we’ll be focusing primarily on seasonality, and giving some examples of holiday patterns, and how to help your infusion center deal with the changes and holidays. Seasonality changes you can be seeing at your infusion center. Here are a few common trends that are often associated with seasonality trends. All these changes correlate with changes in the season. As we said before, when there are bigger trends, it is often easier to see this seasonality pattern. However, smaller trends may still be impacting your operations, but are a little harder to identify. 

We will go back later to understand how you can best use iQueue to identify seasonality changes. We will share four examples of changes that may be occurring in your infusion centers due to seasonality changes. The first two examples on here are changes in volume and the changes of number of no-shows and add-on patients you are likely to see directly because of seasonality. You may oftentimes see volume changes, the decrease or increase in the number of patients managed, such as our Florida example. During the holiday month, you experienced an uptick in the number of patients visiting the center. And then during the summer, the volumes will be likely to decrease. The next example, changes to the number of no-shows and add-on patients. Oftentimes, in the season change, it may change the rate of individuals coming to the center. Maybe during the summer months, patients are more likely to not show up, and then be needed to be added on last minute to a different day. 

Maybe during the winter months, there are more delays. Meaning patients are more likely to be arriving late to your center, and making your operation stop. There are additional examples of changes you may be able to see in your data that may be linked to seasonality. When looking for these changes, it is important to make sure you are looking for changes that are regular and predictable, and correlate to changes in season. Other changes your center may be facing include changes in staffing, hours and operations, and closures of specific days. These are important to note that these two changes could be happening at your center is maybe because of changes in the volume or changes in the holidays. 

Although, we do not consider these seasonality changes of the holidays when there are closures, it is helpful to understand how it will impact your center, and how to best accommodate for this. It is important to also note, as we said before, all changes with seasonality are around the same time each year, and our regular, predictable pattern will then return to the same as they were prior. Identifying seasonality within your center. So you think seasonality is impacting your infusion center. It is important to have a way to figure out if seasonality’s impacting your center. Based on the information we have reviewed, we have put together four questions to ask yourself, to encourage you to delve a little deeper into the effects of seasonality, and how you can talk about these changes within your center. 

These are the four questions we put together. Question one, does this change happen every year around the same time? It is important to make sure that this change happens year over year, as we talked about. And then returns to a regular pattern during the off season– returning to their original rate. Does this change return to the same state afterwards. 

Question two, is this change predictable? Seasonality is relatively predictable, happening year over year. 

Question three, does this change last more than a week? Seasonality and changes last more than a week, and more and more likely to be seen for a month or multiple months. 

Question four, does change coincide with changes in the weather? Often temperature and weather correlate with seasonality, as we have given a few examples, where centers notice changes in the weather, and oftentimes they notice many changes in their operations. If you answered yes to these questions, you are most likely experiencing seasonality. 

These changes you are feeling can be linked to seasonality. We will show you additional ways to utilize iQueue to help you look for changes within the season. Using iQueue to help you detect seasonality. With the metrics right at your fingertips, iQueue makes it easy to see operations that can be affected by seasonality. Let us work together to help determine which of these areas in your infusion center are being affected due to seasonality. There are many places you can look within the application to see seasonality. Let’s make it easy. You can start by looking at the operations digest that’s in your application. The operation digest has great metrics all summarized located within our application, highlighting the key metrics you want to focus in on for seasonality. With our most recent enhancement, you can now look at the data, comparing it with the data you would like, and by different month, day, week, or quarter. 

For this example, and to look at the effects of seasonality, we find it useful to look at it by month. The graph that you’re showing is currently organized by month. You can easily see which month could be affected, likely caused by seasonality. You can easily look at the volumes, and then scroll down to look at the wait times, patient arrivals, and other metrics all on operation digest, which can all be linked to seasonality. So after looking at the operation digest, you said yes to all the four questions about seasonality, and now believes that seasonality is infecting your infusion center. So here from this diagram, we can see that there are oftentimes lower volumes in the summer, and higher volumes in the winter. 

Further in our presentation, we will delve a little more into this example, and see how your infusion center can make multiple templates to accommodate for the different trends, and the volume levels during winter and summer. So let’s jump into how iQueue can help with the effects of seasonality. Some of them mainly, iQueue can help combat seasonality. It’s like the graph we just showed, it’s through metrics. Other is through optimized templates and changes in operation, effectively accomplished through good communication. We will now walk through five examples of how centers have been affected by seasonality and hol or holidays, the problems they were experiencing, and how they solved this problem using iQueue or working with the iQueue staff to figure out solutions to these seasonality and holiday [INAUDIBLE]. If you believe your center is experiencing one of these issues, it is good to bring up to your iQueue product management team. If you’re not currently working with an iQueue team, feel free to reach out to us, and we’ll be happy to talk to you about iQueue, and put you in touch with an iQueue product manager who can help you go over seasonality, and how it may be affecting your center, and ways to improve your operation. As we walk through these five examples, we will learn about how metrics, templates, and communication can be used to better your operation. 

The examples here are often for customers directly or currently on iQueue. Our first example is the example we briefly touched on before. Increases in volumes during different seasons. The first example, may be a common one for your center and it is often easy to spot. Oftentimes, seasonality can affect the volumes of patients coming into an infusion center. The volume of the patients can increase or decrease depending on many factors. Let’s go with the example of increasing, like we talked about before. This example is particularly common, as we said, in areas such as Florida, or areas that are warmer than others during the winter. As I talked about. Florida, you notice there’s an increase in volume in the winters. Some centers often notice a decrease in winters in their volumes. Often patients will delay their treatments during the holiday season for personal reasons, or due to changes in operation. Whatever the cost, there is a correlation here with decreases in patients during the winter, being another problem, certain centers face due to seasonality. Oftentimes, centers also have noticed increases during the fall, after summer, or at the beginning of the year in their volume. 

These changes can affect centers who face smaller seasonality outside, but may even be facing just [INAUDIBLE] changes within their own center. So the problem we’re discussing here is the increase in volume during the winter months. You notice the problem happening every year around the same time. On the flipside, you also notice smaller volumes during the summer months. You may be wondering how to best deal with this seasonality effect to make sure you have enough appointments for your demand. We will now explain how creating multiple templates can help combat the changes of seasonality, and help ensure that your center is meeting the demand level. The solution here, as I stated, can be creating templates to match with your seasonal volume. We look at your past seasonal volume, and while looking at these seasonal temps, we can also plan for growth. In our template, we can accommodate for add-on volume, no-show volume, and cancellation, giving you the best level-loaded templates for your center. For multiple season volumes, as we’re showing here, high season template and low season template. 

First thing is to find the right volume. How we do this is we take the lower volume template, and then find the correct ratio between the low season template and the high season template. In order to minimize changes, we suggest using your low seasonal template as a base. What we mean by a base is that you use your low season template to build off of. Meaning, you add additional appointment to this template on top to get your high season volume. Here is an example of a high and low season template. For this example, when they see an increase in the demand for winter, they will use the high season volume. And then for the low season, the summertime, the low season volume. When their volumes are closer to 51 a day for those summer time, and then for the winter time their volumes are closer to 59 for those high seasons. This is just a one day, templates can also vary by day if you have different demand patterns for different days. With high and low season volume, you are also able to make changes in your hours. For this center, they were able to keep their current hours, and just change their volume.

If you are familiar with iQueue, and you are currently using our product, you have probably seen templates like these within our application. We use our application to generate our templates, and generate the best level loaded distribution of appointments, with a smooth ramp up, a smooth ramp down, and level loaded days. We can now see that the low season template allows for a buffer, and that the data level loaded for both high season and low season. These templates help to accommodate the differences in volume you may be experiencing over your season. Our next example is an example when you’re experiencing an increase in the amount of no-shows, causing delays within your operation, or overestimate with your current template. Variations in arrival of patterns of patients can affect operation. When there are changes outside of the control of the infusion center, it can be challenging for your infusion center to navigate. One example, the one here, we will be talking about is an increase in the number of no-shows or cancelations. Within our application, we have a couple ways to help predict the number of the patients that arrive. There are two main areas which you can see the projection of members that are expected to show up. We can help predict that when we’re creating the template. You have the option to run a template simulation. The template simulation shows you how the template is likely to unfold, based on if your scheduled correctly to your template. Another example is in our daily huddle section. 

The other section that shows you projected volumes based on the amount your center has scheduled. As for this example, centers with high rates of no-shows are likely to see a decrease in the number of appointments completed against the number they are scheduled. With the iQueue application, under the diagnostic section, customers can see breakdowns of add-ons, and no-shows and cancellations to better understand the changes during the different seasons over a different time. For this example, you can use IQ to help you understand that during the summer months, you may be having higher levels of no-shows. From this diagram, you can be seeing the peak for the summer months with the level of no-shows. Meaning, that our amount of appointments scheduled will shrink during the day due to these cancellations and no-shows. This can be a problem because it makes it hard to ensure that you are utilizing your chairs if you are having such high rates of no-shows. And that these chairs are often going unused. 

After you have determined the high no-show rate, you can work with your iQueue infusion team to help create templates to help deal with the higher shrinkage rate. Let’s walk through the solution to see how predicting the no-shows in cancellation rates can help create templates that is utilizing chair capacity. Here is an example of a day of an infusion center with high rates of no-shows. When you are on the iQueue application, you can easily see this chair utilization view under the daily digest. If you are an iQueue customer, this view also comes in your email as the daily digest email. To review, and for the people who are not too familiar with iQueue, the green line is our template line. In this picture right here, that green dotted line, that is the mac template, where all appointments are scheduled correctly. The blocks are how the appointments are actually scheduled. The yellow blocks are scheduled a little under the template. 

The gray blocks, [? to ?] template, and the red box, over template. What is interesting to note here is the gray line max chair capacity. You can see it symbolized when it says max chair capacity 39 in the diagram. As you can see from this picture, at most hours of the day, the templates are scheduled over the capacity of chairs available in the infusion center. However, for centers with high rates of cancellations and no-shows, having templates that are higher than chair capacity helps ensure that the chairs are used, even with the higher rate of cancellation. For this center, there are 15 cancellations that day, bringing the completed volume to almost 130, also a lot of infusions. It is important to notice that the chairs were booked well to capacity. The pink line in this diagram, the pink line with the circles being what actually happened and actually unfolded. And you can see from this, the appointments were actually seen in the infusion center were right at that chair capacity. Meaning that these appointments were booked at the right level with the shrinkage. 

As changes occur in your add-ons and no-shows, it can be helpful to figure out the best strategies to make sure your chairs are being well utilized and level loaded for the majority of the day. Such as this example of creating templates to accommodate for shrinkage. Our next example is changes in provider’s schedules. Provider’s schedules often play a major role of when patients come in to the infusion center. Oftentimes, infusion center feel a midday rush during their peak hours. Specifically for late appointments, appointments where the patient sees the provider first, and then has an infusion to follow. This can go lead to delays in the infusion center, as it is often hard to handle all these volume, and centers are often needing to constantly overbook during these main hours. When seasons change, and hospitals get new providers, this can especially impact infusion centers, as the demand for infusion to follow can drastically increase during those peak hours. 

One example is during summer time, when centers oftentimes get you providers from near the end of the year, when providers begin to change up their schedules, or increase the number of patients they are seeing. The problem we are seeing here is this infusion center has too many appointments during peak hours. They are seeing this often because of the changes in providers’ schedules, and the demand of providers scheduled to see many patients during those peak hours. Solution. The solution here is to see how to make slight changes with providers scheduled to help make sure they align with the infusion template. At first, this may sound like a huge change, telling providers to change their schedules. 

Let’s walk through this example to understand how this can be a big impact, but a small easy change for the providers. For this example, we worked with this center to calculate the number of infusions they had available for each hour by creating optimized templates, and then matching these with the provider’s schedule. We determined how many infusion appointments they would need at this provider appointments, and made sure they had the right mix. When we tried to make sure there were enough infusion appointments, we saw that many of the providers had all of their scheduled appointments with infusions to follow, around the same time. Meaning that these infusions appointments all needed to start at the same time. The infusion center just did not have enough chairs to accommodate this level of appointments. So what we did was we helped take a look at the providers’ schedules, and tried to figure out small changes they could make within their already existing provider template. What we mean by this is when we looked at the providers’ schedules, and made sure we did not change the hours or days of their schedule. 

Rather making small adjustments to the appointments that were there. For this example, every appointment that said TX to follow, meant an hour later there would be an infusion afterwards. Looking at this provider schedule, and others with infusion scheduling, many of these were leading to the bottleneck time. Having this provider switch their treatment from a 10:15 to 11:30, was their return visit, which did not need an appointment afterwards, specifically an infusion, helped lessen the high demand of an infusion appointment during the center’s main hours. So from this picture, you can see that we recommended on the left side is the original provider schedule that we recommended moving based on their infusion to follow appointments. We recommended moving that treatment to follow to 11:30, and switching that with the return visit. The return visit did not have an infusion to follow. 

This small change for the provider, switching the two appointments, was small for them, but had a big impact on the infusion center. This was just one provider schedule we changed. But when you change a couple of these small changes, it can really help change the demand level on your infusion center, getting rid of those bottlenecks. The key here is to make these changes work efficiently through communication with everyone, providers and infusion staff. Telling everyone how impactful these small changes can be will make everyone’s operations run smoother. If you are currently working with iQueue, it can be helpful to talk with your team about making sure your providers’ templates align with your current infusion template. When the seasons change, and the time of year is changing, it can be helpful to check in with your scheduling team to make sure schedules are all aligned. Our next example, although not directly related to seasonality, it is related to holiday changes. And it is helpful to understand the impacts of this, especially during this time of year. One problem centers often face is during holidays, there are lots of changes. Changes in hours, changes in closures of days, and changes in staffing. This impacts a center, as they are trying to make sure they are still getting their infusion appointments in. 

The solution here is it can be helpful to three different templates. For change start, the staffing may have changed, or remove start, as staffing may not be accommodated during the holiday time. By planning ahead for the holiday time, you can help a level load your days, and make sure you are still seating the necessary appointments. Here is an example. For a center where we worked to a specific holiday template. These templates have been created for the changes in staffing, hours, closures for Thanksgiving, and the day after. The changes of this picture can be seen from the week of November 25th to November 29th. With December 2nd to December 6th being a normal week. It is easy to see the changes from the days against this week, where no changes for the holidays have been made for the following week. Let’s focus on last week since this was the holiday week. Since two of the days were going to be closed, additional volumes were added on to the beginning of the week. Three additional appointments were added on to Monday and Tuesday to help with the decrease in volume from Thursday and Friday. This center also had modifications in their staffing hours, which allowed more appointments to ramp up earlier in the morning. November 27, the box in red was where the center actually changed their hours. Here on November 27, they closed at 3:00 PM, so the templates were adjusted to increase their appointments earlier in the day for an early closure. The nursing shifts were also affected, which allowed more appointments to start in the morning, ramping up their day quicker to allow more appointments to be seen right away, to allow the center to have a better level loaded day, despite the early closure. Once we understand all of the parameters, we then use our temple generation within iQueue to create the best templates on the holiday constraints. 

By making these small changes, it helped make sure operations were running smoothly, even though it was a holiday week. We have talked about many template changes you can make to help accommodate for seasonality, as well as how you can use your analytics and metrics to help predict your load, and see changes in seasonality. We also briefly touched on how having flexibility and small changes within the provider team can help your operation. This example will focus more on flexible staffing. The problem in this example we are faced with are a couple different problems. This infusion center has multiple floors, and it’s closing on the holidays. There is also an unbalanced demand across the different floors. When the holidays are happening, it can be hard for the infusion center because they still have to accommodate per patient. This may mean that some of the center’s changes are hours, and staffing, and the [? use. ?] But the usual number of patients and appointments will also fluctuate. 

Also because of the holidays, many patients also cancel their appointments, or hold off on their appointments until after. Changing the levels of no-shows and add-ons. This means that the pods who usually have consistent amounts of patients, are constantly having different levels over the holiday time. This can make it hard for centers who has a very rigid number of nurses for a specific pod or floor. One solution for this problem is having a float nurse who can see patients across different floors of different pods. We will explain more about how iQueue can help you best use this float nurse. As we talked about for this problem, having the float nurse, allowing them to go to different pods, when you have multiple pods, can be very helpful, especially when the center is seeing fluctuations in the number of patients they are seeing for each pod. By having a float nurse, this is what the pod that needs the most help. 

For example, on this. Friday, November 28, pod A has lower volumes compared to pod C. And pod C has the lowest. Even though each of these pods have around similar levels, the model appointments that are scheduled into the pod can be a bit different, especially with the holidays. We chose this day specifically because it was the day after Thanksgiving. Based on what is actually scheduled, it can helpful to have the float nurse go to different pods. On this Friday, a [INAUDIBLE] to this week, it could be helpful to have that float nurse go to pod B to help out with this additional volume, as the other unit has a lower volume. And after you have the float nurse go into pod B, it can be helpful to send additional add-ons during the day to pod B because there’s a float nurse helping with those additional appointments. Not only by having a float nurse does this help lessen the load, and make sure all pods and nurses have similar work. Some centers also have float chairs, where they can add additional chairs on days that they will see it will be very busy, or that they could be potentially running out of room. 

By having flexibility, it helps ease the effects of seasonality on the center, making sure operations run smoothly year around, even the seasonal changes and holiday changes. We have now walked through multiple examples to show you how iQueue can help lessen the effects of seasonality on your infusion centers. Ask them these examples, the main thing is not letting seasonality surprise you. One of the main key takeaway is being prepared for seasonality. The next key takeaway is use iQueue to check your matches, to see the way seasonality may be affecting your operation, and obvious and less obvious metrics. Third key takeaway is work with your iQueue team to mediate the problems you may be encountering with seasonality. Whether this be better understanding of analytics to predict seasonality trends, creating new templates to help with seasonal demand, or helping communicate changes with your team, our iQueue team is happy to help. We will now take any questions you have about seasonality. 

HOST: OK, so like. Caitlin said, we’re going to move over to our Q&A portion. So if you have any questions that you haven’t submitted yet, please do so in that. Q&A widget that you can see on your screen. And we have received one question here. And it is can you start using iQueue during any season? 

CAITLIN ISOBE:. Yes, you can start using iQueue during any season. We work with your previous year’s data, and in this data, we are able to look at seasonality trends. We will be able to assess if seasonality is affecting your center, and the best approaches to handle these situations, and allow us to have the best templates for your center. 

HOST: OK, and then one of your examples was about shrinkage. Can you create templates that account for add-ons? 

CAITLIN ISOBE: Yes, this is definitely something we can help with. We look at your past volume and trends, and ensure that we are matching your historical pattern. For the example we saw, we saw a center that was having lots of no-shows and cancellations. If on the other hand, we saw additional add-ons coming in, we can work with your centers to accommodate for these changes.

 HOST: OK, perfect. And then the final question here is what if my center is experiencing other changes that aren’t linked to seasonality? 

CAITLIN ISOBE: Yes, so if your center is experiencing other changes that are not related to seasonality, there are many ways we can help. One of the ways is we can easily look into your past volume, and we can check to see what’s going on. We can see if this change is looking like it’s going to be a permanent change, or if this is maybe a change due to deconstruction or changes in your operation. Once we determine what the likely cause of the changes or how we see the change affecting future operation, we are able to work with you to create potentially better templates to help with these overall changes. 

HOST: OK. It looks like that was the final question of today. Thank you, Caitlin, for today’s webinar. And thank you everyone for joining us. Have a great day.