Throw the (Over)Book at Them Webinar Transcript
DANIELLE: OK, folks. So today, I’ll be talking about making and managing a booking escalation pathway in a way that, one, minimizes overbooking, two, doesn’t overload this scheduling staff at any level with the amount of workload that they have to complete. And three is to maintain high levels of patient satisfaction with the equipment options available to them. There are some big problems that infusion centers faced with regard to scheduling patients. Most have at least one and potentially all of the following issues– high patient wait time, especially in the middle of the day and that peak, 10:00 AM to 2:00 AM time frame.
Utilization is uneven throughout the day, causing bottleneck in chair usage, lab, pharmacy, and other resources. And infusion nurses, they miss their lunch and other breaks due to high demand in the middle of the day. Typically, the way we try to tackle these problems is high-level loading appointments throughout the day by the use of templates, quotas, or other tools that are meant to keep too many patients from being scheduled and treated at once. But with the use of those templates, quotas, and other limitations to protect our utilization, we add more complexity to our already large number of limitations that schedulers must navigate in order to book appointments.
For example, the schedulers must respect limitations around staffing, treatment types, and clinic flow, such as coordinating clinic visits and infusion visits, such as the way after the clinic visit isn’t too long before they have to go to their computer and visit. So they need to schedule non-treatments, the end before closing time, especially nurse and staff breaks having to deal with the fact that some days schedules show up in advance. And you still may have patients that need to be treated on that day. So wrong or incomplete treatment information and scheduling requests, that need space for last-minute treatments. That means, have some clinical urgency they need to go that day, as well as working on patient availability.
But in addition to those needs, and we also have to respect staff and limitations around sharing staff utilization. It will inevitably lead to situations where some of the constraints can flesh in. Scheduling staff may need to make another booking. You can see here in this chart that the center and the dates represented here, they had to make some overbookings in the middle of the day where they only have 40 chairs. But it looks like they booked up to 50 patients to be in treatment for an hour or two later, starting at noon.
There are a few different ways that folks use to protect their schedules. These can be safe for now. But an overbooking is an appointment that is made out by the template or a pre-approved spot– as a result, unplanned over-utilization of chairs for nurse staff on the day of treatment. So to folks who are already on a template, you can see that we’re booking as– booking to make outside of the template in addition to the number of plots of the template.
And for people who are using something less formal, more just like a guideline that say you can only have three starts per hour throughout the day, an overbooking would be any appointment we made where there’s a force start because you’ve made that rule to protect your resources. And now, you’re at risk for over-utilization. The way our overbooking is something we want to avoid in our schedule– well, overbookings can cause staff overload because nurses miss lunch and other breaks.
Overbookings can cause delays as patients must wait for a chair or nurse to be available with proper treatment. It can also– even if a chair or it does come available, having too many patients in the system at once reduces the ability of operation to bounce back after a period overbooking because patients will regulate, delays will occur in pharmacy, and treatments run long, which means if you look and you see you’re only overbooked for two hours after all of those additional delays occur, that bottleneck will sort of spill into the third hour or in the fourth hour, making it really hard to cover service for that day– cover, some good slow service for that day. For example, on the left, we have a schedule with a lot of overbooking.
You can see that this graph shows the planned chair utilization for that day. With the time of day on the horizontal axis found here, you can see they go from 8:00 AM to 8:00 PM, and the planned chair utilization on the vertical axis, going from zero chairs to their total of 17 chairs. And we think that there is a lot of overbooking on this stage. As you can see, that they have nice level loaded day in the morning starting at 9:30 and going until about 11:30. And they’re really just using 12 or 13 chairs. And it’s a pretty even day. But then here, you can see that they book many more patients than 12 or 13. In fact, they booked over 20 patients, which is even more patients from the number of carry they have to treat them in.
And then, we see that level of busyness, really all the way until the late afternoon when the day starts to ramp down. So for this day, with all the effects of overbookings, we expect long afternoon wait time, nurses working through lunch. And you can see that there’s actually no space in the afternoon for add-on. So those folks who go to clinic in the morning, when their commission sees these supportive care, that will make it very hard to find space to give them an appointment in the afternoon for hydration, or an injection, or whatnot. And then for the example on the right, this day actually has just as many appointments as the example on the left.
I think there’s 51 in this example, and 49 in this example. But the appointments are better spread throughout the day, and there is a minimal overbooking. You can see here that they never booked more patients. And they have chairs throughout the course of the day. So with this schedule, we would expect to have lower wait time. Nurses have a chance to take lunch. You can see sort of from this 11:00 to 1:00 period that there’s a little bit of space that folks could take a few minutes to get away. And there is some space for add-ons.
You can see that you’re sort of books to capacity here. I think that’s one to two. But there is some room later in the afternoon, starting after 2:00 that you could put those add on appointments. Now that we understand how operationally disruptive overbooking can be, you can talk about how to limit overbooking in a way that as few as possible are made, understanding that at least some of these bookings are unavoidable. And when they are made, that they’re made in the least disruptive way by the person with the needed expertise to the information to make an overbooking well.
Key idea behind an escalation pathway is that if an appointment can’t be booked into a pre-approved or template slot, it doesn’t mean we can just go ahead and book it anywhere. We have to take additional steps before we take that action. And we put in a potentially disruptive overbooking. In order to control overbooking, an escalation pathway must establish who overbooks, why do we overbook, and where do we overbook? Or for overbooking, look for an alternative to overbooking.
So for the question of who overbooks, we can participate basically in that escalating pathway. We have infusion schedulers. You have front desk path. We have the lead schedulers– so the folks who are leaving up to your infusions scheduling team. We have clinics schedulers and staff– often generate the questions. You can see it in that process. In-patient schedulers and staff, in-patient charge nurses who are those folks who may be for example, approving add-on on the same day appointments, as well as the patients themselves.
As for why can overbooking be made, we have a couple examples here that you can include in more escalation pathway. So one example is you can make an overbook, potentially to coordinate with a clinic appointment. You don’t have any open slots until 1:00, but they’re out of clinic at 9:00 AM. You may want to make an overbooking, so they don’t have to wait for hours. You can overbook to respect capacity limits. For example, if you know you can’t have more than three starts in that first hour of the morning because you don’t have the early morning staff to support it, you may have to make another booking a little later in the day.
Let’s say in the 9 o’clock hour in order to get that patient in at an appropriate time, you may also overbook to respect time constraints and when you need to start long treatments. For example, if you know you can’t– you’re not supposed to start a six-hour appointment after noon, but if there’s no slots available before noon, that might be inappropriate time to make an overbooking. So you can get that person on the needed date. You can also overbook to respect on the patients from pharmacy, especially if it stops mixing the certain drugs later in the day.
As they wind down, you may need to make an appointment at 4:00 even though they’re not open up until 5:00, so that pharmacy will be able to make that drug and then wrap up and go home. And you can have the drug by the time that the patient is ready to receive it. And the question of where– where should overbooking be directed? Again, this is something that you can customize to each ventures, escalation pathways. But here are some examples. We would say you could direct people to use it and have people direct overbooking to the early morning in the late afternoon.
Or if you have other off-peak times, let’s say you’re finding even your early afternoon is underutilized, you can direct overbooking there. You could direct people to overbook only when a couple of texts, got those a chair and a nurse will be available on that day’s schedule to treat your overbooked patients. Or you can say overbookings, in general, need to check other dates, their locations, before they can be made because you prefer to really not make any overbookings. And so you say, oh. Well, if we can we treat them tomorrow, I know we have three slots. Or you could even say, we’re not accepting of overbookings on Monday. You can have those other time. Tuesday, that’s the lighter day. And Monday is your busier day. So there’s a lot of possibilities in terms of deciding where you want to direct to those couple of appointments for experts and already at the slot available.
So here is an example of an escalation pathway. There are several elements here. And it’s not a one-size fits all example. Some centers will need. Fewer steps and some centers may need more different steps. But just to walk you through what an escalation pathway could look like, you can see here the process starts or our example process starts here, determining if an appointment is an add-on. If it is an add on so, yes, it must go to the charge nurse for that day who will book the appointment for later that day according to a staffing she knows she has on hand for that day.
So she has [INAUDIBLE] charge nurse who is a person who has the best knowledge of seats on the floor and who finds it a bit long, who is not. As well as the queue of the appointments that have been scheduled for that day, and that is the person who can really take a look at really what is my active load. And can I really set this on the same day add-on? And so that’s why we have– even though we don’t expect most appointments being add-on, that’s why we have that as the first step in the process because we don’t want to have someone– we don’t want to book that out on appointment without having the needed approval from the clinical staff.
The next step, so that’s not an add-on. It goes to this next step in the booking process. And that is set then to an existing slot. We expect most appointments and booking pathways to be able to be booked by going into an existing slot. So if there’s a pre-existing slot at/or near the requested appointment time, the scheduler can go ahead and book it. On the case that there isn’t an existing free slot at/or near the requested time, we recommend that schedulers, before they go all the way down here to the overbooking section, try a couple alternatives, such as looking at another time or location. So you can offer a time a little later in the day. Or if there’s a nearby location that has availability at the request of time, it could be that the patient is willing to go there or at the clinic that is wanting to direct the patient there if you’re dealing with a clinic’s scheduler.
In that case, you should book in the new agreed time or location. We also recommend that before making an overbooking, you look for something called a trade off. And we’ll go into a little more detail about trade off in a later example. But basically, you can know for now that a trade off is when you book appointment into a slot that’s technically reserved for another treatment type. But because you’re really working around to try avoid a potentially disruptive overbooking, sometimes it’s OK to take up those reserves slots, even though it is technically for another time. If you’re only booking, let’s say 5% to 10% of your appointments that way, it can sort of work out. And we’re both in a better net schedule, and if you had just left those reverse slots alone.
So if you can find a trade off, of schedule or book the appointment into the trade off resource. And then, only after we’ve exhausted our alternatives– overbooking– that we start to make overbooking on the schedule. So there are sort of two options for overbooking. One, we’re calling sort of a front-line overbook. And that’s where, really, you’re allowing your front-line schedulers to make overbookings on your schedule. There are some cases where you might not want to do this.
For example, if your front-line schedulers don’t have all the needed training or all the needed information in order to know how to identify where the best place to overbook, for example, if you told them you only want overbooks from locations where there’s a chair and nurse available, but your front line schedulers don’t have the visibility or the information they need to determine that, you might want to skip this front-line overbook entirely and pass that overbooking until a more qualified scheduler.
It’s called an escalated overbooking. And there is a different set of people who have all the information they need to overbook who will pass it to them. And then they could go ahead and make the overbook. It just sort of depends on the flow of information in your center and the number of folks you have looking into your department. But basically, the appointments should be booked at either one of these steps– either one of these overbook steps. And then there’s one more step in our escalation path, which is to basically look at the consequences of that appointment and decide if it’s put you overcapacity or maybe the blocker for that day or a bottleneck for that day.
For this step, we often recommend that if you’ve seen a blocker or you’ve seen a bottleneck, you can go ahead and do a little bit of what we call schedule grooming, which is when you look at the day’s schedule. And you try to go through and figure out if there’s just a handful of appointments. You can move just one or two. That will remove the bottleneck and, basically, open up additional capacity in your unit so that you can go ahead and book those last couple of appointments. Or remove yourself from a difficult situation where you had planned over utilization of nurses at one time, bring that utilization back down so that your schedule is more reasonable.
And then [INAUDIBLE] once we made the booking and double checked the schedule, that the booking pathway ends. You can see over here that we have this little arrow describing the number of bookings. And we expect most bookings to be made early on in this process. We want them to either go into a free slot or if you can’t find a place slot in the first part of their conversation based on the first time requests, try to have a little bit of a discussion with the people requesting the appointment, either a patient or a clinical scheduler to get them into an existing free slot.
And then ideally, the most booking will go into a pre-approved, very completive slot. And then it’s really only a small minority of appointments that we want to end up in a state where we’re making over booking, either front-line overbooking or escalated overbooking. Rules, guidelines, and permissions are a critical element of a booking pathway since that each stage of the pathway, they will help the schedulers either figure out the best place to book an appointment or if they need to escalate your request to another person or process.
So a guideline is a statement that directs bookings– isn’t a hard and factual. For example, the guideline would be, try not to allow overbookings over lunch, unless there’s an urgent clinical need. So you can see there with the guidelines sort of utilize what preserve the one space, but exceptions can be made at the judgment of the scheduler. So there’s not even additional process around, like, guideline. The guidelines, as opposed to rules, have the benefits of that. They result in fewer escalations because they’re flexible, and you’re more likely to discover compromise of an option because you can have a little bit of give-and-take conversation.
But for the disadvantages and that they’re hard to remember, they don’t stop all bad behavior because they aren’t a rule. And they require a little bit of training. Actually, it’s time and weeks go on, and people have all these other booking pressures associated with making the appointment. And plan on their patients, then you might sort of forget that guideline a little bit and may require some encouragement and retraining. A rule, on the other hand, is a statement of sort of a hard and fast guideline on what’s allowed in the schedule and what isn’t.
So an example of a rule would be, do not schedule appointments longer than four hours after noon. And so with that, there’s really no room for discretion when the scheduler is booking that appointment. Well, it can be beneficial because the aid results in fewer bad bookings because no one’s doing this one, went-off judgment software. Maybe their judgment is wrong, or maybe they didn’t have all the information they needed to make a decision about that guideline. And another benefit of rules is that it can sort of set expectations with other stakeholders, like clinic staff and patients. for example.
If you instituted the same rule, you can’t have these long appointments after noon. And you don’t want patients calling and finding that they can get an exception made for them just once because once that expectation is set, they were the patients. They’re going to call back the next time and also want their long appointment after noon, et cetera, et cetera. So it does have benefits, especially in a time of a lot of change because it can send a good consistent message to all of the other stakeholders about your scheduling teamwork sweats. And then the last option that we’re going to discuss today is the permission.
So a permission is like a rule, and then it has no flexibility or discretion in how it’s enforced. But it is incorporated into the booking system or the EHR in such a way that the schedulers physically block from making the booking. So I don’t know if you ever encountered this, but let’s say you want to go book an appointment after hours, or your appointment does going to run long. And some setups will be blocked. And you can’t make that record on the day’s schedule.
So the benefits of a commission versus a rule– one is obvious. It’s that it doesn’t require any manual enforcement. No one can do any bad behavior. No one can break the rule. No one can be spending the guidelines too often. And another benefit is that you can give different people on your team different permission. So say you want most of your schedulers not to be able to book an appointment someone’s after hours. But you know there are sometimes valid exceptions then you want the scheduler to have the permission to do that. And then with the expectation that any appointment that really, really, really needs to be booked, such that it runs past closing hour of the center, it will be escalated to the least scheduler. And she can use her permission to overbooks that appointment.
Some of the drawbacks, however, permissions are that if you require changes, the institute, either by your IT department or your EHR department in order to set up the rules and assign the permissions in a way that it works as expected. To clean up most of the appointments to go into a pre-approved slot, we recommend schedulers to try a few alternative overbookings in the case, nothing initially request if time cannot be accommodated. Not all of these options we discussed will be a good fit for your center or the way you operate. But at least, if you will.
One option is to make a trade off and booking them into a slot intended for a different type of appointment. Again, neither of the trade offs that we mentioned earlier, and we’ll dig into how we do that and then example in the later section. Another option is to book an appointment later in the day it were requested, which would leave time for a patient to grab a drink or a snack if they have a clinic present beforehand. One way, you can negotiate avoiding an overbook is to clarify if they’re surgical, clinical, or operational need for the requested appointment time. And if not, explain that you need to move the visit to one of the non-requested or later time, perhaps because there is no medical operational need.
You can make a rule that appointments, which don’t require the same day clinic visit you booked off-peak hours, which preserves peak hours for time slots that are really needed for clinic coordination. And ideally, you sort of reduce overbook in the peak time because what’s going to happen is if you don’t reserve that space, people will go ahead and overbook there anyway, because they’re saying they need for the patient to not be waiting five hours, six hours after a clinic to get their infusions started.
You could pre-identify times, put same day add-on, which avoids overbooking the [INAUDIBLE].. With serving those add-on slots, meaning that each time an add-on needs to be approved, someone doesn’t need to go into the schedule and hunt around for a suitable option. You could first offer available slots to patients and clinics in the beginning of the booking conversation, waiting requested time altogether. And we’ll talk a little bit about the scripting you need to do that in the later example as well. Or you could book the patient on another day, and ask them to come back if they live locally.
This can be a little bit of a difficult option, especially for organizations where you don’t have a policy of coupling those clinic visits and the infusion treatments. But if there are cases where this would be clinically acceptable, and the patient doesn’t live too far, you consider offering it to them because it can actually result in not only a better schedule for you because you’ve avoided overbooking, but also a better experience for the patient who has the chance to go home, and then come back on an off-peak time where there’s a free slot, and have sort of a less busy infusion center and less wait times.
Potential problems with an escalation pathway– everyone here has at least some sort of booking pathway already established. So even if you haven’t gone through the formal exercise of mapping out the pathway and evaluating it, some of these issues will probably already be familiar to you. Most of the problems that are encountered before the point of scheduling have to do with not having enough information to book the appointment properly. For example, for late schedulers, you may not have information on the next thing, infusion staffing to know if they can fit in one extra add-on appointments.
For example, that’s why we often say, well, we might want to escalate the charge nurse. Or at least an infusion staff nurse who has that sort of insider information on exactly what the clinic’s staffing– the infusion clinic staffing is going to be the next day. The front desk staff might not have the clinical information to know if they’re doing some schedule grooming. No appointment can be moved to a different time or has to be administered within a specific window, unless that was made very clear in the notes, in the appointment request. So that’s an example of sometimes when the schedulers doesn’t have all the needed information on the need to make the optimal booking or the staff overbooking.
Within the booking pathway itself, we are most concerned with bottlenecks and delays. That can, of course, occur. For example, if you have to process 15 add-ons per day, but you only have one charge nurse to approve them, that can end up being a lot of work for that charge nurse who not only has other duties, I mean, other things to monitor throughout the day. Another example, if you had many escalations to a head scheduler, say you’re finding, you’re escalating up to 30% of your appointments schedule because your front-line schedulers aren’t really sure how to book them, that might indicate a problem with your booking pathway or at least an opportunity for improvement. And then you should go back and basically try to bring that number down to something more manageable, like, again, 5% or 10% because we do want the majority of claimants to be managed by the booking process pathway and to have fewer and fewer exceptions– the things that need to be escalated.
Problems that we think of as occurring after the booking pathway are an area related to having too few resources left to make additional appointments. So one example is if this schedule is for an infusion, that clinic keeps booking more appointments that need a treatment afterwards. That could be a problem. Another after scheduling problem could be that if your nurses are calling out or going on PTO after you booked up the day, that creates a little bit of a resource problem too because you might not have the staff you need to treat everyone the next day without delay or wait times.
So now we’re going to dive into a [INAUDIBLE] a few examples of issues in a booking pathway, many of which are based on real situations that we’ve seen in our experience working with customers. So our first example is a center’s charge nurse of the day is struggling with the need to approve 15 to 20 add-ons per day, interrupting their other duties. Before I dive into the solution, you can actually see here on the right that we’ve included a simplified version of our example pathway and highlighted the sort of place on the pathway we are now, to sort of help follow along. And then figure out how many placements we expect to be going through this process and when we start this part of the escalation process to occur.
So going back to our potential solution, if we have all of these add-ons only one person to deal with them, so one of the logical solutions would be to try to find more people who are qualified to approve the same day add-on to spread that load around. So our potential solution here would be to allow other nurses in the charge rotation. So those are nurses who are not in charge that day but who do have charge experience, so they already know how to approve items. They already have access to the resources, like the staffing and the next day’s schedule to go ahead and make an informed decision, and whether or not they should allow the add-on. And have those folks ask the infusion center that day, take some of the add-on approvals from the charge nurse.
So with the outcome being if you have 4 nurses in the charge rotation, I guess, you can approve those 15 to 20 add-ons. Then the workload of the charge nurse for the day goes down 80%, right? 75% or 80%, that could be very helpful for the center. One consideration to this solution would be, the more people you do get involved in an approval process, or the more people you get pulling acquaint ant request from one’s place, it adds just a little more complexity and the need for those folks to coordinate with each other to make sure there are never appointments sitting, waiting to be approved, to make sure that there’s a layover.
So the staff they need and go– they need to go and approve an appointment. Or else, we’ll think, oh, the other person’s going to get it. The other person’s going to get it. As well as the need to make sure everyone knows to look back the appointment, loop back with the appointment effector, as those people know when their appointment time and also let the other charge nurses know that you’ve dealt with that specific approval. So they don’t think it’s up standing.
For this example, you’re focusing on the next step pf the booking pathway, in which we try to use an existing free slot. And our problem statement is, a center receives many requests from patients to book midday appointments, leading to a lack of available slots. So in this case, we sort of have schedulers who are realizing that there might be a time for filling up too quickly. And they may want to try to encourage people to use off-peak time so that when they have, let’s say an appointment with a critical need to come midday, maybe you have a couple of free slots available. And what we recommend is that you’re front-line scheduler would head back to the location. And instead of asking clinics what time the patient would like to come, it could start by offering the requester time that works for the requested treatment.
So pick up the phone, you say hi, hello, what certain treatment would you like to book. And then before you have a chance to say, oh, and I really want to come right at 11:00, so that I can get more at work, or avoid traffic, or whatever. You could– a scheduler can look up the treatment type. And then instead, come back with– well, we have a slot at 10:00. And we have a slot at 3:00, which one would you like? And this sort of does two things. One is it sort of prevents the requester from getting into the mindset that they even had a preference to begin with, or that there’s some helping denies that something you asked for. And then second is by making sure you offer multiple selections once you find out the treatment type your requester feels like they have options.
They do have options, like they have options. And so that can be a good patient satisfier as well– like you had options, and that was one that works for you. So we find that the outcome when people make these sorts of changes to their scripting is that many patients will accept one of the top level slots. And few will sort of ignore the options and move on to, like, no. Well, a very specific time and I was hoping we could request it to make those changes, your overbooking, to decrease because you’ve more effectively put patients in two slots and off-peak slots, letting you better spread appointments throughout the day and save your existing slots for those folks who have different medical needs.
However, there is a little bit of an a challenge in implementing this change, which is that this conversation can be a little bit difficult in the beginning, especially when you’re working with patients who have had their requested time for months or years. So they really need other infusions on a regular. I very much used to coming in. They always wanted to come in 11:00 or 12:00, and I have a whole routine. So it can just be a little bit complicated to get those folks on to the idea of choosing from options, rather than being able to sort of demand to the time that works best for them.
So the good news is that once everyone is used to the change, their old patients will be more accepting of having the options when you need patients to whenever really used to being able to select their exact appointment time. We’ll just say he’s thermal because that’s how your center has always run as long as they’ve been there. So for this example, our problem is infusion schedulers frequently get appointment requests from clinic specifying the treatment time, which they feel obligated to meet and would overbook.
And so in this case, what was happening is that the clinic staff were a people who were primarily requesting appointments for the patients because they had to schedule the clinic appointment and wanted to make sure they could get a different period on the same day. And those folks would communicate on the time the patient preferred to come and the time that the treatment needs to be at. So if there was a clinical need, in the same way, you still meet the clinic need, hydration at 2:00 PM.
I mean, teaching staff would have no way of knowing if that need was based on the clinical and operational needs, or if it was just when the patient wanted to come. So the potential solution here would be for clinic schedulers to read, to note clinical need request, the patient preference time request differently. So that when the infusion scheduler or a staff could request, they could sort of look or overbook the appointment according to the priority where– and they had a guideline for this– where if they can accommodate a patient’s preferred time, they should. But if there’s no existing free slots, and they would have to make it overbooked to accommodate it, it shouldn’t. It would only be overbooking to meet clinical needs.
And with this change, it basically enables them to make fewer overbookings because they knew sometimes when they get a request with a specific time on it, whether or not it needed to be an overbooking, or if it could be nudged a little earlier or later in the day because it was based on a patient request. So again, we’re still sort of operating in this space very high up in the booking pathway where we’re trying to push, or nudge, putting request into an existing free slot, rather than escalating it to a front-line overbook or an escalated overbook.
So here, the problem statement is schedulers often overbook even though there is availability at a nearby infusion unit to see that patient. So this is a problem that will be unique to organizations that have several units nearby. Sometimes there are units on a different form of the same hospital. Or they can be units that are sort of separated in different parts of a town or city. In this outcome, we’re hoping to highlight how sort of changing the time or offering a different location can be helpful to patients, and helping them find a more convenient spot, as well as helpful to schedulers and helping them level load volumes across the center.
So we have ones that are naturally busy and ones that are that has some made tests. Are there productive ways to direct customers to underutilized area? So here, we say the potential solution is to open infusion complex the clinic schedulers to book into pre-approved template slots only. And then use the permission to keep the clinic’s schedulers from overbooking. So basically, in the past in this scenario, what would have to happen is a patient would give their availability to the clinic scheduler. And the clinic scheduler will have to call until 1:00 and see if there’s a free slot. And if there’s no free slot, they then call center two to see if there’s a free slot.
But in this scenario, we’ve basically opened up the schedule of both infusion centers but then they each charge to the clinic schedulers, so they can check and see while they have a patient life in front of them on the phone. So we’re on the phone, so basically say, we have multiple options for you today. We don’t have an option at your preferred time at 10:00 AM in infusion center one. But we do have an infusion center two. So you can either wait later in the day at infusion one. Or you could good to infusion two and receive it at your desired time, which it does work especially for those folks who’ve already seen their medical oncology provider earlier in the day.
They can go, and they can drive often to a center that’s a little closer to the home and receive their treatments there. This is also a good use of a good example for the use of permission because they were very careful to not allow clinic schedulers to overbook into their infusion locations. It’s sort of schedulers who don’t have all the information about the patients under. They don’t have any information about the staffing or operational rules. Because using being pre-approved slot, they can’t go and make bookings that don’t make sense or could be operationally disruptive.
However, a drawback of having that permission is that if a clinic scheduler can’t find any spot, they still have to get on the phone and call up an infusion scheduler to go ahead and make up a booking. OK so we’re moving down the pathway just a little bit. Now we’ll be talking about trade off. So in this example, our problem statement is infusion schedulers overbook appointments midday because there aren’t enough of the right treatments slots to meet demands coming from clinics. So in this example, speaking of a specific situation I’ve seen, they had about 30% of their appointments for being related to overbooking.
Because they didn’t have the right types of slots, they felt like they didn’t have the right treatment slots midday to meet. Sometimes it’s very in demand that come out of the med oncology clinic. And so what they did is instead of giving your schedulers, they had made schedulers the permission to overbook, which could– even it says a 12 schedulers, and a scheduler’s thinking one overbook a day, it’s 12 overbooked every day just to start with. And that can be pretty disruptive to the operation. So instead of giving your schedulers overbooking permission, they give them trade off permission, which meant that they had a slot available for, say, a two hour appointment, we could book of a three hour appointment into that two hour slot, which can sound a little funny.
But actually in preserving most of the time– reserving more for the time that was going to be used by the original two hour slot, they’re really protecting the chair utilization and protecting the nurse who was going to take that appointment in, more or less, the same way than at a two hour appointment was. So it’s a little bit of a fudging of the schedule seeing that it’s not quite the right duration. But it’s almost that. And it ends up being way better than overbooking itself because you’re basically taking away an appointment that would have been treated in the test.
So when you do these trade offs, you end up with, for example, the rate starts per hour in approximately the right number of patients and chair as originally planned. Whereas when you make it overbooked, you end up going over. You end up adding to the number of starts instead of adding a start, but then also taking away a slot that can no longer be used by another appointment. All right.
Here’s our last example– revising overbookings and doing schedule grooming. So the problem statement here is that treatments must happen on a specific day, but the schedule is already full. Our recommended solution is to review the day. Ideally, have a senior staffer review the day because sometimes it’s a little hard to do schedule grooming if you’re not totally familiar with operations. Unless those people identify either any, a, wrongly identified appointment or appointments that are creating bottlenecks in your day. And for example, you can see here, we have a couple examples of days that needed schedule grooming. You can see the bottleneck here in red and orange. And then by moving just one or two appointments on each of these days, the day ended up being much more level-loaded.
And now, they are at/or under capacity for most of the day, instead of in a state where they are planning to have more patients. Then they have chairs or more starts than they nurses. So this is the sort of schedule grooming activity that we’re talking about, right here at the end of the booking pathway. Again, you know that moving appointments can be painful. And that’s actually why they’re at the very bottom of the pathway because we really only expect to impact a small number– one, two, three– depending on the size of your center to use some of that extra benefit of having done some post-booking, level loading of your day.
So to recap some of the things we’ve talked about today, wanting to just go over the steps if how you want to make your own booking path and/or if you want to review the existing booking pathway. The first step would be to map out the current pathway, sort of the way we’ve mapped out over here and over here in this slide. Map it out, know what the steps are, and why you would escalate to each step. Identify major sources of overbooking. So if you feel like too many appointments are going to overbook step, then look for any bottlenecks.
So bottlenecks is where your scheduling staffer’s overloaded by requests. And try to redesign the booking pathway to reduce those into what those issues earlier on. So feel free to use the examples in this deck as a springboard to come up with new guidelines, rules, and permissions to address those factors causing overbooking. And don’t forget alternatives overbooking like scripting, trade off, or changing the treatment time or location in order to deal with some of those problems in your pathway as well.
And on a closing note, being talked can help. Infusion scheduling can be complex if you’re not a customer already. Our template optimization and machine learning predictive analytics can empower schedulers to transform your schedule and have some of those more level loaded days. So be sure to ask if you’re interested.
WOMAN: Hey. Thank you, Danielle. Reminder, if you have any questions, click the Q&A tab at the bottom of your screen. We still have a few moments to answer any that come in. I see we already have a couple of questions that have come in. First one is, what if the clinic appointments are double booked or triple booked and I need to accommodate those volumes in the infusion?
DANIELLE: In the incision area, huh? Yeah. So the good news is that if your clinic is double and triple booking appointments, you don’t need to double and triple book appointments to yourself. We very much don’t recommend that. Instead, what we recommend is that if you’re getting folks who are requesting basically at the same time because they think they’re going to get out of the clinic at the same time, try to book them with just a little bit of spreading. Because you know that due to variations on the day of, for example, some of those patients will be late at the clinic.
Some of them will experience different delays in clinics. They’ll have delays in their labs and orders. So you know that they’re not all going to show up at your infusion center at once, even though they’re booked a clinic at the same time. Like, the three folks show up at 9:00. And clinic are not all going to come at 10:00– 10:00 on the dot. So try to sort of spread them out a little bit. And you can offer one a 10:00 AM slot. One is 10:30 and one in 11:00 slot, knowing that in reality, they are going to trickle down. Appearing in infusion center probably is not going to be– they’re not going to all come at once. So take advantage of having those different slots on different kinds of day to spread out that infusion volume a little bit.
MODERATOR: OK. It looks like we have one more question. What do I do when my day at the infusion center is full, but the clinic keeps sending me new patients?
DANIELLE: That’s good ones. Our first recommendation would be to try to coordinate with clinics a little bit. And do let them know that they’re full. And if possible, they should try to fill their slots with the rest of their clinic slots that day with patients who are sort of consoles or new patients. And they’re not expecting to have a treatment later that day, to defer those people who need treatment later that day, to the next day or the day before. So that’s really a first step. It’s to try to stop that flow.
The factor, that would be go ahead and try to do a little bit of schedule grooming to free up some capacity if you’re all the appointments on that day are scheduled correctly. If they’re on– if there’s one or two appointments in the middle of the day that are going to plan to use up all of your chairs or maybe even go over the number of chairs you have, if you can move them there early or later in the day to free up a little bit of space for those last few remaining appointments, that can be productive as well.
And our last recommendation– I guess, we have two more recommendations– would be to go ahead and plan to staff up if possible. We know that there are some centers who find themselves chronically understaffed. But for the busiest, busy days, do try to get an additional resources be it from your tool or if you have agency nurses try to have someone come in.
And then, sort of our last recommendation, again, not everyone can do this but you could try to decouple appointments if people are coming in for their clearances with their oncologist on a Wednesday. In your opinion, center’s floor is full, fit for comfortable coming back on a Thursday– potentially, early in the morning or later in the afternoon when all their labs and then orders will be ready. And they can come in and get their infusion with minimal weight.
MODERATOR: OK. Thank you. I don’t see any other questions coming in. So thanks to Danielle for presenting today’s webinar. Thanks again for joining us.