After staying on the sidelines for the first few years of the company start-up, I joined full time January 2015. Having a thirty-year dialysis career background in multiple roles from staff and charge RN, clinic manager and director of clinic services, I have an understanding of the clinical side, business side and Medicare regulations. I earned my Master’s in Healthcare Innovation from Arizona State University and love to help clinics and organizations find new and sustaining ways to solve challenging issues.
If you have seen our recent social media posts, you know we have been busy this past year! We recently rebranded from ScheduleWise® to RenalWise because our solutions have grown beyond scheduling. We now have a survey readiness tool called SurveyWise® and a home program tool called ScheduleWise® Home.
One of the things I love about my job is collaborating with our customers. It’s motivating to hear their ideas and work alongside them to address opportunities together. For years, we have heard the challenges nurses and healthcare providers face in their home programs like:
Paper schedules are not easily shared between multiple discipline providers.
Coordinating patient appointments with multiple disciplines in the same office visit is a challenge or does not happen.
Scheduling and optimizing staff and room resources is a struggle.
We listened and collaborated closely with our customers to build a solution that meets the unique demands of home dialysis scheduling. I want to introduce you to ScheduleWise® Home, a tool that brings the best organizational practices and methods to your home dialysis program so you can:
Optimize the Patient Experience. Patients will appreciate a streamlined and coordinated care experience with the entire interdisciplinary team during clinic visits. Patients will receive printed and emailed reminders for upcoming appointments, improving overall attendance.
Make the Most of Staff Time. Because all disciplines will have access to the calendar, they can easily add time around a scheduled visit to ensure they see the patient, too. No more wasted hours or missing time with the patients—just smooth, coordinated care.
Manage Clinic Resources. Assign staff, including physicians, to specific patient appointments and rooms. Easily see the schedule for a specific room, patient, or staff member.
Maintain HIPAA Compliance. As always, our software keeps HIPAA compliance a priority.
And the innovation doesn’t end here. Coming soon, our CKD to Home pipeline tool will revolutionize how you track patients – from the moment they’re first notified to the day they start in your home program. This visual tracking system gives you unprecedented visibility and control over every stage of the patient’s journey.
This is not just scheduling software—it’s a strategic tool for delivering exceptional patient care and optimizing operational efficiency.
After staying on the sidelines for the first few years of the company start-up, I joined full time January 2015. Having a thirty-year dialysis career background in multiple roles from staff and charge RN, clinic manager and director of clinic services, I have an understanding of the clinical side, business side and Medicare regulations. I earned my Master’s in Healthcare Innovation from Arizona State University and love to help clinics and organizations find new and sustaining ways to solve challenging issues.
Do External Surveys and Survey Readiness Feel Like March Madness?
March Madness isn’t just confined to the basketball court; it can also manifest itself in the dialysis industry, mainly when working to stay prepared for a survey on the CfC (Conditions for Coverage) rules written by CMS (Centers for Medicare & Medicaid Services). A CMS survey of a clinic can occur anytime, and the fear of an unplanned inspection can be stressful for all staff and patients. Some organizations try to control the unknown timing by acquiring certification or accreditation from an outside organization. We will go into details of this approach in a future blog.
I believe that if we take a different approach to survey preparation, clinic staff will no longer feel frenzied, like they are in the middle of a March Madness tournament.
It makes sense that survey readiness programs should involve all staff. In my thirty-plus years working in the dialysis industry, I have often found that survey readiness programs include minimal education about the Conditions for Coverage rules. When they do, it is not inclusive of all the roles in the clinic. Typically, internal audits are performed by just a few staff members, who then leave the manager a report of all standards that are “Not Met.” This person checking for survey readiness is often internal to the company but external to the clinic. In my experience, this method has proven to be “Not Helpful,” and I believe it’s time to change how we educate and train clinic staff so they are ready at any moment for an internal or external survey team to walk in.
One critical component of a successful survey readiness program is the involvement and preparedness of the entire clinic staff. When the staff is ready, the feelings of “March Madness” chaos diminish.
Tips for Clinics to Tackle the Madness:
Create an environment that prioritizes correctly following patient safety standards at all times. This means following policies that (hopefully) meet or exceed the Conditions for Coverage rules.
Educate all your staff on the rules of the Conditions for Coverage. There are 304 pages of Interpretive Guidance to “help” us understand the rules, and that feels like a HUGE undertaking! However, education is necessary because each clinic meets these standards during a survey. Proactively educating and involving staff assists them in following standards as a cohesive unit.
Engage all staff in your clinics’ survey readiness program. It is only minimally helpful when your survey readiness program consists of one or two people who perform internal audits and then write up a POC (Plan of Correction). It gains a bit more momentum when the areas not meeting the CfC are discussed with the entire staff. The most valuable gains are made when engaging all the staff in survey readiness.
Create your pod assignments so they can be worked safely and independently by the assigned caregiver. This leaves one or more nurses (depending on clinic size) free from needing to assist with turnover and fully available to provide oversight and feedback if non-compliance with policies is noted.
Navigating the survey process can indeed feel like March Madness for clinics. The key to success lies in comprehensive preparation that involves all staff members. This preparation should include education and a formal auditing program that helps the clinic self-identify areas of non-compliance, tracks trends, monitors for compliance with the rules of the Conditions for Coverage, and helps the clinic staff create a Plan of Correction.
Staff is constantly prepared for any survey when a cohesive survey readiness program is implemented and maintained at a clinic. Then, when an actual survey occurs, staff will be calm, ready, and welcoming. The survey team will feel like they entered a spa, not a March Madness game!
SurveyWise was developed with this approach of educating and involving all staff members in survey readiness. If you want to learn more about SurveyWise and how it can help your organization to always be survey-ready, let us know, and we can schedule a talk.
Does survey readiness feel chaotic and frenzied for you? Does an approach of involving all staff members resonate with you? We would love to hear your feedback in the comments
Mary Kay Hamilton
After staying on the sidelines for the first few years of the company start-up, I joined full time January 2015. Having a thirty-year dialysis career background in multiple roles from staff and charge RN, clinic manager and director of clinic services, I have an understanding of the clinical side, business side and Medicare regulations. I earned my Master’s in Healthcare Innovation from Arizona State University and love to help clinics and organizations find new and sustaining ways to solve challenging issues.
Introducing RenalWise – Your Hub for Renal Software Solutions
It is with immense excitement that we announce a pivotal moment in our company’s journey. After over a decade of innovation and success under the banner of ScheduleWise, we are thrilled to introduce our rebranded identity: RenalWise. This transformation is more than just a change in name – it’s a reflection of our commitment to expanding our horizons and providing solutions to the renal industry.
Our Origin Story
Founded over 10 years ago, ScheduleWise became synonymous with efficiency and safety in scheduling solutions. We pioneered (and patented!) groundbreaking software that truly innovated how organizations manage their patients and staff schedules emphasizing safety and quality first.The success of ScheduleWise laid a strong foundation, propelling us to explore other pain points and address evolving industry needs.
Serving the Needs and Requests of our Renal Community
As we enter this new chapter, we are proud to unveil not one but two groundbreaking software solutions that extend beyond scheduling in the outpatient dialysis clinic. ScheduleWise Home and SurveyWise mark our dedication to solving other industry challenges, catering to the unique requirements of the renal industry. This expansion is a testament to our commitment to innovation and our desire to provide comprehensive solutions for our clients.
The Birth of RenalWise
With the introduction of ScheduleWise Home and SurveyWise, it became evident that our identity needed to evolve to encompass the broader spectrum of our offerings. Hence, the birth of RenalWise – a name that encapsulates our dedication to delivering software solutions and services tailored specifically for the renal industry.
Tagline Unveiled: Software solutions for the renal industry
Our new tagline succinctly captures the essence of RenalWise. It reflects our mission to listen and identify the needs within the renal community, offering solutions that streamline processes, enhance efficiency, and empower organizations to thrive in an ever-evolving landscape.
What to Expect
RenalWise is not just a name; it is a promise. A promise to continue delivering excellence, innovation, and reliability in all our software solutions. Whether you are familiar with ScheduleWise or are discovering us for the first time, we invite you to join us on this exciting journey.
As we embrace the identity of RenalWise, we extend our deepest gratitude to our loyal clients, dedicated team members, and partners who have been instrumental in our success.
Mary Kay Hamilton
After staying on the sidelines for the first few years of the company start-up, I joined full time January 2015. Having a thirty-year dialysis career background in multiple roles from staff and charge RN, clinic manager and director of clinic services, I have an understanding of the clinical side, business side and Medicare regulations. I earned my Master’s in Healthcare Innovation from Arizona State University and love to help clinics and organizations find new and sustaining ways to solve challenging issues.
Question from the field: “Should I set up my patient schedule with all four-hour slots so that I can easily move my patients from one spot to another? Kind of a one size fits all schedule?”
I dare to say that one size fits all philosophy is not true for clothes and definitely not true for meeting individual patient needs when setting up your patient schedule!
Every dialysis patient has the same needs, correct? They are there because their kidneys are not functioning at a level that can sustain life, so the same set-up and treatment should work for all. If we believe that to be the case, then providing care for them should be the same, right??
I think that we can agree that the belief that every patient is the same and should receive the same treatment is just a foolish thought. All patients with high blood pressure are not treated with the same medication or the same dose, and dialysis prescriptions are no different. Patients are scheduled for treatment durations based upon the current function of their kidneys, body size and other medical parameters. The prescribed treatment time changes based upon lab results, type of vascular access and physician assessment of what the patient needs.
If we stop there, plugging in only the prescribed treatment time into our patient schedule, we are short-changing both the patients and the caregivers. What more is there to consider, you may be thinking? You’ve taken the time to work in ontimes between treatment starts (maybe 15 minutes) and time between an off in one chair and an on in the same chair (maybe 45 minutes). This may appear to create a smooth schedule, but it will still cause the staff and patients a lot of frustration as one of the most important pieces of quality scheduling is missing — adding in time for patients’ individual needs, or their acuity needs!
Over the years, we have performed many time studies to better understand the workflow of the patient schedule. We repeated those studies after Medicare’s 2017 ruling of vacating the station before disinfection and setting up for the next patient. Our studies showed that when staff follow their policies, it takes an average of 15 minutes to put a patient on and 15 minutes to take them off. The 15 minutes to initiate the treatment includes 10 minutes before blood hitting the dialyzer and 5 minutes post-treatment initiation. The 15 minutes for taking patients off was all after the alarm signaled that the treatment duration was met. Let’s take a look at an example that shows a pod of patients that are all allotted 15 minutes to put on and 15 minutes to take off.
Example 1: All patients seen with equal needs
Blocks of time (orange line) in which the caregiver (green line) is putting on or taking off patients.
If all patients truly take 15 minutes or less for care, this schedule works
The word bolded above, “average”, is key. Patients have different needs, you know this, but you may not have considered it relative to how the patient schedule is set up and that more time may be needed between some patients while no extra time is needed between others. You may be able to meet those needs in that 15-minute span to put a patient on, but that same easy put on is a long bleeder at the end of treatment and needs 25 minutes after treatment before they are ready to vacate the station. (See Example 2)
Example 2: Impact of acuity
As Mickey Mouse requires 25 minutes to be taken off, the caregiver is still busy providing his care when Donald Duck is scheduled off.
In these cases, something gives. The caregiver either asks for help (often the RN) or add/cuts time to patients’ prescription durations, which means that treatment may be against a physician’s order.
Thinking about your own patients, you know those who need additional time because they are in a wheelchair, a stretcher, possibly requiring a Hoyer for transfer. But there could be others who are not so obvious and that’s where your PCT’s and RN’s come in. Ask them! Engage them in the schedule set up and revising. Create an environment in your clinic in which the caregivers share which pods are challenging, review each patient’s acuity needs in that pod and make adjustments to your schedule.
By taking the time to understand which patients need additional time, and accounting for that time, your smooth appearing schedule becomes a truly smooth, functioning schedule where the staff now have the time to care for each patient based on their individual needs.
Join the conversation! We’d love to hear from you!
Have a question you would like us to answer in a future post? Just ask!
In your clinics/organization, how do you account for patients that need additional time on your patient schedule?
How often do you review your schedule to ensure it is up to date with treatment durations and acuity needs
Question from the field: “Should I set up my patient schedule with all four-hour slots so that I can easily move my patients from one spot to another? Kind of a one size fits all schedule?”
I dare to say that one
size fits all philosophy is not true for clothes and definitely not true for meeting
individual patient needs when setting up your patient schedule!
Every dialysis patient has the same needs, correct? They are
there because their kidneys are not functioning at a level that can sustain life,
so the same set-up and treatment should
work for all. If we believe that to be the case, then providing care for them
should be the same, right??
I think that we can agree that the belief that every patient
is the same and should receive the same
treatment is just a foolish thought. All patients with high blood pressure are not treated with the same medication or the
same dose, and dialysis prescriptions are no different. Patients are scheduled for
treatment durations based upon the current
function of their kidneys, body size and other medical parameters. The
prescribed treatment time changes based upon lab results, type of vascular
access and physician assessment of what the patient needs.
If we stop there, plugging in
only the prescribed treatment time into
our patient schedule, we are short-changing both the patients and the
caregivers. What more is there to
consider, you may be thinking? You’ve
taken the time to work in ontimes between treatment starts (maybe 15 minutes)
and time between an off in one chair and an on in the same chair (maybe 45
minutes). This may appear to create a smooth
schedule, but it will still cause the staff and patients a lot of frustration
as one of the most important pieces of quality scheduling is missing — adding
in time for patients’ individual needs, or their acuity needs!
Over the years, we have performed many time studies to better understand the workflow of the patient schedule. We repeated those studies after Medicare’s 2017 ruling of vacating the station before disinfection and setting up for the next patient. Our studies showed that when staff follow their policies, it takes an average of 15 minutes to put a patient on and 15 minutes to take them off. The 15 minutes to initiate the treatment includes 10 minutes before blood hitting the dialyzer and 5 minutes post-treatment initiation. The 15 minutes for taking patients off was all after the alarm signaled that the treatment duration was met. Let’s take a look at an example that shows a pod of patients that are all allotted 15-minutes to put on and 15-minutes to take off.
The word “average”, is key. Patients have different needs, you know this, but you may not have considered it relative to how the patient schedule is set up and that more time may be needed between some patients while no extra time is needed between others. You may be able to meet those needs in that 15-minute span to put a patient on, but that same easy put on is a long bleeder at the end of treatment and needs 25 minutes after treatment before they are ready to vacate the station. (see Example 2)
Thinking about your own patients, you know those who need
additional time because they are in a wheelchair, a stretcher, possibly requiring
a Hoyer for transfer. But there could be
others who are not so obvious and that’s where your PCT’s and RN’s come in. Ask
them! Engage them in the schedule set up
and revising. Create an environment in
your clinic in which the caregivers share which pods are challenging, review
each patient’s acuity needs in that pod and make adjustments to your schedule. By
taking the time to understand which patients need additional time, and
accounting for that time, your smooth appearing schedule becomes a truly
smooth, functioning schedule where the staff now have the time to care for each
patient based on their individual needs.
Join the
conversation! We’d love to hear from you!
Have a question you would like us to answer in a
future post? Just ask!
In your clinics/organization, how do you account
for patients that need additional time on your patient schedule?
How often do you review your schedule to ensure
it is up to date with treatment durations and acuity needs?
In my previous post on Productivity, I reviewed what Productivity is and a simple calculation of productivity equaling half of the average treatment duration in your clinic. This provides a ‘good’ productivity goal for organizations to use in determining an appropriate clinic-specific goal.
In this post, I will be going into more detail on how a productivity number relates to dollars and the impact that can be made by improving your productivity by as little as 0.1 hours/treatment.
I often get asked…
Question: What’s the big deal about a productivity number of 1.7 versus 2.0? Answer: A lot!
Let’s take a look at just how much that could be in dollars. What I’ll be describing is an oversimplified way of looking at it, but I believe it will help make sense of something that can be quite complicated.
For this example, I will use a $25.00 blended rate (RN=$35 and PCT $15 is roughly a $25 blended rate). Your hourly rates may give you a slightly different number, but $25 is good enough for our example.
Every 0.1 hr/tx improvement saves $2.50/tx.
Here’s the math (don’t be scared!)
Back to our original question, if your current productivity is 2.0 hrs/tx and you get it down to a 1.7 hrs/tx, it represents a 0.3 hours/tx savings. Or $7.50 per treatment!
Now take that dollar savings and multiply it by your average weekly treatment count, and you can see how quickly it adds up! Assuming you do 300 tx/wk. That comes out to saving $2,250… each and every week!
And here are the monthly and annual potential savings:
$2,250 per week x 4 weeks = $9,000/month
$9,000 per month x 12 months = $108,000/year
The below table summarizes these findings:
WOW! Right?!?!
When I first show our clients these numbers, their first thought often is, does this mean I have to cut staff? If your organization is happy with its bottom line, then the answer is no.
For most clinics/organizations, labor is their greatest expense, so if you’re looking to find cost savings, right-sizing your staff is the greatest opportunity to meet that goal. As you have seen in this post, even a 0.1 improvement can improve the financial health of your clinic/organization!
In my next and last post on this lovely topic, I will share a few ideas that you can implement to improve your clinic’s productivity.
We’d love to hear from you!
Did this help you get a handle on productivity calculations?
Were your surprised what a difference in your clinic’s bottom line could be made by simply improving your productivity by 0.1?
Has this information been helpful?
If so, please feel free to share!
If not, please let me know how your organization looks at it differently.
We’re always interested in learning how we can best support the renal community!
Productivity, this simple word is anything but simple and often
causes hearts to race, stomachs to turn or we simply want to ignore it and hope
that it goes away. However, it’s a vital
piece of information to help us understand ‘how much staff do I need’? ‘Am I really short or am I over staffed?’
Part of the distaste for productivity could be related to not fully understanding it.
It’s just some number given by finance, and what do they know about running a clinic? Does it feel like you have no control in meeting the goal, if you even understand the goal to begin with? Many people I have had the opportunity to work with are surprised at how easy it really is to understand, when it’s explained in terms of what it means to the daily operation of the dialysis facility and then equally find it easy to implement changes that can get them to their goal, or at least heading the right direction.
Alright, time for some full disclosure. Like many of you reading this, I went to school for nursing. I cared about people, loved science and wanted to better understand how I could take care of others and bring them back to optimal health. After working as a staff and charge RN for a few years in dialysis, I became the manager of a clinic. When I first started in the role the responsibilities were so different. At first, it was good! The main duties included monitoring outcomes, survey readiness, hiring (and occasionally terminating) staff and my favorite part, team building.
As you may have noticed, there was no mention of running a multi-million-dollar business, which our clinics are. There were no business classes in my nursing school to help me understand P&L Statements, EBITDA, doing annual budgets, the bundle, payers, QIP and achieving a productivity goal. HECK! At first, I didn’t even know what made up the productivity goal. It was just a number I was supposed to achieve, and I was told every month (after the fact) if I made it or not. AND, there were no useful tools out there to help me figure it out proactively. It was very frustrating, to say the least!
OK, enough about me! My goal here is to give you a better
understanding of productivity, both from the perspective of what it is and how
you can manage to it! I recommend sharing this post with your entire
team. The more everyone understands it,
the more successful you will be in meeting it… it really is a team effort!
It’s important to first state that meeting productivity does not ever mean that you compromise your quality of care in any way! Quality and safety remain the first priority always! If you are interested in a full presentation on this topic, you can go to the National Renal Administrator Association (NRAA) Education Station website https://www.pathlms.com/nraa and watch/listen to my presentation, “Understanding and Achieving Productivity”, which I presented at the Fall 2016 NRAA meeting and in February 2016 as part of the NRAA Webinar Wednesday series. https://www.pathlms.com/nraa/courses/2091/video_presentations/23511
To start this discussion, I would like to take a couple of minutes to explain the difference between the cost per treatment ($/tx) and productivity, which is typically measured in hours per treatment (hrs/tx). When looking at dollars per treatment, you are looking at actual costs and this number is more often looked at in arrears, in other words, many weeks after the fact! Salary and wages are more or less set by upper management and not very controllable by a clinic manager. For example, if you have an experienced staff, use a lot of overtime and/or use RN’s to cover what would otherwise be PCT shifts, your dollars per treatment will be higher versus the clinic that has a blend of experienced staff, uses little overtime, doesn’t need to cover PCT shifts with RN’s and/or does not use travelers.
While some overtime is controllable prior to it happening, for the most part as a manager, the dollars per treatment are impacted by less controllable factors. Whereas focusing on and adjusting hours scheduled for an expected number of treatments is something that a manager has control over proactively. By understanding how to calculate the needed staffing hours of PCT’s and RN’s, you can create a schedule that will meet your productivity goals.
Most dialysis organizations look at productivity as the number of
hours worked by the PCT, LPN/LVN and RN on a per treatment basis. These are the employees providing direct patient care (DPC) that are usually paid
by the hour. Your clinic may have
additional support staff, not providing direct patient care (sometimes referred
to as Indirect Patient Care or IPC or Fixed), such as nurse managers,
dietitians, social workers, etc. Depending
on your organization, those hours may or may not count towards the total
productivity goal. If IPC and DPC are
both used in the total productivity goal established by your organization, then
using the calculation discussed in the next paragraph is not the correct final
productivity number for you. In a future post, we will discuss how to determine
total productivity including those support roles, what amount is the right
amount for each of those roles and which portion of the total is the DPC
portion.
I am often asked what a “good” productivity number would be.
If by “good” you mean the right amount of staff to provide quality care to our patients in a safe environment, then I suggest taking the average treatment duration for all your patients and dividing that number in half. For example, if your average treatment duration is 4.0 hours, if you divide that by two you get a productivity number of 2.0. If your average treatment duration is 3.5, then a “good” productivity goal would be 1.75. Instead of having one goal for the entire organization, my suggestion would be to look at each clinic individually and apply different goals based on that clinic’s average treatment duration. Two clinics with very different average treatment durations should not be expected to achieve the same productivity goal.
Using this rule of thumb will serve to establish a good
starting point for a productivity goal giving you the minimum amount of staffing
hours per treatment to provide safe and effective care to your patients. If your budget allows, you can add additional
staff to meet your additional needs. Keep
in mind that this goal is what you need to provide Direct Patient Care(RN, LPN,
PCT). It does not include the Indirect
staff.
Where do ratios come into the equation?
For the vast majority of States, we see staffing ratios of 4:1 for our PCT’s and 12:1 for our RN staff. You can usually meet those ratios by using the above approach. If, however, your state requires certain ratios (e.g. Georgia requires a 10:1 RN to patient ratio) or your organization’s policies require a smaller patient to staff ratio, then your productivity goal will most likely need to be higher.
And that is about all the productivity talk anyone can
muster in one sitting! Thanks for
reading! I hope this post helped you
better understand what productivity is and how you may choose to set a realistic
productivity goal for your clinic or organization. There will be a Part 2 of this post in which
I will provide more detail of how productivity relates to dollars and the
financial health of the clinic and organization.
We’d love to hear from you!
Does your organization have a set productivity
goal for your clinic to meet?
How are you doing in meeting that goal?
If you are over your organization’s stated
productivity goal, yet your staff tell you they feel that they need additional
help, how are you handling the two different viewpoints?
Has this information been helpful? If so, please
feel free to share! If not, please let me know how your organization looks at
it differently. I’m always interested in learning how I can best support the
renal community!
Throughout my career, there was often something on my mind keeping me awake as a lay my head down at night, usually a work-related issue. Some thoughts that crept into my mind were…
Did I handle that personnel issue the best way possible?
Oh no! I forgot to call that physician back!
How am I going to keep Mr. Always-Arrives-Early from becoming upset at the staff when they don’t put him on before his ontime.
How am I going to meet the budget??
The surveyors have been doing their rounds, is one of my clinics next?
Patient satisfaction surveys go out next week, what are my patients going to say about the care they are receiving?
That last one was particularly bothersome as I knew that one of the biggest complaints that patients state on these surveys is not getting on at their on-time.
These are the thoughts that create nightmares! (just in time for Halloween!) I’m sure that a part of the reason they kept popping up in my mind is that I did not fully feel in control of them!
Do any of these thoughts sound familiar to you? If so, you are not alone! So many people that I talk to have very similar thoughts keeping them up at night. I often tease that the RN after my name meant that I was Really Nice. That was true, and I will add in for me that I was not a huge fan of conflict in my early managing years. I wanted to make everyone happy, my patients, their families, the staff and physicians. As a clinic manager, I knew that it was my responsibility to ensure the safety and satisfaction of my patients and staff. I learned that one of the best ways I could do that was to maintain control over both patients and staff schedules.
Why is managing the patient and staff schedule so important?
(1) Patient Safety / Quality of Care
When you walk out onto the treatment floor during a turnover, do you hear multiple alarms? Are they alarming for longer than during a non-turnover time? Are all your staff busy, everybody with their heads down? Many will call this chaotic. I will add that I also consider a “chaotic” turnover like this unsafe.
Like many of you I, too, am a believer in patient-centric care. I also believe that there needs to be a person, preferably multiple people, in an organization and each individual clinic that are ensuring that the ability to provide safe and quality care are paramount, and that care is being provided even when that means not being able to meet the patient’s exact desire.
For example: Let’s say you have a 12-station clinic and work with a 4:1 PCT to patient ratio. You have three PCT’s coming in one hour before the first patient’s start time of 0600, and a Charge RN arrives 30 minutes prior. You have an open spot at 0620, but your new patient wants 0700. If none of your other patients currently at 0700 want to move to the 0620, do you find yourself saying, “Well, I will give my new patient the time they want, and the nurse can put them on.”
Great! You accommodated the patient’s desire, but at what cost? You now have four patients going on at 0700 and only three direct patient caregivers (PCT’s). COULD your Charge RN initiate the treatment? Yes, I’m guessing they are capable. The better question you may want to ask yourself is SHOULD your Charge RN initiate or discontinue a treatment?
My thought is no.
And the main reasons are that it becomes an unsafe setting for your patients and I want to see the RN’s have improved job satisfaction and be able to have the time they need to provide the type of quality care that they want and need to be able to provide.
Many RN’s have shared their frustrations with having a nursing license and spending more of their time assisting with patient put-ons and take-offs. Then once turnover is over, they still have their RN duties that they had to stop doing to get this done. Many add in that much of their overtime hours at the end of the day are for documentation that they could not get done during their shift. When your Charge RN’s are putting patients on or taking them off alongside the PCT’s, they are not available for emergencies, unable to provide oversight or to help troubleshoot because their heads are down. This is not to say that an RN should never be assigned a pod or a patient, rather, my example stresses the importance of having your RN’s that are not assigned a pod be unencumbered so that they are available for their RN duties.
(2) Efficient Care / Meeting Budgets
Safety is always the number one goal. Caregivers do not choose to work in dialysis with a desire to provide poor quality and unsafe care. We are just not wired that way. As a healthcare organization, your leadership understands the importance of you being able to give and for your patients to receive high quality and safe care. Poor care and the resulting outcomes are NOT good for a business’ bottom line or for patients or unhappy staff (high turnover).
While it may feel there is an occasional disconnect between organizational leaders and the clinic staff, this is what it means to provide efficient care. Organization leaders are often looking at actual numbers worked and treatment (revenue) numbers after the fact. They may be giving the clinic manager feedback that their costs are too high, but to the clinic manager and staff, they seem VERY busy and feel understaffed.
How can you solve this?
It truly goes right back to providing safe/quality care! If your patient schedule has a smooth workflow in each pod (only one patient going on the machine or coming off the machine at one time in a pod, and the direct patient caregiver assigned to the pod has the time built into the schedule that allows them to meet the needs of each patient (especially higher acuity patients), you will be set up to provide efficient care. Costs go up when staff are added for busy turnovers instead of smoothing out the schedule, or the nurse must stay extra hours to complete their work because they were needed to help with a busy turnover.
Thanks for reading! Now it’s your turn. We’d love to hear from you!
What techniques have worked for your organization when it comes to not accommodating the exact time requested?
How have you created a culture of safety in your clinic in which letting a patient know that the exact time they want is not possible?
Have you felt the need to add staff to accommodate a busy turnover? Could the issue have been solved by smoothing out the work, allowing for the assigned caregiver to provide the care independently?
In all my years working in dialysis, I have not come across any other management issue that impacts so much in our clinics than the patient schedule. Why is it so important to you?
Each and every dialysis clinic’s existence depends on the satisfaction of its patients for its success. It’s no secret that patients can be demanding, and it’s not just the results of their medical treatment that matter to them. Their experiences and interactions with your clinic and your staff have an impact as well. As you want to keep the patients that dialyze in your clinic satisfied and healthy and the staff feeling that they can provide quality care, there are a few things you need to keep in mind.
Ensuring that your patient schedule allows the necessary time for the patient to receives their full treatment and for the nurses to have time to review labs and monitor vascular access impacts clinical outcomes.
If you want your staff to treat your patients right, you need to provide them with an ideal work environment. This means giving them the time needed to provide the care you are expecting of them. This time is not the same for every patient. Some patients take 15-minutes to put on the machine and others take 20-minutes. Because of these different acuity needs, your patient schedule should not be set up treating every patient the same way.
Giving the patients’ the times that they prefer and getting them on at their scheduled time impacts the patient satisfaction surveys. When the time that they prefer is not available, how you handle communicating that to the patients, discussing and documenting it in your QAPI Meetings as not getting the time they desire would be considered a patient grievance and resolving it to a level that is either acceptable to the patient or documented as to why you are unable to accommodate the patients specific request is key. Keep in mind, it is not a requirement to give the patients the exact time or chair that they desire. It is however a requirement through Medicare’s Conditions for Coverage to document and address patient grievances.
The staff feeling that they have the time needed to provide quality care, getting out at their scheduled time, and getting the hours they were hired to work impacts staff satisfaction. When the patient schedule is chaotic with pods to busy for the caregiver assigned to work independently and the nurses have to set aside their nursing duties to assist with turnover on a regular basis, their job satisfaction declines and overtime is often required to get their duties completed.
Understanding how treatments, missed treatments and staff hours worked impacts the bottom line.
So with all that said, I’m going to share why I feel it is the manager’s ultimate responsibility. Think of this. If you were the owner of a prominent, well-respected spa/fitness center, who would you want to be ensuring that safety and quality standards were met or exceeded? Who would be your go-to person if you were receiving feedback that those standards were sub-par? Would it be the person checking clients in, the massage therapist, the trainer or would it be the manager?
As we have worked with clinics all over the U.S., we have seen the responsible party being everything from the Clinic Manager, Nurse Manger, the Social Worker, Patient Care Technician, or the Administrative Assistant. We have also seen in a few instances that schedules were managed by an offsite scheduler whose only job is the patient schedule for multiple locations. I often get asked which the best is, and my answer is always the same. The ultimate responsibility of the patients and staff schedules belongs to the manager. They are the CEO of their business, the dialysis clinic.
Scheduling often takes a village to get it right. To go from a good schedule to a great schedule, getting input from the different roles in the clinic is extremely valuable! The nurse manager (if a different person then the clinic manager) reviews the outcomes and gets orders for any necessary duration changes. The Social Worker is aware of transportation or other issues that may make a certain time or days difficult for patients. The Patient Care Technician knows which patients are not best to sit next to each other and which patients may take more time than others or have higher acuity needs which impact the amount of time that the caregiver will need to be with them. The Administrative Assistant may also be aware of transportation issues and is often the “ear” of what patients may be unhappy about and discussing in the lobby. Each of these roles has valuable information, but none have ALL the information needed to create the best patient schedule.
It is for those reasons that I feel that it is the responsibility of the clinic manager to pull all that information together and create and maintain the patient and staff schedules. Could another person in the clinic be assigned the task? Yes, and they could do a good job with it, but even in those cases, heavy oversight must be there by the person ultimately responsible — the clinic manager.
We’d love to hear from you!
In your clinic/organization, who (what role) is responsible for creating and maintaining the patient and staff schedules?
If your clinic is not meeting any of their goals, whether that be clinical, satisfaction or financial, have you investigated how they are scheduling and how that may be impacting the clinic in not being able to meet those goals? What did you see?
