Do External Surveys and Survey Readiness Feel Like March Madness?

March Survey Madness: CMS Survey vs Staff Readiness

Do External Surveys and Survey Readiness Feel Like March Madness?

March Survey Madness: CMS Survey vs Staff Readiness

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.

Ask yourself:  When the external surveyors are in your clinics, are they just asking questions to the clinic manager or person responsible for performing internal survey readiness audits? Your likely response is NO! They watch and ask the technicians and nurses questions because they are the ones who provide direct care to the patients. Inspectors watch and talk to social workers, dietitians, and biomed staff to review areas of their responsibilities.  Additionally, they speak to the administrative assistant, manager, and medical director. In other words, they speak to ALL STAFF!

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. 

Tips for Clinics to Tackle the Madness:

    1. 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.
    2. 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.
    3. 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.
    4. 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.

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

Introducing RenalWise – Your Hub for Renal Software Solutions

Lightbulb UPDATE image

Introducing RenalWise – Your Hub for Renal Software Solutions

Lightbulb UPDATE image

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

ScheduleWise + ScheduleWise Home + Survey Wise = 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.

Grateful with a heart

A Short History of Patient Scheduling Tools in Dialysis – Part 2

We left off having completed the B.C. mini-epoch, Before Computers. In this installment, we are going to revisit the timeline of patient scheduling tools and talk through the A.C. mini-epoch.

A.C. — After Computers

Once computers were on the scene, innovations came quickly. In 2003 when I began in dialysis, most clinics used either Microsoft Word or Microsoft Excel to manage their schedules. So I have to assume that some folks were inputting their patient schedules into a computer roughly by the mid-1980’s.  Let’s take a look at some of the technologies that people tried to use to help them with their patient schedules.

Word Processors: (evolution of word processors)
Word processor… now there’s an ancient term in computing! Nowadays, Microsoft Word is the dominant application, but Corel Word Perfect was what I used long ago. And I’m sure some savvy managers in dialysis transcribed their handwritten schedules into a word processor. And it allowed them to save their schedules, easily edit them, track files historically, and more easily share schedules with others. These were huge gains in productivity! But it was the simplest of use-cases for what the computer could really do. These were the baby steps we took… from handwriting schedules on paper to managing schedules on the computer. And we never looked back! Computers were here to stay! By the way, word processors are still in use. I ran across a schedule in MS Word just the other day!


DOS: (history of MS DOS)
A humble little DOS application for patient scheduling made its way on the scene. The only reason I know about this is because it was created by my first boss and mentor at DaVita, Doug Vlchek (Yoda). I never got to see it in action, just manuals of it. But I loved it! To my knowledge, it was the first “program” built for managing patient schedules at dialysis facilities. 


[INSERT YOUR COMPUTER APPLICATIONS HERE! As I have mentioned before, this timeline is based on my experiences within the dialysis industry. This history can only be complete with your input! If you know of any early applications that effectively predate the dominance of spreadsheets, please let me know and I will put in a blurb about it here! Anything that is 2005 or later would be considered internet-age, and so I plan to include those in a later installment.]


SPREADSHEETS: (history) (history) (history) (history)
Since this topic is near and dear to my heart, I have included several history links for those of you who care to indulge. =]

Not everyone knows this, but the now ubiquitous spreadsheet also has its roots in paper, specifically a long paper ledger that could be unfolded (spread) providing many columns for information management. There have been many incarnations of spreadsheet applications over the years: Visicalc was the first, Lotus 1-2-3 and Quattro Pro (both of which I used in my time) came later. But Excel is probably the most familiar spreadsheet application to everyone.

Dan Bricklin @ 11’17” Harvard commemorates the location of the invention of the first spreadsheet.

When I came to DaVita in 2003, most clinics were already using Excel. So I’d say that it is safe to assume that spreadsheets became the most ubiquitous patient scheduling tool around the mid-to-late-1990’s. But unfortunately these tools were using Excel as little more than graph paper to display the schedule within pretty boxes. And there were TONS of styles and colors. Remember when everyone used Comic Sans for everything!

But the power of using a spreadsheet is in using formulas to do the calculations work for you, like calculating the take-off time based on the put-on time plus the duration. Surprisingly, most people didn’t use Excel to do even this much. And for things like conditional formatting which could help you identify problem spots in the schedule… fuggedaboutit!

Most of the spreadsheets that I have encountered in my dialysis career do not utilize the spreadsheet in any way to help the administrators manage their schedule. They didn’t then and they still don’t now. It’s really puzzling to me, other than to say that it is not a clinician’s first inclination to learn how to use spreadsheets effectively.

Luckily, people with Excel skills came along and began to develop models to help with patient scheduling, and some of these models could get quite advanced, turning the patient schedule spreadsheet into a sophisticated little application.

Spreadsheets quickly became the de facto standard for scheduling at dialysis clinics. As an industry, we did some innovative things with this tool/application. It helped us to be more productive in managing the scheduling process. And it helped some organizations with standardization of scheduling processes because everyone was using the same tool and following the same rules.

But while we made significant progress, there were some obvious areas that the spreadsheet couldn’t address, such as allowing other users to access your schedule easily, or managing your data over time, and reporting trends in your data. These were the next stages of innovation that would need to be addressed in other ways, with better technology. But there is little doubt, spreadsheets provided us with a better way to manage our patient schedules… and staff schedules, too!


We’re not done with spreadsheets yet, though! In Part 3 of the series, I’ll dive deeper into Excel and some modeling ideas that I either saw or created with Excel. There are a number of these models that I will share, and I encourage you to take a look at them… if only for a walk down memory lane.

See you there!

[CALL TO ACTION! I would really appreciate you sending your own spreadsheet schedule templates to me if you'd be willing. I'll post them as part of this little history we are creating (without real patient info, of course)! It will be a grand tribute to the ideas that helped shape scheduling in this industry over the past five decades.]

A Short History of Patient Scheduling Tools in Dialysis

The dialysis industry is coming up on the 50th anniversary since Medicare extended coverage to individuals with ESRD. In that time, a lot of things have changed. If you’ve been working in dialysis for 20 years or more, then chances are you’ve seen a number of scheduling methods and tools come and go!

While I know this is just a small, non-clinical part of the rich history of dialysis… this is such a fascinating topic in the history of this industry — at least for my experience in it. I figured that it needs to be recorded somewhere, so I thought to take a stab at it. And in this five-part series, I’ll look specifically at the history of dialysis scheduling tools and applications.

What I will attempt to outline in these posts is a simple timeline of dialysis scheduling tools that I have been witness to during my career in dialysis. But this timeline cannot be considered complete without your input. I know there are other tools out there, so I hope some of you reading this might share what you know (and even the tools you’ve used! or at least a screenshot) and I will share them here and fit them into the timeline.

In a simplistic attempt to categorize these innovations, I have broken up the history into mini-epochs. Let us call them B.C., A.C., A.E., A.I. Pretty soon, you’ll know what they all mean. Let’s begin!

B.C. — Before Computers

That’s right! You thought I was getting religious on you. =] B.C., in this timeline, means before computers! Before computers were adopted as being useful in the clinic for managing the schedule, we had a few different ways to help us track and manage schedules.

HANDWRITTEN
Can you believe it? It’s almost unthinkable now that someone would have to write out the schedule every day by hand. But still, even as recently as 5 years ago, I have seen handwritten schedules in use. I guess those clinical managers never saw the need to adopt a new tool, tried and true in their own systems they were! They say that old habits die hard, but geez louise!

PHOTOCOPIER: (a tribute to the photocopier)
How did we make copies of our schedules to distribute before the photocopier came of age? Carbon Copy paper was certainly around, but I’m not so certain that it was all that
practical for making copies of patient schedules. But what is certainly unforgettable is the serious contribution of the photocopier! These machines were in use way before desktop computers, and they allowed us to make copy after copy of schedules for staff and nurses stations. Enter in a few changes manually, and you just saved a LOT of time with your schedule!

Interestingly, this is a technology that has not gone out of style either, as they are still very much depended on even today!

WHITEBOARD
While I never witnessed the use of a white board in person, I have been told that schedules were also managed this way in some clinics. It’s not hard to imagine how it was used. One downside with this method, though, you really couldn’t keep a copy of your schedule. So I’m not sure this qualifies as an innovation, so much as for a point in history.

THE MAGNET BOARD
Alright! Now here is a cool concept! Let’s represent our patients with magnets on a board, and when we put them on dialysis, we’ll move their magnet into place so we know who is running and where they sit. And if they had a magnetic whiteboard, they could write all over it, too. When I started dialysis in 2003, this was the scheduling tool in use at one of the first centers I visited.

And I’m not being sarcastic with my “cool concept” accolade. Believe it or not, these sorts of boards are in use at manufacturing facilities the world over. So yes, I do think this is a cool concept to apply to dialysis patient schedules. It actually gave a visual representation of the floor, and a real-time understanding of who was running. It served as a schedule and a real-time operations tool, though I’m guessing it was used in conjunction with a handwritten schedule, or otherwise you’d lose your schedule as soon as you move magnets around the board.

So let’s not discount the humble magnet board as an innovative step toward scheduling patients!

[NOTE: Pictures tell a thousand words. If you readers have any pictures of these relics of patient scheduling, do please share!]


So that was a healthy dose of nostalgia. =] There is a lot to cover in a 50-year timeline, so I’m keeping each part purposefully short.

In Part 2 of this series, we’ll move on to the next mini-epoch, A.C. — After Computers. Once computers were on the scene, innovations came quickly. And we’ll revisit the first part of the A.C. mini-epoch from word processors up through the modern spreadsheet!

Parkinson’s Law and Arbitrary Deadlines

When I was in Corporate America, including my time at DaVita and Fresenius, there were endless deadlines. Everything was required ASAP or by some seemingly arbitrary date.

There is an old adage called Parkinson’s Law that states “work expands so as to fill the time available for its completion.” Sometimes it is indeed the work that expands… maybe in scope as you get deeper into a project. Sometimes the work to be done is not properly defined when ascribing a time period in which to complete it. And then for most of us, there is our friend procrastination. Knowing that we have a given amount of time, we leave the work until the last minute to complete it.

So if we were to compress the “time available” part of Parkinson’s Law, the work could only expand so much. So the arbitrary deadline helps us limit the unnecessary expansion of work. And work will most certainly be completed more quickly, right? I don’t buy it.

Stress of these artificial time constraints can ultimately burn you out. Plus, I wonder if we do our best work under such constraints.

I mean, what really happens when a deadline is missed. Nobody dies. The world still turns. Is it really going to cost the company all that much because the work wasn’t completed “on time”, but a week later?

A tale of two deadlines…

In my last corporate job, I had to cancel the software update on the night of the release. We simply weren’t ready despite our best efforts. Doing so would have had a major negative impact for our customers. I cancelled the release without a second thought. And I got chewed out royally for my decision.

The next time I was in the same situation, I allowed the version update to be released as planned. And our customers were none too happy. And our team paid the price for it for the many months afterward dealing with the fallout. Again, we simply weren’t ready despite our best efforts. We couldn’t meet the deadline.

And the point of that is… who really cares? Nobody. Nobody cares until it starts to impact them. A missed deadline may look bad to a higher-up or a manager. But in software development, the end user appreciates the gesture without ever knowing it. And who even remembers that a deadline was missed? I’d be really surprised if the higher-ups remember. But those folks who dealt with months of the aftermath. We surely remember hitting that deadline.

Moral of the story…

And this is why at ScheduleWise, we don’t worry about deadlines. Yes, we plan dates. But these dates are more like lines in the sand… drawn to give us a goal in which to complete our work. But truth be told, I have missed far too many of them by now. Sometimes by a week. Sometimes by a month. And nobody cares. The world still turns.

But I can tell you this… I’m certain that my team is happy that they don’t have to deal with the unneeded stress because I want to hit a date. And I’m certain that our users are happy, too, because they haven’t had to feel the aftermath of a rushed software update! If we are not ready, I simply delay the release.

The work does eventually get complete, though. And even with our slower, less stressful pace, we still continue to be the world’s best workflow and scheduling application for dialysis companies! Who needs a deadline for that?

Solving Problems Is Hard!

The fact is that solving problems is hard. If a given problem still exists, you can bet that a lot of people have already come along and failed to solve it. Easy problems evaporate; it is the hard ones that linger.

— Steven D. Levitt and Stephen J. Dubner, authors of Freakonomics

Optimizing a Patient Schedule

Now THAT is a hard problem to solve! It might be the hardest problem in dialysis. After nearly 50 years, this problem of scheduling patients and assigning staff in an optimal way has been with us for as long as most working dialysis professionals can remember. It is a really hard problem to solve!

If you’ve ever given it a try, you know exactly what I mean. Especially after you take that carefully crafted document that you worked so hard on and place it into the hands of a patient care tech or nurse and ask them to work that optimized schedule. That is where the rubber meets the road. And then you wait… You wait for your staff tell you in no uncertain terms how you just failed abysmally at making anyone’s day better! Their turnovers are even worse than before, and they can’t possibly get their breaks with this optimized patient schedule. And let’s not even get into what the patients are saying!

Ok, I painted a pretty bleak picture. It’s not all doom and gloom. But that, my friends, is where the fun of solving the patient schedule really begins! That is, assuming you are a glutton for punishment like me.

It is not an easy task to ensure all patients get the exact time and chair they want, and that all the staff get to come in to work and go home when they please. That is not the nature of this business. But at the center of all of this is the patient schedule. And if you can solve it, be proud! Because you have really accomplished something.

Of course, then the very next week, two patients expire, you have three new patients, and you just lost a couple of your staff. Where does it end?! It’s back to the old drawing board.

Is There Any Hope?

One day, I promise… there will be an easy button. I talked about this very thing in my post “Is Effective Patient Scheduling More An Art Or Science?” But you will have to let go and welcome your new computer/robot overlords.

Until then, there are easier ways to address the seemingly constant problem of the patient schedule. But don’t get me wrong. It’s still a HARD problem to solve. Even though we think ScheduleWise is the best tool for the job… even we know that we haven’t fully solved this problem. It still takes work! And so we continue to work at it, sharing with you the techniques and principles we have learned in working with over 3000 clinics, and coaching organizations on how to manage their workflow.

In the meantime, if you are stressing out dealing with your patient or staff schedules, let us know in the comments down below. After all, you have enough stress, and this is the stuff that should keep US up at night… not you!

ScheduleWise’s Top 20 Features of 2020

This may be late, but as they say, better late than never!

If you ever want to take an adventure through our Release Notes, you may find a treasure trove of features that escaped your attention in the past year. But we wanted to be sure you didn’t miss these!

Here’s a look at some of the big features that were released in ScheduleWise this year.

On the Patient Schedule:
Pod Graphs — update individually, zoom, blocks, breaks, open chairs
Staff breaks and lunches
Mega button – Export, Productivity, and Center Graph all on one button
Export Templates can display staffing data
Drag/Drop Shared Chairs and Unavailable Chairs

On the Patient Demographics Screen:
Easy Delete button
Callback Timesheet for bringing back patients from the lobby

On the Staff Schedule:
Copy Shifts Modal
Copy All Shifts in Panel
Assign Nurses to Pods/Charge
Display float hours
Assigned shifts modal
Discontinued Shifts

On the Dashboard:
Reports

On the Users Screen:
Last Login Date
Automated Password Resets
Mobile access for staff schedule

New Screens:
Screen Tours
EHR Activity (integration)
Merge Patient Screen

So if you weren’t aware about some of these updates and want to know more, then take a dive into the Release Notes and you’ll learn how to make the most of ScheduleWise while managing your patient and staff schedules!

Question from the field: “Should I set up a one size fits all schedule?”

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

The Software We Use To Run Our Business

Tools of the trade are not the same anymore. Instead of hammers, screwdrivers and pliers, we have laptops, phones, and iPads. And that is just the hardware. The software is what really makes these new tools come to life.

But have you ever taken a moment to consider just how many tools, software applications, websites, and services that you need/use to run a small business? It is literally astounding just how many we use at ScheduleWise! To create, deploy, and support our Scheduling/Workflow Management Software, we have had to become competent and sometimes expert users in so much other software!

In a recent fit of wild transparency, I’ve highlighted below the most prominent applications/services that we use to run ScheduleWise. Not all of them do we use every single day, but for the most part, we touch each of these applications at least once per month.

When they say that software is eating the world, you can see why!

Here is a listing…

For administering the business:
Highrise
Google Apps
— email
— calendar
YouCanBookMe
MS Office – Excel Rocks!
Website – Content Management System – WordPress / Elementor
TeamWork for Proj Mgt and Dashboards.
Zoom
Mmhmm
Freshbooks
Quickbooks
MindMeister
Dropbox
Notepad++
Evernote
Mailchimp
Zapier
Wufoo
Twitter
Grasshopper
iPhone and apps galore!
iMessage
TeamWork Desk for Support
Adobe Acrobat / PDFsam
FreeCommander – File Manager
ScheduleWise – That’s right, we use our own app to do work for our clients.
Wistia
Fiverr
99Designs

For development of ScheduleWise:
JIRA
Slack
Atom
GIT
BitBucket
Sourcetree
SQL Server Management Studio
Azure
Sophos VPN
RDP
Viviotech Hosting
Chrome/IE/Edge/Firefox/Brave
Chrome Dev Tools / Firebug
ColdFusion Dev Server
ColdFusion Security Analyzer
IIS
Screenpresso
Camtasia
Adobe XD
Gimp
NPM – Node
live-server

Software no longer in use… either replaced or no longer needed:

For administering the business:
Google Apps
— Analytics
— Adwords
Website – Content Management System – MURA
Trello
Join.Me
Prezi
SFax

For development of ScheduleWise:
Lighthouse Issue Management
Cisco VPN Clients
FireFTP
Eclipse
Tortoise SVN
Hosting.com/Edge Hosting

Oh! And I would certainly be remiss if I didn’t mention good old paper and pencil! I have my handy, dandy notebooks which I have been journaling, ideating, and diagramming for the past 12 years.

So that about covers all of the applications, tools, and services that we use to run our little company. When we started ScheduleWise back in 2008, we didn’t know all the things that we didn’t know. We knew how to optimize patient schedules and workflow and created an application that did just that. For all the other stuff it takes to run a business, we learned over time. As needs arose, we found tools and services to help us along the way. It’s no wonder that most small business do not survive the first five years. There is just so much to learn and do!

Truth be told, it’s probably easier today than anytime in human history to find just the right application or specialist for a job. Not only are the tools themselves most likely out there (ScheduleWise is one of those such tools!), but also insanely important is the ability to find them with the help of your favorite search engine.

But the next time you have a big, glorious idea, and you’re thinking about starting a company of your own, take heed! You’ll be learning a LOT more than you bargained for. But isn’t that half the fun?!

The Rule of 100: Be willing to do something one hundred times to get good at it.

fencing finals

I was getting frustrated with my step-daughter. She recently acquired a knack for whining that she isn’t good at something and therefore wants to blame everyone else and give up.

For example, in a recent quiz in chemistry, her teacher said she got all the hard math stuff correct, but missed the easy problems. So her takeaway was that she just isn’t good at chemistry. Forget that all last year she griped about just not being good at math… Ugh.. teenagers!

It is amazing that we take these lessons like this from childhood into our adult lives without ever really reflecting how these ideas came into being. So it’s something we want to correct now while she is still young.

In another area, she has become a pretty competitive high-school fencer. In just one year, she went from no knowledge of the sport and limited coordination to becoming one of only two girls to letter in their freshmen year in the history of the school!

I reminded her that just 12 short months ago, she could barely hold the épée or do her footwork drills. But eventually, she found her groove and began to excel. It took hundreds of those drills over several months for her to not just get good at her fencing skills, but to learn to enjoy the process as well. She still hasn’t become the champion fencer that she is striving to be, but she is continuing to build her skills and experience. Touché!

So I challenged her rationale and likened her fencing to her school work. Clearly one is fun and challenging while the other is, well, in her eyes, just challenging. But the central tenet remains the same. If you only go through your drills once or twice, you’ll never be proficient, much less expert at that skill.

The same is as true with fencing as it is with solving math or chemistry problems. You can’t just do one or two problems and claim that you’re good or not good at it. You have to do hundreds! Hopefully you learn to enjoy the process along the way, but you will most assuredly progress in attaining the new skill! She acquiesced, but didn’t seem thoroughly convinced. Teenagers. =]


This is what I think of as the the Rule of 100, that is, being willing to do something 100 times in order to get good at it. Put another way, don’t let your initial ineptitude or trepidation prevent you from something challenging that you want/need to accomplish.

Do the work. Learn the skill. Become expert at it!


Thinking about this in our line of work, although we train people how to use our software ScheduleWise… what we are really doing is helping people learn how to change. Changing their patient schedule entails a whole lot more than just changing a schedule!

It consists of determining a better schedule, communicating with patients, families, transportation, staff, and physicians. It encompasses teaching how to communicate, hand-holding to help managers take back control of their clinics, and constant course-correction with staff and patients as they get used to a new normal.

And when you see the teams we work with have those lightbulb moments when everything just clicks, and they see how well their clinic can function, it’s not just highly rewarding for us, everyone wins!!!

For the clinics we are helping, this is likely their first time with such an undertaking. A wholesale change to the patient schedule isn’t something that a clinic undergoes all that often. So it is easy for people to become dismayed because they haven’t yet mastered the skills to sustain the optimized workflow of their patient schedules.

But the point isn’t to view the schedule change as one-time event. Think of it as the first step toward constant change and improvements. Each day that a new patient need is identified, the schedule may change. Each new change is an opportunity to build on your newly acquired skills of learning how to modify your schedule in order to maintain an optimized workflow.

After implementation, the first few times of managing schedule changes on your own are often full of hesitancy. No one wants to change what they just worked so hard to achieve in optimizing their schedules! But this is the essential skill you must practice in order to gain the proficiency that leads to mastery.

Remember the Rule of 100! The first 10-15 times, it will take you awhile. You will feel uncomfortable making changes, asking patients to change their time or chair again. After 40-50 times, you’ll be over that uncomfortableness, but there might be a handful of harder scheduling issues that involve multiple changes, or reworking an entire pod.

After 100 changes to the schedule, you’ll find most of the schedule changes to be pretty routine, with a harder challenge happening once every so often. After 200 changes, nothing will surprise you any longer. You’ll have mastered your schedule and learned to maintain an optimized workflow! Kudos to you!

Don’t worry, though! New challenges will reveal themselves as you master one skill after another. The learning never stops. Just remember to embrace the Rule of 100!