“I love it when a plan comes together!”
— Hannibal Smith

Here’s an often heard bit of conventional wisdom “…even a bad plan is better than no plan at all.” While I love to be the contrarian, I have difficulty arguing against this sound bit of logic.

So how can we exemplify that with what we love to talk about most in this blog… how about the patient schedule?  🙂

Basically, your patient schedule is your plan. So rewording our conventional wisdom, it would go like this… “Even a bad patient schedule is better than no patient schedule at all.”

And to this, I would heartily agree! Do you?

Believe it or not, some clinics do not even have a true schedule! What they have is a first-come first-serve setup by shift. For example, first shift starts at 6:00 AM. So all first shift patients should arrive by 6. There are only so many patient care staff, though, so not all patients would actually go on at 6:00 AM. Instead, they are put on in a first-come, first-serve basis. (note: some of you may counter that this is a schedule… but I have to draw the line somewhere, my friends!)

As you can imagine, competition is fierce! So a significant number of patients arrive as early as possible. They might even be waiting outside the facility doors before it even opens so they can get the coveted 6:00 AM put-on times.

And assuming a 2-shift clinic (you could hardly manage a 3-shift clinic in this way), the same thing happens all over again for the second shift. Assume staff takes lunch together. And assume an average treatment duration of 4.0 hours. Thus, the second shift would start sometime around 12:00 or 1:00 PM.

Does this sound good to you?  It depends on what you do at the clinic, I suppose. But it is not a recipe for long-term success given the dwindling reimbursement rates and higher costs in just about every category from supplies to staff.

Here are some of the real problems with this type of plan:

• There is no consistency day-to-day. Different patients show up each day and potentially get put-on in a different order. Every day (every shift even!) is a new adventure for the staff. This may be appealing to some… but this level of variability is not ideal for a clinic or a business. There is no feedback loop for you to make changes day-to-day to improve the workflow. It’s ever-changing!
• It does not consider the manageability of each pod by its technician. All patients going on one by one is fine… but when do they come off? Several patients could come off at the same time. That takeoff time could get highly chaotic for the technicians and patients.
• It does not consider the effectiveness of the nurse to do pre- and post- assessments in a timely manner. Again, while the pre-assessments may be somewhat orderly… the post-assessments could get really hectic.
• It is tough to gauge patient satisfaction trends with no schedule. Obviously a survey might give you insight. My main assumption is that patients would prefer consistency in their schedules. It is tough to make any predictions on patient satisfaction.
• It is just as tough to predict staff satisfaction. The day-to-day variability will attract certain types of staff who can handle it. They may like the long breaks. The best indicator here would be retention of your staff to understand how effective this method of scheduling is.
• It is not a productive/efficient way to treat patients. Whereas the previous two bullets were uncertain, this one is clear. This type of plan is hardly a recipe for success along the cost front. It is just too much unproductive time… that is, time when staff is on the clock, but no patients are receiving treatment.
• Ideally, we group tasks such that we minimize the time for turnovers, and we find time for lunches while patients are being treated. These costs directly hit the bottom line of the clinic, and a plan like this especially hurts the viability of the smaller independent dialysis clinics.

So the moral of the story is:    No Schedule = No Plan

And if you believe the conventional wisdom, then you believe that even a bad patient schedule, is better than no schedule at all.

Remember, even with a bad plan, you have a mechanism for feedback and revision. We learn from our mistakes. Without a plan, we tend to repeat our mistakes too often. Instead, having a plan, even a bad plan, forces us to think and reason about the problem more, instead of venturing into the unknown each day.

Here are some simple questions you can ask yourself to get feedback from your plan/schedule (not an exhaustive list):

• Did the patients arrive on-time?
• Did your schedule allow the technician to put the patient on at their scheduled on-time?
• Were your nurses able to get their specific work tasks complete?
• Did you meet your productivity goals?

Revise the plan/schedule:

Based upon the data from your feedback, you can tweak your bad schedule to make minor improvements each day.

Rinse and Repeat:

This is not a one-trick pony. A feedback loop is just that… a loop! This is what we talked about before in “The schedule is a living, breathing document!” You must manage it frequently.

After all, even a well-oiled, fine-tuned machine needs an oil change and a tune-up after continued use.

A few iterations with this simple process and it will become second nature. And you’ll love it when your plan finally comes together, too!