Losing Control of Your Dialysis Clinic

Losing Control of Your Dialysis Clinic

Maintaining control of a dialysis floor is no easy feat.  Clinics are constantly going through change.  New CMS regulations, new staff, patient duration changes, shifts, acuities…etc.  The list is long.  Patients as well, have gone through quite a bit of changes themselves.  Not too long ago, most of them were living a normal life not requiring dialysis.

I found while working as a technician in hospital acutes that there is unfortunately not a lot of mental preparation given to the patients about what life will be like as a dialysis patient.  Many patients that I worked with in acutes knew very little about dialysis, and how long they will need treatment.  And when they begin outpatient treatment they are told when to arrive at the clinic, how long they will run, how often they will run, what to eat, how much fluid they should drink, and what medications need to be taken.  It’s easy to see how patients could feel like they are not in control.

Having worked with many outpatient clinics, I hear many of the same complaints.   In some clinics, I hear that the patients at times seem to be in control of the floor.   “Patient A will not move from that chair.  Patient B will yell at us if we change her time!  And Patient C has threatened to call the network!!!”  Does this sound familiar at all?

As clinical staff, we joined the medical field to help people.  Being caring often means that we tend to avoid confrontation or situations that may make a patient upset.  So as change occurs in the clinic, our day-to-day workflow may seem not to work any longer, and we end up just trying to “survive the day.” To make it work, we may call patients in early, we may pause treatments, or call our nurse over to help.  All this, just to get through the day.  None of this is new to anyone, I’m sure.  But essentially, control of the floor has been lost.  So how do we regain it?

First, we have to talk about where the loss of control comes from.   And believe it or not, the main culprit usually lies with us and our ability to manage the patient schedule.  The patient schedule changes constantly, but are we maintaining the schedule for these changes?  Here are some of the biggest reasons for change to a patient schedule:

  • Changes in patient treatment durations
  • Shift changes 
  • Discharges and Admissions 
  • Changes in patient acuities

Most changes to the schedule are unavoidable and often out of a clinic’s control.  Yet we are tasked with providing safe patient care, that is also reliable with concern to on and off times.  And that’s where constraints come in.  Patients have lives outside of the clinic, after all!  And many of our patients rely on outside transportation to and from dialysis, so their schedule is central to their lives.  I’m sure we have all seen patients left in the lobby if they run late or are put on early.

Here are some other important patient hurdles that need to be overcome:

  • Patients who work
  • Childcare needs
  • School
  • Patient preferences on where and when they have treatment

These constraints are often equally as difficult to navigate.  And in working with our clients, I stress that the clinic must always look at the big picture and not solely on particular “wants” of every individual patient.  Yes, I know it is easier said than done.

So we’ve covered a lot of ground here…  going over some of the basic issues causing a feeling of lost control in the clinic.  Do you have some experiences you’d like to share on this topic?  Please write them in the comments below.

And then join our email list so you don’t miss my next post where I’ll discuss how to regain control of your clinic through workflow management in which I’ll share with you some of the techniques we have implemented with clinics across the country.


Brandon Hamilton

Brandon Hamilton

I have been have been training and implementing ScheduleWise for our clients since 2015. I started in dialysis as a technician in January 2008 and became a preceptor in 2009 in many different settings including large outpatient clinics, small rural clinics, and the last few years with inpatient acutes. I enjoy working with our clients to overcome patient and staff scheduling obstacles that all clinics face.

2 Replies to “Losing Control of Your Dialysis Clinic”

  1. Thanks for making software that ruined the job I once loved to do. Thanks for taking away my patients free time along with my own simply to help large dialysis providers screw employees out of hours. It makes so much sense to have a chair ready, a patient ready, a tech ready but you have to tell your patient ” I’m sorry you have to wait for no reason”. After being in healthcare for twenty years I think I’m done and your program is what finally did. You people must be lazy Democrats.

    1. Thank you for taking the time to share your thoughts. It sounds like you have had a long career in healthcare. There have certainly been a lot of changes in the past twenty years!

      I can not speak for your clinic or organization specifically, but I appreciate the opportunity to share our intent when we built ScheduleWise. First, I think it’s important to know that we are all dialysis people who work for the company ScheduleWise. This includes a technician, nurse, clinic manager, and process improvement specialist. We truly understand the work that is done in caring for your patients. The software was built to help the user to visualize the impact of the on-times, off-times, and any additional needs that may require the caregivers more time to provide care while they are creating and maintaining your patient schedule. We license the software to dialysis organizations who ultimately make the final decisions on how to schedule their patients and staff.

      You mention frustration on having to wait to put a patient on even though they are there and you are ready. As much as you may not want to hear this, there is likely a very good reason. For the most part, getting all your assigned patients on is not the tricky part. Turnover is where the challenge is. As you are likely aware, with different treatment durations, your patients may end up coming off too close together, causing an unsafe situation. That is why most clinics will put in place the rule or practice of putting all patients on at their scheduled time.

      If I may suggest, talk to your clinic manager or the person who works on the schedule. If you feel there is an opportunity to improve your patients’ experience by changing the patient schedule, offer your suggestions. They can always see how your suggested changes look in ScheduleWise and either implement your recommendations or show you why it may not work in the bigger picture.

      Thanks again for taking the time to write us. I wish you the best of luck in making any future career changes.

      Mary Kay Hamilton

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