The Patient Schedule is a Living Document

ScheduleWise - Living Document

Having been in hundreds of clinics, sometimes what we’ve seen getting passed off as “tools” are nothing more than bullet points and platitudes and are just as often forgotten as soon as they are mentioned or read.

Here’s one: The patient schedule is a living document that must be managed daily.

It’s one of those easy to say phrases that just rolls off the tongue, but unfortunately is not practiced, at least not with respect to “managing” the schedule, and certainly not daily, and by the way, what the heck is a living document?

So let’s break this down so we understand.

Patient schedules change.  And they change fairly regularly.  Each week, physicians changes orders, transportation needs change for the patient, new patients get added to the schedule, and some patients expire or transfer, so they get removed from the schedule, et cetera, et cetera.

So when ANY of the above things happen, the schedule must be updated.  And while this is a relatively simple activity, we often don’t consider all of its ramifications.  Even a simple duration increase of 15 minutes can have a tremendous impact on the schedule.

What is the effect of these changes to the schedule?  Actually, let’s start with WHO will make the change?  Wait, can we even assume the change was made to the schedule?

Orders sometimes get changed in the Electronic Health Record, but not on the schedule itself.  That can make for an interesting and hectic day when your staff are expecting one thing based on the schedule, and then surprised that Mr. Jones’s treatment will be run 15 minutes longer, and Mrs. Brown is going to be angry because she doesn’t start on time.

The possibilities can get ugly if the schedule isn’t updated at all.  So ok, let’s say the change was, indeed, made both in the EHR and on the patient schedule.

So then we get to the question of WHO updated the schedule?  I’d like to assume that the person updating the schedule has the bigger picture in mind, so that they ensure patient safety and pod management is considered when changing schedules… every clinic has a scheduling guru.  But sometimes we just need to ensure that the change is made so it doesn’t get lost amid the 10,000 other tasks each day.  So the non-guru makes the necessary changes to durations and on-times, and hopefully communicates it to the “schedule guru” to make any other necessary adjustments.

And so finally we get back to the original question, what is the effect of these schedule changes?  Effect on what exactly?  There are two considerations:

  1. the effect on the patient in terms of transportation and any change in the patient’s on-time or chair;
  2. the effect on the staff in terms of providing them a schedule to be able to manage their pod safely and effectively.

Most of the time, we consider the effect on the patient’s transportation, that is, we ensure that either the new on or off-time does not affect their transportation constraints, or we communicate with the transportation company to make the necessary changes.

Where we often fail with the schedule change is on the staff side of things.  We assume
the technician will be able to adjust accordingly to the new on or off-time.  And we do not give enough consideration to the altered workflow when turning over the pod with this new off-time.  If we don’t consider the impact to the technician’s workflow, then we are doing a disservice to our staff.

Here are some examples of the potential change in workflow for the tech.  First off, we want to ensure that increase in Mr. Jones’s duration doesn’t create a new off-time that would overlap the next patient in the chair, Mrs. Brown.  We need to ensure that at least 45 minutes is available for turnover the chair (a topic of debate and one we will give attention to in another post).  And of course, Mrs. Brown isn’t going to be happy that her time is changed. Again, a later topic. =]

Other possibilities are that the new off-time could now coincide with the off-time of another patient in the same pod.  So how would the tech handle this situation where two patients come off at the same time. It’s stressful.  And leads to cutting corners on policies and procedure, or cutting times.  Often, it leads to getting help from the nurse, who is now torn away from his or her duties to manage a takeoff.  And don’t think the patients don’t feel that stress.  They are now being cared for by someone who is needlessly stressed. I must humbly offer that this is not putting our best forward for optimal care.

OR the new off-time could coincide with another put-on.  All the same things that I enumerated above could come into play.  It’s really a no-win situation for all involved.

Once you understand the potential pitfalls, it is easy enough to avoid them. How? By shuffling things around.  That is, changing some patient times or their chairs, which is akin to opening Pandora’s Box.

This is where I get to stress that it is incumbent on the clinical manager to make these necessary changes for the safety and quality care of our patients, as well as to provide a manageable pod for our direct patient care staff.  In short, to MANAGE the patient schedule.  If we do not, we pay the price.  Patient satisfaction decreases as their on-times become meaningless, and they have no choice but to have stressed out staff caring for them.  And staff satisfaction goes down as turnovers remain hectic which leads to a decrease in staff retention.  The schedule is connected to everything.  So clinical managers must make the hard changes up front and be confident that this is for the greater good for optimal care.

For our sake, and the length of this post, today is a happy day, and we will assume that the change to Mr. Jones’s treatment duration caused no issues.  Sometimes things work out just fine like that.  Not often, but sometimes. =]

Just remember that the schedule must be MANAGED daily.  Each day the clinical manager must ensure that his or her direct patient care team can handle their patient load in a safe manner and have the time to deliver optimal care.

I’m glad you took the time to read about the patient schedule as a living document.  Never again will you be able to hear this phrase and be unaware of all that it entails.  A simple duration change can have a ripple effect through a pod.  Just imagine when there are three and four changes!


Please share your own stories or comments below.  And if you don’t agree with anything I’ve written above, please share that too.  It is only through open dialogue that we come to understand one another.  Let’s just be respectful while doing it.

–Mark Sessoms

Mark Sessoms

Mark Sessoms

I'm supposedly a helluva industrial engineer since my alma mater is Georgia Tech. But what I really enjoy is continuous process improvement, in any and everything! I've been tackling scheduling practices in dialysis since 2003. Five years later, the stars aligned and ScheduleWise was born...

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