In my previous blog post, I discussed where the loss of control comes from in many clinics that I have either worked at as a Patient Care Tech, or that I have had the opportunity to work with as clients of ScheduleWise. And most likely, you will find those reasons pertain to your clinics as well. So, the big question… How do we regain control and then manage our patient workflow?
You might be thinking, ‘What the heck is workflow?’ Workflow is loosely defined as a sequence of tasks or processes through which work passes from initiation to completion. In our world of providing dialysis care, one thing that workflow translates very directly to is the work required to initiate and terminate treatments, better known to us as put-ons and take-offs. We can think of these put-ons and take-offs as workflow events.
Breaking this down further, we know from experience that each workflow event lasts typically 15 minutes each for your average patient with normal acuity. And that a workflow event requires undivided attention from a technician.
Workflow events are not particularly difficult during first shift put-ons. We put each patient on roughly 15 minutes apart, one after the other. That’s the easy, no-brainer part. But things become more difficult, and sometimes untenable, during turnover. In a typical 4:1 pod there are 8 workflow events during a turnover from first to second shift (4 take-offs and then 4 put-ons). This same idea goes into 3rd and 4th shifts as well.
So what does this all mean?
When these workflow events overlap one another during turnovers, that is when two or more events are scheduled to happen at the same time (e.g. two take-offs occurring at 10:00AM). When this happens in several different pods and over each turnover, the clinic begins to feel chaotic, and many issues arise:
- Patient safety concerns
- Technicians feel rushed
- Nurses are called into the pod for help
- Patient and staff satisfaction decreases
- Treatment durations may be cut short which impacts adequacy and other outcomes
Knowing this is half the battle. And that gives us the power to solve this issue and we can begin to regain control!
Understanding our workflow as clinical staff, we are the ones tasked with making sure our patients are receiving safe quality treatment above all other constraints.
Therefore, it is imperative that we construct the patient schedule so that we have no more than one patient event at a time scheduled per pod assignment. Often deeper thought is required than simply spacing the time between patient events at 15 minutes. Especially given that there are many more hurdles we face today than simply initiating and terminating treatments, including:
- Patient acuities both pre- and post-treatment.
- Hoyer lifts
- Bleeders
- Staff needing to hold access sites
- Wheelchairs/walkers
- Visually impaired
- Patients who take extra time to vacate their chair
- Consistent tardiness
- Patient scheduling constraints
- Work
- Transportation
- School
- Childcare
- General preferences on time and location in the clinic
These constraints are typical in every clinic, so staff must identify the workflow constraints that need to be overcome, and then work the schedule around them. In the clinics I have worked with, we often employ new scheduling methodologies to tackle all of the numerous constraints. But you must be very attentive to each of the workflow events to set your staff up for success in meeting the demands of the patient schedule. This is where a scheduling application like ScheduleWise really shines (shameless plug!) in displaying your workflow events in an intuitive chart to help you avoid chaotic turnovers, and meet your clinic’s overall goals!
We then come to schedule execution. I have always shared with our clients to always follow the schedule to the best of their ability. Meaning, do not deviate by calling patients in early and rearranging the schedule anew each day. That being said, there are always unforeseen issues that arise, and are unavoidable.
- Machine failures
- R.O. issues
- Late patient arrivals
- Unforeseen patient events
The issues above are often unavoidable on a day to day basis. Where clinics often compound the problem is self-inflicted to some degree. Schedules are not followed for avoidable reasons.
- Patients demand to be put on early and we oblige
- Patients are called in early to back fill open chairs
- Patients are moved around the floor without careful consideration given to their durations or acuities
- Treatment appointment times are not adjusted when treatments durations are changed
Self-inflicted may seem like a harsh phrase. But we have to admit our problems if we are to solve our problems. If you ask yourself the question, “Why do our patients come in or ask to be put on early?” Typically, the answer is because we put them on early and that became the expectation. And there are many more reasons that point back to us as staff for the reason turnovers are chaotic.
When the patient schedule is updated, adjusted regularly, and followed as written with the overall workflow in mind, many issues begin to subside over time.
- Patients trust that their appointment time is correct
- Early arrivals decrease
- Patients cutting treatment time decrease
- Patient and staff satisfaction increase
- Professional roles on the floor are realigned (i.e. nurses get to be nurses)
In a follow-up post I would like to talk about the complexity of the patient schedule and the fact that it is fluid. Often, we think of the schedule as stagnant and never changing, but it is quite the opposite. Schedules are always changing, and the needs of your patients is always changing.
See you next time!
