The Art AND Science of Patient Scheduling

Previously I took us down the philosophical rabbit hole of whether managing the patient schedule is an art OR a science. I wanted to consider a different path line of reasoning this time, shall we? This time that patient scheduling is necessarily both an art AND a science.

In my last post, we discussed the “control” aspect.  But for this post, let’s consider that you are in total control.  No computer is going to do the work for you.  So you have to put your thinking cap on and manage all the changes to the patient schedule this week.

You’ve been doing this patient scheduling thing a long time, so you know the ropes. You’ve learned over time all of the patients’ likes and dislikes, their acuities, and you have jotted down some notes so you do not forget certain things like a transportation issue with one patient, and when a certain doctor may round. All of these things are in your head, and you’ve developed a certain knack over the years that when you have to make changes to put-on times, you know what ontimes work best in what chairs.  When you put your pen to paper, you aren’t even thinking any more. The schedule seemingly just writes itself.

Some call this “the art of scheduling”. And they’d be right. Not many people have the ability, and not many people WANT this ability either! 😉  And when a schedule is done right, everybody is usually happy. They don’t look at the piece of paper with the schedule on it and want to immediately go and frame it, but they do consider the maker — the artist if you will — to have special talents.

But of course, this is the best case scenario. Every clinic has one or more persons in charge of managing the schedule, but not every clinic has an artist-in-residence. Learning these skills can often take years. And it’s a job that is often unwanted to boot!

But what happens when you add science to the equation? That is, if we learn all the techniques and considerations that the artist was able to apply to his or her craft of patient scheduling, and we could program our supercomputer to manage all this work for us, then all we would have to do is enter any new patients or changes to treatments, and with the click of the easy button, voila! Out pops a schedule worthy of admiration.

What’s nice about this last scenario is that ANYONE could manage the schedule. We no longer must depend on the artist. It’s not unlike the great advances we’ve seen with photography. We used to have just a few artists. They were experts with the technology of their day. And yes, they were indeed artists in their framing of their subjects and lighting and all the elements to consider when shooting. But along came the point-and-shoot cameras and the world of photography changed. And once the industry went digital, the costs for development were virtually zero, and thus the barrier to becoming more artistic for the average Joe decreased. And with smarthphones, now everyone has a camera in their pocket. And we have a world flush with photos. Everyone is now a photographer!

But is everyone an artist? Not necessarily. But one could say that there are many more artists than there were previously when the technology was more difficult, and the costs were higher, of course.  So we actually could attribute the rise in artistry and photography was due to the decrease in difficulty of the science of photography. To manage that, they had to hide all the science from the user (inside the camera), and make the interface dead simple. Art AND Science collaborating to make a better world of photography for all!

And so it is with scheduling software (you knew I’d come back to that, didn’t you?). The costs have decreased tremendously. The science has been hidden away in the algorithms underneath the hood so to speak. And the interface is simple so that anyone can manage the schedule.

Well, this will be the eventual congruence for patient scheduling, but as of today, we don’t trust the easy button yet. That gets back to the “control” issues I wrote about previously. Eventually, though, clinicians won’t want to waste any more time doing this task that the computer is better suited for. Instead, we’ll be content to know that we do have control of the inputs, and we’ll accept our eventual the transition to the Easy Button!

Between now and then, we still have some evolving to do. Slowly but surely the technology will get better and easier, and before long, we’ll all be artists!

Is Effective Patient Scheduling More An Art Or Science?

Vincent van Gogh's The Starry Night

Vincent van Gogh’s — The Starry Night — 1889 — at Google Cultural Institute

Let’s begin with a recent milestone in the art world. We now live in a world where art and science have collided. Computers have begun to mimic human creativity. It’s really amazing (and scary!) to see what has already been done. I found this particular article fascinating.

Computers Can Now Paint Like Van Gogh and Picasso

This was from September 2015!

If you followed the link to that article, you’d find that computers were able to mimic the style of some of the world’s greatist painters (think Van Gogh, Munch, Picasso) to create a relatively simple scene of row houses along a river.  It is incredible to think these were done by a computer!  And yet, not, given how far we’ve come with computing!

The next level of fascination for me is the human psyche when it comes to man vs. computer. I picture that if we had a young art prodigy in our midst who was able to paint any scene in the style of several of the great masters, we might say that they are nothing short of incredible imbued with talents from God above. But once we find out that a computer was able to do this (a sophisticated artificial neural network to be more accurate) we may tend to pass it off as not so incredible. Amazing yes, but almost an expectation these days… and we may even begin to find its faults, it’s non-human characteristics. Or maybe we won’t even like it precisely because it was done by a computer, because its imperfections are programmed… on purpose. This is fair since understandably we fear the eventual congruence of machine and humans (unless it makes for a great character! link to Data or Blade Runner). I know I do to a certain extent.

And such are the mind games we play when we apply computers (more specifically optimization algortithms) to patient scheduling. The computer can now help us produce the perfect schedule… a thing of beauty. One that meets all of our patient’s needs and our staff’s desires, with just some inputs and the click of a button. Art, meet Science.

And that’s where it all goes wrong… because the moment we “lose” control to the machine is the moment we start finding fault with all that it provides. Sure, we have control of the inputs. Things like which patients run on which shifts. What are the patient’s durations?  How long are the treatment durations? Etc.

But do we have control of ALL of the inputs? Are we also plugging in the constraints of patient transportation? The preferred patient ontimes or preferred seating assignment? And do we have control of the methods used to derive the schedule? Does the computer take into consideration the workload on the patient care techs and provide buffer for adverse events? The questions go on…

And the simple answer is… we (in this case, the users) don’t know! Because it’s all hidden away in the black box we call the computer. Instructions were given to it, and it follows those instructions by creating the best possible schedule based on its constraints and its objective function. This gets into the scienc-y part of it all. So let’s skip that. Ultimately we accept the science because it is beyond our capabilities, but the art, **that we can judge!** and quite frankly, we often don’t care for it. Maybe it’s because we can’t really argue with a computer. And getting mad at it doesn’t really do anything either!

So, in the grand argument of patient scheduling being an art or science, I would posit the difference comes down to “taste”. Where the word taste can be substituted with control. If you are OK with giving up some control, than you can appreciate the science of scheduling. But if you have that rare person in your clinic who manages a satisfactory and workable schedule week after week, then you may be in the art camp.

What really may get your goat is that you (nurses and techs working the floor) have lost control either way. You have given up control to either an artist, or a computer. We just think we’re in control to some degree because we can argue with the artist when the schedule doesn’t work well!  🙂

Where do you fall on the art vs. science argument?