We left off having completed the B.C. mini-epoch, Before Computers. In this installment, we are going to revisit the timeline of patient scheduling tools and talk through the A.C. mini-epoch.
A.C. — After Computers
Once computers were on the scene, innovations came quickly. In 2003 when I began in dialysis, most clinics used either Microsoft Word or Microsoft Excel to manage their schedules. So I have to assume that some folks were inputting their patient schedules into a computer roughly by the mid-1980’s. Let’s take a look at some of the technologies that people tried to use to help them with their patient schedules.
Word Processors: (evolution of word processors)
Word processor… now there’s an ancient term in computing! Nowadays, Microsoft Word is the dominant application, but Corel Word Perfect was what I used long ago. And I’m sure some savvy managers in dialysis transcribed their handwritten schedules into a word processor. And it allowed them to save their schedules, easily edit them, track files historically, and more easily share schedules with others. These were huge gains in productivity! But it was the simplest of use-cases for what the computer could really do. These were the baby steps we took… from handwriting schedules on paper to managing schedules on the computer. And we never looked back! Computers were here to stay! By the way, word processors are still in use. I ran across a schedule in MS Word just the other day!
DOS: (history of MS DOS)
A humble little DOS application for patient scheduling made its way on the scene. The only reason I know about this is because it was created by my first boss and mentor at DaVita, Doug Vlchek (Yoda). I never got to see it in action, just manuals of it. But I loved it! To my knowledge, it was the first “program” built for managing patient schedules at dialysis facilities.
[INSERT YOUR COMPUTER APPLICATIONS HERE! As I have mentioned before, this timeline is based on my experiences within the dialysis industry. This history can only be complete with your input! If you know of any early applications that effectively predate the dominance of spreadsheets, please let me know and I will put in a blurb about it here! Anything that is 2005 or later would be considered internet-age, and so I plan to include those in a later installment.]
Not everyone knows this, but the now ubiquitous spreadsheet also has its roots in paper, specifically a long paper ledger that could be unfolded (spread) providing many columns for information management. There have been many incarnations of spreadsheet applications over the years: Visicalc was the first, Lotus 1-2-3 and Quattro Pro (both of which I used in my time) came later. But Excel is probably the most familiar spreadsheet application to everyone.
When I came to DaVita in 2003, most clinics were already using Excel. So I’d say that it is safe to assume that spreadsheets became the most ubiquitous patient scheduling tool around the mid-to-late-1990’s. But unfortunately these tools were using Excel as little more than graph paper to display the schedule within pretty boxes. And there were TONS of styles and colors. Remember when everyone used Comic Sans for everything!
But the power of using a spreadsheet is in using formulas to do the calculations work for you, like calculating the take-off time based on the put-on time plus the duration. Surprisingly, most people didn’t use Excel to do even this much. And for things like conditional formatting which could help you identify problem spots in the schedule… fuggedaboutit!
Most of the spreadsheets that I have encountered in my dialysis career do not utilize the spreadsheet in any way to help the administrators manage their schedule. They didn’t then and they still don’t now. It’s really puzzling to me, other than to say that it is not a clinician’s first inclination to learn how to use spreadsheets effectively.
Luckily, people with Excel skills came along and began to develop models to help with patient scheduling, and some of these models could get quite advanced, turning the patient schedule spreadsheet into a sophisticated little application.
Spreadsheets quickly became the de facto standard for scheduling at dialysis clinics. As an industry, we did some innovative things with this tool/application. It helped us to be more productive in managing the scheduling process. And it helped some organizations with standardization of scheduling processes because everyone was using the same tool and following the same rules.
But while we made significant progress, there were some obvious areas that the spreadsheet couldn’t address, such as allowing other users to access your schedule easily, or managing your data over time, and reporting trends in your data. These were the next stages of innovation that would need to be addressed in other ways, with better technology. But there is little doubt, spreadsheets provided us with a better way to manage our patient schedules… and staff schedules, too!
We’re not done with spreadsheets yet, though! In Part 3 of the series, I’ll dive deeper into Excel and some modeling ideas that I either saw or created with Excel. There are a number of these models that I will share, and I encourage you to take a look at them… if only for a walk down memory lane.
See you there!
[CALL TO ACTION! I would really appreciate you sending your own spreadsheet schedule templates to me if you'd be willing. I'll post them as part of this little history we are creating (without real patient info, of course)! It will be a grand tribute to the ideas that helped shape scheduling in this industry over the past five decades.]