In all my years working in dialysis, I have not come across any other management issue that impacts so much in our clinics than the patient schedule. Why is it so important to you?
Each and every dialysis clinic’s existence depends on the satisfaction of its patients for its success. It’s no secret that patients can be demanding, and it’s not just the results of their medical treatment that matter to them. Their experiences and interactions with your clinic and your staff have an impact as well. As you want to keep the patients that dialyze in your clinic satisfied and healthy and the staff feeling that they can provide quality care, there are a few things you need to keep in mind.
- Ensuring that your patient schedule allows the necessary time for the patient to receives their full treatment and for the nurses to have time to review labs and monitor vascular access impacts clinical outcomes.
- If you want your staff to treat your patients right, you need to provide them with an ideal work environment. This means giving them the time needed to provide the care you are expecting of them. This time is not the same for every patient. Some patients take 15-minutes to put on the machine and others take 20-minutes. Because of these different acuity needs, your patient schedule should not be set up treating every patient the same way.
- Giving the patients’ the times that they prefer and getting them on at their scheduled time impacts the patient satisfaction surveys. When the time that they prefer is not available, how you handle communicating that to the patients, discussing and documenting it in your QAPI Meetings as not getting the time they desire would be considered a patient grievance and resolving it to a level that is either acceptable to the patient or documented as to why you are unable to accommodate the patients specific request is key. Keep in mind, it is not a requirement to give the patients the exact time or chair that they desire. It is however a requirement through Medicare’s Conditions for Coverage to document and address patient grievances.
- The staff feeling that they have the time needed to provide quality care, getting out at their scheduled time, and getting the hours they were hired to work impacts staff satisfaction. When the patient schedule is chaotic with pods to busy for the caregiver assigned to work independently and the nurses have to set aside their nursing duties to assist with turnover on a regular basis, their job satisfaction declines and overtime is often required to get their duties completed.
- Understanding how treatments, missed treatments and staff hours worked impacts the bottom line.
So with all that said, I’m going to share why I feel it is the manager’s ultimate responsibility. Think of this. If you were the owner of a prominent, well-respected spa/fitness center, who would you want to be ensuring that safety and quality standards were met or exceeded? Who would be your go-to person if you were receiving feedback that those standards were sub-par? Would it be the person checking clients in, the massage therapist, the trainer or would it be the manager?
As we have worked with clinics all over the U.S., we have seen the responsible party being everything from the Clinic Manager, Nurse Manger, the Social Worker, Patient Care Technician, or the Administrative Assistant. We have also seen in a few instances that schedules were managed by an offsite scheduler whose only job is the patient schedule for multiple locations. I often get asked which the best is, and my answer is always the same. The ultimate responsibility of the patients and staff schedules belongs to the manager. They are the CEO of their business, the dialysis clinic.
Scheduling often takes a village to get it right. To go from a good schedule to a great schedule, getting input from the different roles in the clinic is extremely valuable! The nurse manager (if a different person then the clinic manager) reviews the outcomes and gets orders for any necessary duration changes. The Social Worker is aware of transportation or other issues that may make a certain time or days difficult for patients. The Patient Care Technician knows which patients are not best to sit next to each other and which patients may take more time than others or have higher acuity needs which impact the amount of time that the caregiver will need to be with them. The Administrative Assistant may also be aware of transportation issues and is often the “ear” of what patients may be unhappy about and discussing in the lobby. Each of these roles has valuable information, but none have ALL the information needed to create the best patient schedule.
It is for those reasons that I feel that it is the responsibility of the clinic manager to pull all that information together and create and maintain the patient and staff schedules. Could another person in the clinic be assigned the task? Yes, and they could do a good job with it, but even in those cases, heavy oversight must be there by the person ultimately responsible — the clinic manager.
We’d love to hear from you!
- In your clinic/organization, who (what role) is responsible for creating and maintaining the patient and staff schedules?
- If your clinic is not meeting any of their goals, whether that be clinical, satisfaction or financial, have you investigated how they are scheduling and how that may be impacting the clinic in not being able to meet those goals? What did you see?