Like most of healthcare, there are many areas of opportunity to address in operating an infusion center. I have seen lists of performance improvement (PI) projects that would take years to complete. Most PI projects are good, but when faced with numerous choices, it can be quite daunting to pick where to start. This is compounded by the fact that most projects are interconnected – when you change one area, there are ripple effects across the whole operation. The following exchange between two managers exemplifies the issue:
- Manager 1: “If we change the appointment schedule, our doctors will have to be better about finishing appointments on time.”
- Manager 2: “If we don’t change the appointment schedule, our wait times will remain high.”
This becomes a chicken and egg problem. Should you focus on improving doctors’ schedule compliance before changing the infusion appointment schedule? In my experience, the infusion appointment schedule should come first. The appointment schedule is the bedrock around which the infusion center builds its operations. Most centers have built their schedule to accommodate sub-optimal performance practices. When the infusion schedule is optimized, this becomes the forcing function to innovate and improve other areas as well. I have seen many great ideas implemented following a schedule refresh such as:
- Compound medications prior to patient arrival for specific appointment types
- Use a nurse team based approach to allow nurses to cover additional patients while others go on break
- Adjust scheduling practices so that patients that just need an infusion are scheduled at the beginning of the day
If your hospital is struggling to accommodate additional appointments or has long wait times, I encourage you to deploy an optimized schedule and solve the rest of the puzzle as you go.