Reducing scheduling variation.

Abstract

This work was undertaken at the Chemotherapy Day Unit of Ballarat Health Services in Victoria, Australia by a team comprised of the redesign lead, unit team leader, and clerical staff. The need for improved scheduling was highlighted in the Victorian Chemotherapy Service Redesign Project (VCSRP). During baseline data collection it was determined that 50% of patients were experiencing non-value added chair time. The intervention was comprised of using the Model for Improvement (IHI) to determine measures around baseline, benchmark, and sustainability. Expected length of treatment (time in chair) vs. actual length of treatment data was collected for 30-days. Variances were investigated and assessed against benchmark. Direct care time during treatment was identified as greatest influence to variation. Direct care time by treatment was reviewed and given an ‘acuity scale’. This matrix was then applied by the team leader and clerk when scheduling appointments. Further P-D-S-A cycles included adjustments to expected length of treatment and smoothing out allocations by assessing acuity in 15-minute blocks. These changes resulted in a reduction of non-value added chair time for the patients, improved on-time scheduling and a reduction in over-time for unit staff. The improved matrix was used to establish electronic scheduling plans. The Scheduling Improvement work demonstrates the benefit of reducing non-value added chair time to patients by adding an acuity scale for smoothing workflow. This method has also been used in the Theatre Perfect List project with success and could be used in a variety of healthcare settings where direct care is provided.