Oncology staff are a precious, limited resource. Make sure that they are spending time on the activities they are uniquely able to perform.
In addition to rethinking workflow, cancer programs are taking a hard look at staff members’ roles and responsibilities to focus each individual on the highest-value activities.
When Gundersen Lutheran Medical Center reworked the patient flow and care team configurations at its medical oncology clinic, hematology clinic, and infusion center, the hospital also made sure that clinicians were working at the top of their licenses—and sought ways to off -load low-priority tasks from higher-paid to lower-paid staff.
Use a scope-of-practice matrix to cascade responsibilities
A critical tool in this effort was Gundersen’s Scope of Practice (SOP) Matrix, which was created by the hospital’s nursing department as part of an institution-wide initiative to ensure top-of-license practice.
The simple grid, shown here, outlines different clinicians’ scope of practice relative to patient assessment, planning, intervention, documentation, evaluation, delegation, and leadership.
By summarizing key information about clinicians’ scope of practice in the state of Wisconsin, the matrix makes it easy for Gundersen’s cancer center team to identify opportunities to shift responsibilities to the appropriate-level staff.
For instance, it was clear that physicians should no longer perform nursing assessments, but delegating that responsibility to nurses hinged on finding additional nursing time. The SOP Matrix enabled the team to see that many of nurses’ responsibilities—especially phone triage and rooming patients—could be performed by a medical assistant, a role the cancer center hadn’t used before.
Of course, this new model required Gundersen to add staff : five MAs and two RNs. Gundersen didn’t have any budget to grow its staff but calculated that just one additional patient visit per physician per day would generate enough revenue to cover the FTEs.
After completing the staff redesign in 2008, Gundersen saw an increase in patient, staff , and physician satisfaction, along with greater capacity. The process was such a success that the hospital was just starting to do it all over again when we spoke to them following the implementation of an EMR in the cancer center.
Consider non-clinician roles, too
This value-driven clinic staffing model doesn’t just apply to clinicians; cancer centers should consider all staff when scrutinizing the interplay between process and people.
When the infusion center at the 504-bed Overlook Hospital in Summit, New Jersey, was experiencing significant volume growth, nurses approached administration asking for a third nurse FTE. Patients were waiting up to two hours to start their treatment, and nurses were shouldering overwhelming workloads.
Convinced that an additional nurse was the right solution, leaders decided to conduct a Six Sigma analysis to document the need. They developed a tracking sheet, featured here, to get to the bottom of the center’s long and variable patient wait times.
For each patient, the nurse documents the start time for each component of care—when the patient is seated in the chair, when the various medications are delivered, and when the patient leaves the chair. If a delay occurs at any time during the treatment, the nurse must circle the corresponding reason.
Collect time stamps to pinpoint the cause of delays
After collecting data on the causes of treatment delays for every patient across a two-week period, Overlook got a surprise.
The main reason for delays? Phone calls that pulled nurses away from patient care. Each call lasted just a few minutes, but across an eight-hour day, the calls added up to hours in patient wait time.
Understanding this root cause allowed Overlook leaders to develop a cost-effective solution. Instead of hiring another nurse, Overlook hired a tech, tasked with answering the phone, as well as managing the schedule, registering patients, checking patient charts, and performing initial patient intake.
- Managing for Growth, Volume II
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The new model worked, freeing nurses to focus on patient care, decreasing average wait times to just seven and a half minutes, and enabling the infusing center to conduct about 300 additional procedures per year—resulting in $74,000 of incremental profit.
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