Time to Update Scheduling Methods Whiteboards and schedule books have long been the mainstay of cardiac catheterization laboratory (CCL) scheduling, but with the advent of less costly PC-based systems, cardiology departments can now display procedure schedules locally or over the Internet. Communication of real-time procedure schedules helps all concerned parties stay informed regarding the status of procedures in process, and keeps the catheterization schedule transparent for improved physician relations. Optimum Scheduling System An optimum system for scheduling procedures in the CCL would be comprised of an enterprise-level tracking system with the capability to: (a) track a scheduled patient procedure from the time a physician’s office schedules it; (b) notify registration and initiate preregistration authorization; (c) notify and interact with the scheduler who has specific CCL knowledge of procedures and room specifics; (d) allow the scheduled event to be manipulated by the scheduler or “board-runner” based on real-time events such as case delays; (e) be viewable to all stakeholders such as the CCL staff, pre- and post-procedure areas, as well as in-patient nursing units; (f) be visual and easily understood by all users; (g) be made anonymous and displayed in waiting rooms; (h) be transmitted to physician offices in real time, using a Web-based platform; (i) track changes made; and (j) be searchable with database backup. Costs If all can agree on what comprises an optimum system, the next question is, “Does this system exist, and how much does it cost?” Enterprise scheduling system costs are affected by several factors. The main concern when introducing a new system is whether the existing hospital information system is capable of handling the required tasks. An overall strategic plan is indispensable when designing and implementing a hospital information technology (IT) system. If your hospital has had the foresight and capital to plan for this, it is probably already equipped with such a system. If your facility has the IT “backbone” in its structure to support a scheduling program, but has not yet implemented one, then it is likely that those involved have not placed such a tool at the top of the priority list. Oftentimes, a scheduling system has not even been considered because so many staff members have been accustomed to the old way of doing things. CCL managers whose centers don’t have a scheduling system need to re-think things. It is extremely helpful for physicians’ offices to be able to view their patients’ procedure schedules remotely, and such capabilities will be seen by these physicians as a positive move toward better alignment of physician and hospital goals.2 If a hospital already has electronic scheduling capabilities, or has the capability to upgrade to such a system, it is worthwhile to take advantage of these compatible added components, even if they do not offer all the latest options. If the hospital system is in the discussion and planning phase of an upgrade, the timetable will most likely be quite lengthy, and the CCL may not be able to wait. Properly planned “patches” can work for the CCL if a cost/benefit analysis proves the case. Enterprise-Level Software Enterprise scheduling systems are designed to improve revenue cycle management through more efficient and reliable billing, while also eliminating the operational confusion of inadequate scheduling processes, which pose a hardship on both patients and healthcare personnel.1 Centers that use any of the major hospital electronic medical record (EMR) vendors most likely have the opportunity to interface with the EMR’s scheduling software modules. Cardiovascular Information System (CVIS) vendors have also recently developed open platforms for EMR integration, so if your center has decided to use another vendor, make sure that the solution makes sense for your requirements. Often when deciding on systems or software, vendors offer several options, but perhaps not all of the applications a department would like. Be wary of EMR systems that claim they can meet all of a healthcare organization’s needs. Specialized cardiology scheduling programs are available that can do the job and deliver a product that is more specific to the CCL’s needs.4 “Off-the-shelf” scheduling programs exist in various forms, but such systems are best utilized as a “patch” or a temporary fix, as they do not offer total connectivity to registration, billing and other hospital functions. While understanding the limitations of off-the-shelf programs, the CCL manager can use these programs in a phased approach for their department’s immediate needs. A product such as Office Tracker3 (Milum Corp., Austin, Texas) has been used in several cardiology settings as a solution to “in-house” and Internet access needs. Office Tracker software can be very useful; however, it is limited in that it does not offer connectivity to other hospital systems. Office Tracker can offer visual similarity to a traditional “whiteboard”, with the versatility of PC-based connectivity. As a patient progresses through the system, users are able to communicate the patient’s status via changing color schemes. This software is appealing in that it is easy to set up, train users, and offers Internet access capabilities. The cost of the software is also very attractive and scaleable, and it has the added benefit of exposing hospital staff to electronic scheduling when and if the hospital implements an enterprise-wide electronic system. Organizational Development Plan Stakeholder Involvement The implementation of any system that is radically different from what was used in the past will need to have a well-organized development plan and be clearly communicated to all stakeholders. Devise a data-gathering plan that involves all staff members using, for example, a set of questionnaires or surveys to determine how the proposed plan can be of help to those who will be using the system. These data-gathering efforts also serve as a foundation for change, and they support the argument for implementing such a plan. After all data are collected and coded, work teams should be designed with end-users of the product in mind. This will be the most important step in engaging users with the plan and ensuring its overall success. It is important to publicize the project to ensure staff buy-in and ownership. As a project leader, clarification of the intended goal is the number-one ingredient for successful implementation. Even with self-managing teams, the project leader can provide support, coaching and counseling. People have to learn how to be good team members and how to collaborate, solve problems together, make decisions by consensus, communicate openly and honestly, and trust one another, because each is dependent on the other’s performance. The most important aspect for a plan’s success is the individual member’s level of commitment to the team’s goals. Anticipate Resistance Change is most easily realized when there is dissatisfaction with the present situation. Knowing that change is essential for the organization’s survival and ability to function at an acceptable level are powerful motivators. Uncertainty and fear of the unknown are two of the key reasons for resistance among staff. Those feelings threatened by change need management’s reassurance and clear communication of the plan’s vision and the benefits it will provide once it is up and running. The management of staff at all levels requires communication of the vision and continued updates on the status of change initiatives. The project managers should be prepared to answer questions and provide consistent and reliable information. A solid communication plan is crucial to smoothing the way for implementing change. Conclusion Electronic scheduling systems can be of benefit to the cardiovascular service line with regard to throughput and communication. Having access to a procedure schedule using a secure Internet connection offers the capability to observe the status of the cath lab in real time from remote sites. If the need arises, the manager can also access the next day’s workload from home or office. Oftentimes, the CCL manager needs to schedule nonproductive time for staff or room repairs, and having the ability to manipulate a schedule remotely is convenient and efficient for these managers. In the present climate of competition among hospitals, the value of physician satisfaction cannot be underestimated. Remote schedule viewing capabilities for physicians and their office staff greatly enhances physician satisfaction with a hospital. Transparency and reliability with regard to procedure scheduling are elements of healthy physician/hospital goal alignment that the cardiovascular team can contribute to. The hospital leader who makes the physician’s job easier will be the winner.
1. Anonymous. Appointments made easy. Health Management Technology 2005;26:4. Retrieved August 10, 2008 from, http://findarticles.com/p/articles/ mi_m0DUD/is_1_26/ai_n8692186/pg_1?tag=artBody;col1 2. Bon Secours Health System, Inc. selects TempusOne to improve patient access and increase customer satisfaction. Business Wire Nov. 9, 2005,Nov 9. Retrieved Ausgust 10, 2008 from BNET Web site: http://findarticles.com/p/articles/mi_m0EIN/is_2005_Nov_9/ai_n15786771 3. Point, click, schedule. Office Tracker, 2008. Retrieved August 10,2008 from http://www.officetracker.com/ . 4. XPER whiteboard viewer web page. Philips Medical Web site, 2008. Retrieved August 10,2008 from http://www.healthcare.philips.com/main/products/cardiovascular/products/IPC/xperim/xperwhiteboard.asp The author can be contacted via: Phil.firstname.lastname@example.org