Centralizing Scheduling: Many Reasons to Overcome Barriers

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Terry Duggan-Jahns, RT, and Rick Wendt, RTR

There was no shortage of reasons for centralizing outpatient imaging scheduling for four Franciscan Health System hospitals in Tacoma, Washington, within 45 miles of the flagship, 320-bed St Joseph Medical Center (SJMC). Improving efficiency, capacity, ordering consistency, and contingency planning for staffing were foremost among them. “With increasing competition and financial challenges, better centralized scheduling was not only a good idea, it was necessary,” Terry Duggan-Jahns, RT, manager of diagnostic imaging, SJMC, told attendees.

With 5 schedulers at St Joseph’s and two schedulers each at the three other hospitals, the plan was to centralize all scheduling at St Joseph, a level II trauma center. The intention was to offer a greater choice of imaging sites to patients and referring physicians, increase physician and patient satisfaction by offering same-day service, utilize scheduling staff more efficiently, utilize open slots at all sites, and put an end to busy signals. “By putting 11 schedulers in one room, the likelihood of anyone getting a busy signal is greatly diminished,” notes Rick Wendt, RTR, manager of diagnostic imaging, 80-bed St Anthony Hospital. “If they get a busy signal, they call somewhere else.”

Centralized scheduling for three of the four sites went live June 1, but before that could happen, Duggan-Johns and Wendt needed to clear multiple hurdles: sell the schedulers on the idea, re-route the phone lines into the centralized scheduling line, update an outdated RIS, get the radiology group that covered all four sites to standardize exam protocols, train schedulers from the smaller sites on procedures performed at the larger ones, and turn four close-knit teams into one.

Duggan-Jahns shared the following implementation time frame:

March 2009: The plan was hatched.
April 2009: Remodeled a mammography ready room to accommodate 7 schedulers.
May 2009: Announced the move to provide the 21-day notice required by the union and coordinate with IT to redirect the phone calls to SJMC and added ACD Queue Incoming and Outgoing Calls to better track, measure, and proved scheduling needs.
May 19, 2009: The first schedulers moved in (SJMC and St Clare) and the phone system crashed.
May 21, 2009: Phone system upgraded.
June 1, 2009: Go-live with schedulers, who had to be rescripted to include the name of the flagship and the name of the site actually called. Scheduler skills were evaluated and a DI scheduler matrix was developed to ensure coverage for each modality.
August 2009: Reviewed inconsistent preps and protocols and communicated with radiologists, who developed consistent protocols over the following two months.
September 2009: Established regional IR and nuclear medicine schedulers, challenged to make best use of IR time because they only had afternoon access to the labs. Room created in RIS for IR, and a new scheduler was hired.
October 2009: Began educating referring physicians on ordering compliance and faxinmg and emailing daily openings to referrers. Field reps took maps to the offices.
February 2010: St Anthony schedulers were moved to SJMC, difficult because this was the newest hospital with great resources. “They were living the dream,” acknowledged Duggan-Jahns.
June 2010: Discussions began with Enumclaw Diagnostic Imaging Manager, which is 45 miles away, leaving some uncertainty as to whether or not the schedulers will agree to move.
July 2010: Official announcement of the Franciscan Appointment Center for all orders (DI).

Getting to the endpoint was fraught with challenges. Wendt compared the initial reaction of staff to Mt St Helens erupting. “We had territorial and control issues,” Wendt reports. “We had to change workflow for all DI staff. They couldn’t run down hall and schedule an appointment because they weren’t there anymore.”

But hopes are high that improvements on all fronts will be demonstrated this time next year.