Create self-scheduling program for aides
Client satisfaction rises, aides more productive
Scheduling hassles were such a problem at one Ohio home care agency, not only did productivity suffer, but up to one-third of patients were cancelling visits because of poor service.
"We were losing a lot of visit volume," says Joan W. Phillips, RN, home care aide services coordinator for Meridia Home Health in Mayfield Village, OH. The freestanding agency is part of the Meridia Health System and is affiliated with the Cleveland Clinic.
Productivity suffered because when patients cancelled visits, aides often could not schedule another client visit to replace the cancelled visit. So even if they saw the patient who cancelled on a different day, their schedule would not have as many visits as it could have had.
"We'd reschedule them," Phillips says. "But it created so much havoc trying to fit them in the schedule."
The QI solution was obvious to Phillips: The agency needed to create a system in which aides could make their own schedules.
So Meridia Home Health developed an aide self-scheduling system, and as a result the cancellation rate has been reduced to 5% from 30%. Anecdotal evidence suggests that client complaints have dropped off.
Here's how agency's QI project worked:
1. Describe the problem.
Customers complained about having too many different aides. They said they always had to explain everything to their aides, and they found it difficult to schedule aides to come at the times they preferred.
Aides also were dissatisfied because of patient cancellations and their inability to rely on regular cases. Aides also said they often were unfamiliar with their patients and the areas in which they lived.
Aides were less productive, with fewer visits than they could have had, and the clients' cancellations created scheduling headaches and inefficient use of aides' time, Phillips says.
2. Develop a program for aide/patient self-scheduling.
Phillips says this seemed the logical solution because the current system had schedules done by a third party who didn't know about other urgent matters that aides and patients had to attend to, such as team meetings, doctor appointments, etc.
Phillips wrote out this blueprint for self-scheduling:
· Aides work within multidisciplinary team structures.
· Aides work in specific geographic areas and are assigned territories by zip codes.
· Full-time aides work a five-day work week, alternating every fourth weekend with Tuesday and Thursday as alternating days off.
· Part-time aides worked Monday-Friday 1/2 days or Monday-Wednesday-Friday full days, alternating every fourth weekend. But the agency recently has eliminated all part-time aide positions.
· Aide service is available to patients seven days a week and on all holidays.
· Each aide is placed in partnership with another aide who works opposite weekends and whose zip code borders the first aide's zip code.
Based on this blueprint and the scheduling calendars the agency already had been using, Phillips created a calendar that listed each day of the week. Aides would use one of these calendars for each patient they saw. (See Meridia Home Health's aides' patient schedule calendar, inserted in this issue.)
Phillips also created a monthly calendar that would allow aides to note all of the patient visits they had to make in a particular week. (See Meridia Home Health's monthly calendar, inserted in this issue.)
3. Teach aides how to do their own schedules.
First, Phillips created guidelines for how aides will create their own schedules. (See scheduling guidelines, p. 107.)
"I started with one team at a time," Phillips says.
Each team had six to eight aides at that time. Once the aides in the first team were up and running on their own schedules, then Phillips began to work with the other teams in succession.
"We had people who could mentor each other on the initial teams," she adds. Within three months, all the teams were trained to do their own schedules.
Each team was given an aide scheduling folder that contained:
· all original patient calendars for aide service, placed behind the appropriate aide's divider by zip code;
· all the original copies of the aide's monthly visit schedule.
The scheduling monitor takes the referral and assigns the client to an aide, placing a computer label on a patient calendar, and filling in all of the following information:
· patient's name and address;
· care manager's name and team number;
· start of care date;
· aide visit frequency and client's preferences in days and times (the visits are written, for example, as 4w2, meaning four visits a week for two weeks; if the client wants no visits on a certain day of the week, an X is placed under that day on the calendar);
· special needs, which might include a note about a particular aide the client prefers;
· a total of nine weeks dated with Sunday as the starting date.
Aides have some flexibility in scheduling days and times and make their schedules in any fashion that works well for them and for the clients.
The aide will schedule five to six patients a day, writing in their names and zip codes on the master monthly calendar schedule. Then aides call their patients on the day before or the morning of their visits to confirm the appointment.
The flexibility has allowed aides to make their schedules more consistent, Phillips says. If, for instance, an aide has only three patients on one day and six on another day, then the aide can move one patient's visit over to the light day. They also may ask their team partners to see a patient if they have trouble fitting it into their schedule. All of this must be carefully documented.
It didn't take long to teach aides how to use the calendars because they already were following schedules and knew what these entailed, Phillips says.
Learning to budget their time on schedules was more difficult because they had to think further ahead than they were accustomed to, and they had to consider where their patients were located and what their patients' schedules were like, Phillips adds.
"The aides changed their perspective when they had to do it themselves because all of a sudden they couldn't complain about the scheduling," she says.
4. Monitor aides' self-scheduling.
The process needs to be diligently monitored to find errors, Phillips says.
First, the aide's partner checks his or her sche duling work, and then supervisors will randomly check the schedules. For the first six months to a year after the self-scheduling process was begun, the agency did spot-checking of schedules. Now the checks are made each quarter.
"We literally check their schedule, check where they put their initials, and did they write the patient's name down on days they indicated on the calendar," Phillips explains.
Errors included the following:
· forgetting to schedule a visit;
· failing to decrease the frequency of a visit to match what the schedule monitor had written on the original calendar (this occasionally has led to aides having an unbillable visit);
· giving away a patient visit without changing that on the calendar;
· forgetting to initial the calendar.
When errors are found, Phillips will counsel the aide and correct the problem. "Then we save our notes so if this problem happens a second time, we know which aides are having a regular problem."
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