By Danilo B. Concepcion, CBNT, CCHT-A
Our early ancestors used the moon, the stars and the sun to gauge time and were content with knowing it was early morning, mid-day or night. The stress and concerns of needing to be somewhere at a specific time did not exist. Today, time-pieces are designed to give us accuracy within a hundredth of a second in harmony with the atomic clock whose accuracy does not gain or lose a second in 20 million years.
With technology came the promise that we would have more time to relax; instead, we worry about the seconds that are wasted. We demand punctuality in a world where time has become priceless.
Every second is priceless and should not be wasted; wasted in waiting, wasted in inefficiency and mismanagement of time. Waiting is one issue that is consistently cited as causing patient dissatisfaction.
Like with so many facets of life, there are contributing factors beyond the individual’s control that complicate the management of time. The dialysis waiting lobby is not immune to such complications.
The time management of dialysis requires that all participants associated with the schedule, work together to maintain the temporal harmony of the treatment schedule. Transportation service, the dialysis unit readiness, the patient’s family or the patient themselves, the staff-to-patient ratio, all must coordinate to minimize the length of waiting. With so many components prone to inconsistent control of events and time, the issue of minimizing wait time is one that has perplexed the dialysis community. It’s an organized chaos in which one interruption can cascade into a disruption of the entire schedule.
Strategies, such as staggering appointment times, holding both patient and the unit accountable to a window of time, using software scheduler to simplify and maximize the maintenance of the schedule, requiring patients to arrive not too early, instructing staff not to put patients on until the appointed time, using a schedule that definitively segregate the shifts rather than the staggered scheduled, are examples that may help mitigate the wait time. The sensitive balance of the schedule can easily be compromised and can lead to a reactive schedule rather than maintaining the planned schedule. So many different factors can cause tardiness on both the patient side and the facility side; traffic, untimely pick-up by transportation service, difficult cannulation, patient medical issues, machine problems, water issues, staff issues—such as sick-call—are just a few examples that can complicate the timeliness of the treatment schedule.
Wait time cannot be eliminated. It is not the wait time that should be of focus but how to productively use the unavoidable time that patients must wait before being called in for their treatment.
The dialysis patient comes from varied cultural backgrounds, educational levels and socio-economic status. They come from cultures in which punctuality may be secondary or punctuality is an insistence. Some live with intact family, some from a broken family, and some live alone. There are patients with a strong support group and some without.