Ahead of their presentation at Transform Infusion Center Operations Virtual Summit on December 11, Becker’s Hospital Review recently spoke with Johns Hopkins Medicine chief administrative officer, Jamie Bachman, and clinical program director of oncology, MiKaela Olsen, about the innovative and AI-driven changes that are optimizing the operations of the Hopkins Kimmel Comprehensive Cancer center’s six infusion sites.
The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins—which recently celebrated its 50th anniversary—sees more than 60,000 patients and conducts over 8,000 life-saving cancer treatments annually.
Question: Can you describe the current landscape of cancer in the U.S. and how it influences your work at the Sidney Kimmel Comprehensive Cancer Center?
Jamie Bachman: The landscape of cancer care today is defined by an unprecedented volume of patients requiring complex and often long-term care. In the U.S., about 2 million people are diagnosed with cancer annually. While we've made incredible strides, the system that we have is not built to absorb the number of people we care for and the survivors that we're generating.
Operational challenges stemming from the massive influx of patients seeking cancer care—including infusions—were particularly acute for us at Johns Hopkins, where we care for over 15,000 unique patients each year, with more than 70,000 infusions annually. The key for our cancer center and many others facing an expanding cancer landscape lies in systematic improvements that allow us to absorb growing volumes without compromising care quality or patient experience.
Question: As a leader on the frontlines of cancer care, what are some of the day-to-day challenges Johns Hopkins is facing within its infusion centers?
MiKaela Olsen: When I moved to the ambulatory oncology setting, I quickly realized the scale of the challenges we were facing. On a typical day, we were managing 120 patients who were all scheduled to have their labs drawn, see their provider, and undergo infusion treatments on the same day. This tightly packed sequence created a domino effect—if one step was delayed, everything else fell apart.
Delays were all too common. Some stemmed from unsigned orders or incomplete preparation, while others occurred because patients who were too sick for treatment had still been scheduled. These disruptions not only impacted patient care but also put enormous strain on our resources.
I often describe it as a disorganized airport: imagine passengers arriving without tickets and no flight attendants to assist them. That’s how our operations felt. Infusion chairs sat empty while drugs were compounded during the day, leaving patients to endure long wait times ranging from an hour to as many as eight hours. Such delays are unacceptable for anyone, but especially for individuals already dealing with the physical and emotional toll of cancer.
A major contributor to these challenges was inefficiency in scheduling. Our schedules were highly "unbalanced," with mid-day peaks and frequent overbooking that overwhelmed staff and created additional bottlenecks. Addressing these systemic issues became an urgent priority for our team.
Question: Can you describe the solutions that helped address these challenges?
MO: One of the pivotal changes was the creation of what we call the daily "war room." This interdisciplinary team began each day by dissecting patient delays from the day before, uncovering the root causes, and implementing targeted solutions. It became clear that advanced preparation was the key to resolving many of these issues.
We introduced the Advanced Clinical Evaluation (ACE) program, which involves nurse verification starting 48 hours before appointments. Nurses review and confirm orders, ensure labs are complete and proactively address any potential delays. By 2024, this approach, combined with other workflow adjustments, reduced the percentage of patients seeing their provider on the same day as their treatment from 45% in 2018 to 37%, alleviating same-day scheduling constraints.
In tandem with these process changes, iQueue for Infusion Centers, the AI-powered solution by LeanTaaS, became a cornerstone of our strategy. By optimizing schedules and distributing appointments more evenly throughout the day, iQueue allowed us to maximize the use of our existing resources. It helped us avoid unnecessary overbooking and mid-day congestion, making operations more predictable and manageable. Additionally, we adopted advanced drug preparation, with over 65% of cancer drugs compounded and ready by the time patients arrived, streamlining the infusion process even further. Armed with a reliable, data-driven scheduling forecast, we can be confident that the life-saving drugs we’ve mixed in advance won’t be wasted and that patients can trust that they’ll receive the care they need on time.
Question: What kind of impact resulted from these changes in the clinics and for patients?
JB: The results have been transformative. Wait times have decreased by 20%, and overtime hours for staff have dropped substantially, allowing nurses to leave on time more consistently. Staff retention improved, as did their overall job satisfaction.
From an operational perspective, we achieved a 13% increase in patient volumes across six sites without adding additional hours or chairs. By using resources more efficiently, we avoided the need to extend clinic hours or open on weekends. Patients also noticed the difference.
The combination of innovative practices like ACE, alongside the operations and scheduling efficiencies enabled by iQueue, has allowed us to keep pace with increasing patient volumes without compromising care.
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Jamie and MiKaela will dive deeper into this story of transformation at Johns Hopkins Medicine at the upcoming Transform Infusion Center Operations Virtual Summit on December 11, 2024. Register for the event today!