Dialysis Clinic Patient Flow and Work Design

Problem Definition: For 433,000 patients in the United States with advanced kidney failure, hemodialysis is a life-sustaining treatment. Approximately 7,600 outpatient dialysis clinics serve these patients, whose treatments cost over $25 billion annually. Each treatment involves a pre-treatment “put-on” task and a post-treatment “take-off” task performed by patient care technicians (PCTs). These frontline workers face intense, overlapping demands that can compromise patient safety and contribute to PCT burnout. We study how to jointly schedule PCTs and patients to reduce makespan and increase labor efficiency in dialysis clinic operations through better patient flow.

Methodology/Results: We first analyze the prevailing “push” approach, which starts put-ons as soon as a technician and station are free. We then propose two alternatives: an “interlaced” scheme that staggers put-ons and take-offs to reduce idle time, and a “tandem” scheme that pairs two PCTs — one specializing in put-ons and the other in take-offs — across twice as many stations. We derive closed-form expressions for each approach’s makespan under constant treatment durations and show that interlaced schedules achieve the shortest completion time, whereas tandem configurations can reduce labor per patient. We also incorporate heterogeneous treatment durations and stochastic task times and arrivals to show numerically that our insights are robust.

Managerial Implications: In contrast to the push-focused approach, these insights direct facility administrators’ attention to the primary driver of labor efficiency: minimizing the time that stations sit unoccupied between successive patients. Due to the inefficiencies of the push approach for a single pod, transitioning to an interlaced or tandem system while increasing the standard time allotted for tasks can alleviate workplace stress and promote patient safety without increasing labor costs. Specifically, dialysis clinic managers could move from the common 15/15-minute put-on/take-off scheduling standard to a 25/20-minute standard, thereby allotting PCTs 50% more time to complete tasks.

Methodology/Results: We first analyze the prevailing “push” approach, which starts put-on tasks for treatment as soon as a station is free. We then propose two alternatives: an “interlaced” scheme that staggers put-ons and take-offs to reduce idle time, and a “tandem” scheme that pairs two PCTs — one specializing in put-ons, the other in take-offs — across twice as many stations. Under standard conditions, we derive closed-form expressions for each approach’s completion time and show that interlacing finishes earliest with homogeneous treatment durations, while tandem configurations can lower labor per patient. We also incorporate heterogeneous treatment durations to show numerically that our insights are robust.

Managerial Implications: In contrast to the push-focused approach, these insights direct facility administrators’ attention to what is most important for labor efficiency: minimizing the time that a station is unoccupied between successive patients. Due to the inefficiencies associated with the push approach, transitioning to an interlaced or tandem system with increased standard task times can alleviate workplace stress and promote patient safety without increasing labor costs. Specifically, dialysis clinic managers could move from the common 15/15-minute put-on/take-off scheduling standard to a 25/20-minute standard, thereby allotting PCTs 50% more time to complete tasks.