Beth Cavanaugh, RN, MSN, director of clinical services at The START Center for Cancer Care, leads infusion center and clinic operations across the organization’s San Antonio locations. As patient volume grew, the independent oncology practice faced a familiar question: Did it need more physical space, or could it make better use of the capacity it already had?
In this Q&A, Ms. Cavanaugh explains how The START Center used demand-based scheduling, real-time capacity visibility and more balanced staff assignments to increase volume, reduce drug wait times and avoid an estimated $1.43 million in capital expansion costs. She will share more during Transform Infusion Center Operations Virtual Summit on September 9, 2026, from 10 a.m. to 1 p.m. CT.
Question: What led The START Center to reconsider whether it needed to expand?
Beth Cavanaugh: We operate six clinic locations across San Antonio, with infusion centers at two of those sites, and completed about 35,000 treatments over the past year. As our volume grew, both infusion centers felt like they were operating near capacity. It would have been easy to assume that we needed more chairs and more space.
But when we really looked at the data, we saw something different. We had significant open capacity in the afternoons, low chair turnover and an uneven distribution of work among nurses. We did not have a capacity problem. We had an optimization problem. Before committing millions of dollars to construction, we needed to understand whether capacity was hiding in plain sight.
Question: What operational challenges were keeping you from using that capacity effectively?
Beth Cavanaugh: Our scheduling processes varied by location and did not always align with actual patient demand. At one location, nurses scheduled their own patients directly from the chair. At the other, we had a dedicated scheduler, but the templates we tried to create ourselves did not reflect actual patient demand. We would make assumptions such as putting all the shorter appointments in the afternoon, but that created bottlenecks at certain times while leaving capacity unused at others.
We also developed a habit of overbooking because we thought we were being responsive to patients. In reality, it masked our true capacity and impacted overall patient experience. Our patients were usually brought back from the waiting room very quickly, but once they were in the chair, they waited too long for their first drug to be hung. That was stressful for patients, nurses, schedulers and the pharmacy team.
Question: How did you begin reshaping the way appointments and resources were managed?
Beth Cavanaugh: We partnered with LeanTaaS and used its iQueue for Infusion Centers solution to better understand our demand, optimize our templates and make capacity more visible to our schedulers. In 2022, we completed a demand-based template refresh, redesigning our templates around actual demand patterns instead of guessing or doing what we had always done. Capacity modeling showed that we had the potential to accommodate considerably more growth within our existing footprint.
The biggest workflow shift was moving from static EHR templates to the platform’s Daily Huddle for dynamic slot management. Our schedulers can now see the capacity that actually exists as appointments are booked, moved or canceled, along with the trade-offs associated with each booking decision. We paired that visibility with more systematic nurse-to-patient assignments, adjusted shifts to better match demand and began filling afternoon availability more proactively.
We also established a no-overbooking policy in 2024. That was uncomfortable at first, but it allowed us to establish an honest baseline and understand where we really stood.
Question: How did you build trust in a new way of working?
Beth Cavanaugh: Clinical buy-in is essential. Nursing leadership helped drive the implementation, but staff buy-in grew when people could see their own utilization data and recognize that it matched what they were experiencing every day.
Transparency made a major difference. Schedulers can see how full the day is and continue booking confidently as capacity approaches 90%, knowing that cancellations, no-shows and rescheduled appointments are also part of the normal pattern. They are no longer guessing or worrying that they are creating an unmanageable day.
Physician support was also especially important when we stopped overbooking. This work requires more than technology. It takes leadership commitment, consistent communication and a team that is willing to keep adjusting the process.
Question: What impact has The START Center achieved?
Beth Cavanaugh: At our Medical Center location, we increased patient volume 13% while reducing drug wait times 72%. At Sonterra, we achieved 10% volume growth and a 38% reduction in drug wait times. We also improved afternoon utilization and created a more balanced workload for our nurses.
Across the two locations, we estimate that improved capacity utilization and scheduling generated approximately $16.7 million in additional revenue over multiple years, or about $1.84 million on an annualized basis. But the most important result for us was avoiding an estimated $1.43 million in capital expansion costs for additional treatment rooms, pharmacy and lab space.
These gains have been sustained over time. We are serving more patients, our wait times are lower and our nurses can manage a higher daily volume without feeling as rushed because the work is distributed more effectively.
Question: What should other infusion center leaders consider before adding physical capacity?
Beth Cavanaugh: Before you break ground or commit millions of dollars to construction, really look at your data. Establish an accurate baseline, because overbooking and inconsistent scheduling practices can make it difficult to see the capacity you already have.
It is also important to recognize that templates are never one and done. Oncology care changes constantly. New drugs enter the market, treatment durations change and shortages can require rapid adjustments. We have refreshed our templates multiple times, and we will continue doing so as our demand evolves.
We may eventually need to expand physically, especially as we add physicians and serve more patients. The difference is that we want the data to tell us when we have truly reached that trigger point. Optimization is an ongoing process, and absorbing growth within existing resources is definitely a team sport.
Want to hear the full story?
Beth Cavanaugh will share how The START Center unlocked capacity, improved patient and staff experiences and avoided a costly facility expansion during Transform Infusion Center Operations Virtual Summit on September 9, 2026. Register here.
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