Cluster Care: Healthcare systems and parents should be thinking about it!
- pietruszkaraye
- Feb 19
- 6 min read

As a parent and a professional regardless of your "title", I am sure most people can relate to this image. Yes, this image is AI generated because I am definitely juggling. To me, this image represents two main thoughts: One, we often wish we had more resources to accomplish our "job" whatever that may be, and two, we are juggling more than one "job" at any given time. Seasoned professionals and parents often develop efficiency in "grouping tasks" over time to get the job done. We learn this the hard way. We think creatively and employ strategies or mindsets like "not wasting an up, a down, or an over", "multi-tasking", or "working smarter, not harder". Essentially, these are all daily life experiences that represent Cluster Care. When we experience the benefits, we begin to master these skills. We soak in the glory of saving time, feeling less stress, and we become driven to enhance the overall experience for ourselves and everyone involved.
"Work smarter, not harder" - Allen F. Morgenstern
In the healthcare realm, Cluster Care is combining medical care events in one visit (or sometimes in a single task) to reduce patient interruptions. This blog was inspired by a recent patient experience - a success story that underscores the importance of Cluster Care and why this approach to care should always be in the back of your minds, as healthcare professionals, as schedulers in the healthcare system, and as parents at the heart of it all.
The Success Story:

Like many children (and adults), this patient developed a fear of needles which resulted in avoidance to healthcare, simply refusing to have a blood test. In this scenario, the patient had an upcoming, unrelated surgery due to an injury. It's important to note, the blood test and the surgery were rooted in different healthcare systems. Hats off to the parent in this scenario who was able to advocate for their child and request that the blood test be done simultaneously with the IV (intravenous) catheter placement needed for surgery. Hats off to the medical team players (particularly the anesthesiologist) who supported this parent's request. This was an excellent example of collaboration and cluster care which highlighted the drive to support this patient's emotional safety.
Cluster Care vs. Isolated Healthcare Events:
In my years practicing as a certified child life specialist in various hospital settings, I saw first hand the struggles and stress that children and families experienced when medical care was scheduled as isolated healthcare events. Although the roots of cluster care stemmed from inpatient stays, particularly to address the complications associated with sleep disruptions as a result of routine, frequent, and isolated healthcare events, cluster care approaches can be applied to outpatient settings. Inpatient stays are often marked with inadequate sleep, delirium (common in ICU stays), days and nights becoming off sync, and physiological complications can arise. Likewise, the outpatient experience is often marked with it's own set of "complications" which are rooted in the complexities of an individual's healthcare needs. Meeting these needs often requires multiple specialty doctors or healthcare systems which work independently from the other and often overlook the whole picture. Complications often include extra visits to the hospital (resulting in more time off of work, missed school, and sometimes, more co-pays), extra needle pokes with more tears, and even added exposure to anesthesia.
As a medical imaging child life specialist, I used chart reviews and patient assessment pre-calls to go "hunting". I asked parents about upcoming medical tests, procedures, treatments and hunted for cluster care opportunities. I asked schedulers and ordering doctors, can this be one poke and one visit instead of 2 pokes with 2 visits? I spoke with multidisciplinary providers across various departments (and sometimes medical systems) to coordinate cluster care when it made sense. I hunted for cluster care opportunities! Who doesn't want to see smiles, less tears, and parent's follow up message showing the clear benefit of Cluster Care approaches?
The Counter Argument:
The counter argument I bring up here relates to the aspect of cluster care which aims to minimize the number of needle related events. Many parents and professionals hold the belief that children need to toughen up. Some people reading this may think that this example above deprives the patient of a learning opportunity to practice coping skills. Statements like, "it's just a poke, get on with it" and "requests like these will only encourage the avoidant behavior" come flooding to my mind. More needles often increases the risk for more trauma, especially when children are not adequately prepared and provided with the appropriate resources to manage pain and fear. Exposure therapy is a slow progression of interventions that shift the way a person thinks about and reacts to a needle related event. These interventions take place in a space and time where the patient feels safe and invested to learn, not in a space and time where there is an immediate need for a healthcare event which involves a needle and the anxiety is high.
Benefits of Cluster Care Approaches:
Research and evidenced-based considerations to care have linked some of the following benefits to cluster care approaches:
Increased productivity
Time-Efficiency
Work environment satisfaction
Improved patient prognosis and physiological states
Improved patient satisfaction
Reduced costs
Reduced pain

GO HUNTING!!! Seek Out Cluster Care Opportunities!
Hunting for cluster care opportunities truly requires the heavy lifting from the patient (or parent) who is at the center of the healthcare journey. However, healthcare professionals have a key role to facilitate and coordinate cluster care approaches.
PARENTS:
Ask questions! - Do not assume that certain medical events can not be combined. Think outside the box here and ask the questions. You may find that you are pleasantly surprised when you hear, "sure, we can make that work!"
Advocate! - You know your child best. Share information about your child, their coping, and their upcoming schedule. If you foresee a way in which tasks can be combined - advocate for this.
Golden Nugget Tip: 3 vaccines in one visit might not be the best cluster care approach. This may work very well for some children who generally cope well with needle related events and it may backfire for those who are more resistant and aggressive when it comes to anything involving needles. Some children may benefit more from spreading these vaccines out while allowing opportunities for medical play at home, to rehearse coping strategies and comfort positions with you, and to coordinate numbing cream or other pain management options available.
Think outside the box! - Discuss ideas with nurses, providers, and schedulers. Navigating health care can be overwhelming for anyone and even more challenging for those navigating complex medical needs and chronic illnesses. Your medical team is there to support you and ultimately strive for the best possible outcome. You might be surprised to hear, "I haven't thought of that. Let's explore! Sure, looks like we can make that happen!"
HEALTHCARE PROFESSIONALS:
Be open! - When parent's come to you with ideas to consolidate or combine medical care events, take the time to explore and consider. Reach out to the key players who can help determine if this idea will work or not. Consider going above and beyond to coordinate, help reschedule things if needed, and ensure follow through to combine healthcare visits, combine needle related events when it makes sense, and combine other healthcare tasks as appropriate.
Be proactive! - Look ahead in patient medical records. Ask parents (and patients) about upcoming healthcare needs and schedules. You might learn about something they have coming up that could pair well with your investigations or testing. Some parent's will not approach you but they will be very thankful if your hunting saves them a trip to the clinic or saves their child from another needle related event.
The Ripple Effect:
I'd love to hear about your experiences of cluster care in various settings (inpatient and outpatient care settings). Healthcare professionals, how have you applied this approach in your work with patients? Parents, what ideas have you had in your own care or your child's care that gets you thinking...I wonder if cluster care could have helped? Sharing practical examples and evidenced-based experiences can help educate and promote cluster care approaches and our mindset to healthcare.
Kommentare