Stress-test an outpatient therapy backlog by proving that each hold window and restore rule can place unanswered therapy requests inside the planned lane, survive override pressure, and avoid trapping clinics inside a green queue slide that hides long-lived soft holds.
Outpatient therapy backlogs often list a triage plan while leaving restore behavior, override authority, and abort ownership implicit. Those edges decide whether a late hold stays inside the backlog packet or leaves a broken access path live under peak volume. The exercise should follow actual waitlists, discipline maps, and escalation paths rather than a clean access deck.
Inventory before the drill
List every therapy queue class with its response window, waive rule, override behavior, owners, and notification channels. Mark paths that cannot reverse without a manual amendment. Attach the last three outpatient therapy backlog incidents with raw timelines and any waivers. Include the source of truth for open queue counts during the observation window.
Define the phases for detect, hold, divert, abort, and restore. Each phase needs an owner and an exit condition. Write the point after which a stuck hold would require a different procedure, then review whether that action is still permitted. Capture maximum acceptable dwell in measurable units, including which disciplines are excluded from the backlog path and why.
Include the calendar of known events for the next two quarters: referral freezes, staff leaves, and payer auth gaps that shrink the usable response window. A backlog budget that ignores those dates will look calm until the week they land.
Shortage scenarios worth timing
- A minority specialty queue keeps a side-channel while the aggregate therapy dashboard stays green.
- A restore has already left a clinic without a trusted queue state.
- The primary therapy dashboard lags beyond the planned observation window.
- An operator skips a backlog gate because a referral cutoff is near.
- Automated and human divert messages collide under the new backlog rule.
- Abort authority is unclear at week end and the update lands on the wrong amendment.
For each scenario, identify detection time, clinic impact, containment, and the authority to force an outpatient therapy backlog rollback. Require commands and dashboard links in the runbook.
Ownership once the backlog window closes
Run the package in Pingpong with therapy ops, clinic ops, patient access, and care management seats. Ask therapy ops which discipline decision becomes unsafe first if holds still stick after the claimed window. Ask clinic ops whether schedule macros can absorb a forced override. Ask owners to show the exact backlog version or export used as the exit condition.
Related reviews include the therapy ops lead seat, a rehab length target, a home health hand-off, and the clinic ops lead seat. Browse the war-game decisions hub for adjacent controls.
Authorize the published backlog path only after a timed drill restores usable hold hygiene inside the documented budget without an undocumented manual step.