Four Hospitals, One Excel File, Zero Budget

The Problem with Shared Excel Files

My night-shift colleague was head of technicians at the anti-blastic drugs lab — the place that prepares chemotherapy for four hospitals across Tuscany. One night he told me about their coordination system: a shared Excel file. Each hospital booked slots independently, nobody checked actual capacity, and pharmacy staff spent their mornings calling patients to reschedule their cancer treatment. Every single day.

The thing about chemo drugs is they're not like other medications. Some are unstable — you can't prepare them in advance, they need to be done right before administration. The lab is closed Sundays, so Monday capacity has to be reduced. Drug shipments arrive on fixed schedules. And different oncologists have different clinic patterns: some see all their patients in the morning on specific days, which means the type of cancer you have partly dictates when you can be scheduled.

The Excel file couldn't model any of this. It was just a calendar with no constraints.

How It Got Built

I offered to build a replacement and donate it. No budget discussions, no procurement, no committees — just an MVP that either worked or didn't. If it flopped, nobody lost anything. That framing kept it alive long enough to actually ship.

What SGFar Actually Does

The scheduler works on multiple constraints simultaneously. Number of chairs in each hospital. Drug shipping windows. Stability requirements for specific medications. The Monday capacity reduction. Doctor scheduling patterns by cancer type.

Each hospital gets a baseline number of slots proportional to their chair capacity. The ticketing system is for changes — requesting extra appointments, swapping times, handling edge cases. The central pharmacist sees all requests, can approve, reject, or ask for more information. It turned into something like a forum, a Q&A system running in pseudo real-time via database polling. Every request tracked, every decision logged, full audit trail.

The name stands for Sistema Gestione Farmaci Antiblastici. I came up with it at some ungodly hour and just needed something that fit in a URL.

What I Learned

Healthcare software hits different. You're not optimizing click-through rates. When a pharmacist has to call a patient to reschedule, that's someone with cancer hearing their treatment is delayed. That changes how you think about edge cases.

The system ran in production for several months before they bought an enterprise replacement — which is the actual win. A solo MVP on zero budget forced the organization to acknowledge the problem and solve it properly. The Excel file is gone. That was the point.