Welcome to the Webinar 1 Build a Lean Six Sigma Process for Inventory Management to Drive Nursing Satisfaction and Supply Cost Reduction Presenter: • Matt Brennan, healthcare supply chain expert; • Senior Healthcare Supply Chain Consultant to Jump Technologies, Inc. Questions? • Q & A will take place at the end of the presentation • To submit questions at any point during the webinar, please use the “question” function CPEs 1.0 AHRMM - accredited Continuing Professional Education contact hour
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Build a Lean Six Sigma Process for Inventory Management in Hospitals
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Transcript
Welcome to the Webinar
1
Build a Lean Six Sigma Process for Inventory
Management to Drive Nursing Satisfaction and
Supply Cost Reduction
Presenter: • Matt Brennan, healthcare supply chain expert;
• Senior Healthcare Supply Chain Consultant to Jump Technologies, Inc.
Questions?• Q & A will take place at the end of the presentation
• To submit questions at any point during the webinar, please use the “question” function
CPEs1.0 AHRMM - accredited Continuing Professional Education contact hour
Learning Objectives
• Identify benefits that can be achieved by implementing a Lean Six Sigma
approach to continuous improvement with nursing staff
• Understand inventory management approaches and determine how to
select an approach that meets the specific needs of a department or area
of your hospital
• Evaluate less expensive methods of replenishment for less expensive /
commodity products
Emergency Department Background Information
• Level 1 Trauma Center
• 52 Beds
• 12 Observation Beds
• Suburban MSA
• Academic Center
• ~ 200 Visits / Day
• 72,000 Visits / Year
The Problem
• Became the primary Level I Trauma Center within 75 mile radius
• Space / Clutter
• 52 Pyxis cabinets
• 42 supply carts
• Supply boxes in patient rooms
• Poor Pyxis compliance
• Hoarding of supplies
• Little confidence in Supply Chain support
• Highest RN turnover rate in the Medical Center
The Cost
• Average of 2hrs 14mins spent by nursing (per 12 hour
shift) stocking rooms and carts
• Approx. $353,000/year paying nurses and ED techs to
stock
• 52 Pyxis machines in the ED
• $300,000 / year equipment leases
• $70,000 / year line charges
What We Did
Lean Six Sigma Kaizen Event:
December 2012
Design & Evaluate Methodology:
January 2013
Conduct Pilot:
February thru April 2013
Team Included:Nursing
Supply & Distribution
Administration
Black Belt Consultant
What is a Kaizen Event?
Kaizen, also known as continuous improvement, is a long-term approach to
work that systematically seeks to achieve small, incremental changes in
processes in order to improve efficiency and quality.
In a typical Kaizen event:
• Team members meet 5 straight days to overhaul a core work process
• The week begins with just-in-time training in Kaizen methodology
• They map out the current state of the process, analyzing every step to find
all forms of waste: over-processing, delays, loopbacks, handoffs, excessive
inventory, work arounds
• They use their findings to develop a new process that is simpler, faster,
better and more cost-effective
• Action plans address all aspects of implementation, including training and
communication
How Do We Make it Better?
“If you can’t measure it,
you can’t improve it.”
Peter Drucker
RN Satisfaction Survey
Agree, 92.54%
Neutral, 5.97%
Disagree, 1.49%
The current stocking process NEGATIVELY impacts patient care
Agree
Neutral
Disagree
Supply Tech Satisfaction Survey
Agree, 9.00%
Disagree, 91.00%
I am content with the current format of stocking the Pyxis machines in the ED
Flow Chart of Current State
Supply & Distribution
Emergency Department
Operational Adjustments
• Chargeable supplies redefined
< $25 = Non-Chargeable (Kanban) 85%
> $25 = Chargeable (Closed Pyxis) 15%
• Non-chargeable supply amount was built into the visit acuity charge
• Pyxis lease was renegotiated
Kanban Choices Evaluated by Team
• Kanban cards
• Divided baskets
• Left to right
• Front to back
• ‘Flipper’ dividers in metal baskets
• Two colored reversible bins (blue/orange, black/red)
• 3 Bin (One in front of the other) empty bin returned to supplier
• 2 Bin (One in front of the other – neither ever leave the location) *
• Watermarks (accommodates items too large to fit in bins) *
* indicates methodologies chosen
KISS - Keep It Simple Solution
• Pilot Study (Busiest of 7 care areas)
• 60 days, starting in February, 2013
• Remove 11 of 13 Pyxis cabinets in the pilot area
• Replace with closed 2 Bin cabinets
• Scan empty bins by 11 AM, replenish by 10 PM
• Successful interventions will move to entire ED
2 Bin Flexibility
Kanban Types
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Watermark 2 Bin
Bin Refill of the Kanban System
Used the last item in a Bin? Place empty bin on TOP shelf
Pull second bin
from the back
to the front of
shelf
Empty Bin?
Data Collection
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Key Fob Scanner
• 1 Scan / Second
• Micro USB
• Communication
• Charging (Lithium Ion Battery)
• $96 / each
• No keyboard (no data entry errors)
• Single button scan
• Audible and visible ‘good scan’ verification
Mistake Proofing
The 6 Most Common Errors Solved by 2 Bin Kanban:
1) Decision making (eyeballing)
2) Counting
3) Transcription
4) Data entry
5) Math errors
6) Stock rotation
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New Key Performance Indicators (KPIs)
ARV vs. PRV
• When Actual Replenishment Velocity (ARV) is added to KPIs, and compared to historical
or Projected Replenishment Velocity (PRV), supply staff can focus on the 10-15% of the
stock moving more quickly than expected (greatest chance of stocking out)
• The other end of the spectrum, the 10-15% of stock moving more slowly than expected
• This is the stock that sits idle, with greater chance of expiring
• When managed, it can provide space to increase the quantities of the rapidly moving
stock
• Remaining 70-75% of stock being consumed at the projected rate only needs a simple
barcode scan to trigger an error free order
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Simplifying the Data
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Supply Categorization
Visual Item Management
Shelf Labels Examples
Visual Item Management
Visual Cart Management
Cart Signage
Visual Cart Management
Visual Bin Management
Visual
indicator
linking bins
with Item
categories.
Visual Bin Management / Labeling (Kanban)
Efficiencies Gained
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- Fixed quantity replenishment
- Fewer SKUs ordered on a daily basis (40% fewer)
- Reduced touches by staff
- Eliminated cycle counts within PAR areas
- Eliminated data entry errors
- Reduced nursing time
- Reduced restocking time for supply staff
- Fewer stock-outs (1.5%)
- Improved Pyxis compliance (74% to 97%)
- Improved nursing engagement
Bin Capacity Plan
• 2 days / bin X 2 bins = 4 day supply
• Typical Med/Surgical nursing unit
• 3 days / bin x 2 bins = 6 day supply
• Critical Care nursing units
• 1.5 days / bin x 2 bins = 3 day supply
• Monday – Friday, 8 hour clinic locations
Nursing Engagement
Communication Plan for 2-Bin Kanban Implementation Unit: Leadership Contact Name: