Lean Healthcare Services Blog: December 2007
Our Hospital moved to a new Medical Campus in June 2007. After the initial move of patients, inpatient and outpatient units, Central Supply began experiencing issues with delivery, supply stocking, and supply crediting. The issues have been occurring in existing campuses but worsened after the move to the new Campus. A huddle of Nurse Managers and VPs was formed to begin the process of assessing the issues and identifying the fixes needed.At that time our Lean Process Improvement Team was brought in and asked to:Process map the Central Supply processesIdentify IssuesMake recommendationsImplement changes to Central Supply to make it a fully functional supply processThe following process findings emerged:Processes needed to be shared with the Nursing Staff (Mandatory Training Required)Job aides and training were needed for Nursing to explain the following:What time do we need to order by? When will I receive?How do I work the Reconciliation History Report?What is the difference between white and blue supplies? Why does it matter?Do I tap the blue supply items or white supply items? Both? What charges are mine? What are Central Supplies? What are Patient Chargeable?What is "par level", "reorder point", and "critical level"?How do I increase my par?How do I decrease par and get credit for my supplies?What items are special ordered? When can I expect them? What is the process?How do we change our supply bins and reorganize our space?When do delivery trucks arrive with supplies?Who are my storekeepers and how do I contact them? What is the process?What does the supply cycle look like and what does it mean to me?Mandatory Central Supply and Materials Management training for all Nurse Managers, Charge Nurses and Nurse Educators (2,000+ employees).Performance Improvement Plan for the Central Supply Supervisor to develop Supervisory Skills and implement those skills to build trust and respect from her staff.Use Par Excellence to capture blue and white supplies so that the hospital had a better count of inventory to cost savings and the better use of storekeepers to help in making sure that supplies are stocked versus counting stock by hand. Reduction in human error standards.Reports reviewed daily and weekly to sum up the amount of:Supply costs not tapped by nursingLoss charge supplies - not charged to the patientSupply costs used by each unit to determine cost savingsSupplies ordered weekly from vendor that could be ordered once a month for future cost savingsStorekeeper standards and back up coverage so that there was no break in service when storekeepers were out sick, etc.Credit monitoring. The system was not being used to capture supply credits for units. The existing process was a manual process versus tapping in and out the supplies for credit.Assessment of the par and critical level of each of the units to determine if they had supplies that were being stored over 3 months there. The normal par for this hospital was a 3 to 4 day supply. Some units had a 6 month supply on hand. After the assessment a process was put in place to clean up the par and critical levels, credit units and re-use the supplies in units that had a lower par level.Implementation of a borrow card process. This enabled the hospital to capture all ancillary group charges for supplies so that they could be charged to their unit or to the patient.Reduction in the use of overflow rooms where supplies could be used but not accounted for by nursing.Reduction in lost charges. Training was provided on how to address a lost charge, accountability for fixing the issue and sustainability for long-term results. As a result of the above, other Lean projects were identified as part of an overall Lean Transformation program. Some of these projects included:Reduction in steps in arrival process for surgery check inReduction in volume of cancelled visits with chargesIncrease in bed assignment process efficiency for the Emergency Department and Inpatient UnitsStreamlining of grant and research billing processesMaximization of patient access through appointment scheduling in NeurologyStreamlining of the cash and credit card reconciliation process Operating Room TurnoverFirst Case Start Time
Joe Aherne is a Certified Public Accountant (CPA), having received a Meritorious Distinction from the CPA Institute, with over 25 years experience in the multinational sector. He also has attained qualifications from the Marketing Institute of Ireland and from CITY Bank in the U.S.
Joe established the Leading Edge Group in 1995 as a niche boutique consulting and education company supporting the multi-national sector. The Group is now recognized as one of the largest independent consulting organizations in Europe with over 600 projects completed successfully since its inception.
In April 2005, Joe launched the new International Standard in Lean comprising 4 levels of certification commencing with a Yellow Belt certification and leading to a Lean Master Black Belt. He is currently leading a major international drive in the use of Lean Healthcare philosophies and practices.
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