A Lean Transformation Case Study

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 processes
• Identify Issues
• Make recommendations
• Implement changes to Central Supply to make it a fully functional supply process
  

The 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:

1. What time do we need to order by? When will I receive?
2. How do I work the Reconciliation History Report?
3. What is the difference between white and blue supplies? Why does it matter?
4. Do I tap the blue supply items or white supply items? Both?
5. What charges are mine? What are Central Supplies? What are Patient Chargeable?
6. What is "par level", "reorder point", and "critical level"?
7. How do I increase my par?
8. How do I decrease par and get credit for my supplies?
9. What items are special ordered? When can I expect them? What is the process?
10. How do we change our supply bins and reorganize our space?
11. When do delivery trucks arrive with supplies?
12. Who are my storekeepers and how do I contact them? What is the process?
13. 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:

1. Supply costs not tapped by nursing
2. Loss charge supplies - not charged to the patient
3. Supply costs used by each unit to determine cost savings
4. Supplies ordered weekly from vendor that could be ordered once a month for future cost savings

• Storekeeper 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:

1. Reduction in steps in arrival process for surgery check in
2. Reduction in volume of cancelled visits with charges
3. Increase in bed assignment process efficiency for the Emergency Department and Inpatient Units
4. Streamlining of grant and research billing processes
5. Maximization of patient access through appointment scheduling in Neurology
6. Streamlining of the cash and credit card reconciliation process
7. Operating Room Turnover
8. First Case Start Time