Lean economic times make way for Lean management

In fact, cart- and equipment-clogged hallways in hospitals have emerged as standard video fare for any media organization highlighting healthcare reform issues, documentaries on patient care or exposés on inefficient operations.

With the plethora of storage options available to healthcare facilities today, as well as the phalanx of anal-retentive (and sometimes costly) organizational experts a telephone call or e-mail away, administrators can fall back on few excuses for asset and stock disorder – particularly if you discount the act of patient care and dismiss the reams of paperwork.

Still, if supply chain management professionals could reconstruct and redesign the ideal storage systems for their clinical, inventory and sterile processing areas, how would they do it? Online computer-aided design programs? Face-to-face conversations with plenty of hand gestures? What would they include in the mix? Hybrid stationary shelving with detachable mobile units? Automated moveable shelves?

Healthcare Purchasing News posed that to the professionals, asking them specifically to highlight strategies for organizing and storing supplies and equipment within a facility for more effective supply chain management that arguably should lead to improved patient care. Those strategies involve exploring recent and near-future developments in storage system applications and capabilities that will contribute to performance improvement, in addition to smart planning.

The common denominator underlying many product developments in storage systems today involves less of the size configurations and cubby hole offerings and more of the information technology varieties helping to run the system.

In short, automation is driving storage imagination.

Omnicell Inc., Mountain View, CA, emphasized its automated wireless supply mobile cart that can be deployed for emergency supplies, suture, ventriculo-peritoneal shunts, peripherally inserted central catheter lines, pacemakers
(IACD), orthopedic hardware, aneurysm clips, stents and a variety of other high-cost supplies that need to be moveable, according to Robert Mullenger, group product marketing manager.

"This smart mobile storage system provides clinicians the capability of delivering and tracking supplies wherever the patient may be, as opposed to always having to access a stationary storage system in a hospital hallway or common area," Mullenger said. The battery-powered, automated-dispensing vehicle can help facilities reduce inventory, increase charge capture and provide a more accurate and automated replenishment of rolling stock, as well as track clinical workflow and consumption per physician, case type, technician and patient, he added.

Mullenger also spotlighted Omnicell’s new Tissue Center that helps hospitals electronically and efficiently manage and document tissue specimen control. "It’s needed for compliance with regulatory standards and can help avoid infections by enabling a hospital to track tissue identification banks, licensing agencies and registration information as well as the name of the recovery or distribution center," he said.

Pegasus 2-bin basket

Grand Rapids, MI-based Stanley InnerSpace promoted its Internet capabilities that wed the Web-based clinical inventory management system with its array of storage cart offerings, fortified by radio frequency identification (RFID) for supply tracking.

"[Stanley InnerSpace] created a storage system that can tell you who took what supply and when and what patient it was charged to," said Shannon Kennedy, marketing manager. "RFID storage solutions, such as SpaceTRAX plus RFID, work to ensure that your most expensive items are being charged to the patient every single time. It’s difficult for any one clinical department to tell us how much inventory is lost or unaccounted for each year, but our estimation of captured charges compared over previous months shows that departments are losing up to 10 percent or more in unaccounted inventory. If a department can reclaim those missed charges, they can easily save hundreds of thousands of dollars annually."

The company is scheduled to launch this month its InnerSpace ILS "Intelligent Locking System" product for access and security that is "engineered to save money, time and headaches," Kennedy noted. ILS is a wireless tracking and access system that allows cart access programming from any computer, eliminating the need for individual cart programming. In fact, user information can be administered from any Internet-connected PC, she added. Internal studies have shown "ILS can administer 50 users on 100 carts in 15 minutes," she indicated. At the same time, users can be deactivated from all carts at one time.

Cincinnati-based PAR Excellence Systems gave weight to its new PAR Bins offering.

"PAR Excellence introduced PAR Bins at the [Association for Healthcare Resource & Materials Management] show two years ago as a prototype," said Dick Felger, vice president, sales and marketing. Today, with multiple hospital installations throughout the country, Felger argued that PAR Bins are changing point-of-use thinking. "It is automatic replenishment because it creates orders based on weight not nursing compliance," he noted. "No scanning, no touching, no reconciling. Enterprise-wide visibility of every supply in the hospital. And there is a trickle-down effect, as well. Because there is no manual intervention, your orders are reduced and that means less picks."

CareFusion Dispensing Technologies, San Diego, reached out to surgical suite IT vendors to integrate storage unit data into medical records, according to Rusty Frantz, vice president and general manager, Pyxis Perioperative Solutions, a division within the company recently spun off from Cardinal Health Inc.

InnerSpace Casework wood grain laminate storage cabinets

"We’ve partnered with leading operating room information system providers to offer joint customers a solution that automatically integrates their surgical supply information directly into the perioperative record," Frantz noted. "The automated sharing of information between the two systems helps reduce time consuming and costly inefficiencies for nursing and enables accurate flow of information to the patient’s medical record. This integration allows clinicians to update a patients’ chart, charge for the item and reorder inventory with the touch of a single button or scan of a bar code. Reducing redundancy and opportunities for charting errors in the clinicians’ workflow saves the hospital time and money and ultimately provides better, more accurate care for the patient."

CareFusion also is introducing RFID capabilities to its Pyxis line-up for stent tracking to provide "the highest levels of accuracy and security for high-value items or items requiring capture of critical information, [such as] implantable products," Frantz added.

Even though IT may be turning heads, effective footprint and layout continues to draw eyes as they simplify access and reach.

Logiquip LLC, Galesburg, MI, trumpeted the multiple applications of its new three-quarter-size LogiCell cart. "This cart fits a size niche in many applications when used as an OR procedure cart or as an IV solutions cart," said Eric Schuldt, vice president, sales and marketing. "Its smaller size compared to a full, tall double cart makes it easier to see over and maneuver."

Pyxis Procedure Station

Logiquip added the LogiCell cell system to its OR stainless steel cabinetry to increase storage capacity and improve organization and a "skate" caster system to its PAR Wall line to make it easier to maneuver and clean, according to Schuldt.

The company also remains solidly behind the Lean management system for supply chain efficiency and continues to develop applications to incorporate Lean, including the twin-bin Kanban system, he added.

Richard Philippe, president, Logi-D, New York, and Laval, Quebec, Canada, emphasized his company’s association with Scan Modul System and the successful vertical high-density storage systems that maximize space with easy access.

"Vertical high-density systems save space typically lost between shelves, as modules are inserted in a way similar to drawers," Philippe noted. "Scan Modul System offers a wide variety of module depths and a flexible, precise dividing system to ensure no space is lost within the modules. It also uses height ergonomically [in that] its cabinets stand almost 7 feet high. However, the uppermost modules are inserted at an angle, allowing for even shorter users to access supplies without the need for a step stool. These modules can be permanently angled or inserted straight and angled only as they are pulled out."

Philippe urged modularity over built-in or fixed-space cabinet systems. "Gains in storage space generated by these features are as high as 50 percent, compared to traditional and widely-used wire mesh, built-in or fixed-cabinet shelving systems," he noted.

But ease-of-use should trump bells and whistles, Philippe indicated.

"Maximizing the use of space should not come at the expense of the ease with which users find and retrieve products," he continued. "In some systems, storage density can have a negative impact on the visibility of products. The availability of storage space can vary from one department to another, and the number of units or product [stock keeping units] stored on a given nursing unit will also vary by unit type. It can therefore be very difficult to standardize the arrangement of storage units from one department to the next, thus complicating the job of temporary or new employees who regularly change wards and need to find products."

That motivated Logi-D to develop a visual system using product-category-based color identification. Basically, a hospital categorizes its supplies for the entire organization and then assigns intuitive colors to these categories, such as red for blood-related products, for example. These colors are then displayed on the outside of modules or in certain cases cabinets or carts.

"The best storage system is only as good as its implementation," Philippe advised. "To maximize the benefits of the system, we start with a thorough data cleansing exercise in order to document all items that will be stored in the system. As part of this process, quotas are determined and specific locations assigned to every product, based on input from materials management and clinical staff. Once these parameters are agreed upon, the modular storage system is put together, leaving only sufficient space in the compartments of the modules to store the calculated quota for every product, once again optimizing space and eliminating the possibility of storing more than the calculated quota."

PAR Excellence PAR Bins

Ask PAR Excellence System’s Felger about the storage system development he predicts will generate popular demand next year and he’s quick to point to one as an outgrowth of the company’s weight-enabled replenishment capability.

"It has already started," he said, matter-of-factly. "Nurses are taken out of the inventory business. Products are always there when needed. Labor is not only reduced in materials, because no one visits the floor to requisition or reconcile, but phone calls from the nursing staff because of stock-outs are eliminated."

Omnicell’s Mullenger cited integration with other key applications, such as electronic medical records, enterprise scheduling and financial management systems, and supply chain with other vital hospital functions from pre-op to post-op, PACU, and anesthesia on a single database.

"Integration and unmatched sharing and communication through interoperability leads to improved operations and patient care by increasing efficiency, eliminating redundancy and reducing errors," he said. "Integrated system saves both time and money, and allows clinical staff to devote more time to quality patient care."

Kennedy from Stanley InnerSpace acknowledged that the company’s new locking and security application will have to be available on all of its storage carts and cabinets, not just the small models, but recognizes the complexity of the issue.

"We’ve already started going down this road, and we anticipate a wide range of enhanced security features across our entire product line," she said. "We have to be passionate about storage security. Administrators want to secure valuable supplies, but at the point of use, the clinical staff just wants to take care of patients without troublesome locks impeding their workflow."

Mitch Gerber, vice president, sales and marketing, North American Region, Pegasus Medical Concepts Inc., Mission Viejo, CA, veered away from storage systems themselves and toward the philosophy behind how to manage inventory.

"The right storage helps make the strategy better, but it is how you choose to manage the inventory that truly will make the difference," he said.

That’s why Pegasus favors the simple Kanban or two-bin system of supply replenishment as the most cost effective and accurate inventory strategy, which is part of most Lean programs. In fact, Gerber contends that Kanban can improve operations and patient care through lower on-hand inventory levels and less labor, "by assuring supplies have a properly defined home and are always readily available for the nursing staff."

Gerber said he believes hospitals can achieve this while reducing PARs from current levels on about 85 percent of the items in use today, which will enable nurses to quickly locate and access the supplies they need and return to the patient in the shortest amount of time possible. "The nurse is not responsible for performing a function to gain access to standard low-cost supplies and does not need to notify anyone that a supply was taken," he added.

Logiquip’s Schuldt pinpointed six key trends that will drive storage systems in 2010.

Among them are the twin-bin Kanban application within Lean management, open access storage locations thanks to supply charges being incorporated into patient room charges, using automated RFID-enabled storage products for high-dollar inventory that are integrated with patient billing and records and growth in OR procedure carts.

But one trend may have nurses exclaiming their delight. "Nursing’s role in inventory management will decrease significantly as materials management assumes more control of patient floor inventory management," he noted. "This will enable nursing to spend more time on patient care and less time trying to locate inventory."

Above - Logi-D module options Left - Logi-D storage modules can be permanently angled

Logi-D’s Philippe foresees wider acceptance and implementation of vertical high-density storage offerings, which will help consolidate space needed.

"The reduction of multiple storage locations, due in many cases by the limited space and restrained storage capacity of traditional shelving systems, will reduce the time and travel required to find and retrieve supplies," he said. "Gains will also be generated by the ease with which users find supplies in the remaining storage locations."

But locating specific storage areas is not enough, he acknowledged. Supplies must be available so replenishment processes must be examined.

"Traditional automated replenishment systems, which carry a high cost due to their infrastructure, and the materials management labor required for PAR level systems have largely resulted in centralized primary locations on nursing units replenished from a central warehouse or an external vendor," he said. "Products are then redistributed closer to the point of use by clinical or clinical support staff in multiple secondary locations. The end result tends to be uncontrolled and inefficient replenishment processes and an increased risk of running out of supplies at the point of use."

Combining RFID for collecting consumption data with vertical high-density storage options can help facilities decentralize their inventory operations to a point-of-use process with lower management costs and reduced backorders, according to Philippe.

"External studies and our own observations have revealed that nursing staff spend 15 to 30 minutes per individual per shift looking for products they need to perform clinical tasks," he concluded. "We have demonstrated and measured that this time can easily be cut in half by reengineering an institution’s storage locations and replenishment processes."

CareFusion’s Frantz attributed demand being driven by clinical and financial process improvement and performance.

"A core principle of a lean transformation is that you cannot improve what you cannot measure," he said. "By using electronic storage solutions as the data gathering endpoint for the hospital or health system’s IT infrastructure, these organizations can achieve leverage on their capital expenditures by driving performance in their two biggest areas of operational expense, consumables – supplies and pharmaceuticals – and labor."

Frantz advocated partnerships with manufacturers to provide inventory on consignment as a cost-reduction tactic. "By providing electronically captured data from the point the product is used directly to the manufacturer or distributor, a consignment relationship can be a win-win for both the hospital and the manufacturer," he indicated. "Seamless flow of billing and usage data, key data for regulatory compliance, as well as low-unit-of-measure stocking data can truly facilitate an efficient supply chain, benefiting all parties. 

"This increased integration from the point of use directly back to the supply chain will be especially important in the perioperative areas, given the number of ‘direct from manufacturer’ supply chains," Frantz continued. "Additionally, consumer-directed healthcare will be a driving force as hospitals measure and publish their cost of care. While not a new development with point-of-use systems, the significance of capturing line-item-supply-use-per-patient will increase under these initiatives."