The 27,000-sq. ft. supply room houses the Central Sterile and Processing Department (CSPD) and the Materials Management Department (MM). The south campus CSPD processes 500 trays per day, builds 85-100 case carts, and processes over 500,000 instruments per month. The MM department contains 1,300 unique surgical supplies and manages an $800,000 inventory; 108 Omnicells; and 21,437 supply locations.

The LEAN methodology was utilized in the supply room to transform how supplies and instruments were managed and the case cart picking process. Prior to the event, BJC HealthCare (parent organization of BJH) staff performed daily counts on 2,300 SKUs ($2.1 million of inventory) for the ordering process. This task took six hours to complete. The original layout of the supply room was also not ergonomically correct and staff had to walk more than 800 ft. to build a single case cart. The extensive walking and poor ergonomics within the environment caused on-the-job injuries and additional stress to the staff. The original layout was also not conducive for efficient case cart building and did not allow for the development of a just-in-time process for case cart building. LEAN methodology was identified as the best opportunity to help deal with these issues and provide a more visual, manageable, cost effective, and efficient storeroom.

Ten goals were established to ensure delivery of the correct supplies and instruments to the surgical team in the operating rooms:

1. Manageable LEAN 5S process (sort, straighten, shine, standardize, sustain)

2. Defect metric of 97% (3 sigma) – Defects for supplies were identified as overstocked, stocked-out, in the wrong location, or mislabeled. Defects for instruments were identified as tray mislabeled, shelf mislabeled, tray in the wrong location, or the lock was broken on the tray.

3. Reduce supply stock-outs from 200 to 0 (100%)

4. Eliminate overstock

5. Eliminate case cart supply outages

6. Reduce case cart picking time by 25%

7. Implement a Kanban system to help reduce the time it took to order supplies by 80%

8. Provide an ergonomically correct working environment

9. Reduce walking distance to build a case cart by 25%

10. Develop standard work for case cart building

Old storeroom (Instruments)

New storeroom (Instruments)

Old storeroom (Supplies)

New storeroom (Supplies)

To make these goals a reality, the team conducted a Lean 2P (process and preparation) event that helped redesign the storeroom from scratch. Three separate sections were identified: supplies, custom packs, and instruments. Following the 2P event, it took several months of planning and preparation and two separate rapid improvement events (RIEs) to reorganize the supplies and implement a Kanban type of just-in-time pull system.

After these two RIEs, the instruments were reorganized. While reorganizing the supplies and instruments, the team also right-sized all locations and ensured all supplies and instruments had a clearly identified "home". This would ensure that improvements were sustained and no overstocked instruments or supplies could be misplaced.

The major initiative during the instrument reorganization was to set up the area in a proper ergonomic fashion. Following the instrument reorganization, packs were dealt with. The team identified an opportunity to reduce the packs safety stock inventory from 430 packs to 150 packs, with 90 packs arriving daily for the following day’s use.

The final event took into consideration how staff does their work. In the original state, a staff member would build a single case cart (supplies, instruments, and packs) from start to finish. In the new state, staff was trained to build case carts in a flow cell. In a flow cell case cart picking with single piece flow, items are picked-and-passed to the next flow cell to level the work load, decrease walking, and increase efficiency.

With a Kanban system and the new storeroom layout in place, the flow of work has greatly improved and employees are much more effective. The reorder process has been reduced from 6 hours to 0.5 hours and eliminated counting. The 5S score went from a 1.1 to a 4.8 in the supply area and from a 1.0 to 3.8 in the instrument area. The yield percentage increased from 67% to 97%.