Arguably, the pre-eminent parameter for any storeroom or
warehouse design plan is to ensure easy accessibility to any product inside.
If you can find it fast, stockpiling won’t last.
Despite the best of intentions, however, the mammoth scope of a
storeroom or warehouse redesign effort may be enough to inspire
procrastination in doing anything about it.
Sure, hospitals may not be in the warehousing business and
supply chain not their "core competency" as some in the industry have
posited at conferences and trade shows, but either excuse rings hollow and
shallow if the core competency of caring for patients somehow is affected by
a storeroom or warehouse design that enables stockouts or simply makes
things hard to locate.
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Donna Van Vlerah |
In fact, Donna Van Vlerah, Vice President of Supply Chain,
Parkview Health, Fort Wayne, IN, respectfully rejected the diminishing
notion that supply chain or warehousing is not a core competency of a
healthcare organization.
"At the core, a hospital is a business that specializes in
healthcare, but it does not preclude us from the many disciplines of running
a business [that include] Human Resources, Finance, Facility Maintenance ...
and the list goes on to include Supply Chain/Materials Management," Van
Vlerah told Healthcare Purchasing News. "In order for a hospital to
provide excellent care, they must have all disciplines within their core
competencies. I believe the messaging that storerooms are not
important advances the notion we are not critical to the healthcare
mission."
If anything, a well-oiled supply chain and an efficiently
organized storeroom or warehouse both demonstrate competence for its core
service, which is supporting clinicians to care for patients.
From the lights on the ceiling to the cleanliness and
temperature of the air to the breadth and width of aisles to the arrangement
of shelving to the order of products on shelves, design can make a
difference in how a hospital delivers service.
How do Supply Chain teams determine whether their storehouse
footprints need a redesign to improve throughput and workflow? What kinds of
techniques and tools will enable the necessary improvements?
HPN reached out to a small group of provider and supplier
supply chain experts for high-tech and low-tech practices and tools
necessary for redesigning or reorganizing storeroom and warehouse space, as
well as the danger/warning signs that a storeroom or warehouse needs an
update, upgrade or complete overhaul.
In this edition, HPN spotlights high-tech strategies and
tactics; an upcoming edition will feature low-tech strategies and
tactics.
Automation articulation
For Van Vlerah, success can be found in a virtual world where
storerooms and warehouses can be managed with sophisticated software tools.
"These software tools enable the Supply Chain leader to have visibility of
stocking levels in hundreds or thousands of locations," she said. "With this
aggregated virtual view, one can optimally manage obsolescence, expiration
and right-size inventory through demand planning/forecasting. Today’s robust
software packages enable the Supply Chain leader to manage items in the
right unit of measure, too. Point-of-use systems tied to sophisticated
software tools becomes a significant force multiplier. In order for a supply
chain to operate in a Lean Six Sigma environment, management of ‘big data’
via an automated system is a critical element for today’s inventory
management."
Van Vlerah pointed to three options as "nirvana:" A warehouse
management system (WMS), a demand forecasting system and a point-of -use
system.
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Mike Switzer |
Mike Switzer, Vice President of Supply Chain & Support
Services, North Mississippi Health Services Inc., Tupelo, MS, delineated the
differences he sees between storerooms and warehouses, which he considers to
be two separate types of operations. Switzer spearheaded the design of a
consolidated service center for his integrated delivery network that he
currently manages.
"A storeroom is typically set up so that any nurse can find
goods in the off hours," Switzer noted. "In a storeroom like items are
usually placed together. Things like needles will generally all be located
together to make it easier for a nurse to find the goods. A warehouse is —
or should be — totally different. In a warehouse you should never place any
two like items beside, above or below each other [because] this is a
miss-pick waiting to happen."
Like Van Vlerah, Switzer favors the use of a warehouse
management system, which would track item location, proper stock rotation,
lot numbers, expiration dates, receiving, shipping, routing personnel and
even which size totes to take for an order, he indicated. This system also
will enable managing inventory in multiple locations within the warehouse —
both dynamic and fixed — as well as handle cycle counts for a consistent,
accurate inventory and allow you to measure the various [key performance
indicators] to verify how well your systems and your people are doing, he
added.
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Jim Dickow |
Warehouse management systems can help even the newest employees
and intermittent personnel identify picking locations for fulfilling order
selections and putting away stock, according to Jim Dickow, President,
Dickow Consulting Group LLC, Milwaukee.
"Most warehouse management systems have some sort of system to
rearrange the ‘picking ticket’ in the order most efficient for picking
and/or packing," he continued. "This would increase the pace and accuracy of
the fulfillment process."
A WMS also enables employee accountability and responsibility,
Dickow insisted, "keeping track of who is filling a particular order, how
much time it takes and how the performance compares to standards of
operational practice," he added.
"Inventory management begins with accurate tracking of original
incoming inventory for use in manufacturing processes from raw materials,
staging [and] kitting, through work-in-process to shipment of finished
goods," said Amy Flynn, OR/CS Market Manager,
Hanel Storage Systems,
Pittsburgh, PA. In fact, [materials resource planning or enterprise resource
planning] systems provide management visibility for all in-bound, in-storage
and out-bound inventory, she added. "These systems assist in the planning of
the manufacturing process to ensure that all needed components are on hand
at the time of assembly or manufacturing," she said. "The [stock-keeping
unit] level tracking continues throughout the process to keep accurate
stocking levels, create audit trails of employee interaction with inventory,
identify obsolete inventory as well as identify shipping requirements."
Flynn insisted that a comprehensive integrated system is vital
for accurate inventory management in this age of accountable care, tighter
budgets, leaner staffing and Six Sigma methodology, but lamented that "far
too many hospitals are still utilizing a pen-and-paper system or a
standalone software platform for inventory management."
Switzer favors "wire guidance" in the floors to guide powered
equipment, such as forklifts or pickers. "This keeps your staff from running
into the shelves and potentially damaging the shelving, the products, or
even their coworkers," he said.
Believe it or not, Supply Chain should design the building’s
air conditioning system, too, Switzer insisted. "We use a type of system
that uses no ductwork and allows you to store goods clear up top without
having to worry about temperature differences," he said. "A typical
warehouse with standard air conditioning would have about 100 roof
penetrations — which can lead to leaks — and will have air stratification
that can lead to a 15 to 20-degree difference from the floor to the ceiling
in a warehouse. This is very important for temperature-sensitive items. It
also has the ability to filter all of the air and remove all of the dust
from the entire building. The only time we have to dust our goods is when we
receive them."
Visibility matters
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Nancy Pakieser |
Selecting the right technology hinges on many variables,
according to Nancy Pakieser, Senior Director, Industry Development,
TECSYS
Inc., so the exercise can be a bit challenging.
"Our partners often work through the ‘people, process,
technology’ methodology," Pakieser said. "Once they have the right staff in
place and have identified the workflows and processes needed to support
patient care, then we can determine the right technology to put in place. As
an example, in some clinical areas, bar-code readers work well, in other
clinical areas an RFID-enabled Kanban system is the best solution. In the
perioperative setting there may be many technologies in place to support
various aspects of the workflow, such as handheld devices to help build the
case carts, 2-bin Kanban in the core, an RFID reader to capture data use in
the operating room and then a bar-code reader to restock unused items."
Technology merely gives supply chain the inventory visibility
across the health system it serves, Pakieser noted. "Knowing what you have
and where you have it enables an organization to be nimble and responsive to
fluctuations in care delivery needs and to shift items to areas of greater
demand," she said. "You can then leverage this data to right-size your
inventory investment and implement demand-planning practices. By leveraging
the data from any mix of technology capture, you can improve your supply
chain’s overall performance with definite business payback and better
support of care delivery."
Access to real-time data is critical for decision-making,
according to Robert Jones, Director of Logistics,
Medline Industries,
Mundelein, IL. "At worst, most healthcare supply chains rely on gut feel,
and at best, many cumbersome spreadsheets to merge data," he said.
"Forward-thinking institutions should utilize modern database strategies and
business intelligence software to ensure optimal performance. Having
real-time visibility of inventory performance, equipment locations and KPIs
will have a significant positive impact on service to clinical partners."
Supply Chain must be able to visualize its workflow through a
system of record for bin locations so that they can maintain a slotting
strategy, Jones continued. "This slotting strategy should be evaluated with
modern warehouse visualization software, which allows for the ability to
test what-if scenarios for warehouse layouts and slotting strategies," he
added.
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Scott Nelson |
Scott Nelson, Senior Vice President of Supply Chain,
Cardinal
Health Inc., Dublin, OH, indicated that simulation tools would contribute
here as they would allow Supply Chain "to see the impact of design changes
and mitigate any unforeseen bottlenecks or obstacles before moving any
furniture."
Nelson further recommended velocity/profiling tools as another
essential element "to determine the optimal storage location for each
product based on parameters such as velocity, size, and proximity to the
outbound area."
Velocity matters
Gaining access to inventory velocity data can facilitate
planning and forecasting, according to John Freund, CEO,
Jump Technologies
Inc., Eagan, MN, but hospitals tend to struggle with it.
Distributors and suppliers build this data by using technology
such as carousel systems that organize, store and provide access to huge
amounts of inventory, Freund indicated. "Because these systems are extremely
sophisticated, they not only learn the best way to organize the inventory,
they also track every item requisitioned and over time, build accurate
velocity data that supports the replenishment and ongoing fulfillment
processes," he said. "As the system assimilates more data, it can reorganize
the location of supplies for efficiency, set new reordering information
based on actual velocity over time, and make recommendations to assist with
planning."
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John Freund |
Historically, hospitals have found managing inventory velocity,
or item-level usage data, difficult to achieve and maintain for three
reasons, Freund observed.
"First, there may not be a way to centralize consumption data
for every item in each area of the hospital or health system," he noted.
"Second, hospitals must overcome the challenge of unit of measure, with some
areas or systems storing item data as ‘eaches’ and others reporting ‘boxes’
and ‘cases.’ Finally, reporting tools accessible to the hospital may not be
able to aggregate item usage data across multiple systems."
As a result, hospitals rely on PAR replenishment, which
involves "a technician visually assessing items in a storage location to
determine what needs to be replenished, using existing PAR levels to trigger
a reorder rather than true velocity data," Freund continued. "This method
can become highly inaccurate over time, as a tech reports a number to
trigger a reorder simply because some items look low and they don’t want to
stockout."
A lack of systems in place can hinder progress, according to
Kevin Hartler, Senior Director, Services & Solutions Development,
W.W.
Grainger Inc., Lake Forest, IL, which specializes in industrial supplies, MRO (maintenance, repair and operations) equipment, tools and materials used
in environmental services and facilities management.
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Kevin Hartler |
"The increase of slow-moving and inactive inventory is a
universal problem often caused by a desire to improve service levels,"
Hartler said. "Items are added to inventory based on an assumption that if a
part is needed today, odds are it will be needed again in the future, and
therefore should be stocked for future needs. However, Grainger Consulting
Services research has shown the majority of MRO items purchased by an
organization meet infrequent needs that are unlikely to repeat. Many
organizations accumulate substantial inactive inventory as a result of
mistaking infrequent, unplanned needs as the start of a repetitive need."
Hartler noted that Grainger’s baseline analysis of more than
100 organizations across various industries — including healthcare, food and
beverage, manufacturing and aerospace — found the following:
-
On average, an
organization’s MRO inventory turns one time annually
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50 percent or more
of a typical organization’s MRO inventory is "inactive," having no
issuances during the previous 12 months
-
Average turns on
MRO items only increases to 2.5 times annually after excluding "inactive"
inventory
These findings suggest MRO inventory provides a considerable
opportunity for process improvement, cost reduction, waste elimination and
increased value, Hartler added.
RFID should play a key role as it can "signal when inventory
levels are low or depleted, product hasn’t been ordered, and to help
optimize replenishment cycles to right-size bin locations," Cardinal’s
Nelson noted.
Although RFID technology may not be economical for every item
in a hospital supply chain, Medline’s Jones acknowledged, a smart
implementation can reduce replenishment activity and improve performance by
providing visibility to inventory and equipment locations, which is critical
in a hospital setting.
Flynn recognized that healthcare organizations, by and large,
have been slow to use automated inventory systems. "While robotic surgical
devices have gained widespread use, hospitals have not embraced
opportunities to utilize automation to assist in daily inventory handling
environments," she said. "Early adopters, however, are realizing the
significant cost-reduction opportunities available to them."
Flynn cited sterile processing departments at "several dozen"
U.S. hospitals are using high-density storage in automated vertical
carousels to manage sterile instruments, implants, soft goods and a variety
of other stored inventory in the SPD and the OR, reducing the departmental
footprint by 60 percent to 80 percent, and avoiding the need for costly
renovations or construction projects to accommodate additional demand and
volume.
"These systems utilize on-board inventory management control
systems to track all inventory and then quickly bring the item to the SPD
technician, rather than the technician traveling all over the SPD or OR to
locate a tray of sterile instruments, while also delivering the items to the
end user at an ergonomically correct height," she noted.
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Jean-Claude Saghbini |
Automated inventory management solutions that include an
analytics platform and efficient tracking mechanisms can reduce costs and
increase efficiencies by tracking location and usage, according to
Jean-Claude Saghbini, General Manager of Inventory Management Solutions,
Cardinal Health Inc. "The solution ‘learns’ optimum inventory levels
to eliminate over/under-stocking," he added. "It also can provide an early
alert to expiring products, offer an ability to easily scan and marry to
patient records for appropriate charge capture, eliminate tedious and
error-prone manual cycle counting and reduce clinician time spent on supply
chain tasks so they can focus on patient care."
Even as the industry migrates toward centralized inventory
management within organizations, however, Flynn sees value in the opposite
remaining attractive, too.
"Manufacturers have wrestled with centralized versus
decentralized inventory management for decades," she observed. "Where
massive distribution centers once managed most of the largest retail and
commercial suppliers of goods, today the concept of placing inventory near
where it will be needed is more desirable. This storage decision, however,
requires careful planning and implementation of tools to assist with
inventory management."