To improve clinical service and storage, Supply Chain searches for shelf-confidence

June 24, 2021

Shelving and storage are about as important to inventory management as walls and a roof to a house or building – without either, all your stuff is exposed to the elements (think damage and infection) and the possibility of theft.

Proper storage remains an art as well as a science. In fact, storage in some cases can serve as an art form as well as something practical. So how can healthcare organizations – either acute care or remote care, hospitals and all other facilities – optimize their storage footprint?

Think out and up.

Balancing the scales

The formula for success always should include employee and patient care, emphasizes Ian Loper, Vice President, DSI.

“As science and art balance each other out in the healthcare field so does the marriage between equipment and the inventory on its shelves,” Loper told Healthcare Purchasing News. “The magnet that brings science and art together are the people. If the systems and processes in place focus on the employees and the patients, then everything else will fall into place. Storage equipment plays an integral part within this relationship.”

In fact, Loper posits that if a department fails to be organized from a space and workflow perspective that they are “literally losing profits” on the shelves.

“The downstream impact of wasting space can lead to compromising employee care, patient care, and increasing costs throughout a hospital,” he insisted. “Slower than normal retrieval times, delayed supply replenishment, expired inventory stored in sub-optimal spaces, and product overflow into adjacent rooms are just some of the inefficiencies that result in an unorganized Supply Chain. Space Optimization initiatives should be at the forefront of every Supply Chain, Materials, OR, and CS/SPD process improvement list in 2021.”

Loper urges healthcare facilities to investigate the economics buttressing their options. He estimates that the average new construction costs for a hospital can span $400 to $625 per square foot, which can motivate decisions.

Hospitals, by and large, have two choices, according to Loper. “One – keep the same footprint and upgrade to a more space-efficient storage system, or two - keep the current style of open shelving and plan for renovation or new construction. The former is cost-effective and non-invasive. The latter is expensive, disruptive on the daily operations, and not optimally designed to maximize space,” he noted.

“One way of making a positive change would be to upgrade the storage equipment from traditional open wire shelving to an integrated high-density system with pullout baskets and adjustable compartments,” Loper advised. “A high-density storage system can save a department up to 25% to 50% of the existing storage space, enabling the department to work and grow organically within the current space without any construction or renovation costs, disruptions, etc.”

Yet the pendulum can swing between having not enough space to having too much space to having space poorly organized.

“Often times we visit hospital supply rooms and we find that storage space is underutilized,” observed Zach Malingowski, Senior Director, Medline Supply Chain Optimization. “For example, the room may be set up with wall mounted panels and 12-inch-to-18-inch hanging bins. However, if the room is wide enough, they may be able to utilize 24-inch or even 30-inch deep wire racks to increase total capacity of the supply room.”

Sifting through inventory can make a difference, too, advised Amy Flynn, OR/CS Market Manager, Hänel Storage Systems.

“By re-evaluating PAR levels and weeding out unused products, supply chain departments can become more efficient and potentially gain much-needed floor space,” she said. “One of the most common storage errors in supply chain is not right-sizing bins and corresponding racks, resulting in overstuffed or partially empty bins on racks that are either too big or too small, all resulting in a poor use of space, making it difficult to find product and correctly manage inventory.”

Brian Hazelwood, Marketing Manager, Midmark, acknowledges that the increased number of medical products and frequency of supply usage, along with the need for safety and improvements in workflow and productivity, demand more organization in storage.

Well-organized storage in exam, procedure and patient rooms and storage areas can improve efficiency in supply and equipment utilization and also assist with inventory cycling to help ensure first-in, first-out (FIFO) usage for dated supplies, according to Hazelwood.

Hazelwood proffers six ways supply chain can maximize storage space.

1. Visually seeing equipment and supplies is important. “Not long ago there were items such as swab jars and culture swabs stored in jars on counters in the exam room. The products may change but the need for visual and easy access to products has not. Easy visual access to products can help improve caregiver efficiency and the patient experience,” he indicated.

2. Use of bins or dividers can assist with organizing supplies and equipment. “Having to search through a drawer or cabinet to find supplies can detract from the efficiency of the patient visit and the care experience, which is important in developing patient trust and improving outcomes,” he noted.

3. Organized shelving and racks can be an important factor in a facility’s storage footprint. “Like visual jars on a counter, shelving and racks can help make supplies or equipment easy to find and less likely to be overlooked in ordinary searches,” he added.

4. Systematic checking and replenishment of supplies/equipment and locations of those items are also important. “It is imperative to have supplies or equipment nearby. In an emergency, having the proper supplies/equipment in the designated storage areas can be critical to patient care,” he insisted.

5. Locks on cabinets, drawers, carts and supply closets can help eliminate theft and improve safety in the facility. “The last thing you want is patients or staff taking supplies for personal use that could potentially cause them or others harm. And not being able to locate supplies or equipment due to theft can endanger patients in need of those items,” he warned.

6. Best practice is to follow the 5S Lean Workplace model. Hazelwood cites from and references https://www.5stoday.com/what-is-5s/.

• Sort – keep only what is necessary and discard the rest (when in doubt, throw it out).

• Set in order – arrange and label necessary items for easy use and return.

• Shine – keep all areas swept and clean.

• Standardize – standardize cleanup to preserve the state that exists when the first three pillars (or Ss) are properly maintained.

• Sustain – make a habit of properly maintaining procedures.

Dave Salus, Market Manager, Healthcare Division, InterMetro Industries Corp., promotes the durability and reliability of long-standing high-density storage as the “most cost-effective way to maximize storage space.

“It essentially eliminates the need for redundant aisles by allowing the user to move the aisle to the storage unit they need,” Salus said. “Today, these systems can support wire shelving for general supplies, epoxy-coated or stainless steel shelving for corrosion protection, and even advanced polymer shelving that not only protects from corrosion, but also protects from rips and tears for wrapped items, like found in the SPD department.”

Salus acknowledges that mobility remains another key aspect, and not just for transport.

“For areas that don’t utilize high-density systems, configuring storage on casters provides some advantages that will be utilized over time,” he continued. “Ease of cleaning for one. Casters enable storage units to be moved for a more thorough cleaning. Supply requirements change over time, and as such the storage area will require some slight adjustments that mobile storage can accommodate. Some requirements are larger scale; think renovation. Mobile supply storage will facilitate easy relocation of supplies, whether for a permanent or temporary move.”

Pursuing ingenuity

Designing and crafting effective but more efficient storage footprints can range from high-tech automation tactics to low-tech and simple strategies that are user-friendly and visual.

DSI’s Loper argues that anytime a chance emerges to pare down PAR levels and reduce the amount of supplies within a storage area the opportunity should be captured and the new system should be implemented. He points to a two-bin Kanban system as an option.

“When using the first-in first-out method, 50% of the PAR level is stored in the front compartment and the other 50% is stored in separate compartment,” Loper noted. “This forces the staff to pull inventory from the front compartment first, then pull from the back bin after the first bin has been depleted. The two-bin system helps drive supply costs down, increases picking accuracy, eliminates expired supplies being used on patients, and maximizes the storage efficiencies within the allotted footprint.”

Supply Chain can implement this with both storage types – the wire shelves/plastic bin combination and the integrated high-density basket system, according to Loper.

“The combination of wire/plastic bins is a cost-effective, easy to adopt solution,” he said. “The high-density basket system will help consolidate the supplies in a much smaller footprint while increasing its overall storage capacity and enhancing workflow in the department. The two-bin system used in both storage systems reduces inventory levels and makes the department more efficient.”  

InterMetro’s Salus concurs about the utility of two-bin and Kanban systems, but also points to another fundamental area easily overlooked.

“Often times when shelves are assembled, they are simply equally spaced,” Salus observed. “For most systems, this means more effort in re-setting shelves, or worse, no re-setting of the shelves, which results in a lot of wasted space above the supplies below the next shelf.”

Salus recommends systems such as “Super Adjustable” or “qwikSLOT” that offer quick, no-tool, shelf adjustment because “they enable the efficient use of vertical space by making it easy to lower shelves into that dead space often found between shelves,” he added. “This will often result in available space for a few more storage levels per unit.”

Salus applies the vertical logic to the horizontal.

“There are solutions that position vertical uprights (posts) closer together,” he continued. “The advantage is narrower shelves requiring less structure or thickness, therefore consuming less vertical storage space. The disadvantage, however, is that the horizontal spaces or compartments become fixed. So now instead of having wasted vertical space between shelves, wasted space between uprights becomes prevalent. Smaller items that don’t fill the space are often seen with dead space on either side of it.”

Then supply chain must wrestle with what to do with those larger items that won’t fit between the fixed uprights, Salus adds. “The way to overcome this is through accessorizing,” he assured. “While traditional shelves have more girth, that girth provides for longer spans, spans that can be compartmentalized by item size. Essentially, the space that is lost by uprights every 16 inches and wasted space found next to the items between can be reclaimed by configuring shelves, not only vertically, but also organizing horizontally, to maximize the amount of space available to store items, of any size, efficiently.”

Hänel’s Flynn emphasizes the importance of vertical space, too, that is served by its software-equipped Rotomat carousel.

“By utilizing the entire height of the room, the Rotomat automated vertical carousel can gain valuable storage space for supplies while also maintaining inventory control and the ability to send PAR level and reorder information to a higher-level system like Cerner or Lawson, for example,” she said. “The Rotomat and HänelSoft software provide real-time inventory visibility, the ability to perform cycle counts, quickly locating and removing recalled products, and the ability to pick case carts in a path optimized fashion.”

Pharmacy is no stranger to automation and storage – including merging the two – and may offer worthy examples for supply chain to emulate, according to Greg Haas, Senior Product Marketing Manager, Central Pharmacy, Omnicell Inc.

“Advanced automation and intelligence solutions are driving safer, more efficient storage of medications,” Haas said, and health systems adopting these technologies reap at least four key benefits:

• Scanning 100% of medication bar codes to track inventory that enters and leaves the system, as well as when the medication is administered.

• Leveraging automation to reduce labor-intensive employee activities and the opportunity for human error, while freeing up employee time to focus on more value- added activities that could increase patient satisfaction, reduce costs or generate additional revenue.

• Leveraging intelligent software that manages workflows and inventory data to minimize waste of expired medications, maximizes efficiency of automation and employee dispensing activities and provides a central repository of data that informs decision makers of necessary metrics to optimally manage inventory levels.

• Taking advantage of available services that help pharmacy professionals focus on being pharmacists while the medication supply chain is being optimized by people that are medication logistics professionals.   

Still, Midmark’s Hazelwood suggests the synchronicity of simplicity works.

“[The] use of labeling and organization tools may not always look pretty on drawers, cabinets or shelves, but labeling can help organize the contents and help improve workflow efficiency for better patient experiences and outcomes,” he said.

Hazelwood also recommends using dividers or tray dividers in drawers that resemble what you see in a kitchen silverware drawer, labeled racks and angled shelving similar to stadium seating and even bins that can enable the customization of spaces for storage efficiency.

“Mobile carts can be inventoried for specialty use and moved to rooms for scheduled times of usage in that space, such as pediatric days at a clinic, for example,” he continued. “Resupply carts can make it easy to move supplies and replenish rooms daily/weekly.”

At best, Supply Chain leaders should know their end users and customers, Medline’s Malingowski urges.

“It is important to visit supply rooms frequently and gather feedback from supply technicians and nurses who are in the room day in and day out,” he said. “They can help identify items that are not being used. This will help make space for faster moving and supplies that are critical for patient care. Furthermore, complete a PAR level optimization every three to six months. When we help customers with PAR optimization, it is not uncommon to find that nearly 30% of the inventory in the supply room is not used at all. PAR levels are often set during the initial set-up of a supply room, but then forgotten about. Completing a frequent PAR optimization can help provide critical insight on supply usage, improve labor utilization and ensure valuable storage space is available for supplies highly used by the clinical team.”

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