To improve clinical service and storage, Supply Chain searches for shelf-confidence
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.
Sifting through inventory can make a difference, too, advised Amy Flynn, OR/CS Market Manager, Hänel Storage Systems.
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.”
Looking ahead for shelf-fulfilling, shelf-serving prophecy
Some of the most innovative advancements to shelving and storage in recent years include the incorporation of technology that automates security, tracking and weighing of products, manages temperature and even protects against bacteria and viruses on surfaces. What might be a new bell or whistle coming down the pipe that might be worth adding to the mix? Healthcare Purchasing News asked several experts to share their insights without giving away any prospective developments or trade secrets.
“Inventory control software can be a substantial benefit in maintaining proper equipment/supply volumes and utilization. The software can also help healthcare organizations detect if significant theft is occurring. Digital, key card or even keyed locks on doors, drawers, shelves, mobile carts and storage closets can aid in security. For high-value equipment or larger equipment that is used in multiple rooms, locating systems, such as a real- time locating system (RTLS), can speed the location process and protect against theft.
“Real-time locating systems are also valuable for their contact tracing capability in the event of a COVID-19, MRSA, Norovirus or other outbreak at a clinic or hospital. The technology includes software and hardware that can trace everyone who was in the facility or a particular area of the facility at the time or day the outbreak occurred, aiding in minimizing exposure within the facility and to the general public. While this technology does not protect against an outbreak, it can help identify the people who were exposed, the rooms that need disinfected and which supplies/equipment to dispose of or disinfect. Cleaning and disinfecting are extremely important as many contaminants can live on surfaces from several hours up to months. In the future, decision-modeling software may be used in hospitals and clinics to help with efficient replenishment and utilization of equipment and supplies. Mapping and tracing technology that maps staff patterns can help improve staff efficiency and ensure they are using equipment and supplies in the most efficient way.”
Brian Hazelwood, Marketing Manager, Midmark
“There are several technologies that are becoming available to automate the reorder signal using RFID, Kanban, or weighted driven replenishment models in supply rooms. These models require limited clinician intervention while providing real-time data on supply utilization, allowing for on-the-fly PAR level adjustments.
“Finally, we often find room organization and storage space utilization deteriorates due to poor labeling. Electronic labels can allow for easy, mass updates on SKU and reorder point information. A product conversion or PAR optimization may have required thousands of supply items to be manually re-labeled. Electronic labels can be updated instantaneously with the room number and product information. Additionally, inventory issues, like backorders, can be flagged through electronic labels so care teams are aware when they go and pull supplies.”
Zach Malingowski, Senior Director, Medline Supply Chain Optimization
“With the growing popularity of radiofrequency identification (RFID) technology for inventory management in healthcare, storage solutions need to be RFID-friendly. This means it needs to be made of a material that will allow these signals to pass without causing interference. Polymer or plastic shelving is an ideal solution for these deployments. Systems like ‘MetroMax’ provide the durability and strength of its wire counterparts and yet provide the tech-friendly design to not only mount RFID readers, but also allow the signals to pass without issue. Another advancement that is included with MetroMax is antimicrobial protection. The plastic is infused a Microban additive that inhibits the growth of microorganisms on the surface to keep the product cleaner between cleanings. This is a benefit that should be sought for all storage areas.”
Dave Salus, Market Manager, Healthcare Division,
InterMetro Industries Corp.
“The Rotomat automated carousel has the ability to securely store supply chain product by restricting user access through scanning a badge into the system and the option of an automatic locking door. HänelSoft can track and manage users’ transactions, track inventory by PAR level, expiration date, or LOT number and directs the user to the requested product through a graphic display at each Rotomat. Since the Rotomat is a six-sided box, it can reduce the likelihood of airborne pathogens accumulating on product or shelves. The worktable is stainless steel and the carriers are powder-coated, both easily cleaned with any non-caustic cleaner. Also, in the event that a room is not well controlled by the hospital’s HVAC system, there is an option for temperature and humidity control within a Rotomat.”
Amy Flynn, OR/CS Market Manager, Hänel Storage Systems
“Only 12% of pharmacy leaders believe their pharmacy technology and informatics is optimized.1 This means there is a lot of room for growth and improvement to realize the greatest return on pharmacy technology investments: Financial return, as well as returns on safety for patients, efficiency for pharmacy leaders, and job satisfaction for pharmacy staff. Professional Services help set up a customer to maximize the impact of technology investments on the first day of go-live, Success Services help ensure this performance continues as the needs of staff, patients and the industry change, while Technical Services help proactively monitor equipment and resolve any issues that may arise. The combination of technology hardware, software and services are essential components to achieving the autonomous pharmacy, a vision which to replace manual, error-prone activities with automated processes that are safer and more efficient.”
Greg Haas, Senior Product Marketing Manager, Central Pharmacy, Omnicell Inc.
1 Matsurra GT, Weeks DL. Use of pharmacy informatics resources by clinical pharmacy services in acute care hospitals, American Journal of Health-System Pharmacy. 2009 Nov 1; 66 (21): 1934-8
“More and more healthcare supplies require temperature control during storage and transport, which significantly increases your storage footprint. Cold-chain boxes and phase-change materials can take up a lot of space, and these elements must be brought to the right temperature in a time-consuming process called conditioning with the use of high-grade refrigerators and freezers. Traditionally, in addition to the space and significant investment in conditioning equipment, shippers of high-value temperature sensitive therapies also [have] had to deploy a large labor force and dedicate significant space to the assembly of these shipping containers.
“To avoid this space, labor and cost burden many healthcare suppliers should consider just-in-time ‘conditioned setup’ services. In the case of maintaining supplies at proper temperatures, this means working with a cold-chain service provider that can manage all the packaging supplies, conditioning of refrigerants and proper assembly of shipping containers at its own facilities. Shipping containers are provided each day on an as needed basis ready to load with drug product and ship back out the door, significantly simplifying the process of packaging and shipping temperature sensitive therapies while helping companies achieve their financial and environmental sustainability metrics.”
Jamie Chasteen, Director of Corporate Development,
Cold Chain Technologies
Rick Dana Barlow | Senior Editor
Rick Dana Barlow is Senior Editor for Healthcare Purchasing News, an Endeavor Business Media publication. He can be reached at [email protected].