Shelving and storage serve as the bones, if not the entire skeleton, of a storeroom or warehouse, which represents the bulwark of a healthcare organization’s operational success.
For that reason alone, Supply Chain leaders and professionals must have a set-up that facilitates efficient workflow and pair it with effective service to clinicians and administrators in support of patient care and customer service.
While on paper, that aim may make sense, but in practice, it requires considerable design and fiscal resources to establish and implement, sources tell Healthcare Purchasing News.
Expanding outward and upward may seem to be the most obvious tactics when arranging and designing a storage footprint, but from a strategic standpoint, maximizing and optimizing available space – as in maneuvering shelving configurations within existing space – makes a realistic difference.
“When DSI thinks of efficiency we think of the people working in the department, the processes to retrieve and put away the supplies and the storage equipment being used in the department,” said Vice President Ian Loper. “It seems the most successful hospitals in the country are not only the most well-regarded by the patient community, but they are also very good operators when it comes to maximizing the efficiency of their people, the effectiveness of their processes and the adoption of specialized storage equipment throughout their facility. Capital equipment is sometimes an afterthought during the planning process of a renovation or new construction project, and this presents an opportunity for hospitals to become better. Conventional wire shelving is designed for a one-size-fits-all scenario and that leaves room for wasted space between supplies. A few inches lost here and there quite often becomes thousands of square feet lost.”
“Doing so can vastly improve efficiency and output to levels previously thought to be unattainable,” he noted. “Unfortunately, it’s not uncommon for facilities to (unknowingly) implement storage options that waste space and adversely impact workflow. Even the most powerful teams can realize operation deficiencies if their storage options don’t adequately support their work processes. We often don’t realize how much ‘dead space’ generic storage options waste and lock us into.”
Ramcoobeer encourages the use of multiple sub-divisible bins, modular configurations and bar-code labeling to facilitate quick access and reordering, which can lead to “less time spent stocking, picking and searching for inventory, affording teams more time for other valuable functions and contributing to overall efficiency.”
For David Phillips, marketing manager, Hänel Storage Systems, the prospect of designing shelving configurations should be looking up.
“Existing space can easily be optimized by storing vertically,” he insisted. “The next time you’re in your storage area, take a good look around. Is there much space between shelves, or are the shelves so tightly packed that you can barely remove what you need? Is there empty space above the rack itself? Is there room to reposition the racks to find the items you’re looking for? You need to store vital supplies, not air. Everything you see can be condensed into unused overhead space, with several racks consolidated into a single, smaller footprint. By introducing automated vertical storage, less space is needed for storage, and you can find other uses for that newly vacated area.”
Using a vertical carousel, supply chain operators can press a button to bring the items directly to them, according to Phillips. “The need to reach for and lift supplies is virtually eliminated, and stored items are much easier to access,” he indicated. “Hänel’s Rotomat also helps reduce the time it takes for staff to find what they’re looking for, because no one needs to hunt throughout the storeroom. No distractions or frustrations and less time spent searching for supplies means the staff can focus on their main tasks and become much more productive.”
Equipment options matter, too, because they can provide needed flexibility and modularity, according to Dave Salus, healthcare market manager, InterMetro Industries Corp., which makes available to healthcare organization customers high-density shelving, s-hooks, “EZ-ADD” shelves and computerized design applications to customize planning.
Salus sees high-density track shelving molded in chrome, epoxy and polymer as a solution for larger spaces. “Each unit has the potential to create as much as 50% more storage when added to your storeroom or warehouse design by placing more physical units in limited floor space,” he noted. “Track shelves include ‘active isles’ with sliding mobile units that move to access materials with ease. Tracks can be installed on top of the unit or the floor.”
S-hooks can be used for corner storage space. “S-hooks eliminate the posts in the front of corner shelving units that block access to shelving space in corners,” Salus added.
InterMetro also offers multiple design tools – one for shelf design, one for room design and one for track shelving design – via the company website to help healthcare organizations customize their space. “These tools offer the ability to create 3-D models of your storage solutions and to view them in the room with the [augmented reality] feature,” Salus said.
Remote care rescue
If hospitals struggle for enough storage space for inventory, think about how smaller non-acute facilities fare, according to Brian Hazelwood, marketing manager, Midmark Corp.
“It’s no secret that primary care facilities are challenged with inadequate storage space,” he observed. “Many non-acute facilities have limited storage space depending on the size and configuration of the exam rooms, which can often have a negative impact on patient and caregiver experience as well as the quality of care delivered.
“There are many reasons for the shortage of storage space,” Hazelwood continued. “Sometimes storage is not a major consideration during the design phase, or the facility was not originally designed to handle continued growth and increased patient volume. Cabinetry and storage solutions oftentimes aren’t designed for the medical environment and a changing patient and provider demographic that may interact with the space and equipment in a much different way.”
Midmark studied numerous healthcare facilities across the U.S. to identify elements that were missing from much of the current cabinetry used in clinical environments and compared the findings to Bureau of Labor Statistics data that report 76% of healthcare workers are female and that the average height of females tops out at five feet four inches, according to the Centers for Disease Control and Prevention.
“We found that the typical cabinetry used in clinical environments was not designed for people of that height,” Hazelwood said. “In many instances, they need to use stools or other devices to see or reach supplies on upper shelves of cabinetry. Therefore, the upper shelves often go unused. We worked closely with healthcare staff, infection prevention specialists and ergonomics experts to design a line of wall-hung cabinetry that can improve ergonomic reach and visibility while helping enhance storage efficiency and support infection prevention.”
As a result, Midmark’s latest line of cabinetry “features base and tall cabinets that better position the most-used areas of storage for easier reach by physicians and staff,” Hazelwood described. “The lower upper height and thinner depth of the cabinets improve access to storage with less reach and lean required. The use of gravity-fed, angled flow shelving improves visibility and access to supplies, even for items stored toward the back of the cabinet.” And they can be configured for exam rooms, he added.
Don’t fear simplicity
Ed Granger, Director of Sales, Quantum Storage Systems, cautions supply chain professionals against believing that shelving and storage systems must be automated and elaborate to be effective and efficient. [See sidebar "Unsophisticated utilitarianism may be just right for you" below.]
“Quantum’s products are not sexy or sophisticated,” he said. “Nothing is motorized, no hydraulics, no automation. Quantum’s products are, however, utilized around the world in healthcare facilities. While our products are not sophisticated, they are efficient and effective at a relatively low cost compared to more elaborate systems. Do healthcare facilities want more elaborate and sophisticated items? Yes. But do they have the budget to buy those items? Quantum often becomes the best use of budgetary funds that allows healthcare facilities to operate efficiently and within their budget means.”
Bottom line? Concentrate on proper labeling and storage unit mobility with plastic bins and wire shelving carts for a closed loop system, Granger advises.
“Proper labeling makes products much easier to identify,” he said. “Gone are the issues of searching to find products. Products seem to either up and move on their own, or more likely are not put back in the registered space by a hospital employee. At Quantum Storage Systems we offer shelf labels and bin labels that assist hospital employees find and return products to an identified area. We also can help product identification by using color coding of storage bins.
“When storage systems are mobile – basic wire racks on wheels – an entire cart full of products can be moved throughout the facility either delivering or retrieving products to where they are needed most,” he continued. Mobile wire racks hold as much as 1,200 pounds and roll through the hallways quietly to go unnoticed and to not disturb patients or hospital staff.”
Shelving affects more than storage
Craig Crock, president, Southwest Solutions Group Inc., contends the secret to optimizing shelving and storage space involves the capability of doing more with fewer people and less space.
“Everything you see is adjustable, modular, moveable to the next space, not built in, and is what everybody is moving towards to store more in less space and allow quick access to what is needed to serve the patient,” he told HPN.
Crock highlights how shelving and storage can be configured by department and function.
For example, pharmacy tends to use shelving with gravity-feed and rear-loading capabilities to reinforce first-in/first-out (FIFO) consumption patterns. “This allows for a higher density of meds in the same floor space and allows fast access to everything,” he said. Gravity-feed or gravity-flow shelves are tilted at an angle toward the end user so that when someone removes an item the rest move forward and closer.
In the sterile core of Central Sterile Supply, staff can use an automated vertical carousel storage system or a compression storage system to facilitate access to surgical supplies to build cases and sets for the Operating Room (OR). “Within these rotating Ferris wheels, the units rotate around and use lights to show [staffers] what items to pick for surgical sets,” he said.
“Compression systems are floating aisles where the shelves sit on rails and can be moved along by turning a wheel on the side,” Crock explained. “The shelves spread apart to make aisles.”
Carousels and compression systems also make sense for shelving and storage for the laboratory, pathology and histology for storing lab specimens, DNA samples, glass slides and paraffin blocks even in refrigerated space, according to Crock. Further, when labs use an automated slide-sorting and block-filing system, they can reduce the amount of time and number of people doing the task as well as increase accuracy and productivity, he adds. Crock cites one customer that employed four people to sort, store and track three million samples and specimens on slides each year. By using an automated system, they were able to do it 60% percent faster and “reallocated three of the people to do something more productive with their time,” he recalled. The key is more effective and efficient use of labor, space and time, he adds.
For materials management in the warehouse, Supply Chain can use mobile pallet rack systems or automated picking carousels to reduce square footage requirements and allow faster access to items to do more with less space and fewer people, according to Crock. “You eliminate wasted aisle space and move bins to people rather than people to bins,” he noted.
Meanwhile, in the medical supply rooms staffers can use radiofrequency identification (RFID) with the two-bin Kanban system to link with order fulfillment in the warehouse, which can “eliminate stockouts, expired product and actually can reduce inventory,” Crock noted. “We did a recent project where a hospital had almost $2 million in losses for expired product, and we virtually eliminated that and the savings went back to the hospital,” he said.
Randalyn Walters, clinical education manager-US, Belimed Inc., laments the lack of priority given to storage strategies and tactics during construction or renovations, and that can prove dangerous.
“Storage and shelving options in healthcare, supply chain and surgical operations are often not given the attentiveness they deserve during the planning phases of a project,” Walters said. “Simply waiting until it is too late to determine the type of storage or the amount of size necessary can result in bottlenecks and unsafe conditions. Sometimes a stainless-steel rack is thought to be the end-all-be-all sterile storage, but why is that? With so many innovative products on the market I have found it to be extremely successful in coordinating the storage solution with inventory placed there and including a variety of options for just one department’s needs.”