1. Grasping Supply Chain Concepts in Endoscopy – A Three Tiered Approach to Inventory Management Transformation
Jamie Liebler
SpaceTRAX Pre-Sales Engineer

2. What keeps you awake when you think about supplies?
What do I have?
What does it cost?
When does it expire?
What am I using?
Am I on budget?
Why don’t I have any space?

3. Audience Questions
How many departments have been asked to reduce their spend in 2014?
How many departments already have some type of inventory solution?
How many departments have the supply chain folks managing their inventory?
How many departments have had to reschedule a procedure due to a missing item?

4. Objectives What is lean process improvement and how does it help
Understand the different technologies available for supply chain management in your department
Know how to choose a software that works for GI labs
Open discussion about your challenges

5. Agenda- Supply Chain from 10,000 feet
Process
Technology
Software
Q & A

6. What is a lean process?
Where to get started??

7. The Lean Tool Box Observation Value Stream Maps 5S
Involve the people affected by the work
Direct observation of the process chosen for improvement (no assumptions)
Value Stream Maps
Graphically shows the work flow and wastes in the process
Current State VSM defines the issues
Future State VSM gives a foundation for implementation plan 5S
Sort, Shine, Straighten, Standardize and Sustain

8. Observation

9. Observation- See the process
Choose the activity/process that you want to understand
Introduce yourself to the person/persons that you want to observe and explain you are watching the process, not the person
Use either the observation sheet or something similar to document your observation. Sketch and document either travel or time depending on what you are observing
Make notes of any waste- opening drawers, walking around something, needing to move to different locations in same room
Observe each activity for minutes
Validate the observations with the people performing the work

10. Ask some questions
How does the person doing the activity know what to do?
Does the current system provide clear signals for prompting the activity?
Could a temporary worker be able to come in and understand the activity?
What are the opportunities to reduce waste?
Do different people do the activity differently?

11. Look for Waste in the Process
We let Tim P Wood help to explain the 8 waste that you want to look for in the hospital setting. The examples are:
Transportation- Poor layouts causing employees to walk long distances
Inventory- excess inventory and/or expired product
Motion- Walking to different departments or for supplies
People- Employees not feeling engaged or included in the process. Not asking employees for ideas
Waiting- Patients waiting or employees waiting for work (on-call/low census)
Overproduction- Doing unnecessary testing or repeating steps
Overprocessing- Putting information into a system that isn’t used
Defects- Missing supplies and wrong medications

12. Value Stream Mapping Provides an objective look at how the work flows
Seeing the work flow allows us to clearly define the time taken for each step and allows us to identify waste
Swimlane diagrams allow you to “combine” if you will the work flow that happens in parallel and/or at other times so that you can remove the silos across the enterprise
Can’t be completed without direct observation
One person should complete but validate with the group and/or individuals performing the work
Always do in pencil so you can easily make changes
Apply this to your current supply chain. Gain an understanding of who does what in each step? Look for the delays

13. Current Value Stream Map Example
Draw out the process with sticky notes or on a white board. Think about anything that creates delay in process or is a wasted step/process. Identify those with the “storm clouds”.

14. Future Value Stream Map Example
In the Future State, address the storm clouds and improve the process. Once you have the ideal future state, create an implementation plan to make it happen!

15. How does this help the process?
You involve the people who actually do the work
Identify waste in the process
Enhance the value added activities
Staff adoption is better because the process is enhanced and logical
Opportunity to involve the staff on the front line

16. 5S- Organize your supply/equipment areas
Sort-
Sort through the items being used in the room. Identify items that are needed daily, weekly or rarely. If they are daily, see if you can reorganize your procedure room and have those located where they are used. If they are rarely used have them in the “back” but clearly labeled.
Straighten-
Have all your supplies organized and clearly labeled. Have a similar containers for each product. All procedure rooms should be setup as close to the others as possible
Shine-
Clean up the supply room. Remove anything that isn’t needed, is broken or outdated.
Standardize-
Be consistent in the labeling and location. Put like items together and have a process for restocking for procedure rooms.
Sustain-
Checklist to ensure that steps are being followed and you should check the supply or equipment room monthly to ensure that it is in top condition!

17. Exercise- What do you see wrong?
Different containers for all items
Like items apart from each other
Items falling off shelf
Empty packages
Nothing labeled

18. After 5S Project Everything labeled and organized
Bulk items in the back of room
Like items together
Similar bins

19. Measure your Success Be sure to keep track of your successes!
What have you changes?
Feedback from staff and physicians
Put up a board that celebrates goals and projects

20. Supply Chain from 10,000 Feet
Process
Technology
Software
Q & A

21. Technology in Supply Chain
Automated cabinets
RFID
Barcoding

22. Automated Cabinets Can be very expensive and require IT resources
Can easily be linked to the ordering system of the hospital but compliancy is extremely important
Generally the department can’t adjust par levels on their own, it is based on usage and supply chain department policy
Requires input from the clinician prior to opening the cabinet

23. RFID- Cabinets and Carts
Very good technology for expensive items
Tag is required to be added to products that are tracked in the cart or cabinet
Additional work flow may be too much for lower dollar items
IT support needed for network drops and server setup
Some vendors only offer RFID and not a barcoding option. Both are really necessary for supply chain especially in a GI department

24. Barcoding- the simple and fast way!
Most packages come with a barcode from the manufacturer
Primary
Secondary
Concatenated
Utilize the barcode to input information into an inventory management system that has a global database of products
Collects the expiration date and lot information of the product being added
Enter the items when they are received to department and scan them out to a case when they are used
Establish par levels based on usage instead of fear of not having
Web-based options are easy to implement and require limited IT resources

25. What’s new in SpaceTrax Point of Use 2.4.6?
Process
Technology
Software
Q & A

26. How does software help a GI department?
Provides a method of capturing barcodes when adding or using the product in a case
Some software have a global database of items which means you don’t have to setup an item master
Dictation software doesn’t have allow for par level setup but works well along side an inventory management system
Reporting on what you have used vs what you have purchased
Autonomy in the supply chain process rather than having to use what is used in the rest of the hospital that may not work as well in the GI department

27. What to consider when looking at software
How easy is it to implement?
What problem are you trying to solve?
Do you need your IT people for the project to happen?
What is the total cost of ownership?
How easy will it be for my clinical staff to use?
Are other GI Departments using a similar software?
Does it offer a global database of products?

28. Next steps Read Lean Hospitals by Mark Graban
Research if your facility has a Lean Six Sigma Black Belt or process improvement group
Create a task force in your department (include Physician Champion if possible)
Complete a value stream map of your current supply chain process
Do 5S project in your supply areas
Investigate companies with inventory management system that supports both barcodes and RFID (if needed)

29. Comments or Questions