1. Purdue Research Foundation © 1 LEAN HEALTHCARE: Departmental Supply Ordering And Storage

2. Purdue Research Foundation © 2 How the Journey Started… IRHA offered the opportunity for member hospitals to participate in Lean Training in the 2011 -2012 cycle. Woodlawn Hospital sent 5 people to Yellow Belt training, 1 person to Green Belt training 1 person to Black Belt training

3. Purdue Research Foundation © 3 By The Numbers… 20 critical access and rural hospitals from across the state participated in this project in its entirety 3 Focused Project Areas: – Emergency Department Throughput (8 hospitals) – Transitions of Care (9 hospitals) – Readmissions (3 hospitals) 7 different hospitals used as training locations

4. Purdue Research Foundation © 4 By The Numbers… 85 people attended a 1-day Executive Training Workshop 53 people attended at least one of the pre-training webinars 140 people attended the 4-day Yellow Belt Trainings 41 people attended the 2-day Green Belt Trainings 20 people attended the 1-day Black Belt Training

5. Purdue Research Foundation © 5 Lean Certification Project Woodlawn Hospital, Rochester ED Patient Throughput Discharge Summary revision, testing, staff education completed. Staff pleased with the easier format and can more thoroughly document in the available text box. ED Assessment forms have been shortened from 6 pages to 2-3 pages each ED Log data entry by ED staff decreased by 100% due to new automated ad hoc reports

6. Purdue Research Foundation © 6 Moving Forward... Woodlawn Hospital has made a conscious effort to continue using Lean methodologies and tools to make a difference in our hospital since the completion of the original ED project.

7. Purdue Research Foundation © 7 ON BOARD WITH LEAN Administration support Lean Project Request Form – Here to help – Departments invite Lean in Presentation to Leadership Team

8. Purdue Research Foundation © 8 5S PROJECT PILOT- OB Trouble getting supplies returned – Yellow sticker system Issues with par levels Supplies in multiple locations, some not near point of use Special request items not included in sticker system that nursing staff has to track and order Project Request: Supplies

9. Purdue Research Foundation © 9 FIRST THINGS FIRST Compile team – OB Manager, Materials Management Director, Materials clerk, OB nurses (as available during their shift) Education of project team – Lean – Changes made with them, not to them – Quick Overview of 5 S for Nurses

10. Purdue Research Foundation © 10 DATA COLLECTION Interview those closest to the process – Nursing staff – Comments “Not enough storage space” “We don’t get supplies returned very well” “Delay patient care until the item is located” Voice of the Customer/Stakeholder (VOCS)

11. Purdue Research Foundation © 11 DATA COLLECTION, continued Process Flow Map – Time spent on inventory, ordering, restocking supplies OB staff spent 146 min/week – Materials spent 47 min/week Time to Find 5 Items – OB nurses: 50.1 seconds – Non-dept staff: 7 min 11.8 sec Take “Before” pictures

12. Purdue Research Foundation © 12 5S Simple process of organizing supplies/equipment for improved workflow and better use of resources Sort: – All unneeded items, equipment, supplies removed from area Set in Order: – A place for everything, everything in its place Shine: – Keep items and the work area clean Standardize: – Apply methods consistently across all areas Sustain: – Becomes a part of the culture (this is the difficult part)

13. Purdue Research Foundation © 13SORT Remove from area unnecessary supplies/equipment – Red Tags/Unneeded Items Log Staff completed PriorityFrequency of UseHow to Store Very LowYearly or less Is there even a need? If yes, warehouse it LowLess than once per monthStore away from workstation MediumWeekly or monthlyNear, but not at, the workstation HighSeveral times weakly/dailyAt the workstation

14. Purdue Research Foundation © 14 SORT, continued Comparison of current stock and par levels with annual usage report to identify over- stocking – Established a 3-day par Restock M, W, F (3 days gets through weekend) – Consider staff feelings and experience

15. Purdue Research Foundation © 15 SET IN ORDER A place for everything and everything in its place – Nursery items remained in the nursery – Medication supplies remained by the Pyxis – Supplies were restocked from six locations Decreased to two Supply remains at point of use, but is stocked from central location – Looked at how items are distributed from Materials Syringes-- Box v. Each

16. Purdue Research Foundation © 16 STANDARDIZE Methods applied consistently – Color coding established hospital-wide – Requisition list cleaned up Eliminate unused products Reassessed special order items – If ordered frequently, move to stock

17. Purdue Research Foundation © 17 SUSTAIN Part of the culture – Communication Board – Bins used allowed for just enough space for par levels set Adjust pars as necessary Give staff a voice

18. Purdue Research Foundation © 18 SHINE Clean – As you move supplies, the dust will fly

19. Purdue Research Foundation © 19 The Results Return of supplies in OB totaled $1,545 Time spent on supply management (weekly) – OB: 146 min decreased to 5 min – Materials: 64 min increased to 111 min – 40% decrease in total time spent in all dept – Shift from Nursing staff to Materials clerk (better use of talent) Time to Find 5 Items – OB Nurses from 50.1 sec to 43.7 sec (12.77% ) – Outside Staff from 7 min 11.8 sec to 74.8 sec (82.68% )

20. Purdue Research Foundation © 20 BEFORE AFTER

21. Purdue Research Foundation © 21 BEFORE AFTER

22. Purdue Research Foundation © 22 BEFORE AFTER

23. Purdue Research Foundation © 23 BEFORE AFTER

24. Purdue Research Foundation © 24 Spread of 5S project Supplies centralized Secure Restocked by Materials – Duplicate orders stopped EMERGENCY DEPARTMENT

25. Purdue Research Foundation © 25 Created a centralized supply room Med Room Previously 8 areas for supplies Decreased to 2 and restocked by Materials, not Nursing Able to return a patient room to patient care from equipment storage Spread of 5S project Med/Surg

26. Purdue Research Foundation © 26 Spread of 5S project Med/Surg Med Room Interruption-Free Zone around Pyxis All medication supplies and sharps kept here

27. Purdue Research Foundation © 27 Spread of 5S project ORGANIZATIONAL IDEAS

28. Purdue Research Foundation © 28 Spread of 5S project Kanban Cards Standardization of Rooms Device that clearly triggers action Staff knows where everything is and pars stay set

29. Purdue Research Foundation © 29 Sustainability of 5S project results System promotes adherence to par levels Changes in supplies Pars/Update Order sheets Fire Codes Departmental Follow-up

30. Purdue Research Foundation © 30 Sustainability of 5S project results Staffing/Time Constraints Budget Constraints Data Collection – Found our way back Difficulties we’ve encountered along the way…

31. Purdue Research Foundation © 31 QUESTIONS?

32. Purdue Research Foundation © 32 Dawn Gabrich, MS, ATC, LAT – Rehabilitative Services Coordinator – Lean Black Belt - Woodlawn Hospital Carrie Bowers, MBA – Senior Accountant – Lean Green Belt - Woodlawn Hospital Sheila Kelty, DHA, FACHE – Lean Six Sigma Black Belt - Purdue Healthcare Advisors – kelty@purdue.edu

33. Purdue Research Foundation © 33