Two Bin Supply System at St Clair Hospital

St Clair is a large community hospital just outside Pittsburgh, PA, that has committed to using Toyota/Lean principles and methods for continuous improvement. We just spent 10 months in 2011-12 converting from a par system for replenishing nursing supplies to a two-bin system. This video is a brief overview of our process and the impact the change had on nursing staff.

[@trlyon]

Our next step is to tackle our central supply room. We learned through this process that nursing staff were direct-ordering all kinds of lower volume supplies because of lack of space to stage them in central supply. Seattle Children's overhauled their central supply room and relieved all clinical staff of any ordering responsibilities. They also renegotiated their contracts with suppliers to have them deliver pre-packaged totes with the exact amount needed to fill a bin. We're not done yet!

[@trlyon]

We had hoped to decrease the volume/cost of inventory on the shelves and were surprised when that didn't happen. We found that we eliminated or reduced some items, but added or increased others so that it more or less averaged out across the hospital. We didn't so much purge excess inventory (materials had managed that fairly carefully--even under the par system) as OPTIMIZE inventory. We now have the right amounts of the right items. The benefits accrued to nursing staff workflow.

[@catch9]

Remember that the bin isn't the grail really. It is just a signal. Space concerns could mean going to a single bin with a divider - and the divider could double as the Kan Ban card.....stack bins on each other - this also prevents the hand from going into the wrong bin......Ideally, an exchange cart system would be best. Each day the carts are exchanged for full ones and returned to main stores (or better yet, the vendor) for filling - and repeat. No matter the system, it will be at the mercy of humans - and humans will find all kinds of ways to try and defeat the best laid plans. Just keep pluggin away at it.

[@nelseify]

I think this could be improved by the second bin having some kind of red removable marker, this will allow better visual control of items that are running low and prevent restocking errors or omissions. When the new bin arrives the marker can just be moved to that bin and then that becomes the second bin

[@theeasiestway2822]

correct

[@gamertimer857]

Good job! It is great to see that pull system is there also.

[@FastCapLLC]

Excellent example of lean. Hopefully the implementation time is reduced with each endeavor! I'll be sharing this video on to others. Paul

[@trlyon]

Paul, I have used YOUR videos over and over again in many a leadership or 5S training. I'm delighted to return a fraction of the favor! Tania

[@FastCapLLC]

Tania Lyon Wow Tania. That is very cool. Keep up the great work. I'll be looking for more videos. Paul

[@CraigStritar]

Looking forward for any updates you may post. Some of our unit directors have already seen this video, which really helped to demonstrate how these "manufacturing" principles apply to a health care setting. Good luck on your journey!

[@elibutton]

Awesome job, and excellent video. Love the staff feedback and testimonials at the end, especially being transparent about change.

[@trlyon]

They don't use fewer supplies, but they do *order* fewer supplies (the system eliminated multiple storage locations, hoarded supplies, and hidden supplies--i.e. supplies stacked in unopened boxes so the contents are difficult to see).

[@ConnecticutEmporium]

It looks like the scanner is a bit slow to use (this could be fixed by switching to an omnidirectional model). Also, the entering of 0 qty each time is extremely redundant and can definitly be eliminated. This is definitly a huge improvement though!

[@trlyon]

I'll forward this to our Materials dept. Both good suggestions! We still have hundreds of improvements to be made.

[@troybarnes1572]

It would speed up the process to just scan the bin and have the handheld scanner enter 0 for you.

[@williamstrom6948]

In the setting of this bin and cart system, we did not use kanban cards due to the difficulty of placing the cards and their ability to become lost. The number of items not able to fit in a double bin are few in number, so they are simply highlighted as items that need to be hand counted the old-fashioned way. The material handler will count the 3 or 7 items and key in the number to bring it up to par.

[@prasadkuchipudi6825]

Tania Lyon two bin system is very good system for medical supplies at nursing stations. How you are coming out from following problems, 1. Look a like & Sound a like items 2. Keeping products in a wrong bin, 3. Frequency of replenishment of products. Example micropore different sizes are kept near by and there are chances of misplacing the products. My another question is, do you implement this concept for Drug/Medicines ?

[@gtamir613]

Kanban is the way to go. If only this hospital had a system like Pegasus to actually store the supplies - they would save a tremendous amount of actual space to store their supplies and would still be able to use their kanban software.

[@trlyon]

The handlers themselves have argued that there is no time advantage to bringing the bins down for re-stocking and we want them to be involved in the design of their own work. We will continue to collect data on this and look for the most efficient restocking process for our particular facility.

[@CraigStritar]

Great work! I would be interested to see how this evolves. What is the next step in the PDSA cycle? For example: why does the material handler have to scan the empty bin, go back to the warehouse, place the items on a cart, and transfer them to the bin in the supply room? Is there any reason the material handler cannot just take the empy bins to the warehouse and replenish them directly?

[@CristianSandoval]

good point.

[@mcfegley]

This looks like a great system. Could I ask what the inventory value was for the par cart locations before and after the two bin system was adopted?

[@awesome220]

6:30 The nurse says they use fewer supplies with the two bin system. I don't see why this would be the case. Someone please explain. Thank you!

[@kawaiisenshi2401]

What system/software is typically used for supply / inventory management? 😢

[@michelleklemola7338]

we are planning on switching to this system can you show us the Material side of this? How is your warehouse set up to fill these?

[@quantquill]

This is a great video. I use it in my Intro to OM class. The closed captions have a number of issues. Any chance of having those polished up for students who require captions? One example - there aren't any sentence breaks. Another: Rick Chesnos' name is written as Rick chest nose. Thanks!

[@trlyon]

I did not even know it had captions until you pointed this out, so thank you! It took me a while, but I think I have successfully cleaned them up. Please tell me if you notice any errors in the transcription!

[@joemcilhattan7359]

Hey Tania, great video! Have you ever considered upgrading from Kanban to a weight-based system? Some combination of both?

[@trlyon]

Joe - I've never heard of a weight-based system. What is it?

[@jimcasto4005]

Tania - I'd be happy to get you information around our weight-based technology. Essentially, when items are removed from a bin, the system keeps track and orders accordingly. No need to scan or check for empty bins to determine what a nursing location needs. This allows for accurate inventory on-hand visibility at all times across the facility (critical alerts, built in reporting/analytics, etc.). Jim - [e-mail]

[@prasadkuchipudi6825]

@@jimcasto4005 Weight based technology may not suitable for hospital supplies. Weight based technology is very good in automobile and manufacturing industry.

[@clarencelucas1082]

Weighted bins can sometimes be time consuming when subs are needed or allocation issues keep in mind

[@worldofthought8352]

I think their trying to include a similar system to our area but there's the matter of costs and not getting planning persmission as the nhs trust I work doesn't own it's own hospitals. I am concerned with the number of container bins given the amount there are to clean, how do you approach it, you clean x number of containers one day and x number after that?

[@awesome220]

From what supplier did you get the plastic storage bins?

[@williamstrom6948]

The supplier we used was Global Industrial.

[@jondrosdick9858]

Will, I would like to speak to you regarding a similar project. My email is [e-mail] if you want to connect.

[@doolegr]

Tania, how deep are those wire shelves? I'm only working with 14 to 15" deep shelving and there's no way I can fit 2 bins (one bin behind another) on the shelf.

[@trlyon]

Our shelving is 18"-24" deep. Depth is definitely an issue for a two-bin system. We almost always tore out existing shelving and replaced it with new wire racks on wheels.

[@doolegr]

I was thinking 24" deep would need to be the depth of the shelves for a 2bin system. With such limited space I will have to get creative. Thanks for the reply.

[@awesome220]

What about items in the closet that are too big/bulky for bins? Did you simply use a card kanban system instead? Thanks.

[@troybarnes1572]

We use many Kanban cards for bulky items and it works pretty well. Items such as Yellow Gowns, Gloves, Suction Cannister Liners, Mattresses, Water Pitchers, Attends/Depends, Formulas, Saline Flush Syringes, and many more.

[@awesome220]

@@troybarnes1572 makes sense!

[@sandeshshrestha9682]

Hi Tania, Thank you for sharing the video. I am trying to establish Kanban system in my hospital. Assuming the handlers round on the empty bins once a day, what would the Lead Time be. Lets assume that materials can be replenished in 2 hours. Could you please share the formula that you used to calculate the Kanban Size. Thanks!

[@trlyon]

+Sandesh shrestha - You would need to have historical usage data for each item to establish the amount of each item you want in each bin. You also don't want your handlers replenishing every bin every day - you want to level the workload by having items rotate at different speeds and intervals. If you have 200 items in a storeroom, you probably only want about 10%, or 20 items requiring replenishment each day. So perhaps calibrate your stock to last about 10 days each. Bulky items could rotate faster to save space, items with no expiration dates could rotate more slowly to relieve pressure from the replenishment schedule. This is a very general response - I've invited our engineer to respond in more detail if he can!

[@sandeshshrestha9682]

+Tania Lyon Awesome! It's helpful. I have a directional sense. Any detail response would be helpful as that would help us make the transition with less errors. Thanks, Sandesh

[@ieintheed168]

+Sandesh shrestha Please feel free to email me at IEintheED at gmail dot com. I would be happy to discuss your project in more detail privately. Thanks! -William Strom (Industrial Engineering Consultant in video)

[@sandeshshrestha9682]

+IE in the ED Thank you William. Appreciate your willingness to help. I will reach out to you shortly. Thanks,Sandesh

[@junfengchen2961]

My question is how often a material handler should check the empty bins and scan the bins on the top of the shelf.

[@trlyon]

Junfeng Chen In our case, the handlers round on the empty bins once a day. However, you can design the system however works best for you--the more frequently you check on bins and replenish them, the less stock you need to keep on the shelves. The less often you check the bins, the more stock you have to keep in order to avoid stockouts. It's a formula each organization would have to work out for themselves.

[@junfengchen2961]

Tania Lyon That makes sense! Thank you so much! Awesome video!!

[@jamesgao2389]

Hi Tania, Does the handler scan the empty bins and replenish 7 days a week or 5 days a week? I was wondering how the weekend demands can be handled if ordering and stocking only happens Mon-Fri?

[@trlyon]

James, it depends on the unit and how fast they use supplies. Most nursing units are replenished once a day, 7 days a week in our hospital. If you only replenish M-F, then you have to hold enough stock for 3 days and you have waste in your system. In our ED, the supply rooms are checked and replenished 3 times a day. It just depends on your space (if you don't have much space, you have to replenish more frequently) and your staffing (if you don't have the manpower to replenish frequently then you have to store more stock).

[@jamesgao2389]

Much appreciated, Tania! It seems that your set-up at ED is already quite close to an automotive manufacturing factory. We are just about to start and may need to establish a beachhead, although there will be still waste.

[@Heavy-metaaal]

Unfortunately, many people don't believe Kanban system.

[@the3rdbestnikkashopinyoura540]

Should have used a rubber/non-marring mallet to assemble those shelves at 2:30

[@troybarnes1572]

I was thinking that, too. We use rubber mallets when doing this. You drop that steel mallet on your toe, ouch! Rubber, not so much.

[@jonathang6743]

@@troybarnes1572 The mallet isnt for protection of the toes, its for the protection of the shelving.