Jamie Liebler

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 • 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 20-60 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