Does managing inventory need a reboot?
Improving healthcare’s moving parts in moving parts no easy
task
by Rick Dana Barlow
S uccessfully
managing inventory may be fundamental to effective and efficient Supply
Chain operations, but it’s also essential and foundational to clinicians
performing their duties, including doctors, nurses and surgeons.
That makes inventory management a key component of patient care
and quality outcomes with easy-to-overlook direct and indirect touches in
the process.
Bottom line: Without inventory management, patient care and
quality outcomes would be so much more challenging to carry out, let alone
virtually impossible to deliver.
Walk into a department, grocery or other retail outlet and not
see the product you want on the shelf and you’ll likely go to another store
to get it. However, in a hospital, with a patient on the operating room
table in the surgical suite, you clearly don’t have that luxury, costly
freight deliveries or panicked calls to nearby facilities for bailout
notwithstanding.
Unless you’re an anal-retentive obsessive-compulsive type who
breathes order and tidiness your inventory management spaces might need some
work — whether incremental redesigning or a complete reboot. Where to start
with minimal disruption?
Healthcare Purchasing News Senior Editor Rick Dana
Barlow asked five inventory management executives to share relevant
perspectives, success stories and lessons-learned failures and tips from the
pros on effective and efficient inventory management strategies — from
shelving to software to storage products.
HPN: If you could "reboot" inventory management practices and
procedures — given a clean slate with which to work — what would you include
in your blueprint/playbook and why based on current and past performances?
Teran Andes, Executive Director, Product Management,
Global
Healthcare Exchange (GHX)
The first priority is to take a thoughtful approach to
categorization of spend. Review inventory turns to find out where you are
turning well, and where you aren’t. This should not be a single organization
exercise. Every organization is best served by working closely with its
distribution and manufacturing partners to get a thorough understanding of
what’s being stocked. That will enable the organization, across their supply
chains, to determine if it has too many SKUs as well as identify
opportunities for standardization. The ultimate goal is to avoid stocking a
large quantity of lesser-used products, while falling short on high-volume
items.
Inventory on hand is a huge pain point, and expense, for the
industry. Organizations need to build an action plan that establishes true
transparency and visibility for supply chain partners. This will ensure that
the right supplies are on hand based on the schedule. This visibility will
also afford greater flexibility when the schedule changes. All partners can
adjust in unison.
I would also look for opportunities to create lean facilities.
Opportunities are limited in older institutions where the original structure
wasn’t designed to optimize inventory storage and movement. Greenfield
facilities can be designed both for optimal patient and physical flows. Look
for both within your acute and sub-acute facilities.
John Freund, CEO and Chief Technologist,
Jump Technologies Inc.
We have all heard it a thousand times that the job of supply
chain managers is to ensure that the right product is available in the right
place, at the right price, at the right time. This job is made much easier
by the fact that the vast majority of vendors (McKesson, Cardinal, Owens &
Minor, etc.) do the "heavy lifting" regarding distribution logistics,
allowing hospitals to typically receive orders within hours and certainly no
longer than a day or two from the time an order is placed. However, the
software that runs most hospitals today is rooted in manufacturing where the
supply chain is far more complicated and difficult to manage. As a result,
hospital supply chain management processes are bloated, out of date and
expensive for a typical hospital environment due to the high labor costs
associated with them.
So my "reboot" would be to get rid of healthcare’s archaic
supply chain management technology and the processes that go with it. I
would replace it with systems that are quick to implement, simple to use,
and powerful in their ability to provide data analytics. Doing this would
allow healthcare facilities to cut requisitioning costs, increase contract
compliance, reduce inventory, eliminate stock outs, and cut back on waste
caused by expiring products — all while getting the right product to the
right place at the right time at the right price.
This new system leverages current technology like the cloud and
mobile computing to enable simple implementation, use and updates. Vendors
of these systems manage their applications in the cloud rather than
burdening the hospital with the cost of the hardware and IT expenses
associated with managing the software.
Finally, clinicians and supply techs embrace this system
because it allows them to do their jobs more efficiently. In today’s
outcome-based reimbursement world, clinicians will need to get more and more
involved in the materials process. In my new world, clinicians willingly
accept their new role in supply chain management because the system actually
makes their their job easier rather than burdening them with complicated
processes that they will never follow.
Charles Hodge, President,
BlueBin
The biggest issue that we see in the healthcare supply chain
world is that clinicians are spending a significant amount of patient care
time managing inventory, especially in the OR, labs and ancillary service
areas of the hospital. Just recently we have had the chance to start from
scratch — a clean slate — with a couple of newly built hospitals in
Florida. In the BlueBin playbook, a major focus of ours is giving back full
control of the supply chain to the Supply Chain department. This not only
gives the clinical time wasted on managing supplies back to the patient, it
also drives significant cost savings and end-user satisfaction. This is
exactly what we did with the Greenfield hospitals we assisted this year,
implementing a visually managed kanban system that manages all medical
supplies in all departments.
Sandesh Jagdev, Principal,
Logimaxx
In many hospitals, the current state of inventory management is
a result of evolving circumstances and changes over the years, and for many
of them it is absolutely warranted to "reboot" the inventory management
practices. A blueprint for rebooting starts with reevaluating the key
ingredients: Processes, people and technology associated with inventory
management function.
Reengineering of processes is the first and most important
step. Each inventory-related process is evaluated to address the following
questions:
-
Are the functional spaces organized to obtain maximum labor
productivity? This may call for the redesign of the physical layouts and
storage methodologies for improved picking and put-away productivity in
storerooms and shorter search time for clinical customers in the PAR areas.
For example, reorganizing supplies by categories in collaboration with
clinical staff.
-
Do you have right levels of right supplies in each of the
functional areas? In many main and surgical storerooms there are inactive
products that are not used for months and years that are taking valuable
space. Also, many PAR areas have supplies that are rarely used. These
supplies are taking valuable space that is needed for more frequently used
supplies. Going forward, managing inventory needs to be an ongoing process
and is best achieved by a data driven analytical methodology beyond what is
found in a Materials Management Information System.
-
Are the replenishment frequencies for each inventory area set
for best labor productivity? The vast majority of inventory areas inside a
hospital are replenished more than necessary. By reducing the frequency
while resetting the stock levels accordingly, a 40-percent to 60-percent
gain in labor productivity could, in most cases, be accomplished.
-
Are you using Lean concepts to process redesign? Use of Lean
concepts in process redesign helps eliminate redundant steps in a process
which ultimately helps minimize number of "touches" and helps assure having
the right inventory levels in the right places at the right times.
-
Are you using indicators to measure and evaluate inventory
performance and management? An inventory turns ratio provides a snapshot
into how well supplies are being managed, but it is the parsing of the data
that identifies changes that will improve the performance. For example, what
items have not moved in the past year and which of them can be eliminated?
The labor associated with the acquisition, storage, processing and
distribution of inventory is another important area. Yet detailed
productivity measures are not commonly used in healthcare.
Reevaluating technology should not always equate to newer
technology. Often, maximizing use of existing technology delivers better
dividends than major new investments. Here are some keys for evaluating
existing technology options:
-
In some instances, certain technology is purchased [but] not
put to practice. Before investing in any new technology, evaluation of what
is available is a must.
-
Implementation of technology without changes to related
processes also creates redundancy and waste. For instance, implementation of
point-of-use systems without proper training and compliance monitoring could
actually create extra steps in the process.
-
The vast majority of MMIS’ are now offering mobile supply
chain modules and handhelds. Many hospitals have already implemented mobile
supply chain; however, very few are getting maximum benefit from such
technology due to a lack of standardization, retraining and compliance
monitoring.
-
Many already use RFID for tracking durable medical equipment.
Use of Active RFID technology more importantly and with appropriate training
will help gain maximum benefit from such technology.
-
Retraining of people
is another major factor in
rebooting the inventory management practices. Here are the key areas to
address as part of the rebooting process.
-
Standardization: Each of the functions directly tied
to inventory management, such as receiving, put-away, picking, stocking,
cycle counting, etc., need to be standardized as a first step in this
process. In many operations, each person may have tendency to perform steps
in the process slightly differently, which may have direct impact on the
productivity. Part of this step has to be training employees to standardize
the use of technology such as mobile supply chain handhelds.
-
LMS: Labor Management Systems are commonly used in
other industries to monitor labor performance and productivity. Use of LMS
is not very common in the healthcare industry. Adopting LMS tools similar to
other industries could significantly improve supply chain productivity and
encourage higher employee productivity. In the current state, clinicians
spend a certain amount of time in supply related activities. By improving
Supply Chain labor productivity, Supply Chain staff could relieve clinical
staff by reducing their supply-related activities and therefore [provide
them] more time at bedside.
-
Customer Service:Another step in rebooting process
will be to retrain Supply Chain staff to build more credibility towards
clinical staff by improving inventory performance and going beyond what is
expected of them. Also, having a regular communication with clinical staff
to obtain feedback and create continuous improvement cycle is a must.
Here are some key guidelines in implementing an inventory
management rebooting process:
-
Change has to be gradual so that it is not perceived as
disruptive. For instance, for a surgical storeroom that is turning inventory
four times, the next target could be six turns during the next quarter
before you get to eight turns. Also, implementing of major reorganization of
supply areas during off hours and weekends with proper communication briefs
is critical.
-
Communication with all parties involved throughout the
process is the most critical function. Lack of communication is a key reason
for failure in the change management process.
-
Process compliance and dedication to change management is
what leads to longer term sustainability which ultimately helps avoid
another rebooting process.
Michelle Robbins, Industry Strategy Director, Healthcare,
Infor
The consolidation of healthcare facilities and the emergence of
the consolidated service centers (CSC) have, in fact, been providing a
canvas for many organizations to rethink their inventory management and
procedures. At Infor, we are talking with many of our clients today about
our Warehouse Management Solution (WMS), and it is evident that the industry
is thinking beyond managing the activities of the storeroom and shifting to
developing strategies to control the movement and storage of materials
within a warehouse environment.
Taking the cue from other industries, Vendor Managed Inventory
(VMI) would be at the top of my playbook. This is not the traditional
consignment agreements in hospitals today, but instead true VMI like Dell
and Walmart, where the vendors stock and manage their products or designated
space. Remarkably in other industries, vendors actually pay for that space
in the warehouse!
Another item I would include in my playbook would be the
implementation of demand/forecasting tools. The ability to plan and forecast
aggregated demand for the entire integrated delivery network (IDN) to
maximize purchasing strength, analyze trends and consolidating purchases is
crucial for managing inventory practices and procedures.
Outside of healthcare, "intermodal" and "omnichannel" supply
chains are all the rage in the industry lexicon. How might supply chain pros
in healthcare adapt and adopt this mentality/philosophy that spans
warehouse, store/supply room, closet, exchange cart, PAR level and patient
room?
ANDES: It is likely
that only the larger organizations will be able to think about and execute
this type of change. It’s more important for the mid- and small-sized
organizations to think about the supply chain strategically, understanding
what your organization is capable of doing today and the ability to absorb
change or leverage cutting-edge supply chain/logistics techniques.
Most organizations have so much going on already that they
simply do not have the budget, resources or in-house expertise to implement
these capabilities. Experience suggests that they will be better served by
placing emphasis on creating strong partnership with distributors and
manufacturers. Organizations should strive to give their supply chain
partners visibility so that as the schedule changes, all parties can adjust
accordingly and take advantage of these best practices. Distributors and
manufacturers either have specialist capabilities or work with third-party
organizations to bring them to bear. If providers can commit to working
collaboratively, they work with each supply chain partner to keep down
acquisition costs, which will help contain overall costs, and improve
profitability where organizations are striving to be profitable at Medicare
reimbursement levels.
FREUND: "Intermodal" is a freight-handling term that
describes product being put in a single container that can be shipped via
different methods without changing the container. Typically they are talking
about a shipping container that can be put on a cargo ship, transported to a
port where that same container is placed on a rail car, and taken to a
terminal where it’s put on a truck that will take the goods to their final
destination. Intermodal has proven to reduce shipping costs and increased
merchandise security due to less handling of the goods in a container. As
such, this applies to distributors who bring supplies to hospitals and
clinics rather than most healthcare facilities. Their goods are transported
via truck, usually from point to point.
Mobile computing is changing the way we inventory, requisition,
manage and receive supplies in healthcare. Omni-channel supply chain
management refers to the ability to store inventory in multiple locations
but treat it as if it were all in one bucket in the facility. The key to a
successful omni-channel strategy is visibility into all inventory at any
given time in any and every place.
Many hospitals and clinics have launched aggressive iOS and
Android-based mobile initiatives. The same devices running apps for patient
drug interaction, X-ray review, physician reference and more can also run an
app that provides total visibility into inventory across the entire
facility. This app not only identifies where inventory is, but allows for
the simple transfer of inventory to a particular location, or the
requisition of inventory if it is not found anywhere in the facility.
From a receiving standpoint, I can use the mobile device to
receive goods on my dock and track those goods to their final destination,
including electronic signature capture, thus ensuring accurate inventory
across all locations or "channels." Again, the same device that is managing
the inventory in multiple locations is also receiving inventory and tracking
it to its final destination. I believe that omni-channel supply chain
management can be effectively done only on a mobile platform.
HODGE: Intermodal is all about visibility and flexibility,
two things in which the healthcare supply chain could learn a great deal
from industry. The integrating of "modes" requires a process or systems
approach for execution. Intermodal transportation is a holistic focus on
process vs. healthcare’s current focus on infrastructure "components." To
move in this direction, our supply chain leaders need to develop a
comprehensive understanding of their total supply chain capability and
performance. Relational data between participants up and down [the] stream
is needed for the transparency this methodology requires, but also
flexibility (the ability to support through multiple "modes"). But keep in
mind, no matter how much we integrate the various supply chain linkages, it
all starts with the clinical end-user. Everything that happens in the supply
chain should begin as the end-user "pulls" the supply into their operation
(to the patient). And this gets back to Lean.
JAGDEV: Intermodal movements have been part of supply chain
strategy for years and have delivered significant cost benefits across
multiple industries. This concept is designed around putting freight in a
container that could travel across multiple modes without having to transfer
contents while reducing the need for additional handling. Use of rail has
helped bring the costs down however sometimes meeting tight service windows
are an issue with using intermodal.
In healthcare there are multiple areas where this concept could
have an application. Recently, the use of "two-bin kanban" is being
re-adopted by many healthcare organizations. A set of bins going to a PAR
area that is filled at a distributor warehouse or service center (as part of
a low-unit-of-measure program) could be placed in a secured container and
transported on carts to a truck, to a hospital loading dock (or all orders
going to a PAR area stored in a single container), to either a cart or other
internal transport systems, such as Automated Guided Vehicle Systems (AGVS),
to PAR areas for restocking, could be an application using an intermodal
concept.
Another example of intermodal is already used in hospitals
[where] small packages, such as medications and lab samples, are placed in
Pneumatic Tube System (PTS) containers that are hand-carried to tube
stations and then transported to a destination station and again taken to
point of use. Recent advances, such as RFID [allow] secured packages to be
sent, maintaining chain of custody requirements associated with medications.
Omni-channel fulfillment approach is mainly used for a smoother
customer shopping experience, improved service time and inventory levels and
lowered overall cost. In other industries this concept has evolved rapidly
with the emergence of various ways customers could order a product,
including using a mobile Internet device, online, via phone (TV, radio,
direct mail, or catalog), via channel partners/distributors, or going to
actual stores. In the past these channels operated as separate channels of
fulfillment.
The supply chain challenges while managing these individual
channels are particularly acute due to a lack of visibility into inventory
through these channels. This increases pressure on inventory turns and
margins making it difficult to continue to proliferate inventory to support
multiple channels. [This] leads to businesses not only missing out on demand
needs but also missing out on meeting service needs. Omni-channel
fulfillment is concentrated more on a seamless approach to the consumer
experience through all available ordering channels. Businesses are meeting
the new customer demands by deploying specialized supply chain technology to
obtain better visibility, streamlining of processes to support these
channels as if they are a single channel.
In healthcare supply chain similar challenges are in play when
there are various ways of ordering supplies or medications. A clinician in
need of a supply item may use a mobile device connected to MMIS, or order to
a clinical system like Cerner or Epic via PC or online portal or via phone
call. No matter how an item is ordered, one of the key first steps is to
bring the order into the MMIS similar to how an order is generated by a
mobile supply chain device. This will help expense an item to the
appropriate department or entity.
More importantly, if the product is picked from a perpetual
inventory location, such as a storeroom, it will automatically deplete the
stock and close the order upon delivery. In the current environment, many of
these processes are manual and therefore leave room for data entry errors,
timeliness on entry, which could affect inventory level and reordering of
the item (if it falls below the reorder point). The omni-channel fulfillment
approach will mainly improve inventory performance, and even more
importantly improve service by measuring of order cycle time.
ROBBINS: "Intermodal" and "omni-channel" are focused on consumers and
their shopping patterns. In healthcare, the supply chain of the future
becomes more patient-centric. At Infor, we are exploring ways to use
automation to take the clinical time out of the supply chain process and use
integration to personalize orders by patient, as well as to standardize care
packages to minimize waste and improve accuracy.
Smooth
moves in managing inventory
Moving
violations
Going
offroad
|