Tuesday, July 03, 2012

Supplying Ipswich Hospital

As we continued our Lean training workshops at Ipswich Hospital, we spent some time with Thomas, the young man who is in charge of the major receiving and distribution center for supplies entering the hospital.  Specifically, the HSDU ("hospital sterile and disinfection unit") storeroom contains medical devices and supplies and sterile equipment and packs for wards, departments and theatres (i.e., ORs).
All of the managers taking the workshop were tremendously impressed with Thomas -- his devotion to the health care mission of the hospital, his sense of initiative, and his strong sense of responsibility to the patients whose care depends on maintaining an adequate supply of mission-critical equipment.  And yet they also quickly came to understand that Thomas, in essence, is working with one hand tied behind his back, i.e., in an environment that is designed to be inefficient and wasteful.  In that regard, I told the group, he typifies many other inventory supply people in hospitals worldwide.

Thomas and his colleagues in many places live in a world in which they are put in the middle, receiving no visual cues as to incoming supplies from vendors and also no visual cues as to the demands of customers, the wards and ORs upstairs.  Some of his suppliers are reliable, but at least one is not, sending packages slowly and in deficient quantities.  On the demand side, if there is a surge in, say, OR utilization, he learns of it by a quicker depletion of his stocks.  He also has no idea how much inventory is being stored on the wards or, as here, in trolleys in the hallways outside the wards.

So Thomas does what you or I would do.  He plans conservatively, using rules of thumb that result in over-stocking of supplies.  After all, the last thing he would want to do is run short when a patient's life is at stake.  For example, knowing that one supplier is slow and unreliable, he over-orders from that supplier.  If he still runs short, he can pay extra for an emergency delivery.  In both instances, he is essentially rewarding the unreliable supplier.  Because Thomas is not in charge of the procurement process itself and has no influence with that department, it does not matter if he calls out this problem to a superior. 

The knowledge Thomas needs to do his job is essentially inside his head.  If he were to get sick and injured, there is no one else in the hospital with his abilities.  When he leaves for a two-week holiday, he pre-orders extra supplies for those two weeks.  "When I am on leave, I have to cover stock whilst I'm off."

The managers in our Lean workshop left with a greater appreciation for people like Thomas, but also with an understanding that their role as hospital leaders must evolve.  In a health care system facing ongoing cost pressures, the kind of inefficiency represented by the environment within which Thomas is working is unacceptable.  He should be given the tools he needs and the support he deserves to efficiently stock and deliver the millions of dollars of inventory needed for safe and effective patient care.  I believe that, whether or not Lean becomes a hospital-wide philosophy,  our team felt strongly a new sense of responsibility to take steps to adopt its principles in their own work environments.


Satheesh Iype said...

Great session! Very effective management training by very different approach. Lean approach gets things in perspective.
Satheesh Iype

Anonymous said...

Having read your extensive posts on Lean for several years, I am interested how you are managing to do a 'quick and dirty' version of Lean, given the extensive acculturation that seems necessary in the long version. I am especially interested because I have long thought that, although the long version is great if one has the time, funding and leadership to do it, a shorter but equally effective version would be of the utmost value to most hospitals.

nonlocal MD