Wednesday, August 20, 2008

Lean is not about dieting

Following yesterday's story, here's another example of the Lean methodology in action, as presented in an email from one of our nurses to her colleagues this week. Note the involvement from others in the hospital that have had experience on their own floors. Wait, are they having fun, too!? I have heard too many reports of that. Quick, call out the seriousness brigade and put a stop to it.

From: Serrano,Marjorie I. (BIDMC - Nursing)
To: Nursing Farr 6 All

Lean Update on Farr 6 Clean Supply Room

As you could see, there was a lot of activity in the clean supply room today. The Lean team from the President’s office, Distribution plus 11R’s Marnie Pettit, RN and Martha Clinton, PCT, and Farr 7’s Beth Morrison, and Catherine McCollin worked with the Farr 6 team to redesign the clean supply room for better flow. We will be back tomorrow to continue this work.

We received training on key Lean principles which taught us that spending time searching and fetching items means less time spent on real work – time with our patients. Even when we can easily find an item, does it make sense for us to put items out of reach, i.e. too high or too low? Why not imitate the supermarkets that place frequently used items at eye level, like bread!

Lean calls these non-value added steps, “waste”. We spent the day removing as much waste out of the clean supply room process as possible. Last week, we counted the par stock right after it was fully stocked, then counted again the day after before it was restocked. This gave us the number used for one day and was used to determine the amount needed on your supply room carts (called the par number). We realized we had more stock than we needed in some cases and not enough in other cases based on this count so we removed all excess stock as well as added additional stock where needed.

Once we regained additional space, we organized the stock logically by function and for flow. For example, you will see we now will have zones for Housekeeping, ADL, GU/GI, Wound Care, Procedures and Respiratory. We then placed the most frequently used items at eye level to reduce bending and reaching. Most items are now in bins and the bin sizes indicate the amount of stock needed. The bins will have 3 labels: the “common name label” on the front of the bin – what most of you call the item, the “picture of the item label” on the bottom of the bin to tell you when that bin is empty what belongs there, and finally the “reorder label” also on the bottom of the bin that tells you the item number, cost & the ordering amount so when you are out of an item, you have the information needed when calling distribution.

Some examples of changes:

Items moved to the kitchen: Pitchers, liners, straws, cups
Items moved from Med Room to Clean supply room: Stat Lock for Piccs
Some skincare items were removed at the suggestion of the wound care specialist. These items will be reevaluated at the wound care task force tomorrow. (Keri Oil, Keri Lotion, Duoderm, Sheepskin, A+D Ointment, Antibiotic Ointment
Items that were added include: Duoderm Gel, Barrier Wipes, 5x5 Allevyn Foam, Non sterile suction tubing, Wound Cleanser, 9” armboards
Cable ties were moved to the resource drawer with the gun
Flashlights are now stored on equipment shelf in RN station.
Sustaining the gains

Lean taught us that this is a continuous improvement process so please give us your feedback and we will continue to improve. All of us own this process and keeping the Clean Supply room neat and tidy depends on all of us.

Thanks to Marnie, Pam, Bettyna, Marie, Singh, Beth, Catherine, Marnie, Martha, Bill, Jenine, Sam, Brandan


1 comment:

Anonymous said...

Lean loves the 70's technology of bins and labels, I guess you can call that "Going Back To Basics and Forward to Better Quality and Organization."

P.S. Is it the nurses job to organize supply closets?