Optimization of EVS Supplies Stocking Procedure Final Presentation IOE 481 | W17 | Team 7 Kathy Chen, Eve Gendron, Harneet Singh, Joey Varsanik April 14, 2017

Overview Current Process Key Issues Goals & Objectives Project Scope Project Approach Findings & Conclusions Recommendations Expected Impact Introduction & Background- Key Issues- Goals & Objectives- Project Scope- Project Approach- Expected Impact- Findings & Conclusions- Recommendations-

Current Stocking Process

Key Issues Multiple Trips to Stockroom Inconsistent Usage Inadequate Stock Levels Inconvenient Locations Unknown Inventory Levels Cleanliness of entire hospital – 3 million sq feet Broken up to house keepers and stock keepers The closets are stocked every other day. Closets contain cleaning supplies which include mostly paper products like paper towels and toilet paper, but also sharp containers, purel, and soap. Closet in each of the 4 units on the floor, A,B,C,D Problem: stockouts: creating inefficiencies in the hospital and in the cleaning process

Improve Efficiency of Stocking Process Goals & Objectives Decrease trips to supply room 2 Decrease instances of inadequate supplies 1 Improve Efficiency of Stocking Process 3 Propose methods for future study Goal: Create a more efficient stocking process Objectives Decrease the number of trips stock keepers take to the supply room Decrease the number of instances in which closets do not have sufficient supplies Increase the efficiency of the stocking process Propose methods for study high rates of supply usage

Project Scope Included Excluded 21 University Tower Supply Closets Replenishing & Stocking Closets Supply Stocking Process Placing Supply Orders Schedule to maintain PAR levels Creating PAR levels Plans for Future Studies Evaluating Other Products & Closets Priorities floors 4.8

Project Approach Literature Review Data Collection Data Analysis

Literature Review Exchange Cart & PAR Level Supply Distribution[2] Just-in-time method Redesigning the replenishment process with RFID[3] E-Kanban RFID two-bin replenishment system A Guide to Improvement Projects: OR Inventory Optimization[4] Steps to study supply stockage and usage process Exchange Cart- cart as a central location for all supplies, when empty supply cart is replaced Steps Parties involved/needed, deadline Current State Map Solution developed through research, requirements, process map, inventory analysis, technical review, & trail

Data Collection: Process Times Closet # Time to Stock Closet Time walking to Next Closet Time to Restock Cart Time to Stock Floor Time spent in Elevator Start Floor End Floor

Data Collection: Elevator Times Date/Time Building Elevator # Floors Traveled (a to b) Travel Time (from floor a to b) # of times kicked out of elevator Stock keeper

Key Findings Time Studies Current State Interviews & Observations Cleanliness of entire hospital – 3 million sq feet Broken up to house keepers and stock keepers The closets are stocked every other day. Closets contain cleaning supplies which include mostly paper products like paper towels and toilet paper, but also sharp containers, purel, and soap. Closet in each of the 4 units on the floor, A,B,C,D Problem: stockouts: creating inefficiencies in the hospital and in the cleaning process

Time Studies: Findings Elevator Times Time to go down to Supply Room Time to go up from Stock Room Mean Time 26.51 mins 17.98 mins St. Dev. 11.23 mins 11.06 mins Max 37.74 mins 29.04 mins Peak Total Trip Time: ~67 mins Trips to supply groom can be up to 40 minutes round trip Creates large bottleneck in the efficiency

Time Studies: Findings Current Stocking Period 7am to 4 pm

Time Studies: Findings Elevator Times Morning (7am – 12pm) Afternoon (12pm-5pm) Evening (5pm-10pm) Night (10pm-5am) Mean Time 7 mins 4.5 mins 2 mins 1 min St. Dev. 6 mins 3 mins 0.5 mins Peak Total Trip Time: ~13 mins Peak Total Trip Time: ~1.5 mins Trips to supply groom can be up to 40 minutes round trip Creates large bottleneck in the efficiency

Time Studies: Findings PEAK ELEVATOR TIMES

Time Studies: Findings Process Times Stock Closet Stock Floor Number of trips to stock room (per shift) Mean 8.33 mins 42.75 mins 4 trips St. Dev. 0.15 mins 8.73 mins 1.63 Max 17 mins 52 mins 7 trips

Time Studies: Conclusions Time to Stock Room Up to 40 mins one way Elevator peak times 8am-9am & 11am-1pm Trips to Stock Room Room to decrease frequency Process Times Large St. Dev. due to lack of standardization

Current State: Findings Fix picture

Current State: Findings EVS Management Peak internal traffic Stock Keepers Heaviest stocking shift Heaviest housekeeping shifts Housekeepers We can also take a look at the schedules for the stock keepers and the housekeepers. The stock keepers’ shifts, in green, have their heaviest stocking between 8 AM and 3 PM, as there are 3 stock keepers here that do the majority of the stocking. The house keepers have their heaviest shifts from 11 AM to 7 PM, as seen by the multiple discharge teams and general housek keeping shifts. This visual shows how house keeping shifts overlap with about half of the stock keeping shifts, which could potentially be contributing to the stock leaving closets faster than anticipated. STATE FINDINGS AND CONCLUSIONS

Current State: Conclusions Shift Overlap Difficult to track supplies leaving closets Peak Hospital Hours Stock keepers main shift Decision Making Stock keepers make several decisions Stockouts EVS relies on Housekeepers

Interviews & Observations: Findings EVS is not well aware of where supplies goes and how they are used Stock keepers load up their carts differently Stock keepers use different logic to determine when to return to the supply room Model 1: as soon as a certain supply has run out Model 2: once all closets have been visited Stock keepers do not know how much of each stock item to stock on their carts N = 15 hours observations, 10 hours interviews

Interviews & Observations: Conclusions Track Supplies System to record usage Inventory System to know what is needed Stocking Process Need standardization

Recommendations 1 Standardize Training 2 Switch to Night Schedule 3 Create Runner Position 4 Implement Communication System

Recommendation 1: Standardize Training EVS can create a standardized and more efficient stocking process by: Virtual Map of Hospital Visual Management System Standardize Process- trips to stock room, stocking cart Document Best Practices Train with someone who stocks same floors Record what goes into each closet Video training Modules Impact: Reduces variability in stocking process

Recommendation 1: Standardize Training Pros Cons Standardizes work based on best practices Reduces variability of stock times Minimizes trips to stock room Increased job satisfaction Requires strict enforcement Funding for online modules and maps Introduction & Background- Key Issues- Goals & Objectives- Project Scope- Project Approach- Expected Impact- Findings & Conclusions- Recommendations-

Recommendation 1: Standardize Training Implementation Plan 1 Hold Focus Groups 2 Create Standardized Workflow 3 Create Online Modules & Maps 4 Retrain Stock Keepers 5 Enforce Standardization Introduction & Background- Key Issues- Goals & Objectives- Project Scope- Project Approach- Expected Impact- Findings & Conclusions- Recommendations-

Recommendation 2: Switch Night Schedule May want to zoom in on parts Impact: Save ~50 minutes per shift Improved tracking of supply usage

Recommendation 2: Switch to Night Schedule Pros Cons Closets full at start of housekeeping shifts Better tracking of supply usage Decrease time of closet stocking process Need to adhere to quite hour regulations Retraining/rehiring Management has less direct oversight Does not directly affect stockouts on off days Introduction & Background- Key Issues- Goals & Objectives- Project Scope- Project Approach- Expected Impact- Findings & Conclusions- Recommendations-

Recommendation 2: Switch to Night Schedule Implementation Plan 1 Pilot Study 2 Retrain Employees 3 Rehire Employees (if necessary) Introduction & Background- Key Issues- Goals & Objectives- Project Scope- Project Approach- Expected Impact- Findings & Conclusions- Recommendations-

Recommendation 3: Create Runner Position Refill stock keepers carts Use walkie talkies to communicate Impact: Eliminate elevator time to stock room ASK for radio type

Recommendation 3: Create Runner Position Pros Cons Runner Absorbs Elevator Time Stock keepers do not need to make trips to supply room Runner has to wait for elevator Stock Keeper may have to wait on Runner Have to hired another employee Introduction & Background- Key Issues- Goals & Objectives- Project Scope- Project Approach- Expected Impact- Findings & Conclusions- Recommendations-

Recommendation 3: Create Runner Position Implementation Plan 1 Purchase Radios 2 Hire Runner 3 Train Runner & Stock Keepers Introduction & Background- Key Issues- Goals & Objectives- Project Scope- Project Approach- Expected Impact- Findings & Conclusions- Recommendations-

Recommendation 4: Implement Communication System PAR Level stock inventory record sheet Housekeepers record stock they use Stock keepers gather inventory record sheets Impact: Stock keepers optimize space on their carts = less trips to stock room ASK for radio type

Recommendation 4: Implement Communication System Fix picture

Recommendation 4: Implement Communication System Cont. PAR Level stock inventory record sheet Develop advanced online record system Administer electronic tablets Stock keepers record stock taken from closets House keepers review the used items Impact: Stock keepers optimize space on carts = less trips to stock room Microsoft NuVision TM800W610L Signature Edition Tablet [5]

Recommendation 4: Implement Communication System Pros Cons Stock Keepers able to fully stock more closets before reloading their cart. Minimizes trips to stock room Housekeepers could take advantage of the system. Increase work for stock keeper to record inventory. Introduction & Background- Key Issues- Goals & Objectives- Project Scope- Project Approach- Expected Impact- Findings & Conclusions- Recommendations-

Recommendation 4: Implement Communication System Implementation Plan 1 Determine PAR levels 2 Create appropriate record sheet 3 Purchase/Set Up Tablets Introduction & Background- Key Issues- Goals & Objectives- Project Scope- Project Approach- Expected Impact- Findings & Conclusions- Recommendations-

Recommendations Night Schedule High Training Communication Impact Runner Low Low High Effort

Expected Impact Increase Efficiency Decrease Supply Shortages Decrease Trips to Stock Room Improve Working Environment Improve Patient Experience Develop Future Study Methods Increase efficiency of cleaning process Decrease in the number of calls from housekeepers for more supplies Decrease the number of trips stock keepers take to the supply room(s) Improve the working environment for housekeepers Improve patient experience Create ways to study PAR levels and supply usage in the future

THANK YOU

Michael Alexander & EVS Team SPECIAL THANKS TO: Client: Michael Alexander & EVS Team Coordinator: Jonathan Lee Instructors: Dr. Van Oyen Jai Sura

References [1] http://www.uofmhealth.org/maps-directions/medical-center/building-floor-maps [2] Chapter 3: OR Inventory Management. (2011). In Optimizing Your Perioperative Supply Chain: A Guide to Improvement Projects. Ontario: Ontario Hospital Association. [3] Bendavid, Y., Boeck, H., & Philippe, R. (2010, November). Redesigning the replenishment process of medical supplies in hospitals with RFID. Retrieved from https://www.researchgate.net/publication/243459598_Redesigning_the_replenishment_process_of_medical_supplies_in_hospi tals_with_RFID [4] Perrin, R. A. (1994). Exchange cart and par level supply distribution systems: Form follows function. Hospital Materiel Management Quarterly, 15(3), 63. Retrieved from http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/234273281?accountid=14667 [5] https://www.microsoftstore.com/store/msusa/en_US/pdp/NuVision-TM800W610L-%20Signature-Edition- Tablet/productID.5078216000 [6] http://www.uofmhealth.org/our-locations/university-hospital

Data Analysis: SIPOC Hospital Stocking Process Finished: EVS determines amount for next order Start: Supplies are ordered Suppliers Inputs Process Outputs Customers Stock Keeper EVS House Keepers Stocked Closet Supply Order Outage Complaint Money Stocked Closet Outage Complaint EVS House Keepers Supply order is placed Supplies delivered to loading dock Supplies transferred to supply room Carts are brought upstairs to closets Supplies are organized Carts are stocked Closets are stocked If need more supplies go back to stock room EVS determines amount to order House keepers use supplies Head to next floor Too busy? If outage, go and restock