Linen Distribution and Usage Final Report April 17th, 2018 Team #10 Sinem Akinci Michael Derrick Nithya Ramamurthy Michael Staunton 18W10-Final-Report Client: Rolando Croocks, Director of Laundry Services, Linen Distribution Coordinators: Andreea Duma, Performance Improvement Fellow, Continuous Improvement Jamie MacLaren, Industrial Engineer, Continuous Improvement Dr. Mark Van Oyen, IOE 481 Supervising Instructor, Industrial and Operations Engineering Ms. Mary Duck, Staff Specialist, Michigan Medicine

Project Background

Looking for opportunity to reduce waste and analyze linen usage Background Uses 16 lb linen per adjusted patient day Current bed-changing policy: Every Tuesday, Thursday, Sunday Transitioning linen production to co-operative laundry facility Provides ~135 unique linen items, some of which not supported in co-op laundry facility Linen committee meets weekly to continue evaluating existing products to reduce number of unique linen items Looking for opportunity to reduce waste and analyze linen usage 10 million pounds annually

Key Issues Waste in linen usage is leading to increasing operational costs Subjective and unstandardized protocol for linen quantity in rooms As the hospital transitions to eliminating the laundry production operation, optimization of linen usage becomes increasingly necessary Several unique linen items cannot be processed at co-op Will not have this inhouse operation to rely upon

Goals and Objectives To design an improvement plan on how to optimize linen usage and reduce wastes associated with linen consumption Observed the current linen usage process, primarily in discharge Benchmarked with similar hospitals Analyzed collected data

Project Scope Linen Distribution and Consumption UHS Main Campus University Hospital, Cardiovascular Center, and Children and Women’s Hospital Linen Production UHS Primary/Specialty Care Centers Cancer Center

Linen Consumption Process Flow This is how we came about our collection methods

Data Collection Methods

Literature Search Establishing linen standards for patient areas[1] Importance of linen standards Hospital Operations[2] Optimize movement throughout hospital Michigan Medicine Laundry Transition to Cooperative Laundry Final Report[3] Understood the need for co-op Looked for information on linen process and common practices Michigan Research Library Network (Mirlyn) Past IOE 481 Projects

External Patient Room Observations 30 manual hours of patient room observations 2246 patient rooms UH floors 4-8, CVC floors 4-5, and CW floors 7-12 (excluding 9) Monday-Saturday; Morning-Evening; February 5 - February 18, 2018 # Rooms w/ excess linen Total # Rooms Visited Unit Time Date Talk about how the data is collected: we walked around floors and marked excess linen vs not from exterior of patient rooms Discuss how we standardized data collection: tallys, how we defined excess linen Diversified the sample times and days

Discharge Observations 32 manual hours of discharge observations 67 patient discharges UH floors 4-8 Monday-Friday; 5-10 PM; February 19 - March 23, 2018 Date Total #Linen Unit #Fitted Sheet #Blankets #Bedspreads #Bath Towels #Gowns Other (specify) 5-10 pm is the peak time of discharge

Benchmarking Interviews Conducted 12 interviews with nationally ranked hospitals Quantitative Information Usage of Co-operative Laundry Facility Linen Distribution process Internal policies on reducing excess linen Patient beds, lbs linen/adjust patient day, recommendations to reduce linen

Nurse Interviews Conducted 12 interviews in UH, CVC, and CW 7 Question Interview: Awareness and compliance of bed changing practices Suggestions to improve linen services List out some questions How often do you change beds, are you aware of policy, how much time is excess for family

Findings and Conclusions

Literature Search

Literature Search Findings Reduce travel time between clean utility room and patient room in units Ideal hospital: 45 seconds Current state in Michigan Medicine: 60 seconds Establish design standards for recommendations Beds changed frequently due to historic influenza infection in 1962 -first is on optimizing layout of hospital reducing nurse travel time -cant reduce number of bed changes per week to prevent epidemics

External Patient Room Observations

Percentage of rooms observed with excess linen n = 2246 patient rooms

Discharge Observations

Quantity of linen items found during discharge by type in UH

Average cost of excess linen per patient room by floor in UH

Yearly financial impact of excess linen in UH at discharge Includes all clean and folded linen at the time of discharge Only accounts for the laundry price the estimated cost in savings we projected is only what we saw in a room as of the discharge moment n = 67

Benchmarking Interviews

Relationship between patient beds and pounds of linen per adjusted patient day Correlation Coefficient: 0.9237 Correlation between pounds of linen vs number patient beds n = 12 hospitals

Michigan Medicine as an outlier Correlation Coefficient: 0.7955 WITH university of michigan n = 13 hospitals

Residual between Michigan Medicine and linear regression Observed: 16 pounds of linen per adjusted patient day Theoretical: y = 0.0043(1190 patient beds) + 6.0633 = 11.9 pounds per adjusted patient day Residual: 4.1 more pounds of linen per adjusted patient day

Michigan Medicine has the highest number of unique linen items On average, 20-80, maximum was 100 Still prestigious, still have gap between us and competitors, so can reduce and still remain top

Service issues found with co-op 12 hospitals 6 had no co-op experience 6 had co-op experience 4 had no service issues 2 had service issues Service issues found: wasnt fast enough, sometimes felt as if linen got lost or damaged

Number of Bed Changes per Week n = 12 hospitals No area for changing bed??? changing bed right amount of times

Internal Policies for Reducing Excess Linen Huddle discussions Linen cost displays Linen budget review Linen awareness events Linen committee Cabinets in rooms Cabinets in hallways

Nurse Interviews

Nurse practices n = 12 nurses n = 12 nurses Bad communication

Suggestions to Reduce Linen Consumption Linen carts Cabinets for linen storage Discussion on bed-changing policy during daily huddle Plastic wrap for linen

Recommendations

Changes regarding linen storage Standardize usage of nurse servers Nurses with downtime can restock nurse servers Keep enough linen to make two beds Talk about how they currently in place every four rooms, not properly utilized, not all units use them Two beds: enough to remake a bed, but not provide too much waste available

Changes regarding bed-changing practices Increase awareness of bed-changing policy Discuss policy in daily huddles Increase awareness that linen is commodity Put up posters of linen costs Strengthen linen committee Make it aware

Future Work Due to the timeframe and limitations of data accessibility, the team recommends the next project to focus on: Nursing practices for a better understanding of root cause of problem Self collection sheet for EVS personnel to get a greater sample size on wasted linens in rooms Elaborate on struggles

Reduce number of unique linen items Compatible with co-op Michigan Medicine would still remain at top, would not compromise distinction Average of nationally ranked hospitals: 60 Talk about benchmarking

Expected Impact Nurses are more educated and aware about excess linen Less unused linen present in patient rooms 10-15% reduction of clean linen that is discarded in UH resulting in annual savings between $6,394.07 and $9,591.10 From cost analysis

Questions? Special thanks to our client: Rolando Croocks Special thanks to our coordinators: Andreea Duma Jamie MacLaren

References [1]N. Berhane, Establishing linen standards for patient areas. Ann Arbor: University of Michigan Graduate School of Business Administration, 1965, pp. 68-79. [2]W. Hopp and W. Lovejoy, Hospital operations. Upper Saddle River (N.J.): Pearson Education, 2014, pp. 37-41 [3]IOE 481 Fall 2017 Group 3, "Michigan Medicine Laundry Transition to Cooperative Laundry Final Report."