1. 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

2. Project Background

3. 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

4. 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

5. 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

6. 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

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

8. Data Collection Methods

9. 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

10. 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

11. 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

12. 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

13. 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

14. Findings and Conclusions

15. Literature Search

16. 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

17. External Patient Room Observations

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

19. Discharge Observations

20. Quantity of linen items found during discharge by type in UH

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

22. 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

23. Benchmarking Interviews

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

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

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

27. 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

28. 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

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

30. 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

31. Nurse Interviews

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

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

34. Recommendations

35. 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

36. 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

37. 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

38. 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

39. 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, and $9,591.10
From cost analysis

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

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