NEWS
PERFORMANCE from page 9 ing a Gemba walk, one simply walks the area only restocked to these specifications, and
start by defining those processes on which it – the area might be the warehouse, the nurs- excess product is removed and placed back
is based, such as value analysis, contract ing unit storage area, the receiving dock, the in its proper storage location once a week.”
management and inventory control, and OR suite – the locations are nearly endless –
mapping each process in detail,” he and makes observations about what they Hitting speed bumps
said. “Then each step is evaluated for the see,” she noted. “Employees are asked ques- If performance improvement programs,
value it adds to the process. Waste is identi- tions about processes they follow, how they such as Lean and Six Sigma are so impor-
fied in the form of steps that add no value, know what to do, tools they use, what works tant and valuable to healthcare supply chain
and the process is redesigned to achieve the well, what could be improved. Observations managers and organizational expense re-
same goals without the steps that added no about cleanliness and safety are made. duction, why aren’t more facilities adopt-
value. “I will sometimes repeat a Gemba walk ing and implementing the principles?
“Six Sigma methodology requires a com- the following day to see what’s changed or “Too many departmental silos create
mitment among the workforce to abandon what’s remained the same,” she continued. many barriers to getting things done,”
assumption in favor of data as the basis for “For example, there was a Receiving group Murphy said. “It’s real easy for people to
making decisions,” Reiter continued. “This that, on day 1, talked to me about their prac- want to work within their silos. People will
is the major cultural constraint to be over- tice of same-day delivery of incoming pack- migrate to their comfort zone. We have be-
come once leadership is on board. Next, [sup- ages. On day 2, I walked through the same gun to overcome these hurdles by creating
ply chain management] needs to identify the Receiving area. I knew how to read their SMAT process teams who are all aligned to
processes appropriate for application of Six labels from what I learned the previous day, ensure that the right decisions are being
Sigma methodology. Amenable processes and found that some packages that were re- made in a timely manner and rules have
have sufficient transaction volume to lend ceived the previous day were still in the been set and are followed up on and en-
themselves to statistical analysis, with clearly staging area, mixed with newly received forced.”
defined and measurable inputs, outputs and packages. When I asked the employees Terry Cox, MA, MS, FAHRMM, CMRP,
milestones, such as the proportion of item about this, I learned the packages had been director, supply chain services, Texas
master list purchased under contract, time overlooked because the protocol was to Children’s Hospital, Houston, attributed any
from initial vendor contact to signed contract, place received packages scattered on the reticence to the econ-
number of match audits triggered, propor- floor in random fashion with no real orga- omy and inherent fi-
tion of new product requests lacking docu- nization and no consequences if the pack- nancial constraints.
mentation of need/efficacy. Prioritization is ages weren’t delivered – as long as the or- “The economy has
required next, to start with projects of the dering department didn’t call. A quick shrunk over the last
highest urgency.” discussion with the manager resulted in the two years and has had
Ron Geguzys, senior vice president and Six clearing of a rack near the Receiving and a significant impact
Sigma Black Belt, op- staging area, labeled by hospital floor. Re- on hospital budgets
erations, Broadlane ceived packages were placed in the corre- and revenues,” he
Inc., Dallas, empha- sponding floor location on the rack, and said. “Because supply
Terry Cox
sized truly under- were added to picklist orders for delivery chain is an expense
standing Six Sigma to to the hospital. If the rack wasn’t empty at department, justification may be difficult.
make it work as well the end of the day, an additional run was People are doing more with less. Our sup-
as eliminating varia- made to the hospital with the remaining ply chain team recently had a Lean/Six
tion along with its packages.” Sigma-certified consulting firm come into
sources. “This is not Lean 5S is the process of creating work- our organization to review our product se-
simply providing a place cleanliness and organization, includ- lection process. Fortunately for us, this ser-
process map and
Ron Geguzys
ing visual signals, according to Ehrlich. vice was provided at no charge. We imme-
making sure that everyone has been trained Roughly translated from Japanese, the 5 S’ diately saw the benefits of Lean/Six Sigma
and holding people accountable,” he said. “Six stand for “sort,” “straighten,” “shine,” and were able to implement some of their
Sigma defines process understanding in terms “standardize” and “sustain.” She indicated recommendations.
of data, capability and sources of variation. If that during a 5S initiative, storage spaces “However, when budgets are tight, value
you can’t illustrate a process using numbers are used more efficiently, workflow is im- analysis is even more important, but the ex-
that represent the process and are statistically proved, excess inventory may be removed, pense of a Lean/Six Sigma program or de-
relevant, then you can’t control it. If you can’t shelving type is optimized to the product, partment may be challenging,” Cox added.
control the process, then you are at the mercy labels are added, all of which are designed “To overcome such hurdles, having success
of chance. Six Sigma programs enable practi- to make the location much more efficient. stories on the clinical side may eventually
tioners to break down a complex problem into Ehrlich recalled a recent 5S initiative per- move this program toward supply chain ef-
a simple, fact-based, project that is achievable, formed in an OR suite. “The PAR value of ficiencies. You have to prime the pump to
manageable, and that stakeholders can under- the supplies that were on the restocking list make it work and the priming of the pump
stand and support.” was $500. After eight hours of counting and costs money.” HPN
Supply chain managers can apply and gen- identifying product, we found $4,000 in
PROCESS IMPROVEMENT continues
erate benefits from a number of techniques, supplies in the cabinet – and of the $4,000,
on page 12
including establishing dashboard metrics, $1,500 was expired suture. This exercise led
conducting periodic Kaizen events, imple- the hospital to create an item list for each
Editor’s Note: For more exclusive content on this
menting Kanbans events or establishing a OR suite. The item list includes the [materi-
topic, including how to prevent cynical smirking
Gemba walk, according to Geguzys. als management information system] item
and skeptical eye-rolling at the mere mention of
For Ehrlich, the Gemba walk and 5S are number and description, as well as the PAR
these programs, go to www.hpnonline.com/inside/
her two favorite Lean methodologies. “Dur- quantity and storage location. Rooms are
2009-11/November2009.html
10 November 2009 • HEALTHCARE PURCHASING NEWS www.hpnonline.com
0911-Performance.pmd 10 10/9/2009, 5:04 PM
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