For Consideration

This picture shows product returns from a Case Cart assembly process. This is a common discovery I’ve had in Surgery departments across the country. 

The: DESIGN -> PICK -> ASSEMBLE -> DELIVER -> USE -> RETURN, cycle, is a result of the Procedure and Preference Card selection. 

The Preference Card in design is a Novel, (“Dr. Jones likes to talk to the patient before Anesthesia..”), and, in function; is a Shopping List, (Endo GIA x 2 EA). The “Novel” is Clinical, the “Shopping List” is Logistical.

A sustainable solution needs to bridge both Clinical and Operational worlds and requires a shift of historical roles and responsibilities. 

The cultural transformation will be more complicated than the actual process improvements to reduce re-work and waste

 In the supermarket Rice and Beans are in the same aisle. Milk and Cheeses can be found in the Dairy section. 

Hospital supplies also have a logic of product placement, and Nurse workflows need to be considered when CO-LOCATING  items.

Use Visual Management wherever possible and always work with Staff so the stocking locations reflects the daily supply groupings they grab every day.

Supply Chains, Logistics, are foundationally based on a linear flow network. Directly connecting a set of locations without any interruptions in service.

Hub and Spoke and Point to Point models, transport materials from point of origin to the Customer, with as few hand-offs or gaps, as possible. The Amazon package left on the porch has a sophisticated delivery network behind it that is almost invisible. 

The demand signal is clear, the logistical path is clear. Roles and Responsibilities are clear. 

In a Surgical Department the Case Cart assembly is essentially a manufacturing and distribution process. 20, 30, 40, or more, Case Carts are assembled every day and delivered to the point of care. Hundreds of items picked, packed, shipped, (and returned), daily.

But in most OR’s the logistics model is extraordinarily complex with multiple parts and pieces. Ownership is shared (generally), across two to three business units, six to eight individuals, reporting to at least 3 different Managers. 

The opportunities for breaks in the flow, errors, and problems, are large. 

Preparing the supplies for a Surgery requires a comprehensive service model that can deliver the complete “package” to the front porch without issue. 

This can happen by establishing a Patient Centric Supply Chain, that owns all the parts and pieces of what is now, a matrixed process.

 In a hospital, the Red Line separates Surgical and Procedural areas from the general public and indicates higher levels of restrictions and sterility.

Activities that happen behind the Red Lines are the most complex and stressful events in the hospital

Support Departments, Consultants, Vendors, anyone who crosses over the Red Line to HELP, to improve process, to make run things SMOOTHER, need to understand that, all too often, Staff have heard it before, and, in the end; they had to make it work themselves.

Another solution that will make their life better? Nurses know, they can smell it coming a million miles away, and they NEVER forget.

But, because Clinicians are such advocates for patients, because they care SO much and want things to improve, they will sign up every time for the next new thing.

The technology, process disciplines, the product, is the catalyst for change, but computers, bar code scanners, dashboards, process improvement philosophies, don’t produce the results.

Listening, rolling up the sleeves, doing the heavy lift. Staying until its done, and delivering on your promises, brings the TRANSFORMATION.

If the Nurses don’t say its better, - it isn’t.