Background:
In a community hospital setting, is the utilization of the 5S methodology for managing supplies on a pilot unit, compared to a traditional method for supply management, more accurate in diagnosing areas of opportunities to increase revenue through better supply management over a twelve-week period?
The current process in place at hospital X in a surgical progressive care unit consists of supplies being stocked in bins that have barcodes on the outside of the bins. The intention is for the nurse to scan the item when it is removed, therefore alerting central supply that they need to replace the item. However, often supplies are not being scanned, and there are no defined PAR levels, which leads to a surplus of supplies. Furthermore, there is no structure for where supplies are placed (i.e. respiratory supplies by wound care supplies), therefore causing frustration and lost time with the staff when searching for supplies.
There is an apparent gap in the current process on the proposed nursing unit. The problem that will be addressed will be that of supplies that are currently on the unit that either
• Supplies do not need to be stocked on the unit as they do not pertain to the procedures or patient population.
• Supplies that are stocked that have PAR levels that are not appropriate, either too much or too little, therefore there is a surplus of supplies sitting not being used and expiring causing a loss of profit.
• Not having the supplies that are pertinent to the patient population, therefore, causing the nursing staff to spend time searching for supplies rather than being able to spend time with their patients.
Morrow et al., (2013) found that the implementing of a cost savings program within the health care setting that reduces the amount of discarded medical supplies aids in the help of reducing organizational costs. Supply management processes have proven to be highly successful in the health care arena with reports of 58% in reduction of wasted supplies which equates to a 50% cost savings (Morrow et al., 2013).
The problem being addressed is how to efficiently and effectively reduce the amount of waste and unneeded supplies on nursing units. Nursing staff on the pilot in-patient unit will be targeted to assess if better management of supplies needed for patient care will increase staff time being able to be spent with their patients by decreasing the time spent searching for supplies.
The 5S Lean process is the proposed intervention to the PICOT question. As previously stated, the current state is rather simple which includes scanning supplies taken from bins which in turn is communicated to the supply chain via computer and then restocked accordingly. There are no concrete PAR levels for the supply stocked, and all supplies are standardized across all units. However, not one unit is the same as the other regarding patient population, surgery cases, and so on.
The 5S Lean method was introduced by the Japanese culture and is a methodology used in minimizing errors and mistake proofing. 5S, as explained by the experts, stands for: seiri (sort), seiton (set in order), seiso (shine), seiketsu (standardization), and shitsuke (sustain). 5S is a systematic way to improve workplace organization and functioning by establishing the basic conditions that are essential to processing stability. Also, 5S is often a good way for businesses to familiarize themselves with continuous improvement by involving and engaging workers in improving workplace conditions and taking ownership of their organization (Matura et al., 2015).
The Toyota manufacturing company was one of the first major businesses to adopt the Lean philosophy. Toyota set on a journey to reduce waste in any form and inefficiencies, and then create improved solutions in operations, efficiency, and expenses (Matura et al., 2015). The two main focuses of the Lean process are to reduce waste through the use of a standardization process and to involve all employees in the process to create buy-in and ownership through process improvement (Matura et al., 2015). Sort
The first step in the Lean process is to sort or remove unnecessary items from the workspace. A red tag area is created to hold items that are questionable in the area of being needed, or needing replacement. All drawers, work areas, cabinets, and shelves are cleaned, organized, and labeled with the contents in or on such (Matura et al., 2015).
Set
The second step is referred to “Setting an order” or “Straightening.” This step involves putting away the items that are going to be kept. However, they are placed in specific locations. The straighten process places items in areas that increase workflow. Work areas, storage areas, and equipment hold areas are marked and organized with information boards placed to track data as well as track the success of the changes being made (Matura et al., 2015).
Shine
The third step in the process is where cleaning or “Shine and Scrubbing” comes into play. Once all equipment and supplies are sorted and set in in order, all areas of the department are then cleaned. Any garbage or recyclable items are either discarded or recycled, any issues about lightning, dust, or other problems with the work and supply holding areas are addressed at this time (Matura et al., 2015).
Standardize
At this point in the Lean process, each role that the staff member plays are defined, and the process is put in place to keep the areas cleaned and in order. This step will be repeated on a regular basis to ensure compliance, and with the help of visual management tools, it will quickly be recognized if supplies and equipment are in the right area. No additional paperwork is needed once this step is achieved, rather it involves a daily “walk-thru” of the area to make sure “for everything there is a place, and everything is in its place” (Matura et al., 2015).
Sustain
The final step in the 5S Lean process is that of sustaining. This step is viewed as the most difficult with discipline being key to maintaining sustainability. The team follows posted standard work guidelines as well as regular cleaning and work procedures that have defined. The use of the information boards contains relevant information, and the labor and supply areas maintain a neat, clean, and orderly appearance (Matura, et al., 2015).
The development of the 5S Lean process will involve creating a team of members that will be the key players in the process. An executive sponsor, system sponsor, operational owner, project governance member, project improvement director, and project manager along with project team members will be developed. Other key stakeholders will include unit supply staff, system supply staff, patient care technicians, as well as engineering for equipment needs.
Upon development of the team, a project charter will be created and reviewed for gaps in the proposed intervention. Staff will be educated by way of morning and evening huddles as to how the process will be started and what to expect during the first phase of the process improvement implementation. Baseline data will be collected on the type of supplies and equipment on the unit, as well as current PAR levels and any root drivers to the current issue identified.
Next, a team of nurses will use red tags to tag items in the supply room that they feel are not used regularly or at all. Over the course of 4 weeks if any members of the staff use the red tag items they will date and initial the red tag. At the end of 4 weeks, the tags will be collected to determine if some of the supply can be reduced or removed. The next step will involve blue tags, which will be placed in the supply bins to measure PAR levels. The same process will be in place where staff will sign and date when they remove a supply item from the blue tagged items. Again, after a four-week time frame, the blue tags will be collected to determine which supplies have a proper PAR level and which supplies need their PAR level either increased or decreased. The next step in the process involves taking the supplies that have been deemed appropriate and necessary on the unit and grouping them into “like” areas to reduce “find” time when looking for supplies.
A visual workspace will be created with the revised equipment layout and supplies reorganization proposal. Over a four-week period, a map of the supply room will be designed, and it will be determined how grouping supplies will save staff time. Visual cues will be placed throughout the supply unit, having “parking spots” for larger equipment which will, in turn, simplify the process asset control and determining if all supplies assigned to the unit are indeed on the unit.
A risk analysis and abatement will be performed by all key members of the team which will aid in the development of the process to sustain the changes that have been made. Handoff of the finished project will then occur which will place the ownership in the hands of the employees on the unit to continue managing the Lean process.
Financial and inventory pre-data will be collected before the start of the project. This information will contain the total counted supplies on the unit, items that are above PAR level as defined by system supply vendors, items that are at or below PAR levels, again as defined by system supply vendors, items that are considered at the designated PAR level.
The overall objective will be decreasing the stock by 20% of the current stock on hand, reducing approximately 3% of the overall dollars in stock (the time value of money for reduced supply level from baseline on an annual basis), and reducing the total inventory count by 40%. Further initiatives will involve reducing the space needed for on hand supplies by 15% and creating a more streamlined workflow for staff.
Assignment Expectations:
Learners will develop an analysis of ethical issues that must be considered when planning and carrying out Doctoral Capstone projects. This analysis should be rooted in the literature of the profession. The analysis will result in an eight- to 10-page paper that demonstrates
conceptual and practical understanding of the five ethical issues and the way in which they will be addressed in the Doctoral Capstone project. Learners should address the following ethical considerations as part of their ethical review: 1. Mitigating risks to human participants 2. Collaboratively engaging the site/organization and obtaining buy-in and permission 3. Managing potential conflict of interest 4. Managing potential bias 5. Handling issues related to intellectual property 6. Managing HIPAA compliance 7. Following the American Nurses Association Code of Ethics 8. Writing with proper grammar, usage, and expert APA format and style, meeting professional publication standards. 9. Writing with expert paragraph development, transitions, and academic tone, meeting professional publication standards.