Three Keys to a Successful Margin: Charges, Costs, and Labor
Lean Improvements via Implementation of a Regional Pharmacy Kanban Inventory System
1. Lean improvements
implementation of a
kanban inventory system in a regional pharmacy service
quality Summit, May 6, 2014
saskatoon, SK
Presenters:
sharna sernowski
lindsay sperling
shannan neubauer, bsp, Pharm d
2. rationale
Challenged ↓ inventory
Substantial drug wastage due to expiration
System to support us, rather than one that ran us
Eagerness to remove waste to “find additional staff
capacity” to direct to more value-add activities
4. MEDICATION SYSTEM
On Each Ward / Unit
Wardstock Urgent need &/or low risk meds
Narcotic and Controlled drugs Secured, monitored, counted
Patient specific (24-hr supply) IV’s and oral meds
Patient specific multi-dose Inhalers, liquids, ointments
Nightcupboard or Automated
Dispensing Cabinet
To obtain medications during off-
service hours
Pharmacy
Department
Supplies
DISTRIBUTION MODELS
Wardstock Traditional top-up; kanban system, automated disp cabinet
Narcotic/Controlled Secured med-cart drawer; automated dispensing cabinet
Unit-dose 24-hr med-cart supply; automated dispensing cabinet
Intravenous doses Aseptically admixed clean room; counter-top prep by nurse
5. Drug inventory system
Routine Inspection System
Maximum/Minimum Quantities
Short lists (communication)
Individual decisions (non-standard)
Ward-based order forms
Cramped storage spaces
Drug “caches”
Substantial wastage
Kanban Signaling system
Defined quantities (PAR)
Kanban card set inside
inventory
Supply before card used; pull
card (signal – everyone knows
what it means)
Cycle time (everyone knows
when to expect its arrival)
Safety stock
Kanban on the wards; in
community hospital
Kanban inside the Regional
Health Centre Pharmacy
6. APPROACH – YRHC EXTERNAL
Project lead:
Sr Pharmacy Technician
“Belongs” to whole staff, therefore, everyone engaged
Begin in care areas - impact demand for medications
Work WITH the care staff
Finite amount of storage space
Review of all wardstock items (addition required a deletion)
Review of required quantities
Maintained frequency of replacement cycle (ie. twice a week)
Local nurse champion partner
Kanban cards
Lots of communication at daily huddles on wards
7. EMERGENCY DEPT – STORY
Project lead:
Lindsay Sperling / Jamie Zulyniak
Review of space and organization
Sort – Simplify – Sweep – Standardize – Sustain
Local champion
Communicate, communicate, communicate
9. APPROACH – COMMUNITY HOSPITAL
Project lead:
Sr Pharmacy Technician (+ Pharmacy Technician & Pharmacist)
Engaged Health Services Manager (2 meetings)
Worked WITH the care staff
Communications with nursing staff (no more “ordering”)
How kanban would work
Finite amount of storage space
Required new drug storage bins to hold kanban cards right place
Pharmacy team sent to convert the system in a day
CHALLENGES: physical distance, ongoing education/
communications, ordering off-cycle
11. APPROACH – regional pharmacy
Project lead:
Sr Pharmacy Technician (+ Pharmacy Technician Pairs)
Kanban inside the 24-hour patient cassette area
Kanban overall drug storage areas
fridges
shelving bins
purchased parenterals
high-alert products
electrolyte LVPs)
CHALLENGES: pace of completion, agreement on safety
stock, lengthening of delivery times by vendor, unit-dose
packaging time
13. improvements
Transportation – courier costs to St. Anthony’s (q2wks cycle)
Motion – reduced technician steps
Overproduction - unit doses produced
Over Processing – reduced time to order by care area / reduced time
to process in Pharmacy
Inventory – reduced quantities ordered (care areas) and in Pharmacy
Waiting (Affiliate Hospital) – reduced turn around time
Waste (Expired Drugs) – reduced wastage
15. Affiliate Hospital Drug Order Variance
0
50
100
150
200
250
300
350
400
450
QuantityOrdered
Inventory Orders
ACET500
CEFTRX1
TAZOCIN
Impact of Kanban Inventory on
Medication Quantities Sent
16. Improvements other wastes
Waste
Reductions
Pre Post Percent Change
Affiliate wait-time
(days)
7 4 ↓43%
User order time
(min/wk)
46 4 ↓91%
Motion (steps) 2774 1387 ↓50%
Processing
(min/wk)
210 90 ↓57%
Drug Expiry per
Quarter ($)
7,400 1,200 ↓84%
Production of
unit-doses (units)
Data available in
March
18. Medications for hospital patients
include time consuming value-added activities
Medication
inventory
level low
Place order Receive
medication
Enter medication
into inventory
VENDOR
Sterile IV admixture
preparation service
Unit-dose (oral solids)
packaging service
Other parenterals
Topical dosage forms
Oral liquids
Inhalation productsJIT Just in Case
Substantial Value-Add
Incredibly labor intensive
Many safety checks
Require expertise of trained
Pharmacy Technicians
21. Just in Time
JIDOKA
Machine work
completed by machine
Quality assurance –
draws technician to the
defective package
Bar-coded packages
22. interdependency - Staff / inventory level and how we package
Packaging(human/machine)
↔ ↓
↑efficiency
23. Sunrise health region
department of regional pharmacy services
5S – Sept ‘13
5S/kanban – Oct ‘13
5S/kanban – wards spring ’13
Kanban – Phcy Nov ‘13-Jan ‘14
5S/kanban - April ‘14
24. SUMMARY
Wastes Outcome Metric
Inventory – care areas ↓ $
Inventory - Pharmacy ↓ $
Drug Expiry ↓ $
Overproduction ↓ Unit doses pkgs
Over processing ↓ Minutes/week
Motion ↓ Steps
Waiting ↓ Days
25. acknowledgements
Sharna Sernowski, Sr. Pharmacy Technician
Nurse Champions – Yorkton Regional Health Centre
Daniela Fiske, Health Services Manager, St. Anthony’s
Nurses - YRHC and SAH
Kendra Soyka, Pharmacist
Pharmacy Technicians
Stacey Boychuk Tamera Dozorec
Marcy Gunther Brandi Helmeczi
Kyla McLeod Karen Ransome
Sarah Rogalski Lindsay Sperling
Heidi Topliss Kim Volman
Jamie Zulyniak
26. Questions
1. Which of the 7 types of
waste were reduced or
eliminated by this new
kanban inventory system?
2. How is a hospital
pharmacy’s kanban
inventory system different
than one in materials
management? Hint: what
other factor influences your
cycle time and safety stock
levels
3. Inventory stock level,
personnel available to
package and the type of
packaging machine are
INTERDEPENDENT.
Explain.
4. Why is it important to begin
your inventory conversion
at the point-of-care, rather
than in the supply
department?
5. What is Jidoka?