1. N o v e m b e r 2 1 , 2 0 1 4
Stephanie Bachmann
Performance
Improvement
Project at IU
Health Arnett
2. BackgroundInformation
Being efficient and always improving processes are goals at IU Health Arnett as there are
monthly meetings called Rapid Improvement Events (RIE). After observing the nutrition
services department for a few months, there were several areas in the department that could be
reevaluated and improved to make more efficient. One of these areas was the floor stock and
restocking of the provider’s lounge. The process for floor stock consisted of going to the
nutrition rooms and lobbies on each floor and restocking each up to par. Restocking the
provider’s lounge worked in a similar manner. The current process consisted of obtaining a
checklist with par levels and traveling to the provider’s lounge to take inventory. Once this was
completed, the foodservice employee would then travel back to the kitchen and gather needed
supplies and food items for the provider’s lounge on a cart. Once all needed supplies and food
items were collected, the foodservice employee would travel back to the provider’s lounge to
restock the supplies and food items. Both of these processes were preformed in a longer amount
of time than the managers, supervisors, and the primary preceptor thought was appropriate.
Observations of this process were made and it was determined that the process of restocking the
provider’s lounge could be performed in a more timely manner, with some modifications to the
current process.
Extensive research was conducted to decide which method would work best to decrease
the time spent by a foodservice employee restocking the provider’s lounge. St. Clair Hospital in
Pittsburg, Pennsylvania also used the par system in their nursing supply rooms. This system had
several flaws at St. Clair Hospital such as; nurses not being able to quickly locate supplies,
running out of supplies, nurse taking too many supplies, and over ordering of supplies. To limit
these flaws, St. Clair Hospital implemented a two bin system in their nursing supply room. A
two bin system requires two bins to be fully stocked on the shelf. The bins are placed on the
shelf with one in front of the other. The nurses take supplies from the front bin until it is empty.
Once the bin is empty, the bin is removed from the shelf and placed on the top shelf for the
materials handler to refill. The rear bin is then pulled forward on the shelf, and nurses take
supplies from this bin. After the materials handler refills the empty bin, it is placed behind the
bin that is currently being used. This process is then repeated when the bin in front becomes
empty.1 This process was also used at Seattle Children’s Hospital.2
Lean manufacturing was also researched as a possibility to decrease the time spent
restocking the provider’s lounge. The goal of lean manufacturing is to increase value to the
customer while in the meantime decreasing waste. This is accomplished through continual small
improvements.3 In this case the goal would be to more efficiently restock the provider’s lounge,
which provides value for the provider’s of the hospital while not wasting unnecessary time.
Lean manufacturing has many facets, two of which include having a location for everything and
labeling the location to make it easy to locate. Having everything in a logical place and labeling
the location reduces error and decreases time spent on the task at hand.4
3. Objective
The objective of this study was to observe the restocking process of the provider’s lounge
and decrease the amount of time spent restocking the provider’s lounge by five minutes by
implementing the changes of a modified checklist, a pre-stocked cart, and a labeled refrigerator.
Methods
Indicators Measured
For this study, two indicators were measured. These indicators included time spent
restocking the provider’s lounge and the number of steps taken by the foodservice employee
while restocking the provider’s lounge. The average of both time and the number of steps were
taken for this study. Time was measured using the clock on an iPhone 5c and was recorded.
Steps were measured using a Nike+ FuelBand SE and were also recorded.
Pilot Intervention for Improvement
On Wednesday November 12, 2014 and Thursday November 13, 2014 at 7AM, the
foodservice employee was observed restocking the provider’s lounge. On Friday November 21,
2014 at 7AM and 1PM, changes were implemented to the process of restocking the provider’s
lounge to make the process more efficient by reducing the time spent restocking. The
implemented changes included a modified two bin system and lean manufacturing. The
modified two bin system included a cart that was pre-stocked with food and supplies needed for
the provider’s lounge. The foodservice employee placed the new items that were on the
pre-stocked cart behind the older items already in the provider’s lounge. The purpose of the
pre-stocked cart was to eliminate the time spent initially traveling to the provider’s lounge to
take inventory of the provider’s lounge and then traveling back to the kitchen to obtain food and
supplies. Lean manufacturing was implemented by editing the checklist with par levels to be
more organized and easier to read. The checklist was split up into sections titled refrigerator,
table, coffee counter, condiment drawer, and flatware drawer. The sections were organized in
order of where food and supplies were placed in the provider’s lounge, requiring less time to
search for each item’s location. Additionally, the refrigerator was labeled to indicate where food
items were located which decreased the time the foodservice employee’s spent to find the food’s
location.
*See attached checklists
6. Data Collection
Average Time, Steps, and Step to Time Ratio Taken by Foodservice Employee Restocking the
Provider’s Lounge Before and After Changes to the Process were implemented
Time (Minutes) Steps Step:Time
(Steps/Minute)
Before Changes 51 542 10.6
After Changes 40.5 612.5 15.1
Results
Before the pilot intervention for improvement was implemented, the average time to
restock the provider’s lounge was 51 minutes. The average steps taken by the foodservice
employee before the pilot intervention for improvement was 542 steps. Prior to the pilot
intervention for improvement, the foodservice employee took 10.6 steps every minute. The
changes of using a pre-stocked cart, editing the checklist, and labeling where food was located in
the refrigerator was efficient in reducing the time spent restocking the provider’s lounge. The
pilot intervention for improvement decreased the time spent restocking the provider’s lounge by
10.5 minutes. The time spent restocking the provider’s lounge after the pilot intervention for
improvement was 40.5 minutes. After the pilot intervention for improvement the average steps
taken by the foodservice employee was 612.5 steps. This increase of 70.5 steps taken by the
foodservice employee led to 15.1 steps taken every minute after the changes were implemented.
The increase in steps per minute was not efficient. The increase in steps was most likely due to
the foodservice employee forgetting to pre-stock the cart with fruit creating an extra trip back to
the kitchen to obtain the fruit and then an additional trip to the provider’s lounge. The extra
steps can also be due to the foodservice employee inefficiently pre-stocking the cart. Since it
was the first time the foodservice employee pre-stocked a cart for the provider’s lounge extra
trips to and from the freezer, refrigerator, and dry storage were observed.
Discussionand Recommendations
Changes to the process of restocking the provider’s lounge were needed at IU Health
Arnett in Lafayette, Indiana due to the inefficiency of the process. The process of traveling from
the kitchen to the provider’s lounge then back to the kitchen to collect food and supplies and
again traveling back to the provider’s lounge to restock consumed more time than necessary.
The checklist with par levels also added additional time to this process. The foodservice
employee had to search for food and supplies since the food and supplies were not listed in order
on the checklist as they appeared in the provider’s lounge. Implementing a modified two bin
system and lean manufacturing greatly reduced the time spent restocking the provider’s lounge.
By having a pre-stocked cart fewer trips were made to and from the provider’s lounge.
Organizing the checklist by dividing the checklist into sections and putting the food and supplies
7. in order as the food and supplies appeared in the provider’s lounge reduced the time spent
searching for the location of the food and supplies. Additionally creating labels for the location
of food in the refrigerator also helped to reduce the time spent restocking the provider’s lounge.
Although additional steps were taken after implementing changes to the process, this can be
corrected with practice in pre-stocking the cart more efficiently. To continually improve this
process some recommendations can be made. When pre-stocking the cart, it needs to be done in
an organized manner and in the order as the food and supplies appear on the checklist. This will
allow for less confusion and less time finding the food and supplies on the cart when restocking
the provider’s lounge. The checklist and labels in the refrigeration should also be updated as
frequently as need as there are continual changes to the products purchased at IU Health Arnett.
One additional recommendation would be to restock the pre-stocked cart immediately after
restocking the provider’s lounge. By immediately restocking the pre-stocked cart, the
foodservice employee will be able to better remember what was just taken off the cart and put in
the provider’s lounge. This will allow for quicker thinking and less time spent restocking the
cart.
References
1.) Lyon T. Two Bin Supply System at St Clair Hospital [Video]. YouTube.
https://www.youtube.com/watch?v=yjSwwPF5BUU. Published July 12, 2012. Accessed
November 14, 2014.
2.) Weed J. Factory Efficiency Comes to the Hospital. New York Times. July 10, 2010.
http://www.nytimes.com/2010/07/11/business/11seattle.html?pagewanted=all&_r=1&.
Accessed November 16, 2014.
3.) What is Lean?. Lean Enterprise Institute Web site. http://www.lean.org/whatslean/
Published 2009. Updated 2014. Accessed November 16. 2014.
4.) Beyer P. Lean Manufacturing Tour [Video]. YouTube.
https://www.youtube.com/watch?v=mqgHUwSaKj8. Published February 18, 2010.
Accessed November 16, 2014.
