If you want your hospital to operate effectively, standardization is one of the most important tools at your disposal. In fact, over 10 years ago, Dr. Peter Pronovost conducted a test across the state of Michigan of a revolutionary change in hospital I.C.U.s that dramatically reduced line infections. The high frequency and potential severity of line infections—possibly leading to fatality—gives them major importance.
Pronovost introduced a simple checklist, a key component of standardization, and drove compliance by all physicians. Deaths from infections went down significantly during his tests and in broader application. Evidence-based healthcare works!
At a less grand, but still impactful level, hospitals can see benefits by applying standardization to a rather mundane area: the supply closet.
Why do supply closets matter?
You might say, “It’s just a closet. Who cares?” But think about the frequency of use of supplies in your facility, the number of users, the dollar value of the materials that move through the closets, and the impact to patients of these supplies. While not all patients have an MRI, EEG, or EKG, every patient is touched by supplies throughout his or her stay.
It is important to have specific supplies available when needed, sometimes in an emergency. Staff members need to know where to look for supplies and have confidence that the quality materials that they need will be available in the right quantity. Overall inventory management prevents nightmare scenarios of total failure of supply availability, while standardization improves effectiveness. This saves time and money, reduces footsteps and stress, and occasionally might make the difference between life and death in an emergency situation.
How do you standardize supply closets?
Start by forming a team. Not everyone enjoys “organizing,” but you’re likely to find several people who will be very enthusiastic to have the time and authorization to drive improvements. Make sure they are equally energetic about getting input from other staff members. Include some pragmatists from across working teams in the group to ensure the solution is workable for all.
The team should start with an understanding of how inventory is managed in the facility and a site layout showing where supplies are stored. Ideally this will include a Gemba walk, visiting many of the storage rooms across the site to see the current state. They might find some “best practice” locations that will inspire their improvement efforts.
They will categorize storage rooms based on use and locale. For example, they might define closets for daily patient unit supplies, central patient unit supplies, daily OR supplies, daily ER supplies, facility central supplies.
The initial focus will be on storage room categories that are common in multiple parts of the facility. Part of the benefit of standardization is for team members in a unit to have the same setup from one day to the next. In addition, standardization from one unit to another similar unit is very helpful when staff members rotate across floors or specialty areas.
The nuts and bolts of organization and standardization, 5s…or 6s
One of the best approaches to organizing a workspace is using 5S. This is a tool, methodology, and culture that helps workers create a sustainable organization in their workplace for improved effectiveness. The method comes from Japan, with five Japanese words starting with s, now Anglicized:
- Sort – Determine what you have and need. Identify what you don’t need.
- Set in order – Create a place for everything you need and put everything in its place. Remove what you don’t need.
- Shine – Clean the area thoroughly and use deviations from cleanliness to identify any developing problems. Develop a cleaning SOP.
- Standardize – Provide tools, rules, markings, and other requirements to make the first three items permanent.
- Sustain – Put management processes in place to be sure this work doesn’t decline over time.
- Safety (a bonus sixth s) – Build worker safety and ergonomics into the storage organization.
The team will start with a single pilot storage room. While some of the planning for the end result in this room can be done in a conference area, most of the work will happen in the storage room itself. If possible, the “sort” step should involve pulling everything out of storage and putting back in only the things that are needed.
Anything not returned to storage needs to be dispositioned, with typical categories of discard, return to central storage, return to vendor, recycle, or give away.
Within the storage area, the team will assign preliminary storage locations, possibly marked with masking tape. Then a pilot period of several weeks will allow all personnel across rotating shifts to use the storage room and provide feedback. Ideally, staff members from other units will also see the pilot space and critique it. Once the feedback is reviewed, the team will determine a permanent solution and apply it across the organization’s similar storage areas.
Make sure everyone receives communication as the process is underway. Any surprises in the short term can lead to long-term dissatisfaction with the improvements.
Specific organizing tips
Each team will have its own considerations, but many common storage recommendations will apply.
- Maximize vertical wall space. Keep things off the floor. Any item put on the floor is susceptible to damage from floor cleaning or spills. In addition, a box on the floor is a flat surface that invites “stuff” to be put on top of it.
- Use adjustable wall organizers, preferably see-through. This might be wire shelving or varying size open bins. Renovating all storage areas in this category to provide the same shelving will likely require some expense, but relatively small compared to the expected benefits.
- Determine the best supply locations for ease of use. Put the most-used items at eye or hand level. Allocate more space for more frequently used items to avoid frequent trips to central storage. Allocate more space for big items, less space for small items.
- Put like supplies together. Define an overall color-coding scheme to group similar types of supplies.
- Affix sturdy but removable labels. People should be able to quickly see where their needed supply is. The label must be easily changed if supply item locations are changed.
- For safety and ergonomics, put heavier items on the mid to bottom shelves.
- Utilize first in, first out supplies management, i.e., during restocking, new supplies are put at the back or bottom of the specific storage location.
- Take photos of the optimal setup and post as reference, possibly on the inside of the door. Also keep an up-to-date printout of storage locations. This could tie to an automated inventory management system.
- Define a monitoring and maintenance process including roles and responsibilities. This may include a cleanliness checklist, an audit of storage location accuracy, and team reviews of status and changes.
While it may be difficult for some individuals to plan or execute a major storage room reorganization, most folks will be quite happy with the end result if it saves them time or reduces stress. Who doesn’t like working in a clean and well-organized environment?
For more help getting started with storage room standardization, get in touch with EON, your go-to partner for continuous improvement in healthcare efficiency and effectiveness.