Lean Healthcare Problem Solving HeroDoes the following scenario sound familiar to you?

“Materials.  This is Ben.  How can I help you today?”

“Hey, Ben.  This is Anita in lab.” The volume of the frantic voice pushed the receiver away from his ear. “I am out of reagent for the cholesterol panel.  How quickly can you get some in here?”

“Anita, you know you need to order these before you run out.  It’s after 3 o’clock so my distributor won’t process the order until tomorrow.  Ground shipping on a special order is two days.”

“I don’t need your soapbox, just a box of reagent.  Get them in here.  Tomorrow!” she sniped.

“I can have it overnighted from another vendor, but they are not on the master pricing agreement.  You know the price variance and extra shipping will go against your budget,” Ben calmly explained, making a mark on his tick sheet he was using to track the number of times that the lab was expediting orders.  Between Anita and the night shift lead, this was the third time this week, and eighth for the month, that they were getting these desperate calls.

“You gotta do what you gotta do!  I knew I could count on you!  You’re my problem solving hero!” Anita countered trying to make up for her initial attitude.

Anita hung up before Ben could ask why she keeps running out of reagents.  “Problem solving hero,” he reflected, “I feel more like the work-around kid.

Ben had recently attended the hospital’s A3 Problem Solving class and pondered how to apply his new knowledge. “The first thing I need to do is go to the lab and try to understand why they keep running out,” he thought to himself, marking his calendar to go down to the lab tomorrow morning.

As he entered the lab, he said, “Good morning, Anita!  Did you bring any of your famous cookies in today?  You owe me a favor for all these rush orders.”  Frustrated with the recurring problem, he tried to be objective and calm despite her attitude the prior day.

“Do you have it with you?” she snidely asked.

“Overnight orders hit the dock at 10 a.m.  You should have that memorized by now, with all these expedites.  We are 15 days into the month, and you have had eight expedites.  We average $15 extra to order from the secondary vendor and the overnight fees are $35 extra in shipping.  Predictable orders could come on the daily truck.”

“But you’re my hero!  You can always get it in the next day,” she purred.

“I don’t want to be your hero.  I want you to have your supplies when you need them.  Plus, it’s a pain for me to expedite orders and fill out the incident reports for the overage on shipping.  By the time I field the calls from Cheryl in accounting it is about 20 minutes every time.  You know we are trying to reduce unnecessary costs.  Not to mention the fact that there’s a patient somewhere who is not getting a lab result.  And weren’t you just complaining last week about the calls from the hospitalists looking for lab results?”

“Why don’t you order extra and we can just keep it in stock?” she queried.

“It has to be refrigerated.  The last time I let you order extra, you left it out and it had to be thrown away. It does not matter if we get the best price if we throw it out because we cannot use it.”

“Why don’t we get a bigger refrigerator?” she asked.

“Why don’t you order it before you run out?” he fired back, wondering if he could control his rising anger and maintain a respectful attitude.

“I order it when the techs tell me they need it,” she countered.

Taking a deep breath, he recalled this new word gemba (the place where the work is done) from the recent class and replied, “Let’s go see where you store your reagents.”

As they walked to the cluttered corner of the lab Anita cautioned him, “It might be a bit messy.”Ben was not prepared for the disaster zone that was her storage area.  When he opened the refrigerator door, boxes jumped out at him as if they were starting a race to the test benches.

Cued by his skeptical glance, Anita explained, “We know they need to be refrigerated and the refrigerator is so small, we just cram them in there.  I told you we needed a bigger refrigerator.”

As Ben focused on sorting through the boxes, he noticed several that had expired and set them aside, knowing that he had run out of favors and could not bring himself to ask the vendor to swap them for new boxes again.

Fifteen minutes later, he stepped back to admire his handiwork.  He had sorted and organized the boxes in the refrigerator and found that four unopened boxes out of 36 had expired and they had eight boxes of one infrequently used product.  Knowing which products the lab usually ordered, he realized he would probably get another frantic call before the day was out for one of the more common reagents that he could not find.  And there would be enough room if there was not excess and expired product on hand.

“This has got to be better!” he called out, wondering where Anita had disappeared.  He wandered back into the lab and found her toying with one of the complex machines in the lab that he had no clue about.  “If she just could handle supplies like she handles the testing,” he contemplated.

“Sorry, Ben.  Just helping a new graduate with one of the tests.  Getting a good result from a bad blood draw is challenging, but, if you know your stuff, it’s kind of fun.”

As they walked back to the supply room, she glanced at the rejected boxes and, reading the look on his face, commented, “What do you expect?  I went to school to study chemistry and biology, not to be a stock clerk.”

“I know, but we have got to do better.  I’ll help you set up a system, but you have to pitch in as well.”

Relieved to have an offer of help instead of just telling her to do better, Anita replied, “I’m all ears.  But keep it simple, will you?”

Ben was pleasantly surprised by Anita’s willingness to accept help.  Having started as a receiving clerk on the dock, learning the system from the ground up, and then being on the new software implementation team, he just assumed that people understood how to manage supplies.

“The key, Anita, is that you need two things to manage reordering, something to trigger the order, and some way to transmit the order.”

“I don’t know if I can handle some complicated system, Ben.  I need something easy.”

“Think about a checkbook.  The last book of checks has a reorder form on top of the stack.  When you pull out that last book, the reorder form serves as a reminder, a ‘trigger’, for you to reorder.  It also has the mailing address and a website listed as ways to place the order.”

“So what does this have to do with lab supplies?” Anita asked.

“Let’s make some cards that are like that checkbook reorder form.  Just write the product name on the card and we can tape it to the box.  When you open the box, the card will be a reminder to reorder.  As long as I can get new product shipped in before you use that box, you should be fine.  It will also prevent these large orders of items you rarely use.”

“What about night shift?  They get supplies from here, too.  But they don’t place orders.  I’m the only one with system access.”

“I’ve got a few extra brochure pockets from a remodel project down in the warehouse.  We can mount one on the side of the refrigerator. When anyone opens the box with the card (your trigger), put the card in the brochure pocket (your order).  You can just look there for what needs to be ordered.”

“That sounds too easy.  When can we get started?”

“We can start now with Post-It notes.  We can have a working model in 30 minutes.  As you start using this new system, we may want to make changes, maybe add information on the notes that you need to place the order-catalog number, vendor order, any information that saves you time when you order.  Until we trial a change, we may not have all the answers.  But let’s try this and I’ll come back down tomorrow to see how it’s working and what you’ve learned about changes we need to make. I’ll also go ahead and order the high-usage items you are running low on to get the system full as a starting point.”

“This is great, Ben.  I really appreciate your help.”

“No problem.  Maybe you could bring in some of your famous cookies.”

“You know I buy those in a box!”

“Then we will have to make a reorder card for those, too!”

This story is a fictionalized account of real world scenario where a bit of lean thinking, collaboration and a simple solution can make a significant impact.  Are your employees empowered to improve their own processes?  Are they encouraged to trial changes and make improvements?

This week’s blog was written by Richard Tucker, Vice President with HPP.

Richard has served as a coach, facilitator, and project manager for healthcare clients in the training and implementation of Lean Healthcare Tools and Methodologies. Prior to joining HPP, Richard had over sixteen years of business and industry experience in operational and leadership positions.  In addition to his ongoing support of healthcare organizations in their lean journey, Richard is a founding faculty member of Belmont University’s Lean Healthcare Certificate Course. Richard’s educational background includes BS and MS degrees from Tennessee Technological University in Cookeville, Tennessee. Richard has attended formal training courses in Lean Manufacturing, Leadership Development, and Shainin Statistical Problem Solving.

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