In this session, Brooke Mullett, MBA, senior director of operations for perioperative and surgical services at Cincinnati Children’s Hospital Medical Center (CCHMC), and Ash Crowe, project manager at St. Onge Company, walked attendees through a $100 million renovation project of the CCHMC ORs and surgical supply inventory. Even with this budget, they still faced the challenge of being “land locked” in an existing space, as the renovations did not necessarily entail expansion. They had to rethink their strategy around inventory storage.
Mullett and Crowe tackled the project by creating 3–7 people service line groups comprising: a couple of “surgeon champions,” nursing coordinators, scrub technicians, and an “unique role” called resource techs, who are the “right hand when it comes to supply and equipment and understanding supply needs.” They explained the projects in these six steps:
- Define the item universe. “Clean up messy data,” said Crowe. “We put in the time for data cleanup” and separated items/instruments in different categories. For instance, “A” items are the most used, and “dead” stock are no-movement items. However, the presenters cautioned that this approach needs to be tailored to individual facilities. “A children’s hospital will have ‘dead’ stock that absolutely needs to be around, for instance,” Crowe said.
- Review the available data and assign the “clinical factor.” “Next, get the emotion out of data,” said Crowe. In order to receive actionable buy-in from the stakeholders, the data needs to be easily digestible and cleanly visible; it needs to be discussed theoretically before being applied to concrete concepts; and the teams need to have time to get familiar with what it represents.
- Define primary/secondary location(s). “For some items/instruments, you might say, ‘we need this in the room,’ or ‘we need this in the hall,’ or ‘we need this somewhere in the department,” Crowe continued. Some items might need to be in more than one place. This location definition happens once the stakeholders have had time to assess the different items and categorize them by frequency of use (“A” items vs. “dead” stock), predictability (“How soon will I know if I need the item, before or during surgery?”), and accessibility (“Will I need the item within 30 seconds or 20 minutes?”).
“These conversations helped people hold each other accountable,” Mullett said. “The surgeon might say they need an item within 30 seconds, but the scrub tech will chime in with their view point and help them realize the need is not as immediate.”
- Identify “BASOR” items. “Within the set supply budget, 20% is central OR ordered and distributed, and the rest is up to the resource techs at the individual service lines,” Mullett explained. According to her, a goal of this project, besides optimizing space and storage, was to identify what could move from bespoke orders to central orders, which would lead to more efficiency and savings. “This helps with competition as well, so one service can’t claim to ‘own’ certain items or feel like other services ‘take’ their inventory.”
- Calculate par levels. “We call it ‘right-sizing’ because it’s not just about downsizing,” Crowe said, demonstrating their surprising results: 348 items (~$137,000) were flagged for removal; almost 3,500 par levels were reduced; and over 1,200 par levels were increased. Potential net adjustments to the CCHMC supply chain are set to reach $1.3 million in returns.
- Quantify spatial requirements. This spatial analysis, the presenters concluded, was successful in defining, quantifying, and optimizing the existing space in which the renovations had to take place. “Most of the staff were not used to looking at inventory data like they have been exposed to block scheduling data, staffing data, first case on time start data, etc.,” Crowe said. This is a success story where clinicians were introduced to new data that drove innovation and efficiency.