Two Bin Supply System at St Clair Hospital

When staff can’t quickly find the supplies they need
we end up with delayed patient care, frustrated staff, hoarding, and over ordering
of items which adds cost to our system– as well as interruptions to the workflow
when materials handlers have to answer the phone to take special orders. Like
most hospitals we used to replenish our nursing supplies using the par system.
With the par system each item will have a set par level based on historical
usage. The material handler would need to count how many of each item that was
left, enter that amount into the system, and deliver exactly enough of that item
to bring it back up to par. In reality, with every supply room housing over 200
separate items on average, a materials handler would do a quick visual scan to
see what was running low and those are the items that get restocked. A seasoned
material handler could be very effective with this method thanks to years of
experience. For a new employee however, this process has a lengthy learning
curve. Once a material handler scans the items and enters the quantity which is
actually left he goes down to the storeroom on the first floor and
downloads his handheld. The system automatically prints a pick ticket with
the items needed to replenish the unit. He then pulls the stock from the
storeroom shelves and delivers it to the units. At St. Clair Hospital we set out to
find a stable, reliable way of replenishing nursing supplies. We know
from Toyota or “Lean” principles that we want to pull what we need from upstream
whenever possible. So we began experimenting with different
kinds of Kanban systems or signals that would let nursing staff easily signal to
materials exactly when an item is low and needs to be replenished. The trigger
that helped us get on the right track was a New York Times article about how
Seattle Children’s Hospital had converted their nursing supplies to a
two bin system using lean principles and had great results. After a site visit
where the staff at Seattle Children’s generously shared their experience we
decided to follow suit and develop our own two bin system. We recognized that the
work of switching over all our supplies to this pull system would take a
significant investment of time and so with the support of our CFO Rick Chesnos, a longtime advocate of Kanban systems, and Director of Materials
Management Dan Pais, we hired an industrial engineer to help our
material supervisor build the new system. Together they converted 28 different
supply areas in 21 units in just 10 months. Every unit requires extensive
backstage planning and about 70 percent of that time is spent preparing and
analyzing data. First we looked at usage history and through a series of
calculations and statistical analyses established new stocking numbers. Second
we determined size and space requirements, for example, calculating
what size bin is most appropriate for toothpaste versus 4×4 gauze pads. One
major challenge presented was assessing the physical layout of each unit
stockroom as most varied significantly. We created floor plans for each unit. One
thing we learned from this project is that fixed cabinetry is an enemy of lean.
Plant Operations often provided extensive facility changes removing
cabinetry and unused sinks that were taking up valuable real
estate. By carefully reviewing the data and planning the layout from floor to
ceiling, we were often able to add previously non stocked items to nursing
units. The next step was to physically build the carts, load the bins in the
right location, and label them. Once complete, the cards were delivered to the
target supply room and existing stock was transferred to the new bins. Visual cues
were provided to instruct nurses of the new system.
if you pull the last item out of the bin simply place the empty bin on the
top shelf and pull the remaining full bin forward and you’re done.
The two bin replenishment system is now much easier. Instead of counting every
item that needs to be replenished, all the materials handler needs to do is scan
the cart code, then scan each of the empty bins on the top shelf and enter 0
for the amount of each one. The count is 100% accurate every time and requires
only a few seconds per empty bin. When the materials handler delivers the
exact amount needed to replenish the bin he simply places the full bin behind the
front bin thus guaranteeing first-in first-out and virtually eliminating the
chances of having expired items. Usage can be monitored, and fast or slow moving
products can be increased, reduced or removed as needed before they expire. The
nursing staff was asked to start using the new system and provide feedback.
Through this process we fine-tuned the system to each unit’s specific desires
for stock placement. If a nurse cannot find a particular product, a
cross-reference chart is provided to quickly find its location. On 6E we
have been very fortunate through the years– Don has always stocked us
very well. Now we use the two bin system, like it, we never seem to really run out
of anything, so it’s a good system. There was a bit of a learning curve relearning
where everything was located, but since it’s been implemented we do not run out
of things, much less times that we’re frustrated having to wait for things
from materials management. Things are here at our fingertips; we can get to
them quickly in those emergent situations, and even the non emergent
situations; it just helps your flow of care– less
frustration for everyone and so it’s been a good implementation here in the
intensive care unit. Before the ICU was converted from their par system they
were calling down for urgently needed supplies several times a day in one
month alone the ICU sent down 73 handwritten requisition forms. As soon as
the two-bin system was installed the number of manual requisitions dropped to
zero. The best thing about it is my budget– my variance report. My budget on
supplies every month has been under budget since we put this in place and
that’s a good thing for me so that I don’t have to go into explaining why I
use too many supplies, because we don’t. When Bob and Will first came to me with
the presentation for the two-bin system I was totally against it and I think I
maybe even made them cry because I just didn’t want it to happen, but now I’m
here to tell you that it is truly one of the best systems we have ever
implemented in this hospital. There is never a question that supplies
are going to be available to the nurses. They are consistently in the same space
and I have not had one complaint from a nurse or a CNA anyone since this has
been implemented. We have never had a shortage and so I can now apologize to
Will and Bob and say that I was wrong but it is truly a wonderful system and
I’m an advocate for it

27 thoughts on “Two Bin Supply System at St Clair Hospital

  1. Great work! I would be interested to see how this evolves. What is the next step in the PDSA cycle? For example: why does the material handler have to scan the empty bin, go back to the warehouse, place the items on a cart, and transfer them to the bin in the supply room? Is there any reason the material handler cannot just take the empy bins to the warehouse and replenish them directly?

  2. Our next step is to tackle our central supply room. We learned through this process that nursing staff were direct-ordering all kinds of lower volume supplies because of lack of space to stage them in central supply. Seattle Children's overhauled their central supply room and relieved all clinical staff of any ordering responsibilities. They also renegotiated their contracts with suppliers to have them deliver pre-packaged totes with the exact amount needed to fill a bin. We're not done yet!

  3. The handlers themselves have argued that there is no time advantage to bringing the bins down for re-stocking and we want them to be involved in the design of their own work. We will continue to collect data on this and look for the most efficient restocking process for our particular facility.

  4. Looking forward for any updates you may post. Some of our unit directors have already seen this video, which really helped to demonstrate how these "manufacturing" principles apply to a health care setting. Good luck on your journey!

  5. This looks like a great system. Could I ask what the inventory value was for the par cart locations before and after the two bin system was adopted?

  6. We had hoped to decrease the volume/cost of inventory on the shelves and were surprised when that didn't happen. We found that we eliminated or reduced some items, but added or increased others so that it more or less averaged out across the hospital. We didn't so much purge excess inventory (materials had managed that fairly carefully–even under the par system) as OPTIMIZE inventory. We now have the right amounts of the right items. The benefits accrued to nursing staff workflow.

  7. 6:30

    The nurse says they use fewer supplies with the two bin system. I don't see why this would be the case. Someone please explain. Thank you!

  8. They don't use fewer supplies, but they do *order* fewer supplies (the system eliminated multiple storage locations, hoarded supplies, and hidden supplies–i.e. supplies stacked in unopened boxes so the contents are difficult to see).

  9. What about items in the closet that are too big/bulky for bins? Did you simply use a card kanban system instead?


  10. In the setting of this bin and cart system, we did not use kanban cards due to the difficulty of placing the cards and their ability to become lost. The number of items not able to fit in a double bin are few in number, so they are simply highlighted as items that need to be hand counted the old-fashioned way. The material handler will count the 3 or 7 items and key in the number to bring it up to par.

  11. Excellent example of lean.  Hopefully the implementation time is reduced with each endeavor!  I'll be sharing this video on to others.  Paul

  12. Awesome job, and excellent video.  Love the staff feedback and testimonials at the end, especially being transparent about change. 

  13. It looks like the scanner is a bit slow to use (this could be fixed by switching to an omnidirectional model). Also, the entering of 0 qty each time is extremely redundant and can definitly be eliminated. This is definitly a huge improvement though!

  14. My question is how often a material handler should check the empty bins and scan the bins on the top of the shelf.

  15. Kanban is the way to go.  If only this hospital had a system like Pegasus to actually store the supplies – they would save a tremendous amount of actual space to store their supplies and would still be able to use their kanban software.

  16. Hi Tania,
    Thank you for sharing the video.
    I am trying to establish Kanban system in my hospital. Assuming the handlers round on the empty bins once a day, what would the Lead Time be. Lets assume that materials can be replenished in 2 hours. Could you please share the formula that you used to calculate the Kanban Size.

  17. Tania, how deep are those wire shelves? I'm only working with 14 to 15" deep shelving and there's no way I can fit 2 bins (one bin behind another) on the shelf.

  18. Hey Tania, great video!

    Have you ever considered upgrading from Kanban to a weight-based system? Some combination of both?

  19. I think their trying to include a similar system to our area but there's the matter of costs and not getting planning persmission as the nhs trust I work doesn't own it's own hospitals.

    I am concerned with the number of container bins given the amount there are to clean, how do you approach it, you clean x number of containers one day and x number after that?

  20. Remember that the bin isn't the grail really. It is just a signal. Space concerns could mean going to a single bin with a divider – and the divider could double as the Kan Ban card…..stack bins on each other – this also prevents the hand from going into the wrong bin……Ideally, an exchange cart system would be best. Each day the carts are exchanged for full ones and returned to main stores (or better yet, the vendor) for filling – and repeat. No matter the system, it will be at the mercy of humans – and humans will find all kinds of ways to try and defeat the best laid plans. Just keep pluggin away at it.

  21. I think this could be improved by the second bin having some kind of red removable marker, this will allow better visual control of items that are running low and prevent restocking errors or omissions. When the new bin arrives the marker can just be moved to that bin and then that becomes the second bin

  22. This is a great video. I use it in my Intro to OM class. The closed captions have a number of issues. Any chance of having those polished up for students who require captions? One example – there aren't any sentence breaks. Another: Rick Chesnos' name is written as Rick chest nose. Thanks!

  23. As a material handler in that has worked in a "two bin system" hospital, I can tell you now that it doesn't work… You have to rely on the nursing staff too much to pull the Kanbans/bins. The supply area gets messy with pulled bins and you have to find the product twice by finding the empty bin/finding where the bin is supposed to go. Which wastes a lot of time.

    I work in a new hospital and the best way to go is the Uline louvre and bin method. One bin for each product that never moves. Has a barcode label to scan the product on the bin. And the material handler knows to stock the new supplies in the back/bottom of the bin and have the older supplies in the front/top.

    The nursing staff loves it because you can clearly see how much supplies you have on hand for each product. It's neat and organized and actually conserves space to add new product that they need.

    Here is an example of how neat it is:

  24. we are planning on switching to this system can you show us the Material side of this? How is your warehouse set up to fill these?

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