JIT at Arnold Palmer Hospital
Orlando's Arnold Palmer Hospital, founded in 1989, specializes in treatment of women and children and is renowned for its high quality rankings (top 10% of 2000 benchmarked hospitals), its labor and delivery volume (more than 10,000 births per year, and growing), and its neonatal intensive care unit (5th highest survival rates in the nation). But quality medical practices and high patient satisfaction require costly inventory--some $30 million per year and thousands of SKUs.* With pressure on medical care to manage and reduce costs, Arnold Palmer Hospital has turned toward controlling its inventory with just-in-time (JIT) techniques.
Within the hospital, for example, drugs are now distributed at nursing workstations via dispensing machines (almost like vending machines) that electronically track patient usage and post the related charge to each patient. The dispensing stations are refilled each night, based on patient demand and prescriptions written by doctors.
To address JIT issues externally, Arnold Palmer Hospital turned toward a major distribution partner, McKesson General Medical, which as a first-tier supplier provides the hospital with about one quarter of all its medical/surgical inventory. McKesson supplies sponges, basins, towels, syringes, and hundreds of other medical/surgical items. To ensure coordinated daily delivery of inventory purchased from McKesson, an account executive and two service personnel have been assigned full-time to the hospital. The result has been a drop in Central Supply average daily inventory from $400,000 to $114,000 since JIT.
JIT success has also been achieved in the area of custom surgical packs. Custom surgical packs are the sterile coverings, disposable plastic trays, gauze, and the like, specialized to each type of surgical procedure. Arnold Palmer Hospital uses 10 different custom packs for various surgical procedures. Over 50,000 packs are used each year for a total cost of about $1.5 million, says George DeLong, Head of Supply Chain Management.
The packs are not only delivered in a JIT manner but packed that way as well. That is, they are packed in the reverse order they are used so each item comes out of the pack in the sequence it is needed. The packs are bulky, expensive, and must remain sterile. Reducing the inventory and handling, while maintaining an assured sterile supply for scheduled surgeries, presents a challenge to hospitals.
Here is how the supply chain works: Custom packs are assembled by a packing company with components supplied primarily from manufacturers selected by the hospital, and delivered by McKesson from its local warehouse. Arnold Palmer Hospital works with its own surgical staff to identify and standardize the custom packs to reduce the number of custom pack SKUs. With this integrated system, pack safety stock inventory has been cut to one day.
The procedure to drive the custom surgical pack JIT system begins with a â??pullâ? from the doctor's daily surgical schedule. Then, Arnold Palmer Hospital initiates an electronic order to McKesson between 1:00 and 2:00 P.M. daily. At 4:00 A.M. the next morning McKesson delivers the packs. Hospital personnel arrive at 7:00 A.M. and stock the shelves for scheduled surgeries. McKesson then reorders from the packing company, which in turn â??pullsâ? necessary inventory for the quantity of packs needed from the manufacturers.
Arnold Palmer Hospital's JIT system reduces inventory investment, expensive traditional ordering, and bulky storage, and supports quality with a sterile delivery.
1. What do you recommend be done when an error is found in a pack as it is opened for an operation?
2. How might the procedure for custom surgical packs described here be improved?
3. Provide examples of JIT for your arguments and relate them to Arnold Palmer Hospital.
4. When a doctor proposes a new surgical procedure, how do you recommend the SKU for a new custom pack be entered into the hospital's supply-chain system?
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1) Errors in the packing of the pack will be detrimental to the surgery in progress. Another pack must be obtained from the inventory immediately which will decrease the number in inventory for the rest of the day's surgeries. A call must be made to McKesson immediately as well to secure a replacement pack and report the error. The error must be investigated to ensure that no other packs are suffering the same error. McKesson should be working feverishly to amend the error and then to make sure it does not occur again.
2) Check lists are not only helpful for the packers to be sure of totally correct packing, but can also serve as a second check for the pack at the hospital when it is pulled for surgery. Initialing the completed pack will put more responsibility on the actual person doing the packing and narrow the search for the culprit when an error is reported.
3) Working for a civil ...
a case study of one hospital using just-in-time inventory for surgical instrument packs and prescribed medication during patient stay with suggested methods of improving current methods.