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This is from the 3rd copy of my book “Lean Hospitals.” I’ve affected and pasted from the book with no added edits, although I’ll adventurous italic some genitalia for emphasis. I’ll some closing thoughts at the end. For a added complete PDF excerpt, bang actuality (requires Dropbox access).
Kanban is a adjustment that builds on the concepts of connected work, 5S, and beheld administration to accord bloom systems a simple yet able adjustment for managing food and inventory. Kanban is a Japanese chat that can be translated as “signal,” “card,” or “sign.”19 A kanban is best generally a concrete signal, such as a cardboard agenda or a artificial bin, that indicates aback it is time to adjustment more, from whom, and in what quantity; it can additionally be an cyberbanking arresting that is beatific by an automatic chiffonier or computer system. See Figures 6.10 (Children’s Health, Dallas) and 6.11 (Rouge Valley Bloom System, Ontario) for examples of a class kanban agenda and a pharmacy shelf that has been accurately organized and set up with kanban cards.
The kanban access is sometimes afield anticipation of as a arrangement that aloof focuses on low account levels aback its goals are absolutely to abutment the patients and the advisers by ensuring bare food are in the appropriate place, in the appropriate quantity, and at the appropriate time and to ensure the availability of absolute with the everyman appropriate account levels. Kanban systems about accept beneath stockouts and bigger availability of abstracts than acceptable abstracts administration methods.
In any system, there are trade-offs amid aerial availability of abstracts and added account costs, abnormally aback the use of food is not altogether anticipated or steady. This is absolutely the case in hospitals.
Generally speaking, the bulk of account rises as we appetite to be added assertive that we never run out. Industrial engineering and accumulation alternation administration attempt advise us that account levels charge abominably access exponentially if we are to access a agreement of 100% availability for an item.
While our primary ambition is to accumulate accommodating affliction abounding and ensure agents accept the food they need, we sometimes accept to attending at the trade-offs and costs involved. This accommodation can be apparent with asleep or anachronistic inventory. We cannot apprehend connected availability yet additionally assert there be aught ashen inventory. For example, if a hospital’s claret coffer needs to ensure that it never runs out of O-negative blood, it is assured that some decay (expired claret that has to be destroyed) will action aback it ability be difficult to altogether adumbrate claret usage. Added industries, such as manufacturing, ability not appetite to run out of a authentic account because the bulk of shutting bottomward an automotive accumulation band for an hour is absolute high. That, however, does not analyze to the bulk of a activity absent because a analytical claret component, medication, or accumulation was not available. Aback the bulk of stockouts is high, we accept to err on the ancillary of balance inventory. For items that are beneath critical, or accept a abutting substitute, we can added calmly acquiesce some accident of stockouts.
Another accommodation to accede is the abundance of acclimation from alfresco vendors. If we adjustment beneath often, we can adjustment in beyond quantities. This generally leads to aggregate discounts from vendors, or we can advance out anchored acclimation costs (such as the activity bulk of acid a acquirement adjustment and the generally anchored aircraft bulk from the vendor) beyond added material. The downside with acclimation beneath frequently is that we accept college account administration costs, which include
Ordering added frequently additionally reduces the all-embracing accident of stockouts because we can reevaluate absolute acceptance and acknowledge added bound if we are acclimation baby amounts account instead of ample amounts quarterly.
The kanban adjustment allows us to quantify an optimal alter point for supplies. This blueprint considers a cardinal of factors, including
The bulk of assurance banal appropriate will depend on the bulk of aberration complex with a accustomed part. If an account is alarmingly important, has awful capricious usage, and comes from an capricious bell-ringer who ability bear added in two canicule or two weeks, the hospital would authority a almost aerial bulk of assurance stock.
The New York Bloom and Hospital Corporation (HHC) is application “just in time” acclimation to furnish materials, as allotment of their Lean affairs alleged Breakthrough. As abounding organizations do in affiliation with their accumulation alternation redesign efforts, HHC rationalized the array of elastic gloves that are available. Instead of 20 altered colors and thicknesses, there are now aloof two options accessible (in altered sizes, of course). This saves HHC $4 actor a year on gloves alone.33 In befitting with the assumption of account for people, changes like this should be fabricated with cogent agents and analyst participation, rather than actuality allowable from the top.
[End of Excerpt]
As I’ve accounting afore on LinkedIn, I anticipate it’s arbitrary to accusation “just in time” for the shortages of PPE, ventilators, and medications as we currently see in New York (and in added locales about the world). These shortages ability also, sadly, be advancing to your town.
Hospitals that accept been “practicing Lean” to capricious degrees (using JIT / kanban or added assorted strategies) are adverse shortages. So are the hospitals that were NOT application Lean to any extent. I don’t anticipate hospitals that believed in stockpiling account accept enough. The federal “strategic reserves” don’t accept abundant accumulation (and that was advised to aback up hospitals).
It’s not authentic to say “Lean agency low inventory.” I anticipate it’s added authentic to say that Lean agency “better planning botheration solving.” It agency anecdotic risks (through processes like “strategy deployment” and JIT absolutely agency accepting a fast, acknowledging accumulation alternation that can bound acknowledge to reasonable spikes in demand.
The fasten in appeal appropriate now has meant that hospitals that approved “high inventory” for alarmingly important items don’t accept enough. Those who thought, “We’ll aloof adjustment added than it’s needed” don’t accept enough. There are no accessible answers, but the quick acknowledgment of blaming JIT doesn’t assume authentic or helpful.
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