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By July 16, 2012 Read More →

Video on a “2-Bin” Kanban System at a Pennsylvania Hospital

kanban 150x150 Video on a 2 Bin Kanban System at a Pennsylvania Hospital lean

In this post, I’d like to share a nice 7-minute video from St. Clair Hospital in Pittsburgh, showing the transition from an inefficient “par level” system (that often led to stock outs for nursing supplies) to a two-bin kanban system that works. The video was produced by St. Clair, not by me. I appreciate them sharing the video with the world.

The video shows the process they went through, including comments from the industrial engineer, who was hired to put the system in place. With the system in place, they had ZERO stock outs and zero manual requisitions sent down to materials management.

The video also has some interesting comments from a manager who was initially VERY opposed to the kanban system… but is now a fan of the system.

When I tweeted the video last week, there was a comment back about how the items in the kanban system were clearly non-charge items. One hospital (it was either Seattle Children’s or Park Nicollet… or both, I forget) told me once when I visited that, when they put a kanban system in place, they took out MOST (not all) of their automated inventory control cabinets. Many of the items they  thought were charged to patients were actually not charged… so they didn’t need a cabinet to track usage to patients – they just needed a system that ensured staff have what they need for the patients. And, kanban does just that.

There’s certainly time and effort required to put a system like this in place… but it just works. The investment in system design pays off in terms of better staff satisfaction, reduced waste, and better patient care.

The video:

At 1:44 in the video, you’ll actually see a picture of a kanban card from the Lean Enterprise Institute office (used to replenish coffee pods), that I featured in this blog post from 2010. See how LEI helps the Lean community? :-)

The video also makes think of the comment people often make: “We can’t turn the hospital into some sort of factory.” Well, factories generally do a better job of making sure their front-line staff have the supplies and materials they need – right at the point of use. Using methods from factories, like 2-bin kanban systems, allows healthcare staff and clinicians to be less rushed, more caring, and better providers.


mark graban lean blog Video on a 2 Bin Kanban System at a Pennsylvania Hospital leanAbout LeanBlog.org: Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology. Mark is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as the new Executive Guide to Healthcare Kaizen. Mark is also the VP of Customer Success for the technology company KaiNexus.

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20 Comments on "Video on a “2-Bin” Kanban System at a Pennsylvania Hospital"

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  1. Jamie Miles says:

    Very good video with some great customer comments. I especially like the resistance comments and changed to support as the project progressed.

  2. Very generous of St. Clair Hospital to share this video. Tania Lyon had such trouble getting information in the beginning that she created the video to help others get started.

    Also, notice that fixed cabinetry is the Enemy of Lean! We saw this time and time again when I was writing Lean-Led Hospital Design (www.leanledhospitaldesign.com). Standardizing storage rooms is as important as standardizing patient rooms. And creating flexible space (e.g., nothing attached) makes continuous improvement possible. The video hit a lot of notes. Thanks for posting, Mark.

  3. Amber says:

    Thanks for posting this video. It was so helpful to see the demonstration on how they made the change and hear the staff’s experience. Also, including the before and after of the manual requests demonstrated how immediate the impact was.

  4. We overhauled our supply system at Covenant in Lubbock, TX a few years ago with many of the same successes and barriers you mention. We, however, went with the wall hung bins instead of placing on metro carts as in video. They consume much less space but may limit us on how we use the 2 bin system. Has anyone used a bin within a bin with any success? Still same concept but might work with wall hung bins.
    Let me know your thoughts….brad.
    Brad Thornton recently posted..The Two Root Causes of Everything?My Profile

    • Mark Graban
      Twitter:
      says:

      What do you mean by “bin within a bin,” Brad?

      I like the carts because that 2nd bin can be placed behind the 1st, or stacked underneath.

    • Andie Hallihan says:

      Hi Brad

      The wall-hung bins are efficient in space usage (with no space wasted behind the bins), but the metro carts offer tighter first-in-first-out control as it offers only one picking face per SKU. The FIFO benefits are very important to system reliability and stability. It prevents picking from both bins at the same time, giving two empty bins.

      So I would say go with carts and select bin sizes to efficiently use space. The industrial engineer (apologies for dropping the name as he did great work) emphasised the time taken to determine quantities and bin sizes. It is an important point.
      “Bin-Within-Bin” tends to lose on FIFO control and visual simplicity.

      Hope that helps.

  5. Davidd Senecal says:

    Has anyone posted the reduced steps to the Materials Management team? Reduced steps to Central Supply Staff? Nursing? how many delays were eliminated to the patients and how has this impacted outcomes? Any consideration with charges that should be considered.
    we are considering implementing a similar system but need to convince those that like the existing system… metrics speak.

    thanks

    Davidd

    • Mark Graban
      Twitter:
      says:

      I think the best way to convince people is to do a pilot in one department and see what your results are.

      There might possibly be MORE walking for materials management, but the real goal is reducing nursing time/walking and making sure they have what they need for patients.

      I know hospitals have found a big gap between what’s “chargeable” and what’s really being charged. Some items might need to be kept in the automated inventory cabinets for the sake of charging (but then you’re still relying on staff to properly press the buttons).
      Mark Graban recently posted..Easier to Game the Numbers than Fix the System – in Education and HealthcareMy Profile

  6. Nicholos says:

    This is a pretty basic system that works but you will still have to have a huge amount of inventory on hand. This will not cut down your inventory costs whereas if the system manages your par levels you can theoretically cut your inventory in half (reality at least 25% to keep nervous managers happy, they like a reserve in place but that is not necessary).

    • Mark Graban
      Twitter:
      says:

      Nicolos – I don’t understand what you are saying.

      The math to set up the inventory level max is exactly the same with kanban as it is with a par level system.

      The problem is a par level system requires a lot of counting, whereas a two-bin kanban system allows easier and quicker restocking.

      “Nervous managers” is a problem whether it’s kanban or par level.

      Mark

  7. Rob King says:

    What about long items? Those bins appear short, and it looks like it would work for for the items that fit. I like the concept, but those wire racks look like they’re at least 24″ deep, this takes up a good deal of floor space.

    Maybe go with a shelf bin (24″ deep) and set your pars at 10 days and refill at 60% of par. Just have staff scan the items that are running low.

    Our hospital has supply Pyxis for chargeable and ParAssist wall bins for the grab and go stuff (non-charge). We have have 96% + compliancy for the Pyxis charge stations. The Par bins (N/C) are less urgent-type items. Staff seems to like it.

  8. Jean Lund says:

    The 7-minute video from St. Clair Hospital in Pittsburgh is no longer on this link. Is there a way for you to email me the video or share a different location? We find this video useful in educating our staff on what Kanban is. Thank you.

  9. Tapan says:

    Mark,
    Nice Video. so if i was a hospital looking at vendors to buy 2 bin kanban systems from, whats the best way that makes sense economically to pay for this? should we go with subscription model where we pay yearly fee, should we pay by SKU#’s being handled, should we pay by room.

    Different vendors have differnt pricing models, so its really confusing on how to pay for this, i am not talking about the HW i am talking more about the SW with smarts and the service fees. Any suggestions of what pricing model makes sense so i can justify investment?

    -Tapan

    • Mark Graban
      Twitter:
      says:

      Hi Tapan –

      I think you’re asking good questions, but I don’t have enough information here to give you an informed answer…

      Good luck with your evaluation of these approaches and thanks for reading.

      Mark

  10. Great example of using a low cost system with little technology required to bring efficiencies to the organization.

    Key takeaways:

    1. coming in under budget each month (better cost management)
    2. no complaints
    3. no shortages

    How about that!

  11. Simon says:

    Hi

    We have installed a kanban 2 bin system in our hospital. One major problem, The Nurses are not turning the cards to red. The ward managers are telling the Healthcare assistants its there job not the nursing staff!!!!!.

    So everywhere morning (we do daily top ups) we are met with bank of red cards because the staff feel they need stock, not because the first bin is empty.

    so over the first year stock takes are greatly reduced but the saving across the kanbanned wards are minimal..

    Please help, how can we explain the ward managers and nursing staff,

    • Mark Graban
      Twitter:
      says:

      Hi Simon-

      It sounds like there are many problems here. For one, if you do “daily top ups,” that’s not a kanban system.

      I wonder if the nurses were involved in the process of designing the kanban system? Do they really understand how it works?

      If the nurses are using the cards inappropriately, are they getting coached on that? The ward managers should encourage the nurses to turn in the cards when it’s the right time, as that shouldn’t take very long at all.

      There’s no easy answer to that other than maybe finding somebody who can help you on site, somebody who is experienced with kanban and somebody who can coach your leaders. I wouldn’t blame the staff… I’d blame leadership here.

      Good luck,
      Mark
      Mark Graban recently posted..It’s Awful When the Person Teaching #Lean Doesn’t Get the Bad 5S JokeMy Profile