We have a time honored tradition in New England, on the eve of every blizzard, of ransacking local supermarkets shelves for bread, milk, water, canned goods, batteries—the essentials. If you go right before the heavy stuff starts, eyeing the barren shelves you’d think it was the end of days. We can’t help it. The news anchors, the weather team and our civic leaders all encourage us to stock up on the necessities and stay off the road. But let’s be honest, they’re just preaching to the choir. We’d do that last minute shopping anyways, because we know, when that storm hits, if we really need something, we won’t be able to get it. The stores are all closed, the roads are dangerous and impassable—the system is broken, so we all become a bunch of snowbound hoarders.
Where is all of the equipment hiding?
There's been a lot of talk over the years about nurses hoarding hospital equipment and supplies. Let’s get something clear; nurses themselves aren’t hoarders, at least no more than we are when we raid the grocery stores before a storm. Their profession isn’t a refuge sought out en masse by those afflicted with hoarding disorder. Why is it then that hoarding exists in the profession, occurring rampantly across some hospitals? When it comes to hospital operations, it’s a result, a symptom if you will, of the overall system breaking down.
The third edition of “Financial Management for Nurse Managers” points this out:
“As the financial resources available for purchase of supplies, linens, and equipment have dwindled as a result of low reimbursements, there has been more hoarding of supplies and equipment. Although hoarding provides staff with immediate access to the resources they need for patient care, staff do not realize that they add to their supply and equipment problems overall…In actuality, hoarding is a symptom of a larger systems problem. Instead of hiding and storing more inventory for the unit, it is much more cost efficient to bring together a group of stakeholders from appropriate departments to work out a better solution. The solution needs to have the right numbers at the right times in the right places.”
Addressing Severe Equipment Shortages
In 2013, University Hospital in San Antonio was experiencing wide-spread equipment shortages and as a result, equipment couldn’t be located when needed. Equipment hoarding followed, which caused a vicious cycle of more shortages and more hoarding. Gene Winfrey, the director of information services in the biomedical engineering department, summed up the situation when he said, “Our equipment utilization is around 40%, which is as low as it has ever been. Yet, nursing frequently can’t get the equipment they need. This is a systemic problem.”
A couple of years prior to this, UHS invested in a Real Time Location System (RTLS) from Aeroscout, hoping to fix the problem by tracking equipment. The thinking was, that if you know where the equipment is, you can hunt it down when you need it. They came to realize that the RTLS was only addressing a symptom of the problem and not the root cause. They also quickly realized that nursing didn’t have a lot of interest in accessing another software system; especially one that would just provide location information, leaving them still tasked with hunting down the device. RTLS wasn’t delivering the outcomes they expected, it wasn't fixing the hoarding problem.
Treat the Cause, Not the Symptom
For the next go-around, UHS knew they had to get to the root cause of the problem and get nursing out the “pump management business”. They brought together a team of stakeholders that included the CNO, COO, CFO, the VP of the supply-chain department, the director of materials management, and a representative from the biomedical engineering department. The approach they came up with focused on deploying a closed-loop workflow, to ensure that equipment moved efficiently through the Deliver-Use-Recover-Clean cycle. By controlling the flow of equipment, they could boost utilization and improve availability.
With the help of Mainspring, they deployed a hybrid centralized-decentralized distribution model that included on-demand fulfillment, supplemented by minimal par stock in areas with high demand. Soiled pick up was automated using passive RFID to minimize dwell time. This highly automated, closed-loop process provided real-time visibility into equipment availability and utilization, while also providing detailed data for demand planning. The solution significantly reduced the Deliver-Use-Recover-Clean cycle time, creating approximately 30% more equipment available at any given time.
You can blame nurses, re-write organizational charts and role responsibilities all you want, but in the face of an impending blizzard, we will always feel compelled to buy six month supplies of water and peanut butter—or in this case, sock away infusion pumps. It's only when nurses can trust that equipment is readily available, that you've fixed hospital equipment hoarding.