Entrepreneurial spirit wins over budgetary restraints
Entrepreneurial spirit wins over budgetary restraints
Supply project heals rifts, funds new staff
After turndowns of repeated requests for a supply tech staff position, the Department of Medicine at Kaiser Roseville (CA) took matters into its own hands.
In January 1997, the department eked out of its existing budget a .5 FTE (full-time equivalent) position for an orderer. Within the first five months, the department cut its medical supply costs $40,000. By the year’s end — when savings rose to six figures — the administration funded a full-time supply orderer. And better yet, the project laid to rest old rifts between the departments of medicine and materials management.
Picture the chaos: Six 12-member primary care teams, serving 90,000 consumers, who ordered supplies and put them away — in their "spare time." The situation caused wild budgetary swings and wrecked relationships between the materials management and clinical staff.
Catherine Tantau, BSN, MPA, manager for adult primary care in the department of medicine at the Roseville office, explains that people hoarded and stockpiled supplies because they didn’t trust materials management to fulfill orders on time.
Some items went to waste because their shelf life expired before they were used. To make matters worse, "Materials management complained about the redundancy of our orders. They said, there’s no way we can satisfy you people,’" Tantau explains.
Desperation leads to answers
Desperate for a solution, the department of medicine’s charge nurse council built a team to design a job description for an orderer. Participants included the materials department manager, providers, and support staff. "It was a leap of faith on no resources," Tantau notes. "We posted the opening within the department and selected a medical assistant with a background in retail, which was an advantage." (See "Supply Ordering Roles and Responsibilities," p. 162.)
The orderer immediately addressed the interdepartmental tensions and the delays in order fulfillment. Here’s how the position evolved in the first year:
• Build supply links (weeks 1 and 2).
The orderer spent her first two weeks in the materials management department to learn procedures. Tantau observes, "I’m not sure the knowledge was as important as the improved relationship with the department. [Staff] knew she valued their jobs, and they had a better understanding of our functions." The orderer became the designated contact between the clinicians and materials management.
• Design supply management processes (six weeks per team).
One team at a time, the orderer assessed equipment and supply needs. She taught new ordering and inventory tracking procedures, which enabled materials management to provide supplies on time. Tantau explains the methodical transition: "We didn’t want to rush anyone or step on any toes." Indeed, most of the teams welcomed the opportunity to be free of contacts with materials management.
• Develop standardized supply lists (team by team).
Staffers supplied shopping lists. The orderer researched products and prices, seeking best value as opposed to lowest price. For example, clinicians had been ordering two varieties of vaginal speculums. Budgetary concerns caused some to shy away from the one with a light and automatic warmer until the orderer showed them it was actually cheaper after a one-time investment in the light source.
Five months into the project, supply costs dropped 29%. Notes Tantau, "We could tell by looking at the budgets who was on the system and who was not. We noticed that teams that were not yet on the new system were having the same supply cost fluctuations that they had all along." (For the exact figures, see box, "Department of Medicine Supply Ordering Project," below right.)
Other benefits achieved
But the cost figures tell only part of the story; the rest is about benefits money can’t buy:
• Staff learn to explore departmental needs and wants in a collaborative way. Tantau is confident the skills acquired through this project will facilitate future improvements.
• Just-in-time ordering eliminates waste and stockpiling. This would be impossible without the trust born of reliable ordering procedures and cooperation from materials management. In retrospect, she observes, "It’s a good thing because we have grown and there is even less space for supplies."
• New providers learn the supply management system during orientation, ensuring orderly growth. For instance, the orderer sat down with the new health educator, conferred about the educator’s supply needs, and taught her the ordering procedures.
• Administration funds an FTE orderer for the department of medicine in late 1997. The Roseville project became a model for Kaiser Permanente North Sacramento Valley region’s department of medicine serving 270,000 consumers.
The improvement team members earned and kept their co-workers’ trust. "We showed people how we could save money and not hurt anyone — people liked that," observes Tantau. Keys to success include:
1. Everyone who touched the supply ordering process articulated his or her needs and wants.
Tantau explains a personal attitude change, "I used to think you should pick your highest priority customer and aim to communicate and satisfy them. Now, we touch everybody who’s touched by the change or it will erode."
2. The charge nurse council capitalized on chaos to introduce positive change.
"People were ready to try something new because they thought it couldn’t get much worse than it was." Tantau remarks. The largest primary care team converted first and helped bring the rest on board.
3. The changes were voluntary.
"Edicts don’t make sustainable changes," she says.
4. All participants experienced the changes as personally beneficial.
Tantau adds, "An organization can make anything work for a short time. But really good systems work for everybody; if they don’t, they’ll collapse along the way."
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