Daily Kaizen

As adult learners, we have further to go than our younger counterparts who don’t already have information pathways worn in.  When learning new information, it’s helpful to assimilate old information (our “current way of seeing things”—the things we already “know”) with new information in pursuit of new knowledge pathways.

For our first cycle RIM event, our team had the opportunity to work with leaders across 25 medical clinics to solve an inventory management problem they were having with clinically administered medications.  We have nurses who are highly invested in ensuring our patients have what they need whenever they visit us.  This high level of investment meant the pace and par level of ordering inventory was whatever the nursing team felt was safe without much thought to cost or demand.  In fact, medications seen as critical were often “hoarded” or stocked away in hidden locations so we could guarantee we would never run out.  This meant lots of counting inventory, managing inventory, and searching for what was needed (in fact, in one location, counting inventory was such a dreaded task, someone gave up her day off to count the medications monthly!)

And what about scallops, toilet paper, and scotch?  It was apparent to our team that in order to help transform our nursing teams from altruistic squirrels back to trusting nurses, they would need to view their work and the medications they administered differently.  And so we presented the team with an analogy.

If we were managing a grocery store, we might have lots of inventory we’d already paid for sitting on our shelves.  That inventory could be cheap and easy to obtain like toilet paper—relatively low cost, moves off the shelves every day, doesn’t expire quickly, but we wouldn’t want to order too much at once since TP takes up a lot of space. Inventory also could be a very expensive bottle of 50 year old scotch we would not want to sit on the shelf since it wouldn’t be in high demand.  Or, inventory could be scallops, somewhere in between TP and 50 year old scotch pricewise and how quickly they are sold, but we’d want to ensure we ordered as close to the minimum we would sell daily because they expire quickly.  

Like toilet paper, we had fast moving, low cost clinically administered medications.  For example, Lidocaine is inexpensive, but we use it every day to numb sites we do procedures on.  For these items, we set a minimum and maximum par level based on our daily demand.   For our “scotch” medications (expensive and rarely used), the group decided to schedule appointments in advance for these medication administrations and removed the cost from our clinic shelves completely. These medications could also be sent from pharmacy within 24 hours of ordering.  Finally, for the “scallops” of our medications (higher cost fast movers), we encouraged our nurses to set a minimum par level based on daily demand and watch closely to ensure the minimum needed—and no more– was on hand.

TP, Scotch, and Scallops became code words for inexpensive fast movers, expensive slow movers, and expensive fast movers in clinics, and allowed nursing teams to understand inventory ways they hadn’t thought of.  We blended “old information” (we order and administer medications every day) with a new way to look at it (a grocery store analogy).  They were able to see work differently and plan for demand in a way that helped us take over $1,000,000 off our shelves.   The simplicity of the system allowed piloting and spread to all 25 locations in 10 weeks—a significant cost savings to our organization and, most importantly, it allowed our nursing teams to stop worrying about the inventory of an unreliable system and put focus on the patient.  In our case…one small analogy went a very long way!

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