D157 Task 1 Improvement Project Proposal Example

Healthcare Improvement Project Proposal: A Two-Bin Kanban Supply System to End Stockouts and Overstock on a 32-Bed Surgical Floor

Student Name

Leavitt School of Health, Western Governors University

D157: Managing Resources in an Era of Disruption, Task 1

Course Instructor

Month Day, Year

Healthcare Improvement Project Proposal: A Two-Bin Kanban Supply System to End Stockouts and Overstock on a 32-Bed Surgical Floor

The Resource Problem

Supplies are the second largest expense on most inpatient floors after labor, and they are also a daily source of friction for nurses. This proposal concerns a composite 32-bed general surgery floor in a 350-bed community hospital. The floor's supply room is stocked by a periodic automatic replenishment (par) system: a materials technician counts each item twice a day and fills it back to a set level. The system has drifted. Par levels were last reviewed four years ago, before the floor began taking bariatric and colorectal patients, so some items run out daily while others sit untouched until they expire.

Baseline data were collected over the most recent fiscal year and a two-week audit. The floor spent $447,000 on supplies against a budget of $410,000, a variance of $37,000 or 9%. Materials management discarded $6,800 of expired stock from the room, mostly wound care and specialty dressing items. At the same time, charge nurses logged an average of 11 urgent calls per day to central supply for items that had run out, and during two observed four-hour periods, nurses left the patient care area to search for supplies an average of three times each. Time spent searching is time not spent with patients. In a 36-hospital study, only 7.2% of medical-surgical nurses' practice time went to patient assessment and vital signs, and the authors identified work processes and the organization of the floor itself as targets for returning time to care (Hendrich et al., 2008).

Aim

Within six months of launch, the floor will reduce urgent stockout calls to central supply from an average of 11 per day to 3 or fewer, reduce expired supply waste by at least 50%, and bring supply spending to within 2% of budget for the following two quarters, without any increase in nursing time spent on restocking.

The Intervention and Its Evidence

A two-bin kanban system stores each supply item in two identical bins, one behind the other. Nurses take from the front bin. When it empties, they move the empty bin or its card to a collection point, and the back bin slides forward. The empty bin is the replenishment signal: the materials technician scans it, fills it from central stores and returns it to the back. Nobody counts shelves, and the quantity in each bin is sized to cover demand during the time it takes to refill it.

The approach comes from manufacturing but has been studied in hospitals. Rosales et al. (2015) modeled the two-bin system for point-of-use medical supplies and examined how bin sizes and replenishment timing affect stockouts and the workload of restocking, the two variables this project is trying to balance. Studies of supply chains on inpatient floors describe how much of the burden of managing stock falls informally on nurses (Landry & Beaulieu, 2013), and exploratory work on where supplies are located within nursing floors suggests that placement and organization affect how far and how often nurses walk to find them (Bélanger et al., 2018). The two-bin system addresses both: it moves counting off nurses and technicians alike, and redesigning the room at launch is a chance to put high-use items closest to the door.

The system will not work if bin quantities are copied from the old par levels. The project will size each bin from twelve months of usage data for that item, reduce the number of line items where two products serve the same purpose, and label every bin with the item, its reorder quantity and a photograph.

Stakeholders and Roles

The project touches nursing, materials management and finance, and each has a different stake. Nurses want items to be there; materials management wants predictable workload; finance wants the variance closed. The responsibility chart below assigns one accountable role to each major task. I lead the project as the floor's assistant nurse manager.

Resources Required

The project's own costs are modest but real, and they are counted here rather than hidden in the savings. Wages are loaded hourly rates from the hospital's current scale.

Financial Case

If the project closes half of the $37,000 variance through fewer duplicate items and less overstock, and halves the $6,800 in expired waste, first-year savings would be about $21,900 against a one-time cost of $8,060, returning the investment in under five months. These are estimates, and the proposal does not depend on them: the stockout and time measures justify the change even if savings fall short. The finance analyst will verify the variance monthly from the general ledger, so the savings figure will be measured, not assumed.

Timeline

Month 1: obtain approval, pull usage data and form the champion group. Month 2: size bins, remove duplicates and order materials. Month 3: educate staff at huddles and reconfigure the room over one weekend; launch. Months 4 to 6: track stockout calls daily, waste monthly and spending quarterly; adjust bin sizes for any item that stocks out twice in a month. Month 6: report results to the director of surgical services and decide whether to extend the system to the neighboring orthopedic floor.

Risks and Responses

Nurses may take from both bins at once, defeating the signal. Response: champions will model the practice for the first month, and the back bins will be placed behind a simple divider. Bin sizes may be wrong for items with seasonal or census-driven demand. Response: the technician will flag any item emptied more than once between rounds, and the project lead will resize it weekly for the first two months. Materials management may lose technician hours if counting disappears. Response: the supervisor has agreed to redirect the saved counting time to restocking accuracy and expiration checks, which protects the position. Finally, a supply disruption at the distributor could empty bins regardless of the system. Response: the materials supervisor will keep a substitution list for the twenty highest-use items.

Fit With the Organization

The hospital's strategic plan commits it to reducing operating expense without reducing time at the bedside. This project answers both halves of that commitment on one floor, with a method that can be measured in six months and extended if it works. It also gives nurses a direct way to see that a daily frustration was heard and acted on.

References

Bélanger, V., Beaulieu, M., Landry, S., & Morales, P. (2018). Where to locate medical supplies in nursing units: An exploratory study. Supply Chain Forum: An International Journal, 19(1), 81-89. https://doi.org/10.1080/16258312.2018.1433438

Hendrich, A., Chow, M. P., Skierczynski, B. A., & Lu, Z. (2008). A 36-hospital time and motion study: How do medical-surgical nurses spend their time? The Permanente Journal, 12(3), 25-34. https://doi.org/10.7812/TPP/08-021

Landry, S., & Beaulieu, M. (2013). The challenges of hospital supply chain management, from central stores to nursing units. In B. T. Denton (Ed.), Handbook of healthcare operations management (pp. 465-482). Springer. https://doi.org/10.1007/978-1-4614-5885-2_18

Rosales, C. R., Magazine, M., & Rao, U. (2015). The 2Bin system for controlling medical supplies at point-of-use. European Journal of Operational Research, 243(1), 271-280. https://doi.org/10.1016/j.ejor.2014.10.041