D161 Task 1 Final Status Report Example

Final Status Report: Two-Bin Kanban Supply System on a 32-Bed Surgical Floor, Six Months After Launch, With One Target Met, One Exceeded and One Missed

Student Name

Leavitt School of Health, Western Governors University

D161: Nursing Leadership and Management Capstone, Task 1

Course Instructor

Month Day, Year

Final Status Report: Two-Bin Kanban Supply System on a 32-Bed Surgical Floor, Six Months After Launch, With One Target Met, One Exceeded and One Missed

Project Summary

This report closes the healthcare improvement project proposed earlier in the program: replacing a twice-daily par count with a two-bin kanban supply system on a composite 32-bed general surgery floor. At baseline, the floor averaged 11 urgent stockout calls to central supply per day, discarded $6,800 of expired stock a year and ran 9% over its $410,000 supply budget. The aim was, within six months of launch, to reduce stockout calls to 3 or fewer per day, cut expired waste by at least 50% and bring spending to within 2% of budget for two consecutive quarters, without adding nursing time to restocking. The system launched in the third month of the project after bins were sized from twelve months of usage data, 41 duplicate line items were removed and the supply room was reorganized with high-use items nearest the door.

Results Against Each Measure

Results are reported for the six months after launch. Stockout calls come from the charge nurse log, verified against central supply's call record; waste from materials management's disposal log; spending from the general ledger as reported by the finance analyst; and restocking time from a two-day observation repeated at month six using the same method as the baseline.

Analysis of the Results

Stockout calls fell by roughly two thirds in the first month and then plateaued. Review of the call log showed that most remaining calls concerned eight items, six of them wound care products used by the colorectal surgery patients whose volume rose during the second quarter. Their bins had been sized from a year in which that service was smaller. Once they were resized in month five, calls fell, and by month six they were below target. A kanban system is only as good as its bin quantities, and bin quantities have to follow demand when a floor's case mix changes (Rosales et al., 2015). The lesson is not that the system failed but that the plan for resizing was too passive.

Waste fell further than expected because the removal of duplicate items meant fewer slow-moving products sat long enough to expire. The target was exceeded without any separate expiration campaign.

Spending is the harder result. The first quarter came within 2% of budget, which suggests the system removed most of the overstock that drove the original variance. The second quarter rose to 3.1% over. The finance analyst attributes most of that increase to a 12% rise in colorectal patient days, which increased legitimate use of costly dressings, and a distributor price increase on two negative-pressure wound therapy supplies. Adjusted for patient days, supply cost per patient day fell 6% from baseline. That adjusted figure is reported here as context, not as a substitute for the target, which was set in absolute terms and was missed. Reporting a measure in a way that accounts for volume is standard in improvement work, but it should be decided before results arrive (Provost & Murray, 2011). The proposal did not do that, and this report does not do it retroactively.

Lessons by Project Phase

Initiation. The baseline was strong because it combined financial data with operational counts. What was missing was a stated plan for how supply measures would be adjusted if patient volume changed. Next time I would define a volume-adjusted measure at the start alongside the absolute one.

Planning. The responsibility chart worked: the materials supervisor, not the project lead, owned replenishment, and that decision kept the project from depending on me. The weakest part of the plan was the risk response for demand changes, which relied on the technician flagging items rather than on a scheduled monthly review of every bin against usage.

Implementation. Staff adopted the pull signal faster than expected. Four nurse champions, one per shift pattern, modeled the practice during the first month, and taking from both bins at once, the risk I most feared, occurred in fewer than one in twenty bins on spot checks. The weekend room reconfiguration ran over by six hours because facilities had not been told that two shelving units needed new brackets. A walkthrough with facilities before the weekend would have prevented it.

Evaluation. Collecting stockout calls through the charge nurse log was simple but depended on busy charge nurses remembering to write calls down. Central supply's own call record proved more complete, and it will be the source going forward.

Sustaining the Change

The system will outlast the project only if its maintenance is part of someone's job. Three steps have been agreed. The materials supervisor will review every bin quantity against the prior month's usage on the first working day of each month, and resize any item that emptied more than twice between rounds. The floor's monthly quality board will display stockout calls and supply cost per patient day alongside falls and infection measures, so the data stay visible. And the orientation checklist for new nurses and technicians now includes the two-bin rule, so the practice does not depend on the original champions.

Recommendations

First, roll the two-bin model out on the orthopedic floor next door, which uses the same central stores and a similar supply mix, with bins sized from its own usage data and a volume-adjusted cost measure defined before launch. Second, ask finance to report supply spending per patient day for all surgical floors, since absolute budgets penalize floors whose volume grows. Third, add the eight wound care items that drove the late stockouts to the organization's value analysis review, since two of them have lower-cost equivalents already on contract.

Conclusion

The two-bin system met the project's operational aims by the end of the period, exceeded the waste target and returned about two trips per four hours to patient care for each nurse, but it did not bring absolute spending within 2% of budget for two quarters. The shortfall has an identifiable cause and a correction already in place. As a leader, the most important thing this project taught me was that the measure has to be designed with as much care as the intervention (Langley et al., 2009), because a result can only be judged against a target everyone agreed to in advance.

References

Langley, G. J., Moen, R. D., Nolan, K. M., Nolan, T. W., Norman, C. L., & Provost, L. P. (2009). The improvement guide: A practical approach to enhancing organizational performance (2nd ed.). Jossey-Bass.

Provost, L. P., & Murray, S. K. (2011). The health care data guide: Learning from data for improvement. Jossey-Bass.

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