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by Jonathan Washko

Big or small, manage EMS inventory by ‘thinking lean’

Whether you own one ambulance 1,000, EMS agencies should aim for high quality while using the least amount of resources

By Jonathan Washko

When it comes to inventory management, size matters. 

How you manage your supply and logistical workflows is usually dependent on call volume, number of stations, number of employees, supply mix complexity, and budget. 

Smaller organizations tend to marginalize this task onto the existing management infrastructure, meaning it is part of the job for someone who may wear many hats — this may be a line supervisor who is also a field paramedic, a fleet coordinator, a supply coordinator and a station coordinator, all rolled up into one.

On the other hand, larger organizations will typically have a dedicated department and staff to specifically handle the supply and logistical needs of the organization. The structure is typically based on the type of EMS system design you operate under — fire, private, third service, hospital, PUM, etc. — and if you are subsidized or rely purely on revenue from billings to operate.

Money matters

While size matters in terms of workflows and marginal or dedicated infrastructure, there are many common best practices that any organization can use to provide a lean, mean, supply and logistics machine.

Why is this important?

In both large and small EMS organizations, dollars count. Our ability to convert dollars into service through economic efficiency is one of the most misunderstood, yet most commonly valued commodities that management touts as part of their mission. 

When we waste dollars through inefficient practices, we are not being good stewards to our patients, our taxpayers or to our EMS mission.

Lean thinking is providing for the highest in quality, reliably and consistently, while using the least amount of effort or resources possible to obtain that goal. It is something we all can do whether we have one ambulance or 1,000. 

Some may consider these goals diametrically opposed and unobtainable, but they can be achieved through sound systems, process engineering and leveraging technology.

As I mentioned in my article on effectively managing inventory [LINK], knowing inventory usage, expiration dates, par levels, and distribution management is key to lean process success. Learning to leverage this insight to your lean advantage is the next challenge.

Think lean

Lean process is all about minimizing the amount of time, energy, effort, and money that goes into a particular mission, in this case supply and logistics.

If you recognize that a process that takes 10 steps and three hours to complete could be reduced to three steps in one hour by completely revamping how the task is managed through the organization (while improving or maintaining quality), this is what lean thinking aims to achieve. 

Take this concept and apply it to your existing supply and logistical processes. Are there things you could do to reduce waste, par levels, or loss? 

I have yet to see a process that could not be improved in some way. It’s all about thinking differently and breaking the unwritten rules of the organization. In other words, getting out of the ‘we’ve always done it that way’ style of thinking.

This line of thought is what gave birth to supply and logistic best practice concepts such as speed loading, snap packs, service point inspection systems, cabinet sealing systems and more. The ideas behind these types of systems are to reduce waste while simultaneously improving quality and reliability.

Get techy

Using technology is another important way an agency can embrace lean processes. In today’s cloud-based world, information systems that used to be out of the reach for small EMS providers are now available at a fraction of the cost, and usually require little to no up-front capital investment to acquire. 

Cloud-based systems can provide the business intelligence you need to effectively manage your inventory processes and systems — yielding lower costs through less waste and lower par levels. Inventory, scheduling and electronic patient care reporting systems can be used to track usage, manage inventory, allow for remote online ordering, and track dates, all of which improves workflow and inventory intelligence.

With a new thought process and improved data about your inventory, it’s time to start designing new workflows to make the process leaner and more efficient.

For example, if you know your usage of a particular item is consistent, set up an automated ordering process for that item using reasonable par levels. If you find that an item is low-usage and quickly expires, try to target which station has a higher probability of using that item, and move it from a low-use station to a high-use station before it gets stale. 

Your true usage

Also, make it a practice to determine your true usage and identify loss through auditing ePCR records that allow quantification of supplies used. For example, on a reading a chart where a patient received a 12 lead and an IV, you know how many electrodes, IV catheters, IV start packs, tubing, fluids, etc. were used.

With this type of audit, you can extrapolate what your true usage is and compare it to what you are consuming. The delta between these two measurements shows what could be waste, left, or poor documentation and pinpoints where opportunities for improvement may lie.

With this information, you can identify any weak spots and use lean process improvement concepts to fix what you and the data found.

Thinking lean can not only improve your supply and logistic processes in organization. It’s a concept that can be applied to all aspects of managing your organization — large and small.

About the author

Jonathan Washko as been involved in the EMS industry for over 27 years and has held progressive leadership position with small, medium and large EMS systems in government, private, for-profit and not-for-profit entities. He is considered the leading industry expert on EMS system design, high performance EMS concepts, industry best practices, EMS deployment, lean business processes, system status management and is often called upon by EMS systems in crisis as well as those considered at the top of their game, in order to help transform these organizations to become the best they can be. Contact him at jwashko@washkoassoc.com.
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