Reducing Stock-Outs in MD Anderson Cancer Center’s Outpatient Clinics

1. Reducing Stock-Outs in MD Anderson Cancer Center’s Outpatient Clinics Speaker: Kaycee Wilson, Quality Engineer David Bivens, Caitlin Byler, Rachel Douglas, & Kaycee Wilson

2. Supply Availability Project Teams

3. Current Inventory Management Process Clinic Close 1 Note: Items Received were Ordered Night Before Clinic Open 2 5 Note: Those orders arrive the next evening 3 4

4. New Supply Process Objectives • Quantitative Objectives • Minimize: Stock-outs ( Patients Denied Care ) Subject to: • Available Space • Available Labor • Inventory Cost • Qualitative Objectives • Ease of Use • Ease of Implementation • Ease of Sustainment

5. Process Observation and Analysis • Four inventory process areas were identified for improvement efforts • Level Setting • Reorder Signal • Reorder Quantity • Business Roles

6. Baseline Analysis • Level Setting

7. Pilot Solution Level Setting • There are two numbers important for level setting • Reorder Point • Based on a one day delay between order and actual delivery • Calculated with historical ordering data by material reps • Calculated based on items pulled from the warehouse • Derived using statistical analysis yielding stock-out risk • PAR Level • Based on current workload 1. PAR Level 2. Reorder Point

8. Baseline Analysis • Reorder Signaling

9. Pilot Solution for Reorder Signaling

10. Baseline Analysis • Order Quantities The materials rep will have to put the number remaining in the bin in the handheld.

11. Pilot Solution Order Quantities • Always order the same amount Always order about ½ bin size

12. Baseline Analysis • Business Roles • Materials Management • Responsible for responding to clinic requests for par changes • Responsible for order and delivery of supplies • Clinics • Responsible for setting the inventory level of each item

13. 2 1 Daily Clinic Usage Pull the card when the supply level is at or below the tapeline Place the card in the low stock bin Pilot Resupply Process and Business Roles 1 Ordered Low Stock Pull the card when you use the item Nightly Replenishment 3 1 4 2 Deliver supplies & make sure that the waterline holds the “reorder point” quantity Put all cards in the ordered bin back on delivered item bins Scan the barcode on the back of the card and enter the handheld # in handheld. If you have to pull the quantity from the warehouse, pull the warehouse # amount Pull out all of the cards in the “low stock” bin ! Note 7 Place scanned cards in the “ordered” bin Back of Card

14. PAR Setup Process and Business Roles Clinical Team 3 Approve/Disapprove suggested removal of items Materials Management Team 1 2 Request approval for removal of low usage items from Par (Red Tagging) 4 5 Reorganize closet with nursing feedback Reset levels Put in waterlines and adjust preset levels Card Slot 6 7 8 Relabel Reset Par in handhelds Create Stock Cards **Blue boxes represent steps requiring tool created by OPI

15. P59 Melanoma and Skin Center Baseline

16. P59 Melanoma and Skin Center Pilot Setup

17. Tapeline Setting & Fixed Ordering Methodology • (R,s,Q) Model

18. Tapeline Setting & Fixed Ordering Methodology • Reorder Point

19. Tapeline Setting & Fixed Ordering Methodology • Undershoot ** • Fixed Order Quantity **See References Slide

20. Reorder Point Setting & Fixed Ordering Simulation DEMONSTRATION

21. Stock Card Template

22. Summary of Assumptions • Objective – stock-out minimization • Carry a minimum of two days on hand • Constraints – labor, space, and budget • Increase the days on hand to meet labor standards • Distribution of daily demand - normal • Set reorder points according to a normal distribution • Daily supply usage • Estimate daily demand using work days between ordering instances

23. Pilot Issues

24. Future Work • Pedi – Child & Adolescent Center • Cardiopulmonary Center • Breast Center • Leukemia Center • Clinical & Translational Research Center

25. References