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Hospital Topics Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/vhos20

Processing for a Multi-Unit Hospital Complex a

b

Mr. Clay D. Edmands , Mr. Alvin M. Schutta & Mr. Dennis Daly

c

a

Affiliate Division , Fairview Community Hospitals , 2312 South 6th St., Minneapolis, MN, 55454, USA b

Central Services, Linen Distribution , Fairview Community Hospitals

c

CSF Ltd. Published online: 13 Jul 2010.

To cite this article: Mr. Clay D. Edmands , Mr. Alvin M. Schutta & Mr. Dennis Daly (1976) Processing for a Multi-Unit Hospital Complex, Hospital Topics, 54:2, 25-30, DOI: 10.1080/00185868.1976.9950324 To link to this article: http://dx.doi.org/10.1080/00185868.1976.9950324

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Processing For A Multi- Unit Hospital Complex

Clay D. Edmands is Assistant Administrator and Director, Affiliate Division, Fairview Community Hospitals, 2312 South 6th St., Minneapolis, MN 55454. He has a B.S. from the University of Kansas in Business A d ministration Major - Marketing, Labor Relations, and a Masters Degree in Hospital Adminbtration from the University of Minnesota.

Alvin M. Schutta is Director Central Services, Linen Distribution, at Fairview Community Hospitals. He has been active in various haspital related associations and is an eflective speaker and contributor to the literature.

Mr. Clay D. Edmands, Assistant Administrator, Fairview Community Hospitals Mr. A1 Schutta, Director of CSR, Fairview Community Hospitals Mr. Dennis Daly, Associate, CSFLtd. he Fairview organization has grown from one hospital located near downtown Minneapolis in 1916 to a multi-unit hospital complex including three owned hospitals, one managed hospital and services provided to eight other hospitals and nursing home serving 2800 beds. Initially, Fairview was a single hospital with 415 beds, located near the downtown area of Minneapolis. In 1965, a satellite hospital, Fairview-Southdale was added. This was initially a 227 bed hospital. Since 1965 it has expanded twice to its present 401 beds with expensive emergency and out-patient facilities. In 1973, Lutheran Deaconess, a 263 bed hospital in the Minneapolis inner-city was consolidated into the Fairview Community Hospital organization. These hospitals constitute the basic Fairview Corporation; Materials Services provided to other hospitals, not a part of the Fairview Corporation, include: Materials Management, Central Supply, Data Processing, Accounting/Finance, Contract Management and sixteen others shared services. In each case, Fairview Corp. provides the user hospital with increased services, decreased operating costs, or both. In many cases, they provide the user hospital with a service which would otherwise be unaffordable, due to the capital expenditure and set-up costs.

T

Central Supply Fairview and Fairview-Southdale Dennis S. Daly is an Associate with CSF Ltd., a management consultingfirm in the health care field. He previously serwd as Project Assistant, Project Engineer and Project Director for the Community Systems Foundation. He received his B.S.E. in Industrial Engineering from the University of Michigan Mr. Daly is a member of A.I.I.E. (American Instituteof Industrial Engineers) and HMSS (Hospital Management Systems Society) where he is currently serving as chairman of the Task Force f o r Conservation of Energy. MARCHIAPRIL 1976

During the mid to later portion of 1971, the Administration of the Fairviews performed a detailed review of all existing supply processing functions at the two hospitals, the major one, of course, being Central Supply. CSF Ltd., a management consulting firm which specializes in the health care area, was requested to perform this study. 25

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The Department has experienced significant volume increases, particularly at the newer Fairview Southdale. In addition to this workload increase, programs which were at varying levels of the planning stage (such as the expansion of Fairview-Southdale Hospital) indicated that this workload would continue to increase. At Fairview, the older of the two hospitals, a number of problems were apparent; the Central Supply department was extremely overcrowded and was split into three separate areas, which made control and communications very difficult. Equipment was limited, resulting in much unnecessary manual processing. Further, the space which Central Supply occupied was in premium demand by already overcrowded departments, including Surgery, Outpatient and Pharmacy. Potential revenue was being lost, particularly in the Outpatient area, as a result of this lack of available space. Finally, all processing functions, in Central Supply and in other areas (such as Surgery, obstetrics and Laboratory), were in need of review to determine where and how this processing could be done most effectively and efficiently, while providing maximum patient service.

Performing Of The Study The major objectives of lhe study were: 1. Define the quality of service currently being provided by

the Central Supply functions at both Fairview and Fairview-Southdale Hospitals. 2. Define and evaluate all supply processing functions beingperformed at the two Hospitals and determine which departmeni should be responsible for each of these functions 3. Develop a system which will provide optimum service, be c o ~ teffective, maximize utilization of Central Supply facilities, equipment andpersonnel at both Hospitals.

All processing functions performed by the Central Supply Departments at each Hospital were defined and reviewed. The areas or Departments to which these services was provided were documented. The same steps were followed for all other departments including supply processing functions. The next step was a definition of the criteria to be used in evaluating the level of service currently being performed and to evaluate functions which should be transferred to or away from Central Supply. This was a mutual effort between Central Supply, Administration, and CSF. Criteria used are presented in Table 1. With these criteria as a basis, detailed interviews were then conducted with Central Supply personnel and with all other Departments where production functions were under review. Staffing, systems and procedures, workload and volume, inventories, transportation/distribution and service considerations were documented. An initial summary of the information was reviewed with Administration and the following decisions were made: 26

1. Those areas which exhibited an obviously negative potential to change or transfer were ruled out. 2. Areas which exhibited a potential for trander were listed.

Potential transfers were then evaluated in greater detail against the same criteria and final recommendations as to whether or not they should be transferred were presented to the Departments and to Administration for final review and approval. At this point, the final configurations of the Central Supply Departments for both Fairview and Fairview-Southdale had been defined and the second phase of the study could be initiated. In this phase, CSF and the Department developed a set of alternatives for use and dispensation of the Central Supply facilities a t both Hospitals. These alternatives included: 1. Leaving each department exacily as it was. 2. Leaving the Central Supply Departments at each Hospital as is, but transferring processing from Fairview Lab and Southdale Emergency Room to Southdale CSR. 3. Maintaining CSRs at both Hospitals. Transferring the Department at Fairvim from its existing rooms to ONE central area in the basement. Transfer additional processing at both Hospitals from the Departments to Central Supply. 4. Same as alternative 3, except that equipment will be added to CSR at Fairview so that both Departments will have identical processing capabiliiies. 5. Centralize all major cleaning and production at FairviewSouthdale CSR. Relocate Fairview CSR in central location in basement and use only for storage, distribution and emergency processing. 6. Same as alternaiive 5, only replace daily, as needed, distribution system at Fairview with an exchange cart system.

A detailed analysis of costs and of benefits, both fiscal and otherwise was performed for each of these alternatives. Which were then reviewed with the Department and Administration, and a final choice made. The last step was to develop and design the final systems and procedures for the Department. Continued on Page 29 TABLE I Criteria For Evaluation Of Functional Transfer Centra1,SupplyAnd Associated Supply Processing Criteria for Evaluetion 1. StaffingCost

Explenetion Any staffing changes ( + or -1 in Central Supply or associated departments which may result from a change being considered. 2. Space Any changes in space utilization or costs which may result from a change being considered. 3. Equipment Any changes in equipment needs and cost or in equipment utilization which may result from proposed changes. 4. Transportation Any changes in transportation costs or procedures which may result from a functional change being considered. 5. Inventory Changes in inventory costs, controls or procedures resulting from functional changes being considered. 6. Service Any effects ( + or - 1 on the quality of service provided to both patients end hospital departments which result from potential changes in functions. Specific criteria used t o measure effects on service include production quality/quality control, production turnaround time, delivery time required for stat requests, delivery time for standard or scheduled requests, and any factors which may be unique to a specific department.

Continued from page 26 Final Dispensation

FINDINGS AND RECOMMENDATIONS Since the study encompassed a large number of areas it would be difficult to present the reader with all recommendations which were included. Instead, this section will summarize only those changes which had a major effort on the Departments and Hospital. After the review of all processing functions in the two Central Supply Departments, it was recommended that these responsibilities be retained by Central Supply. In the case of each function, the justification for this decision was based upon one or more of the following reasons:

Hospital

Dcparlment --____

FuirviewSuurhdalc

CenrrulSuppl)~

Function _________. A1lFuncrion.s

Retain in Department ~-

Transfer Ito CSR)

X

Fuinkw-

Sourhriurrle

Emer#enc.y Room Linen Puck7 / l a i c , 1nrrrument.s Specid Inrtrurnmr., In.srrumenr Packs Ure.uing.s GIUM H'U,.? Surgeq' nusic ln.\rrumenrr Special l n r r n r m r n r lnsrrummr Pucks 1)rr.ninp Linen Puck, nusin Pudi.s Tru), Pucks 011 Sprriul Insrrurnenr.\ 1n.vrumear Puck, Laboratory Clursn'urrr Nur.sing Srurion.5 Urenrils

x X .Y

x ,I

r X X .I

.Y

s .t .Y

x 'Y

x

x

x ,4

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1. The cost of maintaining duplicate processing equipment in

another Department was high; 2. There was no noticeable improvement in the quality of service provided; 3. The cost to the Hospitals of maintaining adequate inventories was increased; and 4. Staffing costs to maintain the function in a department other than Central Supply were higher, particularly since there was less flexibility to utilize personnel for their functions duringperioak of low activity.

A similar review of the processing functions in other departments at both institutions indicated that a number of departments had one or more functions which could be transferred to Central Supply. These were the following: 1. FAIR VIEW

- Surgery,

Obstetrics, Laboratory, Nursery,

and Outpatient. 2. FAIR VIE W-SOUTHDALE - Surgery, Obstetrics, MedicaVSurgical Nursing Stations, Laboratory, and Emergency Room.

It was now possible to define the specific configuration of manpower, materials, equipment and space for the Central Supply function at each Hospital which would provide maximum services and utilization at the least possible cost. Detailed cost to benefit analyses were performed. The following final recommendation was made: Final Dispenwlion Retain in Department

Transfer (to CSRl

X

x X

x .4 X X Y

x X X .Y .Y

x

s X X

MARCH/APRIL 1976

1. All major Central Supply cleaning and production functions

were centralized at Fairview-Southdale. 2. Processing from Fairview Surgery, Fairview OB and Fairview Lab was to beperformedat Fairview-Southdale CSR. 3. Processing from Emergency Room at Sourhdale was transferred to Fairview-SouthdaleCSR. 4. The CSR area at Fairview was relocated in the basement, near the loadingheceiving area It acted primarily as a storage and distribution function with back-up processing capability only. 5. The distribution system at Fairview was changed to a cart system. 6. The former CSR area at Fairview was used to expand currently overcrowded Outpatient facilities. 7. An existing courier service was used to transport supplies between the two Hospitals, before and after cleaning.

The system resulted in staffing savings of $31,200 annually and projected revenue increases of $35,000 annually. Taking into consideration the costs associated with building, renovation, relocation, and equipment changes, the result was a net annual savings of $22,280 and annual revenue increase of $35,000.

SUMMARY These systems have been implemented over two years. They offer the two hospitals the following benefits: 1. A much more effective Central Supply operation with signif-

cant annual savings in staffing costs. 2. The freeing up of some prime space at the older Fairview which could be used far an Outpatient area which, in turn, generated additional revenuefor the Hospital. 3. Maximum utilization of existing equipment owned by both Hmpitak and deferral of any major investments in new equipment.

The success and acceptance of the system were such that the Department carried these same principles to other areas. At Fairview-Southdale Hospital, now in the midst of completing an expansion program, the Central Supply Department will be taking over all processing from the Surgery Department and going to a Surgical Case Cart System. 29

..,-

Service bepartrnent to continously update and improve the systems as changes occur in the needs and demands of the Hospitals.

TABLE 3.

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SUMMARY

- F I N A L CENTRAL SUPPLY CONFIGURATION

S,.lfmg 1 Stalling r e d ~ c l i o n s 152 F T E 1

NIA

Friday, June 18, 1976 81'45a.m.- 9:Wa.m.

Upstairs - Downstairs - 'Central"Service? Moderator: Phyllis Christensen, R.N.. Director of Central Service, Kaiser Foundation Hospital, Los Angeles, Calif. Speaker: Robert H. Smith, ScD. Director, New Product Research, Oeknatel, Inc., QueensVillage, L.I., New York Summary: Dr. Smith will trace the evolution of Central Service from the surgical closet to today's major department. He will review present physical plan requirements and equate tomorrow's obligations. He will delineate dirty sub-clean and clean areas. Principles and problems of space conversion, utilization and expansion will be discussed. Present techniques will be covered and the supervisor's role in product development. He will discuss what to do when you have an idea for improvement of an existing product or for a new product. Panel Discussion: Drs. Smith, Fahlberg and Irons, and Ms. Christensen. R.N., Ms. Smith. R.N. and Ms. Johnson, R.N. Questionand Answer Period

1O:W- 10:15a.m. Coffee Break 1O:kia.m. - lO:45a.m.

The New J.C.A.H. Recommendations Moderator: Phyllis Christensen, R.N. Speaker: W. J. Fahlberg, Ph.D., Microbiology and Immunology. Baylor College of Medicine, Texas Medical Center, Houston Summary: Dr. Fahlberg will contrast previous recommendations of J.C.A.H. with the new ones, and interpret their significance Panel Discussion: Drs. Fahlberg, Smith and Irons, and Ms. Christensen, R.N.. Ms. Smith, R.N. and Ms. Johnson, R.N.

Z Renovate F a r v i e w CSR " A " lor 10 v r

O"l*'llC"l

10 Y l

NiA NIA

1 TOTALS

1

I $51.100

I $

5.920 $ 2,500 $

500

Question and Answer Period NET RESULTS

Ncl Annual Savlngr lcorlri

$22.280

Net Rwenue IncrealBI

ID~ccea%e~1

$35.000

-

11:15a.m. 1215p.m. Convenience Versus Safety in the Physicel Layout of C.S. Equipmen t Moderator: Phyllis Christensen. R.N. Speaker: Alex Irons, Ph.D. Pharmacology, California Institute of Technology, Los Angeles. Calif. Summary: Dr. Irons will discuss Federal, State and O.S.H.A. regulations on steam ETO and Radiation sterilization Panel Discussion: Drs. Irons, Fahlberg and Smith and Ms. Christensen. R.N., Ms. Smith, R N. and Ms. Johnson, R.N. Question and Answer Period 1215p.m. - 1:30p.m. Lunch Break and View Exhibits Friday Afternoon 1:rnp.m. - 2:Wp.m. Quality Assurance

Moderator: J o Anne Johnson, R.N., C.S. Supervisor, Northridge Foundation Hospital, Northridge, Calif.

30

HOSPITAL TOPICS

Processing for a multi-unit hospital complex.

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