ordlista Hospital logistics for MDH - E. Ström

Transcription

1 ordlista Upphandling (offentlig) Public procurement Förbrukningsmaterial consumables used in health care Varumottagning goods reception Admissions insläpp / besök FSTN Supply/service unit Truck - forklift

2 Mälardalens Högskola, May 6 th, 2013 Supply Chain Managment Advanced course Elisabeth Ström Project Manager / Services and Logistics Elisabeth.m.strom@karolinska.se

3 Agenda Lecture 13:30-14:30 Break 14:30-14:45 Guided tour 14:45-16:00

4 Who am I? Master in Mecanichal engineering (spec. logistics) Karolinska Kanban-storage - Process development - Continuous Improvement & efficiency (Kaizen) - Expert advisor in logistics - RTLS at the emergency ward - Prestudy Bedside scanning - Arrival traceablitiy system for package handeling Today - ICT procurement for NKS - Implementation of a Servicecenter/servicedesk

5 Agenda About Karolinska and the department of Service and Logistics The strategy project NKS the new Hospital building

6 Karolinska University Hospital

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8 One Hospital Several Sites Full Range of Care Solna 8 Huddinge

9 Our Position Regional Hospital for inhabitants in Stockholm most patients from our region National Market Leader in Sweden along with Karolinska Institutet ahead in medical advancements International Internationally Recognized one of the best known university hospitals 9

10 14,700 Employees (Doctors)

11 Karolinska - complexity 2 main sites Solna, Huddinge (& NKS) Operates at several different locations in Stockholm m 2 Each site: 100 wards room 800 delivery addresses The Parties Suppliers Textilia - textile Medicarrier Medical supplies ApoEX, ALP,Apoteket Pharmaci- Pharmacies Sodexo - Food Freight, packages & express The Building Owner - Locum Maintenance - Dalkia, YIT Cleaning ISS and NCA External contractors

12 Collection points in Solna -waste Soprum Miljörum

13 Collection points in Huddinge -waste

14 Services and Logistics - SoL within AIS Administration, Information & Service Facility Management 200 employees 20 M - budget Our koncept Deliver efficient Services for the Health Care today and for the future SoL consists of: Develop and make the flow of goods and service efficient, from order to delivery, including waste management Procurement and Purchasing Controlling* and Process Development, Project Management Supply: Patient- and Goods transports, Goods reception, Waste etc. Internal Services: Internal post, Conferences, Information desk etc. * Outsourced service Food, Cleaning & Textile

15 Flows at SoL Today Supply 140 employees Internal transports at both sites Main flows Food (Sodexo) Medical Supplies (consumables etc.) Drugs, blood & samples Patients Textile Waste Procurement 17 employees Centralised for all purchasing activities Total 200 M * Services 60 M Consumption 100 M Investments 40 M 500 procurements/year, >10k Procurement system > articles (95%) 85% EDI-orders (rows) users Automatic invoice matching * Exkl pharmaceuticals

16 The new Karolinska - Development into the Future 2007

17 The future Why do we have to change? Demography in Sweden Citizens that retire change from tax payer to consumers The balance between tax payers and retried is changing Less people will work (%) The older we get the more healthcare we need tax from 30% to 45% unless we change health care By 2015 every 100 workers will support 35 retired!

18 What to change? - some alternatives! Less public financed health care Pay yourself Insurances and private care suit yourself for lifestyle related diseases Increase tax Medical progress development of new techniques Improve effectiveness Specialisation / Professionalization Lean in Support and Health care processes

19 Logistics for the future - A project within Strategy Projects 2007 Standardised Logistic concept Recommendations: 1. Automatic transports 2. Medicine unit dose 3. Supply strategy 4. Service area 5. Service desk Future Hospital 2015 Lowest Total cost Obvious choice! Solna & Huddinge Leader in Processes & Quality Employee satisfaction

20 1. Automatic transports 24 h / 7 days Pneumatic tube & Medicine unit dose RFID-chip access control Blood, samples & medicine Money, linen, etc.. AGV (Automatic Guided Vehicles) Safety & less damages (lifts ) Several carrier (carts) Waste management systems Several fractions Laundry - dirt linen AGV-served chutes

21 2. Medicine in unit dose requires Pneumatic tube system Safety & access control Automatised prescriptions Follows the patient Patient safety Dose & interaction 13% of time spent due to medicational errors* Care time to care 13%-19% for medications* *acording to Swisslog

22 Pneumatic tube system mm

23 AGV - Automated Guided Vehicle

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25 3 & 4. Supply strategy & service groups External warehouse and order picking Separated flows Standardisation Andra sjukvårdsinrättn. Tvätteri Depå Leverantörer Slutbehandling Geographic service groups Goods & waste and other support services Karolinska Universitetssjukhuset Solna Entré för bud o prover Godsterminal Kök Miljöterminal Kanban systems Double sided cupboards close to the patient Avd Serviceområde Avd Avd Avd Avd Servicegrupp Avd Avd Avd Avd Avd Avd Serviceområde Serviceområde Avd Avd Avd Avd Avd Avd Avd Avd Avd Avd Servicegrupp Avd Avd Avd Avd Avd Avd Servicegrupp Avd Avd Avd

26 Collection points in Huddinge -waste

27 Kanban Storage Helath care consumables The right person does the right thing Everything in one place No more searching

28 How the kanban storage works 1. Items are picked from the front container 2. Someone takes the last item 3. Move items from storage container to front contaioner 7. The goods are delivered to the hospital and distributed to the customer. The right item at the right place. 4. The kanban card are placed on ordering bracket Purchase signal!! 6. The order is sent by EDI to the warehouse and picked for the specific customer...and visualise that the material has been ordered 5. Service staff scan bar code on the kanban card

29 5. Service desk Centralised Service desk for support services Ordering transports of Patient and goods Supply information status and when to arrive? Conferences Facility management Web based & one common phone number The Implementation project started last year Our servicecenter opened 2 april 2013

30 Future logistics - Decisions needed Decisions to be made Specialized service staff Service areas customer focus Sevice-desk easy to reach Decisions made Process focus (Lean Health Care) Hospital Mgmt New Karolinska Solna (NKS) One Sterile & centralized desinfectors Central pick from Sterile Technology dpt System integration - Purchasing & Journals Product tracking and bed side scanning Real time location system, track & trace Wheel chair, infusion pumps, beds, patients Patient self-registration Kanban storage in whole Hospital Linen (Textile) process in Huddinge Patient transports, web AGV & lifts in Huddinge Pneumatic tube in Huddinge PDAs to service staff

31 Vision for the future - Traceability from producer to patient - Automated data capture to medical and other records

32 Logistics of the future: A new hospital building

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34 NKS - Nya Karolinska Solna A strategy for the future requirements of health care

35 NKS building - Number of rooms and capacity m 2 the New Wembley Stadium or 24 Hötorgsskrapor rooms 600 inpatient beds 400 rooms incl. 24 delivery rooms & 125 ICU/IMU, 75 postop 100 daypatient beds 100 hotel-beds 36 complete operating rooms including 3 hybrid-rooms and a number of intervention-rooms 180 rooms for consultations and patientdoctor conferences + space for advanced imaging and other diagnostic equipment 5-11 floors (mantle certain cores)

36 NKS PPP-agreement Public-Private-Partnership 14,5 billion SEK (EUR 1,5 billion) Construction costs: excluding financial costs 1,9 billion/year SEK (EUR 200 million) from 2018 to 2040 Yearly fee to be paid by the Stockholm County Council. 290 million/year SEK (EUR 29 million) fee allocated for services PPP-Company: Skanska & Innisfree (British investment fund) Skanska: Builder Architect: Tengbom based on the design developed by White architects Coor Service Management: Facility management More than 2000 people will be involved in the construction

37 The task - Future Logistics & NKS-PPP NKS is a part of the project the Future Logistics Think new and build accordingly! Decrease Total costs More efficient work processes Higher resource utilization New techniques for call-off, traceability & positioning/tracking

38 NKS - Logistics & Automatic systems

39 NKS standard principle the core - Logistic system - doubled SGV Waste & linen Pneumatic tube

40 RTLS Real Time Location System Implemented at NKS A pilot at the emergency ward in Huddinge 2012 Patients Alarm Track lost patient Reminder for appointment Measurement in real-time Lead-time Equipment & maintenance Infusion pumps (-30%) Carriers Inventory handling & alarm Wheel chairs

41 NKS in figures* - logistic system 63 lift + escalator 25 automatic trucks SGV*** outline laser navigated 12 dedicated lifts Tracking and Positioning system with standardised identities (RTLS** with structure from Pneumatic tube 5 kg load 150 stations 7 km 160 mm tubes Linen handling 10 distribution points AGV served RFID - controlled * Estimated values from 2010 ** RTLS: Real Time Location System *** SGV: SelfGuideVehicle

42 Bedside scanning A prestudy at Karolinska University Hospital If a barcode can track a package around the world. Why can t it track a patient s medication in the hospital? Photo Courtesy of HCA Elisabeth Ström Servicetjänster och Logistik, Karolinska

43 Bedside scanning Product Batch Expiry date Reading and using information in data carriers (bar codes or RFID) at the bedside Bedside scanning: 1. Identification patient, caregivers, material etc to avoid mix-ups 2. Matching information to secure that the patient gets the right drug, blood, implant etc. 3. Automatic record keeping, standardised and correct information RFID Radio Frequency Identifikation

44 Cytostatic in Geneva

45 Why bar coded single dose in Hospitals

46 Bringham, Boston Medication process

47 After implementing E-record and bedside scanning

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49 2013 Ongoing activities - Logistic related New SIQ-award (Swedish Quality Institute) Parcel-tracking in Huddinge (bar code) Pneumatic tube System Huddinge On-going Kanban-implementation Surgery logistics Huddinge and Solna GS1-standards in procurement ICT for NKS Service center project Process management at Sol Implementation of it-infrastructure with the cleaning contractor

50 Questions?