“Jaded Julie, in my earliest recollection of shopping at the local store (there were no supermarkets then), the clerk wrote the price of each item on a paper bag and manually added up the sum. He then bagged the groceries and my mother paid the bill in cash (how else?). Subsequently, the clerk used a manual adding machine and then a manual cash register (with a hand crank and bell). The store’s inventory control was ‘by guess and by gosh.’”
“Does anyone know how to manually sum a column of numbers these days, Curmudge? I wonder if they teach it in grade school. Now the bar codes on all the items are scanned into a computer. The only manual operation is bagging the groceries, and you are the only person I know who consistently pays in cash.”
“You can bet that the computer records each item purchased and uses the information for inventory control. This keeps the store from experiencing ‘stock-outs,’ although they often intentionally drop a particular brand that might not be selling well. Mrs. Curmudgeon considers that disgusting.”
“So what does all this have to do with health care?”
“One might consider a hospital to be like a big supermarket with many separate inventories and check-out counters. If each stored item had a bar code that was scanned when it was used, the hospital’s inventory could be managed just like the supermarket’s. However, Julie, the nurses and staff would regard scanning each item as extra work, and they would prefer a simple process over one that is complex.”
“But what we have now is simple, especially if the storage area has been 5S’d and everything is in its place.”
“At this point inventory control is haphazard. If a department is out of a critical item (which could be tragic), their next order is apt to be larger to avoid the stock-out. And when the larger order arrives, it might overwhelm the storage area. Another problem is that to avoid being impacted by a stock-out, people will hide their own supply (a phantom inventory) of critical items.”
“I guess what is needed is an inventory management system that is simple and effective.”
“And that, Jaded Julie, is kanban. It’s a Japanese word meaning ‘card’ or ‘signal,’ and that’s what it is and does. It is a card or other object that signals when new inventory needs to be ordered and how much to order. Its effect is to ensure that ‘needed supplies are in the right place, at the right quantity, at the right time, and to ensure the availability of material with the lowest required inventory levels’ (1). Oh, and by the way, I’m sorry that you had to learn a new Japanese word; at least it’s an easy one.”
“Curmudge, if it helps us avoid stock-outs, I’d be willing to learn a new word even if it were in Arabic or Czech. Besides, the word kanban is quite specific. If we just used the English word ‘card,’ it might be confused with business card, playing card, note card, postcard, and more. So tell me how this kanban system works.”
“We’ll start with a system that is up and running, like the one for office supplies on the other side of my office (but this same system could be used for everything from prosthetic joints to boxes of 4” x 4” gauze pads). The kanban card for 1-inch wide rolls of masking tape is a pink 4” x 8” card that shows the stock number of the tape and indicates that the maximum shelf quantity is 3 rolls, that tape should be reordered when one roll remains on the shelf, and that 2 rolls should be reordered at that time. For ultimate simplicity, the kanban card protrudes from the stack of tape rolls one up from the bottom of the stack. When a person takes the last roll of tape on top of the card, she knows that it is time to reorder.”
“I presume, Curmudge, that she gives the card to the person in the group who orders supplies. When the new rolls of tape arrive, they and the kanban card are put back on the shelf. What could be simpler? However, setting up the system and knowing how much to order and how much to have in reserve requires someone with experience and judgment.”
“Right, Julie. One would need to know the demand for an item and its variability as well as how long it typically takes for the replacement order to arrive. When starting up the system for critical items, one might have an extra-large reserve supply to ensure against stock-outs.”
“This might be one feature of Lean that I could take home. My couch potato husband would rebel against 5S’ing our kitchen cupboard and refrigerator, but I bet he’d love a kanban system so he wouldn’t run out of potato chips and beer.”
Affinity’s Kaizen Curmudgeon
(1) Graban, Mark. Lean Hospitals p.109. (Productivity Press, 2009)
Check out the latest posting in Curmudge and Jaded Julie’s personal blog, Curmudgeon’s Wastebasket.
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About Me
Kaizen is a Japanese word meaning change for the better. A curmudgeon is a crusty, irascible, cantankerous old person. The Kaizen Curmudgeon blog consists principally of conversations between the Curmudgeon and Jaded Julie. Their topic is Lean (the Toyota Production System) and its applications in health care. We attempt to depict Curmudgeon as the resident Old Guy who possesses some degree of perspicacity and is not nearly as grouchy as the formal definition of curmudgeon suggests. As her name implies, Jaded Julie is a nurse who has “had it up to here” with waste and inefficiency. She is unsophisticated, somewhat feisty, and does not appreciate having to learn the Japanese terminology of Lean. Of course, both the Kaizen Curmudgeon and Jaded Julie are fictional. The author of Kaizen Curmudgeon is a retired Associate Professor of Chemistry who has been a volunteer in health care since 2004.
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