Post on 08-Feb-2017
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RETHINKING THE LAUNDRY PROCESS
Jeffrey F. Solarek, CMRP, CPIM. C.P.M., CIRM, APP, CPCM, CPSM
03-02-09
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Table of Contents
1. Abstract Page 3
2. Project Overview Page 4
3. Improvement Process Page 5
4. Results Page 11
5. Innovation Page 13
6. Sharing our knowledge Page 14
7. Supporting Documentation Page 16
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ABSTRACT
Linen expenditures and laundry processing account for a large portion of our six
members Health Delivery System’s (HDS) budget. As a part of our of our continuous
improvement quality process, we identified the need to streamline our linen and laundry
operations in order to improve efficiencies and drive out costs. Our goal was to utilize
modern methodology and technology to implement and sustain linen and laundry best
practices – therefore driving savings and nursing satisfaction throughout the system.
A cross-functional team from the areas of Laundry Management, Supply Chain
Operations, and Strategic Improvement was created to identify and implement process
improvements. This team mapped current processes in the areas of production and
distribution. They then determined desired “end-state” goals for the laundry operations,
including baseline metrics and flow requirements. Existing processes were then
amended to achieve these end-state goals.
As a result of this linen and laundry process improvement initiative, our HDS has
experienced significant reductions in operational costs and processing errors. We have
increased focus on laundry compliance, cost reduction/containment, standardization
and utilization, and we have greatly improved our nursing satisfaction ratings.
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PROJECT OVERVIEW
Project Title: Rethinking the Laundry Process
Challenge
Linen expenditures and laundry processing account for large portion of our Hospital
Delivery System’s (HDS) budget. Our six member hospitals spend in excess of five
million dollars per year on linen for our patients. We identified the opportunity to
increase savings and improve customer satisfaction by driving out inefficiencies and
costs with our laundry processing. Some areas presenting opportunity were:
Improve flow of soiled and clean linen
Increase linen standardization
Enhance linkage/communication between the laundry, hospital linen distribution
and nursing
Eliminate unnecessary laundry handling and other unproductive activities
Improve safety and ergonomics of our laundry employees
Reduction in cycle time of soiled laundry processing
Diminish inventory tie-up with unnecessary levels of linen
Increase internal customer satisfaction by decreasing frequent stock outs
Cut down space constraints, due to excessive laundry
Focus on cost reduction then cost stabilization
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Opportunity Evaluation
Laundry process improvement was identified as an area with high potential rewards
based upon its large impact on our organization’s nursing satisfaction and budget.
Industry studies prove that deployment of lean techniques and philosophy enable an
organization to reduce number of processes, touches, travel, and mistakes, as well as
standardize work – all leading to cost reduction and improved customer satisfaction.
Vision and Leadership
The Chief Purchasing Officer, Director Material Management and Director of
Strategic Improvement recognized the savings and improved customer service potential
afforded to the organization as part of the opening of a new laundry plant. They
proposed the re-engineering of some of our laundry and distribution functions to better
utilize the new laundry facility. These concepts were presented to the laundry
management team who agreed that improving our laundry flow and procedures would
greatly benefit the organization.
IMPROVEMENT PROCESS:
Phase I
A cross-functional project team headed by a Laundry “Champion” was chartered
from the areas of Laundry Management, Supply Chain Operations, and Strategic
Improvement. The team was to identify and implement a “best practice” solution for our
laundry and linen management group. Once implemented, this solution needed to
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enable us to drive out supply and labor costs, improve customer satisfaction, and
sustain these achievements on an on-going basis.
With the above goals in mind, our project team identified the following essential
features required to make our laundry processing facility world class:
Knowledgeable and trained laundry personnel
Comprehensive laundry management support
Ease of “usability” for laundry personnel
Ability to build on early successes and communicate the successes
Establishment of a culture of continuous improvement
Project Team Composition
In an effort to gain buy-in and ensure all areas of the laundry process were
represented, we assigned stakeholders (Laundry Management, Supply Chain Experts,
Strategic Improvement and Nursing) key roles on the project team. They were involved
on a daily basis in re-engineering our laundry processes. In addition to the daily
resolution of laundry issues, the team conducted bi-weekly meetings with constituents
to discuss the progress of the project and recommend process changes.
Key team participants and their duties are listed below.
The Vice President Supply Chain and Chief Purchasing Officer was the
overall sponsor of the project team. Her duties were to provide project
guidance, expertise and communication with our HDS senior management.
The Director Material Management was involved because of his overall
accountability for the laundry and linen distribution function. He also has
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expertise in procurement, logistics and operations. The Director’s charter
was to keep the project on schedule, drive improvement, work out bugs and
problems, drive internal change management and provide supply chain
expertise.
The Director Strategic Improvement participated due to his expertise in lean
processes, Six Sigma and production expertise. He has worked in several
production plants and is a Six Sigma Black Belt. Our black belt kept us
focused on the “principle of lean” (see Exhibit A).
The Director Capital Acquisition was involved he is responsible for
procurement of all equipment and capital assets. He provided expertise and
guidance on warranties, equipment quotes and contractor relationships.
The Laundry General Manager was a key participant on the team due to his
depth of knowledge of the existing laundry and laundry flow process. The
General Manager also has two extensive industry expertise and certifications.
The Laundry Management Team Leaders were involved due to their depth of
knowledge of the existing laundry and laundry flow process. The team leaders
also have linen and laundry industry certifications.
A Strategic Improvement Fellow was involved due to her expertise in lean
processes, Six Sigma and production expertise. She also had prior laundry
production experience.
The hospital based Linen Distribution management team was involved due to
their hospital linen distribution expertise. They were the key communication
connection with nursing on the project.
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The Laundry Maintenance Staff was involved due to their key knowledge of
the laundry equipment as well as their ability to fine-tune the equipment.
Phase II
The Project Team mapped existing processes in the areas of laundry production
(see Exhibit B), linen distribution (see Exhibit C), and linen standardization to name a
few. They then determined desired “end-state” goals based upon market benchmarking
and best practice findings. The goals included baseline metrics, and other requirements
such as features, solutions and price.
Benchmarking
Benchmarking for the project was accomplished through a variety of methods
including:
Market research from our laundry association and laundry publications (see
Exhibit D)
An industry study completed by National Association Institutional Laundry
Managers (NAILM)
Internal analyses and statistical calculations from our internal lean engineers
and Six Sigma Black Belts
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Best Practices
Key best practice findings from Association Laundry Managers (ALM) were used to
evaluate the project’s progress and results. Examples of some of these best practices
are:
National average healthcare costs for laundry processing is between .28
cents to .34cents per pound
National average healthcare costs for replacement linen is between .10
cents and .13 cents per pound
National average healthcare costs for linen transportation is between .04
cents and .06 cents per pound
Linen Health Delivery Systems have an average fill rate exceeding 99%
Evaluation Process
The team used the following process to evaluate and implement suggested laundry
improvements:
Define our customer requirements
Document the value stream
Select Improvement tools
Develop action plans
Transition action plans to operations
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Phase III
The project team met bi-weekly to identify specific needs and issues at the laundry
facility and at each individual hospital in our HDS. They recommended process
changes based upon their ability to achieve our desired end-state goals. Once
accepted, all recommended changes were tested, and then institutionalized after
meeting our matrix criteria. Examples of some of the process changes we implemented
are outlined below:
We merged a three shift, seven day a week laundry operation into a one shift
seven day operation which resulted in reduction of seven full time equivalent
positions.
Cameras were added which helps us document inaccurate laundry picks,
machine failures and unauthorized access.
We developed cart audits to ensure accurate picks.
We added special signage and visual cues identifying specific laundry processing
areas, thus improving speed and accuracy.
Work procedures for new equipment were documented and communicated to
operators in an effort to ensure safety and productivity.
The “5-S” system was implemented to keep the laundry warehouses clean and
organized (sort, set in order, shine, standardize and sustain).
We employed a “reduce touches” philosophy which reviews unnecessary
handling and other unproductive activities.
Heating and ventilation was improved which added to employee satisfaction.
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A timer was added to our boiler which allowed us to have the equipment ready
for operations when employees arrived for work.
We implemented an automated preventive maintenance process and software to
ensure equipment uptime.
Phase IV
Matrix tracking was utilized during testing and implementation of each change to
ensure continuous improvement during and after its completion (see Exhibit E). During
implementation, the team tracked and compared our “before” reports to “after” reports
(see Exhibit F). As issues were identified and resolved, we used the information
learned to re-engineer our laundry processes as needed. Post implementation, we
continue to use the same process and report to track our cost savings and laundry
process efficiencies.
Information Technology (IT)
IT was used throughout the laundry project to establish benchmarks, track changes,
and ensure quality (just to name a few uses). Some examples of how we used IT are:
We utilized reporting tools from the laundry management software together with
internal data to compare cart pars with actual usage (see Exhibit G). This
enabled us to revise carts pars without compromising customer service.
Matrix tracking reports were created to support the process improvement prior to
and following implementation. This allowed us to track cost per pound and labor
improvements.
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We developed linen and laundry websites to enhance end-user customer
satisfaction. The sites include lists of all stock items, hours of operation, key
contacts, item descriptions and linen saving ideas.
RESULTS:
Impact
Our process reengineering initiative has had a wide-ranging financial and quality
impact on our organization. Some of the changes are set forth here, and summarized in
Exhibit F.
We reengineered the soiled laundry sorting station which resulted in the
reduction of a 1/2 of a labor equivalent. This allowed us to redeploy the person to
another critical area saving $12,480 labor dollars annually.
The tunnel washer conveyor was redesigned, which resulted in the reduction of
1.5 FTE’s of a labor equivalent. This change allowed us to redeploy the labor to
another critical area, saving $37,440 labor dollars annually.
We redesigned the dryer alarm system and reconfigured the dryer gas pressure.
This increased dryer production from 1,875 to 2,400 pounds a day.
A strobe light alarm was added to the tunnel washer which notifies us of a
pending problem that could shut down the tunnel washer. This change increased
production by 2.2 %.
We reevaluated and amended our logistics and delivery strategy. Changes made
resulted in the redeployment of truck driver hours to other needed areas. The
impact was $11,995 in labor savings and $2,389 annual fuel savings.
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Our washcloth folding procedures were revised, resulting in redeployment of 40
hours per week to other needed areas. This is a $24,960 improvement in labor
efficiency. We accomplished this with a simple idea of adding plastic totes to the
hospital linen carts and filling the totes with bulk washcloths.
We revised our scrub folding procedure which resulted in redeployment of 14
labor hours per week to other areas. This is an $8,736 improvement in labor
efficiency. We accomplished this by changing the scrub production area to a
cellular layout.
We reduced our sheet drying time from nine minutes per load to four minutes per
load which increase our daily sheet load by ten loads per day.
A continuous laundry par analysis was instituted on all nursing par carts. This
allowed us to reduce linen inventory levels without reducing service levels.
Magnitude
We calculated the overall magnitude of the project on our organization to date.
Some key statistics are:
Reduction of 29 full time equivalent employees from the laundry startup high
mark
Redistribution of $105,179 in labor costs to other needed areas
52% reduction in our cost per pound from the start up high
Increased focus on laundry compliance, standardization and utilization
Supply chain optimization including logistics, laundry management and
forecasting
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Reduction in rework related to processing errors by following lean philosophy
(see Exhibit A)
Over 15.1% cost advantage over laundries in our geographic area
16.1% increase in volume in one year
Sustainable Processes
We require our laundry management team to utilize key laundry reports daily and
monthly in order to resolve issues and look for opportunities to improve productivity (see
Exhibit G). We review flow patterns in order to reduce linen touches and remove links in
the supply chain.
Measurement and Reporting
Exhibit H is one example of our linen and laundry report. These reports are used to
track hospital linen demand by area, then analyze linen turns and fill rate for
improvement opportunities. We also utilize our linen and laundry management software
to provide key metrics and statistics to nursing units.
INNOVATION:
Our team developed several new and innovative approaches to accomplishing our goal:
We formulated a “team effort” approach to drive laundry optimization. This effort
consisted of laundry cross functional teams which drove synergy and expertise.
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We developed linen and laundry websites which includes a list of all stock
laundry items, hours of operation, key contacts and linen awareness. The
website has allowed clinician’s quick reference to item descriptions, cost, and
linen saving ideas.
Deployed the DMAIC method of define, measure, analyze, improve, control and
monitor. This allowed us define our customer requirements, document the value
stream, select Improvement tools, develop action plans and transition action
plans to operations.
SHARING OUR KNOWLEDGE
Our organization has been proactive in sharing our knowledge and laundry
experiences both internally and externally.
Internally
Our group communicates through our department newsletter called “The Laundro
Chat”. We also communicated our progress and successes through our monthly staff
meetings, on our department websites and at hospital management forum meetings.
Finally, we communicated our success through a presentation to senior management.
Externally
Team members have also shared our laundry reengineering experiences outside
our organization through presentations at trade associations and through industry
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publications (including articles in the National Association Institutional Laundry
Managers (NAILM) local newsletter and the American Laundry News.
LESSONS LEARNED
By deploying lean methodology, principles and practices, an organization can
dramatically boost efficiency and performance. A team approach and assignment of a
team leader to keep the project on track are keys to success.
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SUPPORTING DOCUMENTATION: Attached, Exhibits A through H
Exhibit A: Principles of Lean From their 1996 book Lean Thinking, James P. Womack and Daniel T. Jones defined a set of five basic principles that characterize a lean enterprise:
1. Specify value from the standpoint of the end customer by product family.
2. Identify all the steps in the value stream for each product family, eliminating every step and every action and every practice that does not create value.
3. Make the remaining value-creating steps occur in a tight and integrated sequence so the product will flow smoothly toward the customer.
4. As flow is introduced, let customers pull value from the next upstream activity.
5. As these steps lead to greater transparency, enabling managers and teams to eliminate further waste, pursue perfection through continuous improvement.
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Exhibit D: Example of market data Hospital Annual Linen Inventory Replacement % USA Market
Item
USA Market USA Benchmark
Range
Average Mean Low High
Total Annual Replacement % 81.1% 77.1% 51.0% 110.1%
Blanket 97.1% 84.2%
47.1%
146.1%
Towel 134.0% 125.0% 59%
210%
Fitted Sheet 68.9% 65.3%
37.1% 99.5%
Flat Sheet 72.1 54.7
39.1%
118.2%
Gown 79.1% 62.1%
33.2%
125.1%
Pillowcase 67.1% 63.2%
33.2%
106.1%
Thermal 72.1% 57.1%
30.1%
115.1%
Underpad 92.1% 88.1% 51
133%
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Exhibit E: Example of Matrix Reporting
1-Jan 1-Feb 1-Mar 1-Apr 1-May 1-Jun
Hours
Avg daily labor hours soiled transport time 85.1 84.3 81.2 79 76 74.2
Avg daily labor hours soiled sort 41.2 40.1 39.2 37.6 37.4 36.5
Avg daily labor hours soiled conveyer time 152.1 144.3 141.2 139.5 135.4 129.5
Avg daily labor hours tunnel washer 99.3 88.2 85.2 84.3 79.6 77.6
Avg daily labor hours dry time 121.2 119.6 118.2 117.5 115.4 112
Avg daily labor hours washcloth folding time 7.5 7.5 7.5 0 0 0
Avg daily labor hours scrub folding time 10 9.5 9.25 9 8 8
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Exhibit F: Before and After Tracking Results:
Description Before After Result
Soiled laundry sorting station
5 FTE 4.5 FTE .5 FTE or $12,480 redeployment of labor
Tunnel washer conveyor
1.5 FTE 0 FTE 1.5 FTE or $37,440 redeployment of labor
Dryer alarm system
1875 pounds per hour
2400 pounds per hour
575 pound increase or 30.6% improvement
Tunnel washer strobe light alarm
8 hours 10.2 hours 30% improvement
Logistics and delivery strategy - fuel
$26,759
$24,369
$2389 Fuel Savings Improvement
Logistics and delivery strategy - labor
$85,680
$73,384
$11,995 labor savings redeployment
Washcloth folding 7.5 hours 0 $24,960 improvement in labor efficiency
scrub folding 10 hours 8 hours $8736 improvement in labor efficiency.
Nursing inventory carts
Limited inventory par
analysis
Quarterly review of 212 cart profile for inventory
optimization
212% increase
sheet drying 9 minutes per load
4 minutes per load
80% increase
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Exhibit G: Cart Analysis Report
Stock # Description Daily PAR
Daily Rec. PAR
PAR Variation
Issue Qty.
Average Daily Qty
Qty Value
Qty Weight
Average Daily Weight
100 SHEET FITTED 35 20.0 15.0 516 16.645 192.53 412.800 13.316
101 SHEET FLAT 40 28.9 11.1 746 24.065 347.9 746.00 24.065
102 SHEET DRAW 10 6.2 3.8 161 5.194 46.63 99.981 3.225
103 PILLOW CASE 60 28.7 31.3 742 23.935 69.21 148.400 4.787
106 WASHCLOTH 150 117.9 32.1 3047 98.290 85.27 182.820 5.897
107 TOWEL BATH 65 81.8 -16.8 2114 68.194 443.69 951.300 30.687
108 BLANKET BATH 40 29.7 10.3 767 24.742 554.48 1188.850 38.350
109 BLANKET THERMAL
9 7.5 1.5 194 6.258 280.49 601.400 19.400
121 GOWN PATIENT 10 3.8 6.2 99 3.194 25.86 55.440 1.788
122 GOWN IV TELE
LG 40 25.6 14.4 662 21.355 219.22 470.020 15.162
Department Totals 474 360.7 113.3 9322 300.711 2321.5 4977.571 160.566
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Exhibit H: Example of linen Analysis Report
Par cart analysis daily usage minus daily par
Daily Par
6 month usage
1 month usage
Daily usage
Daily Par - Daily Usage
Blanket 30 4500 750 25 5
Towel 30 4701 784 26 4
Fitted Sheet 25 4235 706 23 2
Flat Sheet 25 4106 684 23 2
Gown 25 3905 651 21 4
Pillowcase 30 3826 638 21 9
Thermal 25 2589 432 14 11
Underpad 15 1996 333 11 4
Washcloth 40 5232 872 29 11
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REFERENCES
Womack, James P. and Jones, Daniel T. 1996 (Simon and Schuster)
authors “Lean Thinking” book Exhibit A
The Association for Linen Management is formerly NAILM, National Association
Institutional Laundry Managers. 2161 Lexington Road, Suite 2 Richmond, Kentucky
40475. The Association for Linen Management (ALM) was founded in 1939 by
Heywood Wiley to provide a network for the flow of information among its members
leading toward their professional development and the advancement of the technologies
they employ.
Website www.almnet.org exhibit d