Re-designing and Transforming Logistics Flow in
JurongHealth with Technology and Automation
Ms Joanne Yap
Group Chief Operating Officer
Jurong Health Services
Singapore
Prepared with support from
Mr Joel Tan, Group Director (Operations, Support Services)
Mr Tan Kok Keong, Asst Director (Operations, Support Services)
Mr Lim Meng Keong, Senior Manager (MMD Logistics)
JURONGHEALTH, INCORPORATED ON 11 JUNE 2009, IS THE REGIONAL
HEALTH SYSTEM (RHS) LOOKING AFTER THE POPULATION IN THE WEST
ALONG WITH NUHS
CGH
SGH
NUH
KTPH
IMH
TTSH
SKH
KKH
NTFGH, JCH,
JMC, LFMC
Started planning for
new hospitals in 2009
• Engage non-healthcare community partners
e.g. grassroots organisations, employers, sports
and other interest groups to help residents stay
healthy in the community – away from the
hospital.
• Provide integrated and seamless care
experience for our community requiring
various healthcare services.
• Work closely with care providers in the
community including GPs, polyclinics,
community hospitals, nursing homes,
hospices, home care providers and social
support groups.
Values
Integrity . Patient-Centredness . Openness . Excellence . Mutual Respect
Mission
Stay Well . Heal . Empower Providing integrated healthcare by working hand-in-hand with community
partners, patients, caregivers, and staff
Vision
Transforming Care. Bringing Health to Every Home.
We design and deliver
care around the needs
of our patients and
their caregivers
We uphold
trust
through all
we say and
do
We give
our best,
every time
We treat each
and every
individual with
dignity
We embrace open
communication,
change &
champion
innovation 3
OUR 1ST GOAL WAS TO BUILD NG TENG FONG GENERAL
HOSPITAL AND JURONG COMMUNITY HOSPITAL TO ADD TO
NATIONAL HEALTHCARE CAPACITY
Pre- Workshop
• Immediate task to build the integrated
development of the 700-bed Ng Teng
Fong General Hospital (then Jurong
General Hospital (JGH)) and 286-bed
Jurong Community Hospital (later in 2011
increased to 400 beds).
• Take over full management of Alexandra
Hospital by 1 August 2010, when KTPH
opens
Park @ Jurong Gateway
JTC Summit
Jurong East Town Centre
We are set amidst Singapore’s second largest Business District
Ng Teng Fong
General Hospital
& Jurong
Community
Hospital
WDA
CET
IMM
Jurong East
MRT
JCube
Park @
Jurong Gateway
JTC Summit
Jurong East
Town Centre
JEM
Devan Nair
Institute
Westgate
Tower C (JCH)
Level 1
• Admissions & Business Office
• JCH Outpatient Clinics
Mezzanine Level
• Clinical and Administration
Level 2 and 3
• Non-subsidised Wards
Level 4 to 12
• Subsidised Wards
(naturally ventilated)
Tower B (NTFGH Wards)
Level 1 to 4
• Emergency Department and other
critical care areas such as the
Intensive Care Unit and Operating
Theatres
Level 5 to 10 (West Wing)
• Non-subsidised Wards
Level 5 to 16 (East Wing)
• Subsidised Wards
Tower A (NTFGH Clinics)
Level 1
• Training facilities, auditorium and
Radiology
Level 2
• Pre-surgery evaluation, Medical Social
Services, Retail
Level 3 to 7
• Specialist Outpatient Clinics
(120 consultation rooms)
Level 8
• Administration
Significant opportunities as an integrated healthcare hub
3 Buildings, 2 Hospitals, 1 Experience Integration of Infrastructure,
Processes and Technology
Jurong Medical Centre & Lakeside Family Medicine
Clinic - our base for community and home care since
April 2012 and June 2013 respectively
• 2 Operating Theatres
• 1 Endoscopy Room
• 15 Consult rooms
• Rehab Gym
• Diagnostics
• 10 rooms for Clinical &
Allied Health consults
• 1 Treatment Room
• 7 Family Medicine doctors Address: 60 Jurong West Central 3,
Singapore 648346
Size: 8262m2
Started: Officially opened in 2006
Nearest MRT: Boon Lay MRT
Address: Block 518A, Jurong West Street 52
#01-02, Singapore 641518
Size: 590m2
Started: Officially opened in July 2013
Nearest MRT: Lakeside MRT
Since opening, we have served 127,292 unique patients – 63.3% of them live
in the western region (Jurong East, Jurong West, Bukit Batok, Choa Chu Kang key residential areas)
Distribution of our patients Data as of 14 Aug 2016
Higher intensity represents more patients in the region.
8
HOW TO MAXIMISE MANPOWER
UTILISATION ?
Linen MMD Pharmacy Kitchen CSSD
• Inefficient
inventory checks
of supplies at
Wards
• Poor organization
of supplies
• Poor storage
management
• Inefficient
picking
• Inspection
process
• Manual delivery of
supplies to Wards
• Different teams handling
different supplies
• Incur idling time -waiting
for lifts and travelling time
THE START OF THE THINKING PROCESS
Disparate systems, sub-optimal workflows and processes and non-standard material handling equipment
HOW TO IMPROVE SUPPLIES
AVAILABILITY ?
HOW TO INCREASE PRODUCTIVITY ?
THREE BUILDINGS ARE 600 METRES APART, 8 – 16 STOREYS IN HEIGHT
11
Consolidation
Area for
Delivery
Logistics Hub
Loading Bay
CSSD
Pharmacy
MMD Linen
Via AGV
Central Receiving
Reduce distribution
timing; 72% of
supplies are used for
NTFGH Wards.
Improve Productivity;
Faster response
during BCP
Ensure supplies
are available at all
times
Cost
effective
DECISION MADE TO CREATE A LOGISTICS HUB CO-LOCATING
RELATED SERVICES, HOUSED IN THE INPATIENT TOWER
GOALS
Maximize staff
utilization rate – 80%
Minimize staff
requirement
INPUTS
AGV Schedule
Task Duration
Work scope
CONSTRAINTS
Retrieval & return of AGV carts upon
reaching svc pts
Timely retrieval of meals carts
Replenishment of drugs, CCSD
supplies
Replenishment of MMD / Linen
Dept staff going to wards to carry out their own function at their own
schedule
HARD
FLEXIBLE
ONE TEAM SERVICE Above the line & below
SOLUTION
ADOPTION OF TECHNOLOGY AND LEAN PRINCIPLES DECIDED UPON Numerous combinations simulated : pace, process, technology & staffing
(Animated video of Logistics Hub)
KEY BENEFITS
THE INTEGRATED LOGISTICS HUB HAS TRANSFORMED THE WAY WE DELIVER SUPPLIES TO SERVICE POINTS & VALUE ADD TO CARE PROVIDERS
7 5 4 6 2 1
Management and replenishment
of supplies
Inventory checks and
supplies re-ordering
(Planned and Unplanned)
Storage Management
Supplies picking
Distribution
of supplies Receiving of supplies (Integrated
Floor Support Team)
RFID Reader
Tabulated weight of outgoing supplies
3
Out-going inspection
by weighing
Warehouse Management System (WMS) with 2 Bin RFID
AGV System
Integrated Floor Support (IFS) Team
• Relive nurses of non-nursing tasks so they can focus on patient care
• Timely delivery of supplies
• Ensure correct supplies
• Ensure right quantity • Consolidate staffing
needs for receiving & supplies management, & pantry services
14
Operations
Manpower Strength 21 headcount (Logistics receiving & distribution) Integrated Floor Service staffing levels are separate.
Materials Handling
Equipment 2 x WAVE (Work Assist Vehicle)
3 x Pallet Truck
2 x Tow Truck 20 units of AGV
Number of SKU 610 (Max capacity 700 SKU)
Loghub Stock Holding level
2 - 3 weeks
Service Point Stock
Holding level 2 - 3 days
Number of Service
Points 113 ( Clean Utility & Sub CU rooms)
Operating Hours 9am to 6pm (Mon - Fri)
9am to 1pm (Sat)
Closed on Sun / Public Holiday
Supplies Daily
Trips
No of Carts
Meals 177 80
4 in 1 156 56
Linen Exchange 33 76
CSSD 22 10
Pharmacy
(patient specific & bulk ) 58 (use 4-in-1 carts)
Total (Planned) 446 222
Total (Actual) 312 0
RH JCH
70% (supply & return)
30% (supply & return)
OPERATIONAL STATISTICS
RFID +
WMS
AGV PRODUCTIVITY
GAIN
THE TRANSFORMATION – PRODUCTIVITY GAINS
IFS (INTEGRATED
FLOOR SERVICE)
Moving from the operations of a traditional warehouse arrangement to an Integrated Logistics Hub derived a saving of 52 headcount: 21% from the implementation of WMS + RFID and 79% from automation (AGV) and process change (IFS).
S/N Process Without Technology With Technology Tangible Remarks
1 Inventory checking &
reordering of supplies
(RFID Trigger ordering)
10 FTE
2 Inventory checking &
reordering of supplies
(Unplanned ordering)
• RFID tags are
configured with
pre-determined par levels.
• Staff spent more time on SAP
system to order the item due to
long and complex items listing.
• The total time taken accumulated
is equivalent to 4 FTE.
Uplanned orders using WMS
• Staff now spent less time to order
item as WMS system provide
pictorial view of the supplies.
• Total time taken is equivalent to 2
FTE.
Using WMS
integrated with
RFID reader:
1. 100%
elimination of
stock counting
at Ward level.
2. Re-ordering is
automated
3. Higher accuracy
of ordering of
supplies and
return of wrong
supplies are
minimized.
THE TRANSFORMATION AND ITS BENEFITS
• Manual stock
count, data entry
using PDA are
laborious and
time consuming.
• This process lacked integration with
Materials Management System
(SAP), and was found to be error
prone.
• Total time taken is equivalent to 6 FTE.
• WMS with 2 Bin RFID eliminates the
reliance on manpower to perform stock
count. Supplies re-ordering is now
automated by dropping RFID tags into
the WMS integrated readers. • Total time taken is equivalent to 0 FTE.
S/N Process Without Technology With Technology Tangible Remarks
3
4.
• Manual process
slow down picking
tasks and create
congestions at
picking lanes
• Times lost due
to repeated
movement
within the same aisle.
• Inspection of
supplies were
conducted
manually. This
is time
consuming and
error prone Tabulated weight of outgoing
supplies
• The weighing of the
supplies helps to
determine if
supplies are over or
under issued before
sending out.
Storage
Management
Supplies Picking
• WMS allows
configuring the bins
locations to facilitate
effective picking
activities. at “eye
level” to minimize
use of ladders
• WMS automate
picking sequence,
bi-directional
single travel
picking is now
possible.
Out-going inspection
of supplies
Using WMS
integrated with
RFID reader:
1. More efficient
picking process.
2. Faster out-going
inspection of
supplies.
3. Improve
inventory
accuracy due to
out-going
inspection.
4. Reduce
wastage of
supplies
THE TRANSFORMATION AND ITS BENEFITS
• Total time taken is equivalent to 6 FTE • Total time taken is equivalent to 4 FTE.
• Total time taken equivalent to 1 FTE. • Total time taken is equivalent to 2 FTE.
S/N Process Without Technology With Technology Tangible Remarks
5
31 FTE
6.
10 FTE
• Supplies were delivered
manually using L
trolleys
• Times were lost due to
staff travelling up and
down.
• AGVs automate
deliveries eliminating
manpower travelling
and idling time from
Logistic hub to service points.
• Using automation, zero FTE is
needed to deliver the supplies to the
Service Points.
• Introduction of Integrated Floor
Support (IFS) team relieves nurses of
having to receive and manage
supplies from different teams; supplies
are better managed, reduce stock out
situations & over-stocking. • With one co-ordinated team handling
multiple supplies, 95 FTE is needed to
perform the tasks. With further
improvement, now 85 FTE needed;
number holds even with all beds opened.
Distribution of
Supplies
(Using AGV
System) – Below
the line
Integrated Floor
Support (IFS)
Team – Above
the line
THE TRANSFORMATION AND ITS BENEFITS
Linen MMD Pharmacy Kitchen CSSD
• From our internal study, different supplies
team going up to the Service Points to
manage supplies is inefficient. Duplication
of work, nurses are called upon to receive
goods every time.
• The study concluded that 105 FTE is
needed to perform the tasks.
Using AGV System
1. 1. Just-in-Time
delivery (JIT)
of supplies
2. Safe and
secured
3. Better working environment.
• At NTFGH & JCH, a total of 680 trips would
have been needed to deliver supplies to all
Service Points. Total time taken is equivalent
to 31 FTE.
Using Integrated
Floor Support
Team
1. Accomplishing
doing more with
less resources
2. Reduce ‘Muda’
– Increase
productivity.
3. Nurses can
focus on patient
care.
S/N Process Without Technology With Technology Tangible Remarks
7.
• Management of
supplies are
difficult.
• Replenishment
took longer time.
• Poorly managed
due to many
sizes of yellow
bins.
• Different
storage system
used
• Better space
utilization of
storage bins.
• Reduce
wastage as
FIFO concept
is possible
using the “2
Bins” system.
THE TRANSFORMATION AND ITS BENEFITS
Using modular
shelving:
1. Optimize of
storage space.
2. Better
organized of
supplies.
3. Better visibility
of inventory
holding at
Wards level
Staff used lesser
time to do
housekeeping and
replenishment of
supplies.
New storage
system more staff
friendly
Management and
replenishment of
supplies
FROM CONCEPTS TO REALITY
(Actual video of Logistics Hub)
CONCLUSIONS
1. Hospitals vary greatly in geographical location, physical layout, culture etc., and this significantly influences how logistics practices can be applied.
2. We believe to achieve true benefits from logistics improvement, a good understanding of the processes and activities in place is required prior to designing the new facilities, processes & selection of technologies.
3. A good logistics system is a source of savings in terms of support services; it can relieve clinical professionals of non-valued added tasks and to spend more time to provide safe, quality care.