Short Case

Just-in-time at Jimmys
St Jamess Hospital, affectionately known as Jimmys, is Europes largest
teaching hospital. It employs around 4!! people to support the "! !!! in#
patient treatments per year and o$er 4! !!! total admissions. %nder
increasing pressure to reduce costs, to contain in$entory and to impro$e
ser$ice, the Supplies &epartment has recently undertaken a ma'or analysis of
its acti$ities, helped (y the consultancy di$ision of )ucas Industries, the %*#
(ased manufacturing company.
+he initial re$iew highlighted that Jimmys had appro,imately -!! suppliers
of - !!! different products at a total cost of .- million. +raditionally, the
Supplies &epartment ordered what the doctors asked for, with many cases of
similar items supplied (y si, or more firms. %nder a cross#functional task
force, comprising (oth medical and supply staff, a ma'or programme of
supplier and product rationali/ation was undertaken, which also re$ealed
many sources of waste. 0or e,ample, the team found that wards used as
many as 1! different types of glo$es, some of which were e,pensi$e
surgeons glo$es costing around .- per pair, yet in almost all cases these
could (e replaced (y fewer and cheaper 21! pence3 alternati$es. Similarly,
anaesthetic items which were pre$iously (ought from si, suppliers, were
single#sourced. +he sa$ings in purchasing costs, in$entory costs and general
administration were enormous in themsel$es, (ut the higher#order $olumes
also helped the hospital negotiate for lower prices. Suppliers are also much
more willing to deli$er fre4uently in smaller 4uantities when they know that
they are the sole supplier. 5eter 6eeston, the Supplies 7anager, said8
Weve been driven by suppliers for years ... they would insist that we could
only purchase in thousands, that we would have to wait weeks, or that they
would only deliver on Wednesdays! Now, our selected suppliers know that if
they perform well, we will assure them of a long-term commitment. prefer to
buy !" per cent of our re#uirements from $" or %" suppliers, whereas
previously, it involved over a hundred.
+he streamlining of the admissions process also pro$ed fertile ground for
impro$ement along JI+ principles. 0or e,ample, in the %rology &epartment,
one#third of patients for non#urgent surgery found their appointments were
(eing cancelled. 9ne reason for this was that in the time (etween the
consultant saying that an operation was re4uired and the patient arri$ing at
the operating theatre, there were " changes in responsi(ility for the process.
+he hospital reorgani/ed the process to form a cell of four people who were
gi$en complete responsi(ility for admissions to %rology. +he cell was located
ne,t to the ward and made responsi(le for all record keeping, planning all
operations, ensuring that (eds were a$aila(le as needed, and telling the
patient when to arri$e. :s a result, the " hando$ers are now down to -; and
the process is faster, cheaper and more relia(le.
Jimmys also introduced a simple kan(an system for some of its local
in$entory. In <ard "s storeroom, for e,ample, there are 'ust two (o,es of -!
mm syringes on the shelf. <hen the first is empty, the other is mo$ed forward
and the <ard Sister then orders another. +he ne,t stage will (e to simplify the
reordering8 empty (o,es will (e posted outside the store, where codes will (e
periodically read (y the Supplies &epartment, using a mo(ile data recorder.
+he hospitals management is con$inced of the (enefits of their changes.
&alue for money, not cost cutting, is what this is all about. We are
standardi'ing on buying #uality products and now also have more influence
on the buying decision ... from being previously functionally oriented with a
number of buyers, we now concentrate on materials management for
complete product ranges. (he pro)ect has been an unmitigated success and
although we are only )ust starting to see the benefits, would e*pect savings
in cost and in e*cess inventory to spiral! (he report on +terile Wound ,are
-acks shows the potential that our team has identified. (he old pack
consisted of four pairs of plastic forceps, cotton wool balls and a plastic pot,
which were used with or without additional gloves. (his pack cost
appro*imately ." pence e*cluding the gloves. (he /new0 pack consists of a
plastic pot, swabs, etc., and one pair of late* gloves only. (his pack costs
appro*imately %% pence including gloves. (otal target saving is appro*imately
1$" """.
Questions
1 )ist the elements in St Jamess new approach which could (e seen as
deri$ing from JI+ principles of manufacturing.
2 <hat further ideas from JI+ manufacturing do you think could (e applied
in a hospital setting such as St Jamess=