Cost Control
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| Those who wear scrubs in hospitals often underestimate the costs associated with replacing and laundering the hospital-issued garments. The University of Wisconsin Hospital and Clinics was experiencing extensive financial losses because no controls existed over the use of scrubs. To rectify the problem, the hospital’s materials management department worked with its linen cooperative to research and implement scrub vending machines. Not only is the hospital saving money, physicians are much happier with the system because it saves them valuable time. |
Almost everyone at the University of Wisconsin Hospital and Clinics (UWHC) has a story about scrubs. There’s the one about a surgeon giving three sets of scrubs to all the members of his daughter’s soccer team. Scrubs are occasionally given to patients as parting gifts. There also are staff who admit secretly to an overflow of scrubs in their closet or car trunk. Sometimes one can even find piles of UWHC scrubs for sale at Goodwill and other thrift stores.
Many other hospitals across the country share the plight of UWHC. Obviously, materials management needs to impress upon others in the organization that scrubs are a significant expense and greater care needs to be taken to minimize this cost.
UWHC is a 471-bed academic medical center with a high number of sporadic scrub wearers. UWHC is one of the owners of an off-site laundry cooperative, Madison United Healthcare Linen (MUHL). The cooperation was spending more than $230,000 annually on scrub replacement due to loss and additional laundry costs for unnecessarily used scrubs. To gather specific data on this problem, MUHL purchased a scrub-counting system from LinenMaster, computer software architects based in Bath, Maine. An investment of $12,000 was made to install soiled scrub sort windows with intersecting light beams. A scrub garment thrown through the window is electronically counted as it intersects with the beam. UWHC was responsible for the largest share of MUHL’s scrub loss, which was $138,000 annually. UWHC’s chief operating officer and MUHL board member, David Entwistle initiated a review of options to eliminate the problem.
After discussions with peer hospitals and other research, it became clear that policy changes alone would not solve the problem. As long as we supplied scrubs on open exchange carts throughout the building, anyone could walk off with piles of the garments. As we researched a technological solution, we decided to expand the scope of the project to address other scrub-related issues such as staff complaints that scrubs that were theoretically the same size, fit differently.
Another pervasive staff complaint concerned availability after the scrub cart had been picked through and many staff members wasted time finding scrubs that fit them. This problem was amplified because numerous employees were taking scrubs when they had no valid need to wear them. When the scrub carts came back to the linen room for restocking, they were in such disarray that it was more efficient to throw all the leftover clean scrubs into the soiled linen and rebuild the carts from scratch. Many hospitals have used automated scrub equipment long before UWHC, but perhaps the implementation process described can assist hospitals that are still struggling with high expenses due to scrub loss. We narrowed our search to two vendors, which were asked to present their products and submit detailed proposals. The vendors were then asked to arrange site visits and provide a list of references. A fairly detailed survey was developed and the references were contacted—most of whom were in materials management departments.
To gain a user perspective, Barb Pankratz, director of surgical services, contacted her counterparts at many of the same institutions. The MUHL general manager and customer service representative were invited to participate in the vendor selection process to lend their unique linen management perspectives.
To facilitate the vendor selection, materials management developed a spreadsheet detailing a side-by-side comparison of both vendors and both offered surprisingly different machines to perform essentially the same functions of issuing and collecting scrubs. After careful consideration, we chose the ScrubEx machines from IPA, Duluth, Ga.
In a move demonstrating the highly cooperative nature of the owner hospitals of MUHL, the board of directors voted to have the cooperative purchase the machines. The hope was that if UWHC was successful in eliminating its scrub loss problem then the other members of MUHL also might install these machines.
The return on investment (ROI) calculation considered the elimination of scrub expense due to loss and also the reduced laundering expense because the machines would preclude unauthorized employees from wearing scrubs.
This is not a straight-forward ROI calculation because MUHL would benefit directly from the reduced loss while UWHC and other members would benefit only indirectly. MUHL members would be charged a lower per-pound charge for scrubs because the charge would no longer have to compensate for scrub loss.
Conversely, UWHC would benefit directly from reduced laundering expenses while MUHL and the other MUHL owners would be negatively affected by reduced revenue.
From the top, down
We created a scrub task force comprised of representatives from the scrub-wearing departments. We started by completely rewriting our scrub policy to reflect the changes required for the use of the machines. To ensure we kept the number of machines needed as low as possible, we narrowly defined who would be allowed to wear scrubs and turned to the infection control team to be the arbiters.
The guiding principle for making this decision is that MUHL scrubs are provided only to staff who work in an environment where a high degree of asepsis is required. Given this criteria, numerous employees who were wearing scrubs are no longer allowed to do so.
When we knew who would be wearing scrubs, we calculated how many machines would be needed. It was determined which departments could share machines and which needed their own. We considered machine size, space constraints, separate machines for locker rooms of both genders, work patterns and the acceptable walking distance for employees to get scrubs.
We were using scrub dresses, scrub tunics and long-sized scrub pants in addition to the standard scrubs. These special items had to be eliminated for the most efficient use of the machines—for special items, additional machines would have been needed. Eliminating low-use items was difficult only for a small minority of scrub wearers.
Two by two
The machines issue scrubs by the pair, though previously scrub wearers could pair any sized top with any sized bottom. That meant we would need to stock 49 different combinations.
Given the machine capacity constraints, this couldn’t be allowed to continue. If we attempted to stock that many, we would only be able to put very few of each combination in each machine and frequent stock outs would result.
We were told that the machines operated most efficiently with up to nine different size combinations, so initially we elected to offer seven straight sizes to determine how difficult it would be for staff to accept. Eventually we decided to add two mixed-size combinations. (Of the more than 2,200 users, only 12 individuals have needed custom sizing and these individuals don’t use the machines.)
To prevent employees from hoarding scrubs, we limited staff to three sets at any one time and we changed the color of our scrubs to green only. Blue scrubs are no longer permitted at UWHC. If we didn’t require that only green scrubs be deposited, employees would stockpile scrubs until they had the same quantity before we installed the machines.
We created an on-line sign-up process so that we could build a database of those authorized to wear scrubs.
Once the short on-line form is completed, it is sent via e-mail to the scrubs administration account and also to the administrator of the department specified by the user. If the department does not recognize the name of the scrub applicant, their application is not processed. Users are required to agree to pay $25 for each set of scrubs they fail to return. The scrub-dispensing machines recognize individual employees by reading the magnetic stripe on the back of their identification badge or a vendor-provided bar code.
A user also can access the machine through the use of a PIN. At UWHC, we use ID badges imbedded with a proximity tag. This technology was new for IPA, but they agreed to change their hardware and software to allow our staff to access the dispenser via proximity card readers.
Vendors who need regular access to scrubs, but who do not have a proximity card, are given a PIN and limited to one set at a time. Ad hoc visitors to scrub-only areas are provided with disposable scrubs. Dispensers are equipped with a digital camera that records what is deposited. Employees who empty the machines report findings of anything other than green scrubs. We can quickly review the digital recording for the time period in question and easily identify the culprit. After the initial grace period, we have been forced to discipline a few employees for attempting to trick the machines to get additional scrubs.
The machines were installed in two phases. Phase one involved basically everyone except the OR. This group comprised approximately one-third of those who wear scrubs, and there was some initial confusion and resistance from users.
For example, users originally had the power to change their size at the machine. Some of our more resourceful employees who wanted a custom set combination would take out a set, change their size and take out another set. They would use the top and bottom they wanted and deposit the unused, clean scrubs back into the machine. This wasteful practice was stopped by discontinuing the size-change function at the machine. In the rare instance that someone needs to change their size they must contact us and we change their size in the system.
Up and vending
About four weeks after we had the first group up and running smoothly, we implemented the OR’s system. When the OR staff started using the machines, we had most of the bugs worked out. IPA and MUHL staff were on site throughout the planning process and during the weeks the system was going live during both phases. The collaboration of IPA, MUHL and UWHC staff was one of the keys to this successful implementation.
The new machines have been operating for approximately seven months and we can verify that our ROI and customer satisfaction goals have been met. UWHC’s $138,000 portion of MUHL’s scrub replacement expense due to loss has been replaced. The organization also will save approximately $60,000 annually in reduced scrub laundering expenses. Also, individual hospital scrub return percentages ranged from the high 80s to high 90s.
Though labor savings haven’t been quantified, it takes employees much less time to stock the dispensers than it did to rebuild scrub exchange carts each day.
Employees’ initial cynicism has been overcome as well. A customer satisfaction survey given only a few weeks after implementation showed that more than 65 percent of scrub wearers were satisfied or very satisfied with the new process. We believe that this percentage will be much higher on future surveys as familiarity with the machines increases.
Physicians have been especially complimentary. Instead of spending several minutes searching through ransacked scrub carts, they can retrieve their scrubs in six seconds. The option for a continuous replenishment program for scrubs is being explored as well. MUHL has access to our scrub-use information via a link into the ScrubEx system. The cooperative ascertains and ships the quantities and sizes UWHC needs without a submitted order.
This technology, in conjunction with our new scrub policy, addresses employee needs for scrubs while minimizing scrub-related expenses.
Robert Scheuer is the Director of Materials Management/Distribution for the University of Wisconsin Hospital and Clinics, Madison.
Criteria on which vendors were evaluated and compared
1. Scrub capacity
2. Ease of restocking
3. Hardware and software user friendliness
4. Software platform
5. Database management and reporting capabilities
6. Maintenance history
7. Vendor responsiveness
8. Installation process
9. Other linen control technology offerings and cost.
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