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

Several principles guided the design of the hospitals, workflows

and adoption of technologies

9

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)

LESSONS LEARNT

1

1

2

3

4

5

6 More improvements can be achieved.

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.

THANK YOU