It's estimated that nurses spend a quarter of their time engaging in logistical tasks. As health services strain under budget and personnel constraints, finding new ways to get the best out of staff is increasingly important. Katri Niiranen, healthcare logistician project manager at DSV Healthcare Solutions, discusses how a trial programme in surgeries is enabling nurses to spend more time performing medical duties - cutting costs and saving time.
Hospitals and operating theatres are no strangers to the stresses of time constraints. Many face a well-documented battle to reduce waiting times between consultations and operations, and with the aging baby-boomer generation boosting patient numbers, such pressures are unlikely to subside. As national health institutions across Europe lack the funding to combat rising demand with personnel hires, many are instead exploring ways to reduce the workload of the nurses and doctors they do have.
According to the World Health Organization there are more than six million nurses and midwives in Europe. As some studies suggest that nurses spend around 25% of their working day engaged in support assignments, around one million of them are effectively 'lost' each year performing activities such as distribution, operation control, purchasing and supply chain management.
Recognising the need to rebalance nurses' schedules, Danish logistics company DSV Healthcare Solutions developed the healthcare logistician service, a concept that seeks to guarantee an unbroken nursing process, free up staff to undertake other duties, and enhance the management of stock and the supply chain.
Healthcare logisticians are logistical experts in the processes, practices and jargon of the medical industry, who understand the basics of risk management as well as the demands of aseptic activities and patient safety. They're able to effectively liaise with other specialists, guarantee that the necessary nursing equipment is available at the right time and promote the functionality and quality of the service chains. The project aimed to introduce healthcare logisticians into operating theatres and integrate a system that pre-stored supplies, improving efficiency and freeing up nurse time.
After the need for this kind of approach was proved healthcare organisations were invited to join the project; invitations gladly taken up by the social and health consortium of Päijät-Häme, the healthcare districts of Varsinais-Suomi and Central Finland, the Lahti University of Applied Sciences and Tekes (the Finnish Funding Agency for Technology and Innovation).
"The project started at the beginning of 2012, the aim of which was to define solutions for improving productivity in hospital operations, to move nurses away from support services," says Katri Niiranen, healthcare logistician project manager at DSV Healthcare Solutions. "We wanted to create a situation where nurses weren't focusing their time on completing logistics tasks in the surgery department. We knew the situation was untenable and that something had to be done in hospitals."
In Finland, the total annual costs of nurses amounted to €6.8 billion in 2011; €1.7 billion of this could effectively be attributed to support services. Under pressure from its third consecutive year of recession and on a slow march towards the EU 60% debt ceiling, the Finnish healthcare system is set to undergo reforms, with preliminary plans set out by the government in September 2014. The numerous benefits demonstrated by the healthcare logistician project could go some way to enabling authorities to improve efficiency.
"Perhaps the biggest benefit is the ability to perform more operations in the same amount of time with fewer personnel," says Niiranen. "We found that, by running the project, the surgery was able to reuse 10% of its staff in other departments. The nurses could concentrate on being nurses and not on logistics tasks.
"To improve the productivity of the surgery department, you want to ensure the operating room is empty for as little time as possible. In between each procedure, you have to clean up and replenish the products; now we only needed to step in to the operating room to change the replaceable carts. Before this project got underway this process took around 78 minutes before the next patient could be seen to. Now we can do the same thing in ten minutes."
Crucially, the model ensures that total costs do not increase, with all gains in efficiency amassed through logistical improvements and relieving nurses of duties. Measures such as introducing competent logisticians, streamlining the supply chain and relocating the storage of medical equipment make realising such dramatic improvements possible.
"DSV Healthcare Solutions helped to create the concept and provide the manager of the project, as well as a lot of the other personnel throughout," says Niiranen. "As well as qualified professionals, we are also able to complete many of the logistics tasks for the hospital; things such as the pre-packaging of medical materials could be most effective when doing it offsite. Ideally one logistics company would be able to serve multiple sites, introducing economies of scale."
By adopting the project across different healthcare processes, hospitals can be served by companies such as DSV Healthcare Solutions. Stock is therefore managed in cheaper locations; this remains the end game. Although this concept has been proven by DSV in other countries already, before it can be scaled up, those involved must first test its efficiency in other environments and ensure they're able to overcome the challenges they've faced installing it.
"It's a huge change and the surgery department is a very traditional organisation with an extremely complicated environment," says Niiranen. "Naturally you cannot amend anything without careful planning; also, this scale of change is made much harder by the fact that the hospital was built in the 1970s and its design was very dated. They had to be very creative when they were operating as often they didn't have the space for some of the tasks."
From the point of view of nursing units, building a robust system that takes logistics services out of hospitals and redefines the division of labour makes good sense.
"We're in the first steps of realising the potential of this project, and in the next few years we will have two other surgery departments in the same hospital ready to try the concept," says Niiranen. "We knew that there was huge potential for a project of this nature but we recognised that changing anything in such a complicated environment wouldn't be easy."
The operations model was piloted in the surgical units of two specialised medical care hospitals. And for those running the healthcare logistician project, surgeries which undertake emergency operations represent the most challenging environment to test the model.
For Niiranen, building a strong working relationship with the hospital was as important as demonstrating the project's efficiency. "One of the main challenges for the nursing personnel was the need to build trust, accepting that someone else would collect the goods for them and perform those logistics tasks to the necessary standard," she says. "But how can we create this trust - that was a huge consideration for us. We found that the trust is best created by ensuring, day by day, a great level of service from the healthcare logisticians. And when the benefits become more and more evident for nursing staff, nobody wants to go back to the old way of doing things."
With the trial having registered successful results, for Niiranen and her team, the next step is to try and scale it up. Without the trust of medical professionals, its impact will be limited. For those running the project, however, demonstrating its efficiency, economic viability and ability to allow nurses to be nurses, will certainly help in instilling the necessary trust across the sector.