We have met over 35-40 hospitals in the last one year. Irrespective of the scale of operations, the one question none of them can answer with certainty is the size of their surgical instrument inventory (3,000 to 1,00,000 line items). They “feel” they lose many instruments every year (estimates range from 10-20%), perhaps inadvertently thrown into trash or laundry. They can’t say for sure if they have optimal inventory for the surgical load handled. One thing they do agree on, though, is that they are going crazy trying to manage this and need a better way.
Contrast this with the airline baggage handling process. Airlines around the world carry over 4 billion pieces of luggage, meticulously (okay, sometimes shoddily!) moving bags to your destination, making transfers, accounting for cancellations, missed flights, etc. And, they mishandle only 0.0056 of these (i.e.6 bags per 1,000 passengers). What’s more, airlines today are 70% less likely to lose bags than 10 years ago* despite the growth in traffic. So, what can we learn from them about handling moving parts at scale in a cycle?
- Unique identity is indispensable
Imagine airlines trying to send bags to the correct location based on baggage tags handwritten by passengers or worse, no baggage tags at all! Impossible right? Printed baggage tags and barcodes are the holy grail of baggage handling systems and are now being replaced by RFID in some cases. The barcode allows any handler / system anywhere to figure out who the bag belongs to, where it is headed, on which carrier. It allows anyone to track the exact location of a bag. Instruments, on the other hand, have no individual identity and yet users are required to account for them, pack the correct one for a particular surgeon and keep track of what’s missing and what’s not. - Systematised process
The SOPs around baggage handling are water tight and are governed by IATA Resolutions
& Recommended Practices. Everything runs as per SOPs. There is no question of rushing some bags ahead because some passenger needs them faster – even priority handling of bags runs to predefined SOPs. Contrast this with the instrument handling process and one can understand why we have a broken chain so often. Granted that when lives are at risk or in the event of medical emergencies, processes may be overlooked, but then those would be exceptions and such scenarios must already be built into SOPs. The big question then is do we wait until a regulatory body dictates instrument handling practice? - Measuring & Reporting Statistics
Perhaps the most critical element of any process, measuring means improving! If airlines worldwide have been able to bring down instances of mishandled bag, a key component of this success would be the simple fact that this process is measured and reported. Of course, one aspect is the fact that airlines handle third-party assets and as such are answerable for any mismanagement. But anything that is tracked can be improved. If we are not able to measure a process, there is no way to improve it.
* SITA annual report on baggage handling 2017