Par Level Vs Kanban Methods – Which One For Hospital Material Management?

We have uncovered an opportunity that could mean millions of dollars in savings to individual hospitals, and billions of dollars to the healthcare system nationally in the US and abroad. It has to do with how most hospitals manage supplies, medications and other materials.

Many, maybe most, hospitals manage their inventory of supplies and medications using what is called a “par-level” method. It works like this: a stocking quantity is established for each item, the par level, based on average usage and a target number of days supply. We might, for example, set a goal of maintaining a two-day quantity of material for each supply item. As the material is actually used, we would bring the quantities “up to par” daily, by conducting a physical inventory and restocking the quantity that was consumed. The goal, sensibly, is to not run out of supplies while maintaining a tight control of storage space and inventory quantities. So far so good.

It is interesting to note that this par method of inventory control is not used in a world-class manufacturing environment, although a manufacturer certainly has the same needs and goals for inventory control as a hospital. The suggestion that we do a daily physical inventory for a large number of inventory items would be greeted with astonishment and ridicule. Many world-class manufacturing companies do not even conduct an annual inventory, by sustaining a high level of inventory accuracy through tight controls and cycle counting.

The method of choice in manufacturing for commonly used items is called Kanban. In a Kanban system, as with the par level method, we set a target quantity that we want to maintain. The principal difference is that instead of attempting to bring quantities “up to par” daily, in a Kanban system we set a fixed quantity that we will use to trigger the replenishment of inventory. In a “two-bin” kanban system, for example, we set up two quantities or bins of the same supply, and only refill a bin when it is empty. While the bin is being refilled, we have a second bin to cover usage during the replenishment cycle.

The Kanban method has seven main advantages over a Par-level system:

1. No daily counting is needed. We wait for a bin to be emptied and always replenish the same quantity. Not having to count can save hundreds or thousands of hours per year in most hospitals.

2. It reduces the number of resupply trips. Since we do not refill a Kanban bin daily, but instead wait for it to be empty, the number of replenishment trips can be reduced significantly. The number of replenishment cycles can be cut by 50% or more.

3. Replenishment quantities are fixed. The refilling process is greatly simplified by eliminating the need for counting required by the par system. If we know ahead of time what the refill quantity will be, the item can be stocked in that quantity.

4. It is easier to manage and improve. By tracking the time between replenishment, the stocking quantities can more easily be refined and adjusted over time. This continuous improvement is more difficult to accomplish if all quantities are refilled daily, in varying quantities.

5. Kanban reduces inventory. Experience proves that, with the same target coverage of supplies, a Kanban system will run with up to 50% less inventory than a par system.

6. It is easier to maintain replenishment discipline. Since they do not have to count all inventory locations, or eye-ball the empty bins, supplies handlers find it easier to identify and refill the empty bins, thereby substantially reducing the opportunities for shortages.

7. Kanban promotes good inventory management practices, while the par level does not. In fact, counting everything is essentially impossible and very labor intensive, and most par-level users simply “eye-ball” the bins without counting. Organization and housekeeping, “5S” in lean terms, is much easier to maintain.

For all of these reasons, Kanban is the method of choice for hospital material management, for much of the material that is procured and managed. The gains in productivity, reduced shortages and reduced inventory represent a multi-billion dollar opportunity for the industry.

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Three Recommended Hospitals in Alexandria, Egypt.

Alexandria is the ancient city founded by Alexander the Great. It is currently the second largest city in Europe as well as a major center of international shipping industry and a prominent trading center. The city located in north-central Egypt is the most well known tourist center in the country. In general, health care systems in Alexandria are well developed with many good hospitals in both public and private sectors. Some of the major hospitals are truly world class and offer the services of English speaking staff. This is a description of some of the major hospitals in Alexandria.

Alexandria University Hospital located at Al-Azarita, Midan Al-Khartom, Alexandria is one of the largest health care centers in Egypt. Faculty of Medicine of Alexandria University has been providing modern and effective medical service to people since1942. The center consists of a university hospital, a hospital specifically for obstetrics and gynecology, a pediatric hospital and a hospital for orthopedics. This premier institute employs 109 eminent physicians. The main hospital has spacious out patient section with full-fledged departments in various specialties and about 1100 patients visit the section daily. The hospital has departments of critical care medicine and diagnostic imaging. There are also well-equipped laboratories, an internal pharmacy and a nuclear medicine section. The hospital is keen to maintain the highest level of quality in all of its endeavors and formed a special quality assurance unit in 2004. Telephone: + 2035910048

The German hospital is a favorite amongst visitors to Alexandria. The hospital is conveniently located at 56 Abd El Salam Aref Street, Saba Basha, Alexandria. The staff includes visiting doctors, and the hospital offers effective medical service in both general and specialized areas at a reasonable cost. The hospital was founded by the German community in Egypt. The surgery department has units in various specialties like urology, plastic surgery and pediatric surgery. The ICUs, the surgical intensive care unit, the hospital pharmacy and the various laboratories in the German hospital are equipped with sophisticated devices and facilities. The center has a notable diagnostic imaging unit and a nuclear medicine department, both of which perform a large number of imaging procedures. Luxurious accommodation is available in the hospital. Tel: +20 3 584 1806

Abo-Qeer Central Hospital situated at Al-Bahr Al-Mayiet Street, Abo-Qeer, Alexandria is another popular hospital in Alexandria. This multidisciplinary private hospital is managed by a famous business group of the country. The renowned Global Air Rescue works in association with the center to arrange various emergency services like air ambulance. The network of air ambulances are provided with the newest cardiac life support systems. The hospital also offers the services of trauma experts, doctors and a supporting staff certified in emergency care and flight physiology. Tel: 20-560-1542

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Hospital Information Software: Bang for the Buck

Hospitals must look ahead to get the most out of their investments in technology. Administrators may compare the sticker price of new IT system packages, but cost considerations should include ease of implementation, time needed for staff training, interface with existing systems, data security, and use of light weight coding that does not become cumbersome to the larger system.

Technology in the hospital setting is no longer just a chip that makes an automatic blood pressure cuff cycle at programmed intervals. Software programs control data collection, and storage, in all aspects of patient care; from patient admission physicals, to creating the bill. Technology is a line item on the modern hospital budget, and it’s not going away.

Traditionally, Hospital Information Technology, and Health IT in general, has made use of many parallel systems with overlapping parts. Points of data entry that developed to store information on patients developed from multiple arenas before computer networking protocols allowed electronic file transfers between machines. Laboratory testing, MARs, (Medication Administration Records), and other sources of electronically stored data, progressed into computerized Kardexes, Nursing Care Plans, physician dictated Operative Reports, and Nursing Intervention checklists, to name a few.

Good IT infrastructure pays for itself. The hidden cost of maintaining outdated systems include more than random call tickets for tech support. Frequent rebooting of buggy software may cause increased wait times for patients and staff alike. Lack of reliable interfaces between systems degrades interdepartmental communication. Unavailable lab results may cause tests to be repeated. Staff frustration and hostility can result from having to work with substandard equipment. The patient who observes system inefficiencies may loose confidence.

Doctors, nurses, and other clinicians rely on Hospital Information Systems to meet patient needs.
Making health care data accessible to providers in a fluid manner translates into more efficient work flow at the bedside. Limiting work flow barriers in the hospital also improves patient outcomes.

Focus on buying smart. Cheap is not always less expensive. Hospitals must look ahead to get the most out of their investments in technology and data management.

Plan and implement your best Hospital IT strategy.

  1. Survey staff about problem IT areas
  2. Set technology specific goals
  3. Create a Technology Panel that includes clinician end users, biomedical engineering, faculty, and administrators
  4. Invite a variety of vendors to present, or “pitch” their products to the Technology Panel
  5. Prepare questions and take notes

Short term and long term IT considerations.

  1. How will unit work flow improve?
  2. How much training will staff require?
  3. Where else is the system in place, how is it working?
  4. Is free tech support available, for how long?
  5. Does this system interface well with hardware and software already in use?
  6. Are patient rights to privacy securely protected?
  7. Can electronic records be transferred securely and efficiently?
  8. Can customized data sets be built as needed by hospital IT administrators?
  9. How much down time is needed to maintain the system?
  10. Does this company rank high for customer service?

Get your team on board. Develop realistic goals for Information Technology, take thirty minutes to brainstorm at a staff meeting. List each piece of equipment and every charting system, likes and dislikes, problem areas. Develop questions for vendors. Invite interested parties, get your “end users” invested in the process. Invest in technology that serves people. Decrease the amount of human resources spent serving the technology, and it will be embraced by Nurses, Physicians, and other clinicians that are the ultimate end users.

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Best Medical Care in Nanjing, China

Nanjing is located in Jiangsu region in East China and is one of China’s fifteen sub-provincial cities. This important city has jurisdictional and economic autonomy and is considered one of the Four Great Ancient Capitals of the country. The city is known for its commerce, tourism and transport networks. Nanjing will also host the Youth Olympics in 2014. In general, the city has a well developed medical sector and high quality health care service is available in many of its leading hospitals. There are also some special international clinics with eminent doctors. Here is a description of some of the famous hospitals in Nanjing.

BenQ Hospital is situated at No. 71 Street, Jianye and is one of the major hospitals in the region. This large multidisciplinary hospital of about 1500 beds is affiliated with Nanjing Medical University. The Hospital is operated by the globally known Taiwan group, BenQ. The hospital features beautiful gardens, sculptures and art galleries. BenQ Hospital has well equipped departments in every discipline including nutrition, dentistry, rehabilitation and traditional Chinese medicine. The hospital employs well known physicians including about 200 overseas doctors all of whom deliver excellent medical care. The surgery department features 32 modern operating rooms and uses a lot of imported equipment. Its general surgery unit is so popular that patients from distant provinces come to BenQ Hospital for advanced surgical care. There is a well-equipped endoscopy center and blood purification unit as well. Tel: 025-52238800

Nanjing Drum Tower Hospital (Nanjing Gulou Yi Yuan) is another famous health care facility in the province and is situated at No.321 Zhongshan Road, Nanjing, 210008. The hospital was originally named Nanjing Christian Hospital and was established by some famous doctors from the American Presbyterian Missions to China in 1892. The center was fully renovated to become a large modern hospital in 2006 and is affiliated with Nanjing University Medical School. The 1500 bed hospital offers advanced medical care in all areas through its 32 clinical departments and 32 medical technical sections. The hospital also has 21 special research units. It employs 2500 staff including about 260 senior physicians, 200 attending doctors, 250 resident doctors and 1100 nurses. These staff members work to deliver effective health care to millions patients every year. There are modern operating rooms, an emergency department and ICUs. The hospital is known for its cutting edge technology and possesses PET, ECT, whole-body CT, MRI, DSA, 1250mA X-ray, EEG Mapping, color Doppler ultrasonic cardio-dynamic apparatus and central monitoring capabilities. Telephone: (86) (25) 8310-5860

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An Overview of Hospital Care in Guayaquil for the Tourist

The largest city of Ecuador, Guayaquil is also one of its busiest and most industrialized cities. The city is one of the most popular tourist spots in South America as it offers superb scenery as well as a lot of different entertainment options. It is sometimes referred to as the “Pearl of the Pacific” and has a number of interesting monuments and cathedrals. Tourists are visiting this city in large numbers recently. The city is one of the most developed in terms of its medical care and treatment fields. Therefore, on a trip to Guayaquil you can be assured that you will be well attended to in the case of a medical emergency.

The hospitals in Guayaquil are all well-funded and have updated standards. These hospitals house the latest equipment and have the necessary facilities for advanced intensive care. The doctors and other staff members are well-trained in their fields. Patients never receive any discriminatory treatment despite the fact that they are non residents. The charges in the hospital are usually lower than those of most hospitals in the United States. The treatments are however, not compromised in any way.

The best hospitals in Guayaquil that both offer first class treatment and are a hugely popular with tourists are Clinica Alcivar, Hospital Clinica Kennedy, Clinica Moderna, Clinica Guayaquil, Clinica Idrobo and the Clinica Kennedy. All these hospitals are privately owned and offer excellent treatment. There are separate wards for emergencies and specialized departments for various types of disorders. Most of the doctors understand English. In any case, if you continue to experience any trouble on the language front, it may be best for you to hire an interpreter. The local students can usually be hired as interpreters as many of them speak English. As a visitor you will never feel let down by the medical services in Guayaquil.

Another important piece of advice for all tourists visiting Guayaquil is to keep their passports and related papers handy as this is their only proof of identity in a foreign land. Make sure that you carry all necessary over the counter medications in sufficient amounts. Bring enough medications to last you for the entirety of your trip. Due to differentiation in the names of certain medicines across the continent, you could end up getting a wrong medication if you try to get it over the counter in Guayaquil.

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Two Excellent Hospitals in Changchun, China

Changchun, situated in northeast China, is the capital and largest city of Jilin province. It is a major industrial, transportation, tourist and cultural center of this part of China and is home to the biggest vehicle producer of the country, FAW. The city has a pleasant climate and is often referred to as the forest city, the spring city and the city of automobiles and films. Like all other major cities in China, Changchun also has a well-developed medical service sector. The leading hospitals are provided with the latest facilities and offer the service of eminent doctors at an affordable cost. This is a summary of some of the well known hospitals in Changchun.

China-Japan Union Hospital situated at 126 Xiantai Street in Changchun in the Development Zone is a huge, state-owned, modern hospital with 1550 beds. The hospital was founded in 1949. This tertiary level hospital is managed by the Ministry of Health and was the first A-hospital in the province. This advanced hospital has an area of 201900 square meters and a construction area of 134,400 square meters. The hospital employs 1501 staff members. There are 274 senior medical staff including 80 professors and 156 associate professors. The Japanese government invested 2.6 billion Yen in the venture and this is why it is also referred to as the China-Japan Friendship Hospital. This service-oriented hospital puts great emphasis on the use of modern technology, high levels of quality and is approved as a “Baby Friendly Hospital” by WHO, UNICEF and by the National Drug Clinical Research Center in the Chinese government. The center has full-fledged departments in all major as well as rare specialties including rheumatology, hematology, infectious diseases, honored traditional Chinese medicine, nuclear medicine and electrical diagnosis.

The First Clinical Hospital of Jilin University is another leading hospital in the country and is located at No 71, Xinmin Street in Changchun, near the beautiful Chaoyang Park. The hospital has a 1,100 bed capacity central hospital and 350 bed capacity subsidiary hospital both of which are managed by the Public Health Ministry. This advanced hospital with a 72,650 m2 area has a glorious history of 61 years. The hospital employs 1855 staff including 113 professors and 232 advisors. It has spacious outpatient department that treats over 1,520,000 people annually. The center has acquired 35 prizes of scientific and technological advancement given by the national and provincial governments during the last decade.

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Chery Automobiles: China’s Auto War Begins

China is laying plans at this very moment to begin shipment of passenger vehicles to the North American market by mid 2007. Chinese automobile manufacturer, Chery, yes read that again… the company sounds strangely like Chevy, is looking at bringing not just one, but a whole fleet of low cost production vehicles to our shores. Proposed prices will astound you and could potentially bring the U.S. auto market to its knees. Don’t think for even one moment that Japanese and Korean automakers will be immune from this flood of low cost cars. Chery vehicles have been designed – some say stolen – from current Asian models and will compete directly against the likes of Toyota, Honda, Nissan, and Hyundai. China’s long awaited war with the US – at one time expected to begin with a Red Army attack on Taiwan — may be fought on an economic front instead.

Chery, a state-owned car producer formed in China’s eastern Anhui Province, is currently building a number of cars in China including the QQ – a compact car strangely similar to the Daewoo Spark [GM’ Korean division], as well as several sedans and a compact SUV. Indeed, recent charges made by Toyota, GM, and Honda have all alleged that Chery mimicked or outright stole designs from at least one of each automaker’s vehicles including the Honda CR-V. For the record, the Toyota case was rejected, Honda is still attempting to work out a solution with their case, and GM recently dropped its suit after the Chinese automaker agreed not to sell their cars in the US under the Chery name which GM has stated is too close to the Chevy name. Chinese courts have also ruled that the Daewoo Spark design was not registered in China, so GM dropped its suit.

At present, the Chery vehicle line up includes the tiny QQ; a compact SUV built jointly with Mitsubishi called the Tiggo; and three sedans: the Oriental Son, the Flagcloud, and the Windcloud. Recently, Chery unveiled a newly designed crossover vehicle along the lines of the Chrysler Pacifica. With an introductory MSRP of under $20,000 the Chery crossover will seat up to seven passengers and come equipped with both four and six cylinder engines. As you might guess the Chery crossover, if equipped similarly to the Pacifica, could be priced some ten thousand dollars less than the Chrysler model.

Current prices on the other models have not yet been set, but published reports this past summer indicated that a basic Chery could retail for as low as $6995 in the US, which would be some three thousand dollars less than the next lowest priced car, the Chevy Aveo [from GM’s Daewoo unit, naturally]. Of course, this particular pricing strategy has raised all sorts of alarms within the automobile industry, chiefly how to counter a flood of low cost cars invading the U.S. market. As some have pointed out, much like Hyundai’s introduction to the North America market during the 1980s, the Chinese cars are expected to initially have only a limited appeal primarily due to expected low quality levels. Still, it only took Hyundai less than one decade to begin to produce cars which consistently matched the quality levels of many American and Asian models. So, it could be just a matter of a few years before Chinese cars receive the positive press now given to many other Asian automakers, resulting in a sharp surge in sales.

While the Chery dealer network within the US has yet to be established, it is under development; a limited version of the dealer network is expected to be in place by Summer 2007 when the first Chinese vehicles arrive. A rapid expansion of this same network across the US and Canada has been planned over the ensuing years and although the Chery name will not be used in the US, you can expect that whatever name is selected these cars will impact the way many Americans buy their cars from that point forward. Oh, by the way, two other Chinese automakers — Shuanghuan Automobile Manufacturing, LTD and Geely Automotive — are also expected to export cars to the North American market soon after Chery makes its debut.

While it is too early to say, the opening of the lucrative North American automobile market to cheap Chinese vehicles could possibly shake the American economy in ways never anticipated. I, for one, shudder to think just how all of this might unfold.

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Trains, Planes Or Automobiles

With the population of the world growing at a steady pace, the governments of various countries are doing their best to provide their people with easy modes of transportation. Today, one can travel across the world easily and at relatively inexpensive rates. All three modes of travelling, including trains, airplanes and automobiles each have their own importance.

Automobiles are best for cities and towns. A journey of ten or twenty miles is an everyday affair for most people and in order to save money, people travel by buses or their own vehicles. A major part of the population travel by bus in many countries. Bus fares are cheap and a large number of buses operate in heavily traveled areas. It is usually easy to find a bus traveling to and from your part of town and a large number of people travel by bus when going to work and even school.

Cars give you the flexibility to manage things according to you. You are not dependent on the timing of the public transport and if you have a job that requires you to make a lot of adjustment in your daily schedule then a private vehicle is perhaps the best choice for you.

In order to travel larger distances, many people use trains. Trains are perhaps the most common mode of travelling for people who have to cover a fair bit of distance to get to their workplaces or offices. Similarly, trains are very useful if you wish to travel from one city to another. The rates are affordable and trains offer a comfortable journey.

In order to travel within the country, one can also get an airplane ticket but the prices are always more expensive than that of other modes of travel. However, with the present economic conditions, the prices of some airfares have been slashed to an affordable amount and some flights are available at cheap rates. Flights are the best option in case of emergencies as well. Flights connecting different cities reach their destination in a few hours. You might have to travel for a day in a train to get to the same destination but flights get you to the destination in just a few hours.

If you are looking to travel to another country, then in most cases you have no other option but to travel by air. One can also travel by a ship, but fares for a cruise are often expensive and the services are restricted to only a few ports around the world. The bottom line is that the mode of transportation that you should choose depends on the distance you have to travel.

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Exporting Automobiles From the United States

The procedure of exporting an automobile from the United States is not a complicated process; However, there are requirements that must be fulfilled for car export. In order to export cars from the United States to other countries, the exporter must be able to provide documentation that proves the ownership of the vehicle. In most cases, this will be the certificate of title of the vehicle. The exporter must present ownership documentation to the US Customs either by certified copy of the original ownership documents or the original documents themselves.

When exporting a vehicle through a land border port, the car exporter must provide the port with ownership documents at least three days in advance of the car export. On the day in which the vehicle is to be exported US Customs will require that you present the vehicle to them so that they will be able to verify that the vehicle is indeed the vehicle that is described in the ownership documents.

For car exporters exporting vehicles via ship or plane, it is necessary to present the ownership documents at least 72 hours before lading to US Customs. The vehicle will then be subject to Customs inspection.

Once US Customs has verified that the vehicle is the vehicle described in the ownership papers and inspected the vehicle it will then be authorized for car export.

While the process is not complicated, requirements must be followed carefully. And, for any car exporters that fail to follow the requirements and meet the compliance outlined by the US Customs a non-compliance penalty may be imposed. Non-compliance penalties ranges from $ 500 to $ 10,000 dollars.So it definitely worth following the rules.

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Protective Film For Cars and Automobiles

For those people who absolutely love their cars, protecting the paint becomes an obsession. Years ago, the promise of perpetually perfect paint was introduced with the invention of clear coat paint protection. Clear coat was definitely an improvement and offered great protection against sun damage and oxidation, but it fell far short when it came to physical protection from road debris and scratches.

To protect against road debris, a couple of inventions came about. One was referred to as a car bra. This was basically a polyurethane cover that fitted over a car’s front end and protected the most vulnerable part of the vehicle from flying gravel and bugs. This helped, but there were two main problems. It didn’t protect the entire vehicle, and it was absolutely atrocious to look at. The other attempt was something called a bug shield. This was a small plastic piece that attached to the front of the vehicle and re-directed the air currents up and over the vehicle. Though somewhat effective in protecting the front end of the vehicle from flying debris and bugs, it did nothing to protect a stationary car from scratches. And, who would want one of those on their $70,000 corvette?

The next evolution in paint protection is commonly called paint protection film, though individual companies refer to it by various names. This is a thin, thermoplastic urethane material that adheres to the vehicle’s paint and protects it from all types of minor damage. It can be applied to the entire vehicle, giving overall protection, unlike the other devices.

The paint protection film is applied in a similar fashion to window tinting film. Anyone who has attempted a do-it-yourself window tinting job understands how difficult the job can be. Though not impossible for amateurs to do, if one expects perfect results the job is best left to professionals.

These days it is easy to find professional paint protection film installers across the country. Nearly all automotive paint shops offer this service for a reasonable price and many offer package deals with the purchase of a new paint job.

There are a couple of important reasons why professionally installed clear paint protection film is the best option. First, the professionals have the proper facilities. Before installing the film, the car must be spotlessly cleaned and must stay that way until the film is applied. The pros have clean, dust-free bays where they can do the work. The average amateur’s garage is somewhat less than a dust free environment. The second reason is the fitting of the film. Applying the film to curved surfaces offers a challenge requiring more than simple straight cuts. It takes time to perfect this technique and the average Joe will likely need several tries to get it right. It’s best to save the time and let the pros handle it.

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