The system got more complicated as Hunterdon Medical Center acquired and opened more ambulatory sites.

The distributor's truck would arrive at the dock at around 6 a.m., at which time receiving would begin stocking items in Hunterdon Medical Center's storeroom. By about 9:30 - before all the items were stocked - distribution would begin picking and loading the vans for delivery to the non-acute-care sites.

"We started to monitor what items were coming in almost every day from our primary distributor, and how fast we were turning them around to place them in our courier vehicles to redeliver to the ambulatory sites," says Voorhees. "It was not making sense."

To maintain order, materials limited Hunterdon Medical Center's ambulatory sites to one order per week. "But the orders got to be so big, our folks had trouble managing the workload," so once a week became two or three times a week, she says. Given the rapid growth of ambulatory sites, "we could not keep up with the picking and delivering of orders. Staff was unable to complete their work."

The customer experience

The materials staff had created some general catalogs, specialty catalogs and a sticker catalog (for kids' items), from which buyers at the non-acute sites could electronically order supplies. But the system wasn't easy to learn or use, says Voorhees. And whenever one buyer or office manager resigned, the materials staff would have to go to the site and train his or her replacement on the system. Training became a full-time job. "It took a lot of work to get everybody on the same page," she says.

In the midst of all the activity, Hunterdon Medical Center was missing opportunities to standardize products and lower non-labor costs, says Voorhees. The ambulatory sites were using some items contracted for the acute-care hospital, even though less expensive ones would work just as well in the non-acute setting. Given that space in the storeroom was at a premium, the materials staff simply didn't have the space to store two or more sets of similar items. "We knew we needed to streamline our process."