Material Management For Hospitals
Material Management For Hospitals
Material Management For Hospitals
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Definition
It is concerned with planning, organizing and controlling the flow of materials from their initial purchase through internal operations to the service point through distribution. OR Material management is a scientific technique, concerned with Planning, Organizing &Control of flow of materials, from their initial purchase to destination.
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The Materials Management Procedures enable centralised procurement and distribution of medical, biomedical, pharmaceutical, medical & non-medical furniture and general items.
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Secondary
Forecasting Inter-departmental harmony Product improvement Standardization Make or buy decision New materials & products Favorable reciprocal relationships
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FUNCTIONS
The Materials management functions are as enumerated below: Standardisation of Items Purchase Storage as per product requirements Inventory Management Distribution Maintain Records utilisation pattern, suppliers list, etc.
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ORGANOGRAM
Medical director
Purchase and stores committee Purchase manager
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6. Dietary
& Linen services
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Standardisation of Items
All the items to be procured, stored and utilised will be fixed by The Material Standardisation Committee
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Item codes are designed to avoid duplication, i.e. no item has two item codes or no two items share the same code Yearly review of the entire inventory, demarcating the non-moving items, slow moving items and the fast moving items
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Contd...
Non-moving items are removed from the inventory, levels of slow moving items inventory is reduced and adequate stock of fast moving items is maintained Inclusion of new items carried out through proper authorisation. This is made possible, if and only if, the respective departmental head is able to justify its utilisation on a regular basis.
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Policy Statement: It will be the policy of the hospital that any product or piece of equipment that is proposed for use within the hospital must first undergo evaluation and approval by The Material Standardization Committee. The Material Standardization Committee, would prioritise the quality of the product in relation to the price. Products not been in the market for a period less than 10 years and tested for its accurate performance would not be considered for listed. Exception to this will be only after authorisation by the Medical Director (Medical)/ Director (Administration)
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All potential products are forwarded to the Purchase and Stores Department by the Doctor, Departmental Head, Hospital Personnel, Sales representatives etc. All items are screened by the respective department prior to forwarding to the Purchase and Stores Department. Their recommendations and comments about the item should accompany all the requests. An agenda is prepared and distributed to the members one week prior to the next committee meeting by the purchase/stores officer
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Committee Meetings
1.
2. 3.
Arranged on a quarterly basis, or on a need base. Committee actions are: Evaluation of the product time period determined Non-acceptance of the Product Acceptance of the Product
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Exception
All items must undergo the above procedure with one exception. If the product is requested on an emergency basis, it can be purchased, and a justification would have to be provided with in 24 hours by the Purchase Officer
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Emergency procedure
Send requisition to the stores If the item available it is issued and if not available is forwarded to the purchase officer The purchase officer or the next person in authority would take authorisation from the Managing Director / Executive Director / Hospital Administrator and purchase the required item from the market. This would be accounted for as an ad hoc purchase The item is handed over to the stores officer who would issue the same to the requisitioning party
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PURCHASE
The centralisation of all the purchase enables to set up quality controls for all the items being procured by the hospital. Items required for all the departments are centrally monitored at this level
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Contd...
Bio-medical and General Maintenance by the respective contractors Stationery requirements of the hospital hospital stores and purchase officer Furniture & Fixtures - hospital stores and purchase officer Capital Equipment - hospital stores and purchase officer (under authorisation of the Executive Director) Kitchen equipment and supplies by the respective contractor
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PROCUREMENT
1. Direct from companies 2. Medical stores/hospital stores
3. Vendors/distributors of region
4. Receiving donations/grants/supplies
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Procurement cycle
Review selection Determine needed quantities
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YES
DONATION DONATION SOURCE SOURCE
NO YES
ADJUST ADJUST QUANTITIES QUANTITIES DETERMINE DETERMINEDRUGS DRUGS & & DRUG DRUG REQUIREMENTS REQUIREMENTS ADJUST ADJUST QUANTITIES QUANTITIES
REQUEST REQUEST OFFERS OFFERS FROM FROM ELIGIBLE ELIGIBLE SUPPLIERS SUPPLIERS
LOCATE LOCATE RELIABLE RELIABLE SUPPLIERS SUPPLIERS NEGOTIATE NEGOTIATE PRICE PRICE & & SUPPLY SUPPLYCONDITIONS CONDITIONS
CONTACT CONTACT
RELIABLE RELIABLE
EVALUATE EVALUATE OFFERS OFFERS & & SELECT SELECT SUPPLIERS SUPPLIERS
DRUGS DRUGS RECEIVED, RECEIVED, CHECKED CHECKED AGAINST AGAINST PURCHASE PURCHASE ORDER ORDER //CONTRACT CONTRACT SPECIF SPECIFICATIONS ICATIONS & & CLEARED CLEARED FOR DISTRIBUTION FOR DISTRIBUTION
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Open tender
Public bidding, resulting in low prices Published in newspapers Term - 4 weeks Quotations must be sent in the specific forms that are sold, before the time &date mentioned in the tender form In technical items, two packets or two bins system is followed. Offers are given in two separate packets. 1. Technical bid 2. Financial bid Cont
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First technical bid is opened & short listed Then financial bid of selected companies are
Earnest money 2 % of the tender amount or as decided has to be paid along with all quotations. In case of default 1/5 is withheld Restricted or limited tender From limited suppliers (about 10) Lead-time is reduced Better quality Negotiated procurement Buyer approaches selected potential Suppliers & bargain directly Used in long time supply contracts Direct procurement Purchased from single supplier, at his quoted price Prices may be high Reserved for proprietary materials, or low priced, small quantity & emergency purchases
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Rate contract
Firms are asked to supply stores at specified Rates during the period covered by the Contract
Spot purchase
It is done by a committee, which includes an officer from stores, accounts & purchasing departments
Risk purchase
If supplier fails, the item is purchased from other agencies & the difference in cost is recovered from the first supplier
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STORAGE
STORE MUST BE OF ADEQUATE SPACE MATERIALS MUST BE STORED IN AN APPROPRIATE PLACE IN A CORRECT WAY
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FOLLOW TWO BIN OR DOUBLE SHELF SYSTEM, TO AVOID STOCK OUTS RESERVE BIN SHOULD CONTAIN STOCK THAT
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METHODS OF PURCHASE
All purchases are usually based on Yearly tender system. The Standardisation of Products Committee will decide the various suppliers for all the items, by March of the preceding year for the next financial year April to March. The call for tenders will be publicised by the month of December All tenders are reviewed with utmost confidentiality The results declared and all the formalities complete by the first week of march ensuring that the products are received by the 1st of April
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1. 2. 3.
Requisition for Purchase As per Reorder levels (ROL) Urgent requirement of stores / department Purchase Order Receiving Process Transfer to Stores
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PURCHASE ORDER
PO is Generated when the requisition is rechecked with the existing stock, and the requirement is genuine. The PO is prepared in duplicate to ensure that the products received are as per the specifications laid down in the purchase order.
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STORES
Centralised stores ensures reduced inventory costs, more organised supply and improved utilisation of space and manpower. Stores control is necessary to curtail the pilferage to a large extent.
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System of stores
Establishes the initial inventories, sets up quantities and supplies of all the items, upgrades the same Specific day/s are fixed for the requisitioning of various items Emergencies are attended through a recheck with respective departmental head All departments send their requisitions with appropriate authorisation to the stores Stores department promptly delivers the requisitioned items to the respective department
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EITHER the items are delayed in the purchasing process whereby store communicates with the respective department of the delay and provides the items as and when procured, OR the items are not stocked in the stores, in such a case the stores department is to return the requisition with same/similar items after confirming the acceptance of the same from the user
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Receiving Process
Specifications are as per the request placed by the respective department and/or consultant Items substituted without prior approval of the purchasing department Shelf life of the items Damaged and/or defective items Excess / Shortage in quantity Supplies for which purchase orders have not been placed (all the above should be verified by reviewing the purchase orders)
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Contd...
All the items when they arrive at hospital will have a Goods Received Note (GRN), which is a counter check to the items ordered to the items received. The GRN would be verified during the physical verification process The Physical verification of the Items is carried out by the Stores Officer along with the respective departmental head / representative of the department to ensure that the item received is the one requisitioned item.
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Contd...
Physical verification for general items require verification of items in a random fashion, in case of high value items verification is a detailed verification of all the features After physical verification the bills are forwarded to the Finance Department, where the payment is made within the stipulated number of days mentioned in the contract. All the items are then transferred to the Stores along with the item specifications and their quantities after physical verification
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3.
4. 5. 6. 7. 8. 9. 10.
Demand estimation Compounding and manufacturing of sterile and non sterile products. Quality control of drugs purchased. Supply of Drugs to In patient, Wards, I.C.U., O.Ts, Emergency etc. Dispensing for Out Patients. Maintenance of formulary system. Furnishing Drug information to Physicians and other professional staff. In-Service training, teaching and research and clinical trials. Patient Education Drug use review
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Types of Pharmacies
1.
2.
3. 4. 5.
Pharmacy for O.P.D. Pharmacy for In Patients Services A combination of both. A retail sale counter in the Hospital A combination of above all type.
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2.
3. 4. 5. 6. 7. 8.
Control of Drug costs. Effective Staff utilization. Human Relation. Consumer Satisfaction. Non availability of Drug. Supply of Sub Standard Drugs. Drug pilferage. Drug distribution system.
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2.
3. 4.
5. 6.
7.
8.
Non expendable stores ledger. Expendable stores ledger. Indent file. Formula file for manufacturing medicaments. Costing returns. Report file. Stock verification returns file. Hospital formulary.
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INVENTORY CONTROL
IT MEANS STOCKING ADEQUATE NUMBER AND KIND OF STORES, SO THAT THE MATERIALS ARE AVAILABLE WHENEVER REQUIRED AND WHEREVER REQUIRED. SCIENTIFIC INVENTORY CONTROL RESULTS IN OPTIMAL BALANCE
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INVENTORY CONTROL
Ensures maximum efficiency in utilisation of the items and enables to bridge the gap between the forecasted and the actual demand of the materials. Inventory control does not mean minimum or lowest inventory levels
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Guidelines for an effective Inventory Control Policy Review past records, and analyse the utilisation of the all the items Assign responsibilities with respect to various to various functions of inventory management
Co-ordinate the procedures of inventory management with the internal auditors and computer systems Clear instructions describing the procedure of inventory procurement, issue, records maintenance and stock audit
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Contd...
All items should be identified with a distinct code which are to be followed either in an automated or manual system, the code is to be clearly visible (specific colour can be provided) The Bin Cards and Stock Register should also contain the specifications of the respective item Classify the inventory, and segregate physical areas for the various items as per their similarities in function and/or specifications
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Contd...
All the items are arranged in the following manner The items are segregated with respect to medical, surgical, linen, spare parts (Electrical, Plumbing, air-conditioning, ventilation etc.), equipment (all the departments), Radiology, Sonography, Laboratory, Pharmacy etc Further the items can be arranged alphabetically for easy access and retrieval of items Sign boards are placed identifying the zones with similar items
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REPLENISHMENT SYSTEMS
Fixed Order Quantity Economic Order Quantity (EOQ) Quantity to be ordered is fixed for each and every product As the order is fixed, the orders are placed at irregular intervals and reduces the ordering cost and inventory carrying cost
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Contd...
The Re-Order Levels ( ROL ) for ordering is reached when the item reaches the quantity reaches the buffer stock plus consumption required for the period of procurement These two methods for quantity required along with the time at which to order would maintain adequate stock and reduce stock out situations to a large extent
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PURCHASING COST
CARRYING COST
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Q = 2RS Where, Q = Economic Order Quantity or optimum number CI of units per order to minimise the total cost C = Cost of one unit of item I = Inventory Carrying cost, expressed as a percentage of the value of the average inventory R = Total annual quantity requirement or total demand S = Ordering cost per order All the factors involved in placing an order are included in determining the EOQ; hence it would reduce pilferage to a large extent.
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RE-ORDER LEVEL: STOCK LEVEL AT WHICH FRESH ORDER IS PLACED AVERAGE CONSUMPTION PER DAY X LEAD TIME + BUFFER STOCK LEAD TIME: DURATION TIME BETWEEN PLACING AN ORDER & RECEIPT OF MATERIAL; IDEAL 2 TO 6 WEEKS.
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ABC ANALYSIS
(ABC = Always Better Control)
THIS IS BASED ON COST CRITERIA. IT HELPS TO EXERCISE SELECTIVE CONTROL WHEN CONFRONTED WITH LARGE NUMBER OF ITEMS IT RATIONALIZES THE NUMBER OF ORDERS, NUMBER OF ITEMS & REDUCE THE INVENTORY. ABOUT 10 % OF MATERIALS CONSUME 70 % OF RESOURCES ABOUT 20 % OF MATERIALS CONSUME 20 % OF RESOURCES ABOUT 70 % OF MATERIALS CONSUME 10 % OF RESOURCES
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B ITEM INTERMEDIATE
MUST HAVE: MODERATE CONTROL PURCHASE BASED ON RIGID REQUIREMENTS REASONABLY STRICT WATCH & CONTROL MODERATE SAFETY STOCKS MANAGED BY MIDDLE LEVEL MANAGEMENT
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C ITEMS
LARGER IN NUMBER, BUT CONSUME LESSER AMOUNT OF RESOURCES MUST HAVE: ORDINARY CONTROL MEASURES PURCHASE BASED ON USAGE ESTIMATES HIGH SAFETY STOCKS ABC ANALYSIS DOES NOT STRESS ON ITEMS THOSE ARE LESS COSTLY BUT MAY BE VITAL
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ABC
A N A L Y S I S
ITEM %
10 %
ITEM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
ANNUAL COST [Rs.] 90000 50000 20000 7500 7500 5000 4500 4000 2750 1750 1500 1500 500 500 500 500 500 500 500
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CUMMULATIVE COST [Rs.] 90000 140000 160000 167500 175000 180000 184500 188500 191250 193000 194500 196000 196500 197000 197500 198000 198500 199000 199500 200000
COST %
70 %
20 %
20 %
70 %
10 %
WORK SHEET
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VED ANALYSIS
BASED ON CRITICAL VALUE & SHORTAGE COST OF AN ITEM IT IS A SUBJECTIVE ANALYSIS. Items are classified into: VITAL: Shortage cannot be tolerated. ESSENTIAL: Shortage can be tolerated for a short period. DESIRABLE: Shortage will not adversely affect, but may be using more resources. These must be strictly Scrutinized
V A AV E AE D AD CATEGORY 1 ITEM 10 COST 70%
B C
BV CV
BE CE
BD CD
CATEGORY 2 CATEGORY 3
20 70
20% 10%
- NEEDS CLOSE MONITORING & CONTROL - MODERATE CONTROL. - NO NEED FOR CONTROL
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SDE ANALYSIS
Based on availability Scarce Managed by top level management Maintain big safety stocks Difficult Maintain sufficient safety stocks Easily available Minimum safety stocks
FSN ANALYSIS
Based on utilization. Fast moving. Slow moving. Non-moving. Non-moving items must be periodically reviewed to prevent 3-11-2008 expiry & obsolescence
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HML ANALYSIS
Based on cost per unit
Highest Medium Low This is used to keep control over consumption at departmental level for deciding the frequency of physical verification.
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Stores Systems
Bin cards - product identification code, product specifications, and stock of products (procured, issued (to which dept), and the balance stock as per date Stock Registers - the stock received, issued, balance, their respective ROL and EOQ Requisition/s issued file Requisition/s pending file Requisition for purchase file
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SALE OF SCRAP
Sale of all the scrap and by-products handled by the stores department i.e. coordinate procurement storage & sale Authority to deem items as scrap lies with store officer Bio-medical items and Linen decided by Material Standardization Committee Vendors for purchase of the scrap and by-products decided on an annual basis through tenders
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Stores Officer, Manager Finance and the Hospital Administrator review the tenders, then decision is taken; and the contracts are usually valid for one year, under the approval of the competent authority like executive director After this scrap sold at rates fixed in the contract \Stores Officer, Manager Finance decide about fresh tenders
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The by-products include (some of the items are): a). Silver [Radiology Department] b). Paper waste c). Plastics and glass ware d). Furniture and fixtures (Market survey is carried out to get the best price)
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STORES Requisition for items from the stores: Stock of respective item reaches ROL Fast moving, high cost and irregular/ consignment items
Procurement Process Prepare and Release Purchase Orders Receipt and Physical verification of items and hand-over to Stores department (Forward the bills to the accounts for payment)
ACCOUNTS & BILLING Maintain Accounts for the payment against bills raised
RECEIPT OF ITEMS Physical verification of items along with the respective departmental representative Ensure that the Goods received note is for the items physically received Transfer of items to stores
STORES MANAGEMENT
Uupdate the stock records Pphysically place the item/s in the respective place Eensure that the required environment AC/ Moisture free etc. is appropriate Iinventory Management EOQ, ROL etc.
Statement of revenue and expenditure Manpower Planning Cost Escalation and Inflation Usage of surgical and medical items Standardisation of new product/items
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Quarterly Reports
Linen Inventory and Usage Report Pharmaceutical services Stock outs Electrical / Air-conditioning / plumbing supplies utilisation
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Annual Reports
Inventory levels New requisitions by medical and other staff for the next year Requests for equipment / instruments for the next year
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Invite Quotations
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1. To maintain minimum inventory level 2. To maintain continuous & stable supply system 3. To ensure proper storage conditions as per the nature of the items. 4. To take adequate measures to prevent pilferage. 5. To formulate Bin Card system 6. To undertake ABC analysis. 7. To implement FIFO system, GRR system. 8. To prepare formats of various stores related documents. 9. To ensure that there is proper co-ordination with all the user departments.
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Store appropriately
Recording of the material on the bin card & issuing of material to concerned department
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CONCLUSION
1. Material management is an important management tool which will be very useful in getting the right quality & right quantity of supplies at right time, having good inventory control 2. Adopting sound methods of condemnation & disposal will improve the efficiency of the organization & also make the working atmosphere healthy in any type of organization, whether it is Private, Government, Small organization, Big organization and Household. 3. Even a common man must know the basics of material management so that he can get the best of the available resources and make it a habit to adopt the principles of material management in all our daily activities
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