Materials management is an underappreciated health care operation that either enables or undermines the organization's greater mission.

The real opportunity to increase capacity and decrease cost is on the front line. Bulk material transport and storage may be done by a few people under the materials management umbrella, but this work is dwarfed by the countless hours of real point-of-use materials management done every day by nurses, doctors and others across health systems.

It is common for nurses to spend 20 percent or more of their total time performing fundamental materials management tasks (i.e., searching, transporting, counting and sorting) and it is not difficult to find nurses who spend more than 50 percent of their time on these tasks.

Meeting supply demands

This challenge is felt in every corner of the health system but, for illustrative purposes, the focus should be on surgical services. This is arguably the heart of today's hospitals, with increasing need for efficiencies and decreasing focus on inpatient stays.

It is also where many key supply chains meet, such as instruments that are owned, loaned and borrowed; consumable supplies; mobile equipment; and, of course, the patient and staff. Add to that the demands of surgeons and anesthesiologists that typically demand highly customized and infinitely variable personal preferences. Everything must be synchronized carefully and highly reliable or the entire system underperforms.

As demand continues to grow, the system will suffer with instruments, supplies, information and staff missing. Every hospital is seeking ways to improve on-time starts, eliminate cancellations, speed up turnovers and generally find capacity. Clearly, there must be a need for more space, more stuff and more staff.

Yet, nearly every hospital has sacrificed crucial surgical space to meet storage needs. In fact, some hospital operating rooms (ORs) are being used primarily as storerooms. Add to that the lost capacity due to delays related to searching for missing tools, supplies and equipment and it becomes difficult to tell whether more ORs are needed or the approach to OR materials management needs to change. If staff are spending 20 percent or more of their time managing supplies, are more staff needed or is better management of existing supplies the answer? And do increased levels of stock improve the ability to deliver care or is it added clutter and expense?

The requirement is simple: Have what is needed where it is needed and when it is needed. Design and operations both deserve attention. If building or renovating, the potential exists to eliminate both initial and ongoing operating expenses while making things easier down the road. In considering whether or how much construction is needed, the realization may be that far less new space is required than thought.

Many hospital leaders are highly skilled clinicians. The opportunity to design new space comes along only a few times in a career at most. Biases trend heavily toward a focus on clinical skill and personal competence, not systems and structure. Designers know that user requirements are passionately declared but often inappropriate....