Hospitals are different

The Autovalet uniform dispensing system has been around for nearly 30 years. This modular machine operates with a coded card and permits users to collect a uniform on a hanger, 24 hours a day. As a centralised distribution system it is highly efficient.

However, distribution is rather academic if the service is not being used and Autovalet’s wider use has been restricted by just one factor: there simply aren’t that many uniforms to distribute nowadays.

In the past, uniforms conveyed rank. Now they are primarily functional. Uniforms were cleaned regularly because a neat appearance was more important than hygiene. Now most staff wash their workwear at home with little regard for appearance or hygiene.

The workwear industry has always focused on functionality and has recognised that, just as for any product, if you get the delivery right, you will sell more. For the most part, its distribution systems are relatively crude, largely due to the standardised nature of the contracts.

Different Hospitals are quite different. Although all users are provided with uniforms, there is often no standard issue and no prescribed rate of change. One near certainty is that take-up of the uniform laundry service is extremely low. Hospital sites are often huge and fragmented. If uniforms are returned to a central locker room, many users will simply not bother. If you offer a 48-hour turnaround and users have an issue of only three sets, they really don’t have a choice.

Many Trusts live in fear of increased take-up because they have no budget for greater throughput or increased allocations. Although it is policy that staff should send uniforms to the laundry, in practice it is often impossible for them to do so.

Contrast this situation with the food, pharmaceutical and catering industries where to be found leaving site in workwear can be a disciplinary offence. This may seem like overkill - after all, there is little scientific risk in leaving a cake factory wearing a white coat. However, that ignores the fact these industries are subject to stringent and continuous customer auditing, whether it be the major food retailers or the FDA. One failure could close them down.

Home washing For the most part, Trusts do not believe that home washing endangers their “product”, which is healthy patients, by importing infection. Yet European hospitals reject home washing on a different basis; fear that it might export infection to the wider community.

Whatever the scientific arguments, there remains an element of bad-housekeeping as Trusts invest in new stock without making provision for its upkeep. They often have no systems in place to methodically allocate new purchases, program replacements or re-use old stock. They have primitive marking and few user databases, in fact, none of the infrastructure necessary for an efficient workwear service.

If, as laundry managers, you wish to introduce a successful uniform service, you have to overcome two significant obstacles. The first concerns uptake. Some Trusts believe that to enforce compliance would mean that 1000 staff send 5000 uniforms for washing every week. In our experience, the average number of uniforms dispensed equates to two per user per week, in other words, 2000 rather than 5000. This appears mostly to be due to the huge impact of part-timers on healthcare systems throughout Europe.

The second obstacle lies in what were the seeds of the workwear industry, the difference between running a laundry and providing a service. In many trusts, the budget for uniform purchasing and replacement is far greater than that for washing. Yet this money is frequently spent without any regard for the life of the garments, their maintenance or security.

In most major European healthcare systems, uniform rental is the norm. It permits the launderer to provide as many garments as are necessary to support his service. So successful has this concept become that the trend is now towards dispensing garments only by size and not personalising them at all. Why ? Because hospitals have realised the folly of buying multiple sets of relatively costly garments for each person’s exclusive use when current employment patterns mean that a large proportion of that stock is usually idle.

To work with a smaller stock to which all users can obtain access on demand is far more efficient because operating costs more accurately match the workload of the hospital. In Europe, cost has not prevented service improvements, it has actually driven them.

So how do you design the best distribution service, one that meets both your laundry’s constraints and your user’s needs? In our experience, a successful system observes three principles: Logistics, location, lockdown Logistical considerations are obvious. Can your laundry and transport support a hanging service or is folded the only option? What is the best turnaround that you can guarantee? How well can you sort; by destination only or by number/ garment type also? It all saves time loading at the distribution point.

Location means the point of distribution, somewhere that you can deliver to but most importantly, a place where users find it convenient, safe and practical to collect from. Consider those factors: convenient means that users do not have to walk out of their way. Safe means that you don’t require female users to descend into a dingy basement. Practical means access is available when it suits users, not just when the linen room’s open.

Lockdown means security. Uniforms don’t have a great market value but any distribution method which ends up being a free-for-all will undermine user confidence. Uniforms get “borrowed” and unless users believe that clean items will be secure from their colleagues’ grasp, they just won’t use the system.

Of these factors, only one is supremely important: Location.

Fundamentally, users are lazy. Staff who come to work in their uniform benefit from a good fifteen minutes extra in bed. They avoid the diversion to the locker room and go straight to their ward. Smaller, discreet areas are required to serve the needs of departments or buildings and so too is a new generation of dispensing systems. Autovalet pioneered automatic dispensing for uniforms in hospitals worldwide and now, a new generation of systems awaits which operates with garments fitted with chips. Not to mention a revolutionary system for flat-linen dispensing.

Intelligent distribution Distribution will become intelligent and elastic, both stretching and shrinking to match demand. This requires more efficient sorting systems and cheaper, smaller dispensers. It’s exactly the sort of convenience and control that is required by clinical departments such as Theatre, ITU and A&E.

The most common response when staff are asked why they don’t use the hospital laundry service is “because they never get it back in time.” Any distribution system must not only deliver but be seen to be delivering. How can it be done? What is the ideal distribution service for the future? Imagine a stock which was marked with barcodes or even chips. Uniform sets are assigned to wearers as now but can be re-assigned through a keyboard. Users could send items in for washing whenever they wished. At the laundry, the only sorting criteria is by distribution point and once at the dispenser, each item is loaded randomly into the first available slot.

All of this is done by first scanning the garment which in itself collects essential user data to plan replacements based on a preset wash-wear rate. Invoicing will be automatic and stock movements recorded to show the whereabouts of every item.

Such systems are also a sales opportunity. They can be used to provide a uniform service by size to departments with high turnover such as catering, where the cost of fitting and marking a dedicated set just isn’t justified. New users could select their own size and would be held accountable for the item until it is returned. Remember, you will have a record of the garment number, the user’s card number and the date and time of issue, so if the item is not returned you can charge for it.

This is not future technology. It all exists now and with improvements in hardware, costs are coming down. This may seem like vending gone mad but it springs from the simple fact that you can only make a “sale” if you have product available.