$25M, found in the medicine closet.

01 · Situation

Good medicine, thrown away.

Every clinic had a medication closet stocked with clinically administered medications: the vials physicians and nurses draw from during a visit.

Too much of it was being thrown out, either opened and unused, or expired on the shelf. At the scale of a whole region, that added up fast.

02 · Problem

Two habits, both well-meaning.

Let me share what we found in the closets...

• A physician would open a brand new vial for a partial dose. The next physician wouldn’t draw from a vial someone else had already opened, so the rest went to waste.
• Staff worried the supply wouldn’t be there when they needed it, so they held on to new vials just in case.
• Many of those stashed vials were never used, and expired on the shelf.

Nobody was being careless. Each habit made sense on its own. Together, they wasted a lot of medication.

03 · Action

Make the supply something people could trust.

The fix wasn’t a new system. It was trust. If people knew the medication would always be there, they’d stop holding it back.

1. Kanban pulls, the original way. Like the Toyota Production System, simple pull signals replenished each closet based on set par levels, so there was always enough on hand.
2. Non-technical on purpose. No software to learn. Bins, cards, and clear par values that anyone could use on a busy clinic day.
3. Built together. We worked side by side with Pharmacy, Administration, Physicians, and Nursing, so the new practice belonged to the people using it.
4. Measured, not guessed. Savings came from sourcing and procurement reports, then post-implementation usage tracking and reporting.

04 · Result

Less waste. Same care.

Once people trusted the supply, the stockpiling stopped and fewer vials were wasted. Medication waste came down by more than 8%.

Across the region, that added up to $25M in annualized savings, identified up front and then confirmed through procurement and usage reporting after rollout.