Experts discuss how to diagnose supply chain inefficiencies, implement sustainable solutions, and monitor ongoing performance. Speakers will provide actionable steps for streamlining inventory management, mitigating waste and risk, and capitalizing on supply standardization opportunities, with a focus on the perioperative space.
Webinar Transcript
Speaker 1 (00:00:01):
Hello everyone and welcome to today’s webinar, supply Chain Strategies to Boost Efficiencies, care Quality and Cost Containment. I’m Angie Stewart with Modern Healthcare Custom Media. I’d like to thank surgical directions for sponsoring and participating in today’s broadcast. Today’s webinar will feature interactive polling questions and audience q and a throughout the presentation. To submit your questions, enter them in the chat feature and press send. In the meantime, test out the feature and drop a comment. Let us know where you’re tuning in from. With that, I’m excited to introduce our presenters. First we have Trevor Bennett, associate Vice President of Operations for Central Puget Sound. Providence Swedish, the largest healthcare delivery system in western Washington. Trevor, great to have you here. Would you like to say a few sentences about yourself?
Speaker 2 (00:00:52):
Thank you. Thank you. I’m excited to be here and for this Humboldt, for this opportunity to be able to have this connection with these individuals. And a little bit about me and my background. I’ve been here at Providence Swedish for almost two years, just a couple months shy of two years. Prior to that, I was at the University of Rochester as the director of Nursing Prairie Operative Services, and then I spent eight and a half years as a division vice president with hca previous nurse. That’s how I started in healthcare. I was a nurse and worked my way up through the ER and operating rooms and never realized that I would end up in the position that I am today, but could not be anyone happier. And I think one thing that I would love to relay to this group is I love what I do regardless of what that looks like or where I’m at, I am excited to pull the covers off every single day and come to work. And to be able to have connections such as this in part of that work is incredibly exciting and rewarding. So thank you for having me.
Speaker 1 (00:01:50):
That’s fantastic. We’re definitely very excited to have you here, have you sharing that excitement, enthusiasm, experience. Next we have Barb McClenan, vice President of Nursing for Surgical Directions. Barb is an mba, RN and C N O R with over 20 years experience as an OR director. Barb, welcome. Can you also give a few sentences about yourself?
Speaker 3 (00:02:13):
Great. Thank you Angie so much. Well, I’m the vice President of nursing at Surgical Directions and a little bit about surgical directions. We’re a specialty healthcare consulting firm and we focus on delivering sustainable performance change within all perioperative service areas. Prior to joining Surgical Directions, I held the role in two large teaching hospitals as periop directors of perioperative services, one of which was in western New York, Buffalo, New York, and it was a greater than 50 operating room facility, and the second was in north central Florida, part of the University of Florida. Then I moved on to work on the beach. It sounds like I had similar pathway to tremor at an HCA facility in the go on the Gulf Coast of Florida. And I just have to add being with surgical directions now, it’s just been an incredible experience to visit almost 400 hospitals with our company to identify what’s working, what’s not working, and really absorb best practices that we see throughout the industry. And thank you so much for allowing me to participate in this webinar.
Speaker 1 (00:03:22):
Again, we’re so excited to have you here and it’s great to hear about your experience. Finally, to round out this great slate of panelists, we have Eric Hartl and experienced healthcare supply chain consultant and partner of Surgical Directions. Eric, thank you for being here. Can you please introduce yourself to our audience?
Speaker 4 (00:03:41):
Yeah, absolutely. Thanks Angie for having me today. And thanks to everybody out there on the call. Eric Harlo. I am a 20 year supply chain healthcare supply chain guy. I’ve had the great fortune to see it from virtually every angle. I started on the manufacturing side doing sourcing procurement work. I moved over to the provider side, did value analysis, sourcing procurement work for a number of years, and then moved into the logistics side of the house here in Chicago for a large academic medical center for about a decade. Transitioned from the provider side over to the H I T side, worked on the E M R strategy space for a while, looking at all things around data consumption and point of use and how to drive efficiencies. From that perspective, transitioned over, spent a number of years working in the distribution third party logistics space, working with healthcare customers, working with manufacturers. Co-founded a outsourced sterile processing center here in Chicago, servicing loaner and bill only materials in the orthopedic and spine space. And I’ve been doing a number of consulting opportunities along the way, my partnership with the folks at Surgical Directions. So again, thanks for having me. Excited to be here with the group.
Speaker 1 (00:05:13):
Fantastic. Thanks for introducing yourself. I’m really excited about today’s very important discussion. We’ve seen the financial challenges that healthcare’s facing and they make it essential to optimize supply chain management to find cost savings opportunities and critical efficiencies. During this next 45 minutes or so, our discussion will be structured around three key components, diagnosing supply chain inefficiencies, implementing solutions, and then third, monitoring ongoing performance. First, we’ll dive into diagnosis with my first question. For our presenters, this is going to be a bit of a rapid fire, so prepare yourselves if an organization wants to optimize their supply chain management, where is the best place to start? We’re going to go with Barb, then Trevor, then Eric.
Speaker 3 (00:06:03):
Well, I think the best place for an organization to start would be to conduct a comprehensive analysis of the current structure. And that would include evaluating their procurement process, how are they getting their supplies, the current inventory on hand, what is their min and their max, their inventory locations? Are they in the appropriate place in relation to the needs of the operating room, the entire charge capture process that we see a significant opportunity. Expiration rates is there, product standardization and key physician and nurse satisfaction as well. So I think those are the areas that you would want to initially evaluate.
Speaker 1 (00:06:47):
Great. All right. And then Trevor, what is your take on that? The starting place for optimizing supply chain management?
Speaker 2 (00:06:56):
Barbara took current stake. I would say that the number one place that I would start is the people. And I’ll probably end up talking a lot about relationships. I think there’s two things here is you can have incredibly automated system. You need one of two things on. The second one always follows, which is you can have the most advanced technology for automation for par, which Barb hit on and you need less qualified people or you need a system that is on pen and paper and incredibly qualified people. But at some point, as much as our processes, we want to rely on, the way that we still get things done is through mean healthcare in general is people taking care of people. And supply I think is vital in that piece. And I think about the organizations that I’ve been with and where it’s been really, really good. I’m super lucky today around that. And when I look back on what the commonalities inside of that, it was the people that were were embedded in that process that made it effective.
Speaker 1 (00:07:51):
Great point. We’re going to keep touching on the importance of those relationships throughout our conversation. Eric, anything else to add? I know we’ve covered a lot with those first two answers, but
Speaker 4 (00:08:02):
No, I would echo both of what Barb and Trevor said. I think starting with your KPIs and measuring, you can’t fix what you can’t measure certainly. And then I think to follow up on Trevor’s comment about people, I’d also say partnership, right? What’s the right relationship between your departments, between your supply chain, between your clin clinicians, your clinical leaders? Is that strong? Is that a stable foundation to build off of? So
Speaker 1 (00:08:33):
Great. Again, we’ll kind of tie in those threads throughout this conversation. So talking about evaluating the state of supply chain, current product pricing, existing contracts with suppliers, those are important to evaluate as part of diagnosing any inefficiencies. What should leaders be looking for? When do evaluate contracts and pricing? Barb, I’ll lob this one to you first.
Speaker 3 (00:09:01):
So when leaders are looking at terms and pricing, I’ll break it down into both areas. So first of all, when they’re looking at pricing, they want to look and see are there opportunities for bulk pricing for better contract pricing, longer term contracts, just truly looking at the overall pricing structure. Also looking at the market. Are you getting the same rate that the hospital five miles down the road with a potentially different gpo? Are we gleaning the same rate? So we’d want to evaluate the market in both areas. As for the contract terms, one of the things we want to look at with your contracts are the vendors. Is there obsolescence or end of life management in place with your contracts? Because what we see is vendors may force hospitals to purchase new products even if the older version is still viable and it’s on the shelf for product quality.
(00:09:57):
We want to make sure that it meets the needs of our clinicians. Are the surgeons satisfied? Often we’ll see a surgeon is keen on one product over another and that’s who we’d want to work with the surgeons and better understand why is this truly a better product? Is it familiarity? And just work very closely, again, part of relationships to see what is the best product for our clinicians. And I think the last thing when we’re looking at our contracts is the contract length. Is it an autorenew? Is there terms for early termination? Can we get out of the contract if there is a better price or if the surgeon chooses another product down the road? So I think those are a couple of replays that leaders can really make informed decisions.
Speaker 1 (00:10:45):
Yes, great points, very practical. I love having responses that people can take back to their organization. And I know I saw Trevor nodding along there, so I think we have some agreement. Let’s talk about key performance indicators, which KPIs should be reviewed to identify areas of opportunity? Let Barb and Eric respond to this one.
Speaker 3 (00:11:10):
Well, I’ll give it a, I’ll start. So I think the very first is we want to look at your product turns, your inventory turns. And we know the industry standards for benchmarking would be for your storeroom between 14 and 24. And if it’s based on the procedure, you want to keep it around eight to 12. And if it’s a higher turn rate, then you’re a little bit more efficient. So we’d want to have that as one of your KPIs. Your back orders huge dissatisfier for the clinicians. So we want to track all the back orders and stockout rates. The next I think would be your stock versus your non-stock. And maybe I’ll want to pump this one over to Eric because are there guidelines in place to determine should the product be a stock product as opposed to a non-stock product where frequently there’s additional charges, there’s transportation fees, there are additional stock charges and risk of expiring?
Speaker 4 (00:12:07):
Yeah, there’s absolutely barb opportunities and standard measures to look at around channel management, channel optimization, right? Thinking about how product is flowing into the organization. Beyond that, when we think about broader measures, I would think about metrics around supply standardization, opportunities to drive performance around utilization, right? Your cost per procedure type measures and metrics that exist out there. More granular measures, looking at labor productivity for instance, your cost per PICC line, what are your all in embedded costs relative to labor and loss and waste associated with preparing for cases. So a number of operational measures, certainly Barb, you had mentioned in the onset looking at things around you, you’re on contract, you’re off contract spend on file, off file, special request, kind of off catalog. All of those are measures around not only your ability to control cost but also really drive operational efficiency. So
Speaker 3 (00:13:15):
Great. Can I piggyback on that for a moment please? Yes. So you mentioned about cost, which is key. And Trevor you may want to add to this, we also want to look at charges and that’s preference cards. That is an area that we see so frequently in the hospitals that we visit where a preference card, in fact every single hospital, there’s concerns with preference cards, how are they being charged? And even if it’s an under $5 product, we still want track if it’s being used so frequently, preference card, the accuracy is not there. We don’t have the appropriate charges and many times it’s a miscellaneous charge, which is another problem. So that’s part of when we’re doing the initial assessment that it’s key to evaluate all of your analytics directly out of your preference cards.
Speaker 2 (00:14:05):
Yeah, I will piggyback on the preference card piece cause I think there is a big piece of the puzzle here. We’re talking a lot about supply When we think of operating rooms in general with preference cards, one of the things that I’ve realized over and over in my 15 year career is that we make an adjustment on a preference card, but we’ve done a poor job in healthcare in recognizing that in the supply room. So we pull it off the preference card and then either we expire out the items on the shelf and then we continue to reorder because that par level’s still established. You need to do a better job in closing those two together and having that communication of, look, if we took this off the preference card, we’re no longer use this or we migrated to a new product, need to figure out a way to close that door on the backside.
(00:14:45):
It’s a huge expense to an organization to expire those products out. And as we migrate to new products, also going to dip back one piece of the puzzle to the contracts in general and already did an incredible job hitting all the highlights on that. Super happy about that. And one of the things inside of that is the G P O and I think depending on where your G P O is aligned, the opportunities you have inside of that. But one of the things that I’m really proud about that we’ve done up here in the Seattle market in Washington is really looking at aligning or opportunities with minority owned companies. I think that’s a new market that that’s emerging and what we have found is that we’ve found incredible pricing in individuals that want to get embedded in the market or on GPOs early in the process. And our GPO has done an incredible job in partnering with us in allowing some of that work to not be out of contract that Eric hit on spend, off spend in navigating some of those new conversations for our opportunity. I would recommend to the people on this call that look at that as an opportunity. It may or may not pan out, but it’s certainly worth looking at as we look at healthcare in 2023 and as we have coined, I’m sure not just here locally, but leaving no rock unturned.
Speaker 1 (00:16:01):
That’s great
Speaker 2 (00:16:02):
As we look to maximize our revenue and kind reinforcement.
Speaker 1 (00:16:05):
Fantastic. Sounds like really exciting things happening over there. I’d like to stay with you Trevor for this next question and it kind of follows onto some of the things we’ve been hearing already. How can supply chain management teams incorporate input from clinicians? So going back to your relationships and the people part of it, how can you incorporate input from clinicians in the diagnosis process and why is that necessary?
Speaker 2 (00:16:32):
Yeah, that’s a loaded question. So I let off with people not knowing that this is where we’re going to end up, but when I think about the people that are involved in this process, I have such an admiration for our supply chain and I will also say central sterile processing. It’s not just that lane as an OR nurse, I got to see the end use of every product and tool and opportunity. There was a practical application in my clinical practice that tied that all together to me. I wasn’t in a storeroom building widgets or following through on a process and I always have just been in absolute admiration of these individuals that are able to conceptually put together what this tool is used for or what that supply is used for. And so why they understand the par levels and the logistics of supply far better than I ever will. You have to have the clinical application as well. So that partnership is absolutely vital. You will not get anywhere without one or the other. And so building that forum and that platform for those two individuals to connect on a meaningful level and find out what is the logistic for the clinician, what is the practical application for the logistics and pull those two together is how I’ve watched organizations really excel in the work that they’re doing.
Speaker 1 (00:17:50):
Great. What are some areas where teams might uncover sources of physician or staff frustration when they’re looking at supply chain efficiencies? Trevor, and I’ll start with you and then I’d like to hear from Eric as well.
Speaker 2 (00:18:06):
So we hit on it a little bit. Specialty order items seems to be the bucket that is probably the most frustration is should we stock it or should we special order every single time? And the process from the time that a provider sees a patient in the clinic knows they need a special graft and then has that process to put in place. Live limit tissue I think is one of those that is very difficult. It’s expensive, there’s FDA requirements, all the things around that is one of the areas that I think causes a lot of frustration, but at the same time has a requirement for the organization to protect itself from broad waste and abuse if you will. So I think those are some of the areas that are really tough, having some navigators inside of that space and some individuals that are specialized in knowing exactly what this is and have not unwrapped the twinki for the very first time in that process to say, look, I just kind of ordered all these things, knowing that maybe it’s not a returnable or has to be kept at certain temperature and where does it land on the loading dock and how does it get to the operating room is probably the piece that we have opportunity across the spectrum of healthcare and closing up in the space.
(00:19:16):
It’s not used all the time.
Speaker 1 (00:19:18):
Yeah. Eric, any follow on thoughts to that?
Speaker 4 (00:19:21):
Yeah, absolutely, and I agree with what Trevor said, and I think I may take a slightly different angle on this, but still in the same vein, we think about the need to better coordinate between supply chain and clinicians. I think this other area really of opportunity is this coordination between providers and vendors, providers and suppliers, and how do you work together in a more partnership basis, less at times adversarial, where unfortunately that that’s what exists today to be able to share information data around surgical schedules and informations that help plan and coordinate the logistics activities in a way that really can become a win-win, right? A win both from the provider perspective and the clinician, but also a win for the manufacturer in ways that oftentimes I think aren’t always maybe as a parent on the provider side. So certainly consideration of how you engage with your supplier partners on a transactional basis to really optimize logistics.
Speaker 1 (00:20:30):
Barb, and actually Trevor and Eric, we’re about to transition into an implementation kind of question and insights here, but any final thoughts on identifying opportunities before we move into that section?
Speaker 2 (00:20:48):
I covered a lot here. I can jump in. I think we talk about it a lot. Sometimes we do it really well and sometimes we don’t. But the ability to listen to, especially for mine, I’m speaking for my vice president role, the ability to listen to our clinicians, our staff in general about what’s going on without that adversarial, as Eric put on it conversation of I know better or no, that’s not right. It feels like conversations that take place, that ability to listen to our people and understand what’s going on at the bedside or what is getting to the bedside, I think is the number. It’s absolutely the most vital piece of the puzzle from my current role.
Speaker 1 (00:21:35):
Absolutely big opportunity to really improve the listening and have coordination and collaboration happening to create some efficiencies. So thank you all for your insights on that. We’re actually audience going to launch into a poll now, so please make sure you’re ready to vote. This is going to be, take a look at this photo and tell us what’s wrong with it. Sort of poll. We’ll leave it up for about 10 20 seconds and weigh in on what you think is wrong. We’ll tell you if you’re right or not. Give a second here.
Speaker 1 (00:22:20):
We go. All righty. So it looked like there was some pretty important things wrong, Barb, what are your thoughts? Was it overflow rooms being utilized to house excess supplies, cluttered, disorganized, nothing labeled equipment sterile and unsterile supplies stored together? All of the above. None of the above,
Speaker 3 (00:22:50):
Angie. I’m going to say all of the above and it looks like this is truly what we do see out in the industry, primarily because hospitals, older hospitals have not been designed to house all the supplies in the equipment that are in the industry today. And so many times we’ll see things are piled into the same room again, through optimal supply management and equipment management, it can be removed with appropriate power levels based on true usage, based on data to determine what you need. And of course, having it in the right location, it looks in this picture where it may not even be appropriate room with airflow and of course not having equipment in with sterile supplies on sterile mixed in. So I, I’m going to go with all of the above for those reasons.
Speaker 1 (00:23:43):
Great. Yep. Thank you for sharing. It’s kind of fun to do these. What’s wrong with this photo supply chain? We talk a lot about the details, so it’s good to kind of have a fun little visual there too. Audience, I’d like to remind you to submit your questions at the end of each section. We’re going to be taking a few, so I see we have a couple here already. The first one that I’ll field to our panelists, whoever wants to jump in on it is what signs should I be aware of to identify a potential supply failure? Interesting question.
Speaker 3 (00:24:20):
I can take that in. Okay, I’ll take this one. So I think some of the signs of a potential supply supply failure would be constant stockouts if staff are complaining they don’t have the products that they need, if there’s case delays or heaven forbid, any case cancellations related to supply issues. If staff cannot find the products, that’s certainly a supply issue. And of course I’m going from the clinical point of view. So Eric, how would you like to maybe you’d like to or Trevor from the business side?
Speaker 4 (00:24:54):
Yeah, no, I mean I would agree with you on that. Certainly from a clinical side, I think again from the business side, warning signs, how are you managing inventory rights systemically, non systemically? What types of data are you utilizing to be able to forecast both historically and predictively? So if you don’t have some of those fundamental pieces in place to be able to quantifiably and from a data perspective be able to manage your supply chain, you’re certainly exposing yourself to risk.
Speaker 1 (00:25:36):
Great. Thanks to both of you for responding to that one. I have another audience question here. So Trevor, if you’d like to weigh in on this one or wait until you here at first, prepare yourselves. What are some signs that your supply chain processes aren’t keeping pace with industry best practices? So another kind of heavy hitter here.
Speaker 2 (00:25:59):
I think it probably kind of even partners back into the last one. I think if you’re not keeping pace, one of the things you’re going to see as a red flag is just in time delivery. That much of that stock is just in time and it’s being marketed as smart and efficient. I think that’s one of the things, I don’t know if it ties into this one, but I would also say the ability KPIs have come up a little bit on this. And I would say if you’re not keeping pace, one of the things that we’ve done inside of healthcare is we’ve gone to a lower cost item. Lexus O Rings. I mean this is a perfect example that affected me personally. We went away from the name brand Lexus O Rings, and then we found out our utilization doubled, so we saved 30 cents and then we doubled every single case. Wow. Some of those things I think probably would be a sign that your supply chain process is not keeping pace with current industry practices in understanding that it’s not just about dollars that oftentimes it’s about practical application as well would be probably where I would place that one.
Speaker 1 (00:27:02):
Great. Yeah, thank you for responding to that one. I think we’re ready now to move into solutions implementation. So once we’ve identified these opportunities, first of all, what kind of governance structure is needed to support implementation of supply chain solutions or innovations? Eric, I’d like to start with you on this one and then Trevor if you’d like to weigh in as well.
Speaker 4 (00:27:25):
Yeah, absolutely. So I think when think about governance, I think most organizations generally have a value analysis structure. They have a process for managing that. I think the question I would ask to a lot of organizations is how robust is that, right? Is it a committee that’s focused exclusively on what products come into the organization and not really a committee that focuses much on what happens once the product comes in? And so I think making space for being able to look at ongoing management of supplies and products in that clinical setting is key. Perhaps you can do that inside of a value analysis. If not, I think having a structure, having a governance committee that’s truly multidisciplinary, it brings clinical leadership, it brings the finance department to the table, it brings supply chain to the table, it brings the right folks who have shared common goals around various initiatives that they’re working on, be it quality, be it savings initiatives, but having folks kind of rowing together aligned in a mission at hand I think is absolutely critical. Otherwise, you’ve got folks working independently trying to push a rock uphill and I think you’re in for a tough road ahead.
Speaker 1 (00:28:58):
Yeah, great thoughts, Trevor, which stakeholders should be involved in impl implementation of solutions? And can you maybe pull on that thread of involvement of clinical teams like Eric just mentioned and we’ve mentioned a few times earlier?
Speaker 2 (00:29:11):
Yeah, absolutely. So I would’ve answered the question just like Eric did. I always learning these as well as everybody else. When I think about surgical value analysis and that platform, certainly you have to have the clinicians involved and you have to have your logistics supply chain individuals involved. But I think regardless of your structure, there’s probably lots of ways to skin that cat. I think surgical value analysis, I’m a huge fan, so obviously I’m biased in this direction. You have to have that and you have to have it dialed in. But I think the layer that makes that really impactful for an organization is ensuring that there’s psychological safety inside of it. Having the ability to have candid conversations that are straightforward, direct, are the key to success. You could put the structure together and go, look, it’s still not working. If people aren’t able to come and present and have that open dialogue with each other around, look, this is really important to me and this is why.
(00:30:09):
And the organization say, look, this doesn’t financially make sense. How do we have that conversation in a meaningful way is the piece of the puzzle. And I’m really proud of what we have. We have a physician-led organization here. I won’t mention his name, but he’s been with the organization 35 years and I think he’s done an incredible job in his career building 35 years of relationships. And he chairs that committee for us as a physician-led surgeon who has built those relationships where he feels very comfortable in fostering that conversation across the spectrum of individuals that are engaged in that process. And when I look at the outcome of why that kind of works, it’s that conversation and dialogue and those relationships that he’s built and the ability for people to have heated, I’m not going to always say it goes really well, heated conversation, but walk away and go, look, I know this is the decision that was made best for my clinical practice and the organization as a whole is a piece that I would ask people to evaluate inside of their surgical governance committee.
Speaker 4 (00:31:08):
Right. Yeah, if I could just jump in on that. I couldn’t agree Trevor with you more on that comment. One other thing that I’ve seen sometimes that’s been successful, I think the help perhaps maybe promote that heated conversation and true transparent conversation is putting a little teeth around the structure from a budgetary perspective, creating some financial guardrails, almost treating your surgical value analysis like a capital committee, and create a little bit of a situation where individuals are, dare I say, vying for dollars, but in a way that truly will force those transparent conversations and some sometimes difficult discussions when there is a known finite amount of money available. So maybe just another thing to consider to promote that type of dialogue
Speaker 2 (00:32:07):
Completely. I will add, so I would say that you need hospital administra. I to be really direct on who I think should be involved, hospital administration, clinical leaders, logistics. I actually prefer the chief medical officer, the CMO to be involved as well. I think it’s a nice balance between the clinician and organizational administration and anybody else that wants to learn about the process. I think the ad hoc ads in that voice to have a global understanding of what’s going on in that meeting is probably where you get a lot of bang for your buck that goes back and says, look, people are really talking about this. It’s not behind closed doors to open. It’s transparent. But those are the key individuals that I would say finance, administration, clinicians and logistics.
Speaker 1 (00:32:54):
Great. Yeah, I think our audience should be taking some pretty great notes here to bring back to their own organizations. We’re kind of going to shift gears bit with this next question. How can technology help streamline business processes and promote standardization as part of this implementation process? Barb, could you jump in on that one first?
Speaker 3 (00:33:16):
Yeah, absolutely. So technology can really help processes. It can help to promote standardization, it can automate tasks, it can help reduce errors, provide realtime data sharing. And some of the examples that I’ve seen out there in the industry is there is inventory management software that does help you track your expiration dates, of course your levels of inventory in your usage. Another technology that’s really up and coming, which is really exciting and I’m excited about learning more about this is barcoding and R F I D technology. Some of it’s even gone to the level of right on your sterile instruments and that’s where it’s really heading in the future. Couple other things I would like to say, data analytics, and that’s where we are really focused. I know within our company we have a software program, it’s called Merlin, and it’s an aela analytic platform that lets us understand when the cases will be scheduled, how many cases are occurring. So it ties right into supply management to better understand forecasting and what the needs are. So truly bringing in technology is the way to go and it not only is it to improve, but also to reduce manual paper-based processes, which it, it’s tough to get away from that. Many times some of the technology starts out where you’ll see a person ordering, writing down what they need and then going to a computer to enter these supplies. So there’s truly a lot of tech solutions out there that can provide data and increase efficiencies.
Speaker 1 (00:35:01):
And you brought up such a critical point here, which is the data. And I’d like to hover on that topic for just a minute. How can data help with managing contracts specifically and containing costs? And what kinds of efficiencies are you finding from the use of this realtime actionable data? Barb, I’ll field that one to you again. And then Eric or Trevor, if you’d like to weigh in on your perspective on data.
Speaker 3 (00:35:29):
So I think the first thing is looking at our inventory turns, that’s going to drive a lot. That’s going to drive our backs, our back stock, our stock outs, that’s going to drive any expiration. So truly having a good grasp on what your inventory turns are, cost per procedure. And that’s where we do need to have data to not only understand what the cost of the products are, what we’re charging for and truly better understand what the cost of a surgical procedure. With that we can identify and do comparisons between surgeons. That’s an avenue for standardization. If one surgeon is 10% more cost effective, what are they doing? Are they using less? What are the products? So truly that’s an avenue to help reduce your expenses. That all ties into the big preference card issue then I’ll let you have it, Eric. And really understanding developing parameters for products use product usage within your preference cards is key. So that that’s a huge component. Eric?
Speaker 4 (00:36:33):
Yeah, I would just say I agree with everything that Barb said. I think as a guy who spent a fair amount of time in the IT space, I think what’s really exciting about healthcare today is the rapid acceleration of cloud technologies, the rapid acceleration of standard data integration models. And this ability for healthcare really for arguably the first time ever to get out of its old model of disparate systems where you’ve got a little data over here, a little data over there, but not a full picture that you need to be able to bring cost and quality and outcomes and all that together to make better, more informed decisions to do all those things that Barb just talked about that historically has been very, very difficult to do because of the disparate information that lives in multiple sources. So certainly the excitement around the advancement of technology cloud, E R P systems and niche solutions that are helping with various elements of your business certainly create this environment to be able to impact change more rapidly.
Speaker 1 (00:37:52):
Yeah, great points. And I, I’d like to use this last question on implementation to again, stay on data since it’s such a critical piece. Like you said, Eric, helping drive better decision making. And Barb, you mentioned reducing some of that unnecessary manual labor and repeat work that people are doing. So with those things in mind, how can data help to ensure accuracy? Or to put it another way, how can organizations leverage data to reduce risk and ensure compliance with certain regulations or standards or policies? Barb, I’ll let you take that one first.
Speaker 3 (00:38:31):
Sure. Data really provides a crucial role for looking into real-time visibility of your inventory levels. It can establish distribution and storage strategies, and that’s part of risk, as you mentioned for compliance and regulation. We want to make sure that the products are in the right location, unlike the photo that you showed a little bit earlier. And we’d want to make sure there’s not a risk of the wrong product or any delays or cancellation. Data’s really important to ensure that they’re managed and it leads to improved patient outcomes. And Trevor, as you mentioned earlier, the one product by changing the product, and I’ve seen it with adhesives as well, going to a lower cost solution actually increases the price substantially because of the amount of usage. So truly using data is key to comply with your regulatory standards and also it’ll help drive efficiencies within the department.
Speaker 1 (00:39:33):
Absolutely. Great insights. Eric or Trevor, any brief thoughts to share on that one?
Speaker 4 (00:39:39):
Yeah, well I’ll jump in real quick and just say again, not just from a data perspective, but really this digitization of health. And if you think about so many workflows that exist in healthcare operationally, clinically where the acceleration of tools and technology to help digitize some of that workflow in ways, surgical timeout, I mean used to be a completely manual process. There’s electronic ways to monitor that today. I mean, as an example, there’s a myriad of those types of applications where we can help to effectively better kind of control some of the processes in a digital way to make sure that ultimately guarding against regulatory type challenges, quality challenges, compliance challenges. So sorry Trevor, I cut you off there, sir.
Speaker 1 (00:40:35):
Yeah, Trevor, what are your thoughts there?
Speaker 2 (00:40:37):
That’s great. I think when I think about data, I’m always thinking about the data rich, information poor what the EM information of emr. We transition from the medic paper, medic emr, medical record, whatever you want to refer to as an organization to a data warehouse, whether that be Meditech or Epic, Cerner, I mean I can name a handful of them. The information inside of them, it is tracking every patient encounter, every nursing interaction, every supply chain transaction that is going on. Inside of that is more information than any human being could ever comb through. And what the analytics side and vendors are doing in this space to be able to present clinicians, executives, staff with the data, that’s the information poor piece in a meaningful way. We have the data transitioning into an articulate story that is believable and in the ability to invest in is the future of healthcare.
(00:41:40):
It drives our quality and safety right. Number one thing, regardless of cost is quality and safety for our patients. We’ve got to take care of our patients in a safe and meaningful way. So the SSI piece, the clinical outcomes, pneumonia, recovery rate, length of stay, all of those things inside of that medical record that exist to be able to pull that out were before we would have to fill paper chart by paper chart by paper chart by paper chart, I think about the contracts inside of our organization. I think at last count we had 27,000 unique contracts inside of the four acutes in Swedish alone, not Providence, but Swedish, our unique market here, 27,000 vendors. Our contract with our organization for one service or another, having the ability to coal allocate them in a way that you can comb through and say, what’s coming up expired? Do we want to renew? Does a life vendor already exist in this space? How do we leverage that relationship in a meaningful way Without data and analytics and the ability for vendors to come to market inside of healthcare, we are going to remain information poor. They are the ones that are meaningfully pulling that together and presenting it in an articulate way so we can move healthcare forward.
Speaker 1 (00:42:53):
Great insights. And I’d like to underscore that point on safety and quality and how the data drives that. I think that’s just a really important point to make. So that brings us to the conclusion of our implementation section. But audience, if you have any questions that you’d like us to get to here, go ahead and submit them. We’re also going to transition into a poll another what’s wrong with this photo. So take a look at your screen, we’ll have a photo appearing up there for you to take a look at. Tell us what’s wrong with it. We’ll put the pull up in a moment. So the options are sterile supplies stored improperly on metal shelves in front of air vents. Products not labeled appropriately, not enough space between the ceiling and the shelves, both one and two or none of the above. All right, let’s see. Still got some answers coming in here and Eric, I’m going to call on you for this one. Can you tell us what was wrong with that photo?
Speaker 4 (00:43:57):
Yeah, I mean I would argue all of the above. Certainly you’ve got improper storage of supplies depending on the nature of these and understanding whether your negative positive pressure being co-located to an air vent like that in violation of your 18 inch rule from the ceiling. So yeah, I mean certainly representative of a supply room that could use some help in terms of organization and control to make sure that product is being stored in a safe manner and is not compromised for use and care.
Speaker 1 (00:44:41):
Absolutely. Thanks for giving us the rundown on that one. We’re actually going to take a couple audience questions right now. So Eric, I’ll pick on you again for this first one, what are some quick hit ways to reduce inventory?
Speaker 4 (00:44:58):
Yeah, I think just going back and looking, one of the very simple exercises that I’ve done with previous life and with clients is looking at your slow move inventory, right? Look at what hasn’t had activity on it in the last 12 months, either purchase or charge history. Starting to facilitate a conversation about do you really need to carry that product, right? Certainly there’s product lines that are there for trauma purposes, but just being able to call out that bucket that often is 20, 30% of your inventory value in some cases higher. It’s a pretty easy way to identify some opportunity.
Speaker 1 (00:45:47):
Awesome insights. Great. We have another audience member who’s wondering, and we’ve talked a bit about preference cards. So this will maybe underscore some of the points, but how do surgeon preference cards impact supply management? Trevor, I’d really like to hear if you can distill it down. I’m sure there’s many ways it impacts supply management, but what are some of the top thoughts coming into your mind?
Speaker 2 (00:46:13):
The preference card can have its own little stamp and bow and everything around that. So I think this is a very difficult question to kind of unpack cause there’s so many planes that you can go down with it. What I will say is the access to preference card is probably the area that is most meaningful. Who has access to it and why? And I think where preference cards end up starting to get a bad name is naming conventions and CPT codes. When you start the lump inside of organizations, like there’s that dynamic between having 5,000 preference cards and 8,000 preference cards and 800 preference cards. Do you make a preference card unique for every single provider and every single procedure? Or do you make a preference card that’s global for the entire group of general surgery for lap poly with collan angiograms? What is the way to do that?
(00:47:07):
And I don’t know if we’ve in healthcare come up with a right idea and I would love to hear surgical directions piece of this puzzle. But I will say from a process standpoint, it’s a clinician and now an administrator. I have done an enormous amount, far more work than I would like to emit on preference cards, vendor alignment, relationship adoption to global access changes. Currently working with a vendor in this space right now that they’ve coined at the Trevor button, which is the recommend accepting every single recommendation that the analytics is accepting. And I am pushing that button as a trial and opportunity to say, do we really know what’s changing on preference cards? Does it really matter that that five mil syringe is on one preference card versus the other? And it goes back to analytics and having the visibility to say, why is this one provider out of the entire group using these 14 items that realistically cost $14 or $7?
(00:48:03):
No big deal until you realize that you do that procedure 40,000 times over the next three years. It’s that exponential piece of the puzzle. So how does supply align with the preference cards? And one of the things that I talked about earlier in this call with that global change that I’m pushing the button, accepting recommendations is the downstream effect. It was one of the things that we immediately realized that we weren’t closing the cap on. We were doing a great job in controlling cost, working towards standardization, getting our providers aligned, which were super engaged in this entire process. And transparency. I gave them access to the platform, gave them information, their own data, gave them rank structured order. Hey, why am I high? Why am I low? And soon as we started resolving some of those issues, we all was immediately had leftover supply. We had out stock, we had liquid cash sitting on a shelf that wasn’t accessible. That downstream cash flow and cash on hand dividend that wasn’t being produced is a piece of puzzle. And I think we could spend an entire hour at least talking
Speaker 1 (00:49:11):
About a whole nother webinar
Speaker 2 (00:49:13):
In general. Absolutely. I mean all by itself, I’m obviously passionate about this piece because it’s so meaningful and from so all of that, and I talked a lot about logistics piece and the supply and the cost as a clinician, circulator, scrub tech in the room knowing what I need, especially if I don’t do that case a lot, is also just a recipe card for my beautiful sourdough bread. I can’t get there with a crispy crust without knowing exactly what’s there. But you also create problems inside of our space because, and I started this conversation with control and I’m going to come back to control who has access to that card because a lot of our primary service nurses have held these things so tight with their life that I can only work with Dr. Jones and I only know Dr. Jones and I’m the only one that works with Dr.
(00:50:03):
Jones. And because Tiffany has done Dr. Jones’s case 4 million times, she hasn’t looked the preference card in the last 400 of them. She knows every little piece of that puzzle. But then I will say the last piece, and I’m going to hand this over cause I really do want to hear what Barbara and Eric have to say about the piece of that puzzle. And what we have automated with our system is now we are dropping charges because that preference card is not accurate. The automation piece is import preference card charges. And then we go through and we mark 1 0 1 0 1 0. And for our clinicians that are on this call, they totally understand this process, but it’s a global import off the preference card for all of that supply that was supposed to come to that room. If your preference card is, you can either over bill or unbill your patient, which both are wrong.
(00:50:49):
And so you lose that objective piece of the puzzle to accurately maximize our revenue for our surgical cases. And so I love that clinicians are dedicated to their providers, you get better patient outcomes become flat. And I will argue that with anybody. We also are dropping in overbilling because we are not accurately reflecting those cards because we’ve, we’ve become normal to baking our sourdough bread without having to look at the recipe. We’ve made grandma’s cookies so many times, we just know it’s a teaspoon salt. We don’t need to actually write that down anymore. But we’ve got to think about the person that’s following us up that Eric’s going to do this case while I’m in Mexico next week and Eric doesn’t know what that recipe is. We need to make sure that those remain accurate. So I would love to talk about preference cards in between time, but
Speaker 1 (00:51:38):
I promise Yeah, that’s why I picked on you with that big question is I can tell you’ve, you’ve got thoughts and opinions. Barb, I’ll give you, if you can give us a brief comment. We have under 10 minutes remaining, so I know that’s a challenge, but just a comment on the preference cards and then we’ll move into monitoring usage. Yes,
Speaker 3 (00:51:59):
A preference card, the original intent five card to know what the surgeon needs for the case. However, there is so much information and it’s not being used information out. There’s no analytics out. We can know product turns, we can know usage by surgeon, we can know charges. It’s truly not extrapolated. And I see there’s so much opportunity in every organization to use the preference cards as a guide. It’s a worldwide web of information that can tell so many stories for managing supplies, for managing costs, for managing efficiency, that the information may not be correct and it’s certainly not extrapolated to make informed decisions. And yes, I think preference cards truly are the heartbeat of the operating room in all aspects for sterile processing, for supply management as well as optimization of patient care. And that’s where it’s not fully utilized and there’s a significant opportunity to enhance preference card use.
Speaker 1 (00:53:03):
Absolutely. Thanks for following onto that one. So in monitoring usage and monitoring the performance of solutions that have been implemented, why is it necessary to continue monitoring, first of all, and then how do you continue monitoring and measure success? Barb, I’ll stick with you on that one. And then Eric, if you’d like to weigh in briefly.
Speaker 3 (00:53:30):
So of course with any change, we need to monitor it. Don’t expect it unless you inspect it. Change is very difficult and we want change, but we want you to go first. So in order to make sure that there is sustainability, you do have to monitor the change. And the way to monitor change is by developing KPIs based on what your change was. Eric.
Speaker 4 (00:53:56):
Yeah, no, I don’t know that I could add much to it. I completely agree with you. You’ve got to be able to monitor, you’ve got to be able to monitor it quantitatively, don’t use it, you lose it kind of mentality. And so if that rigor and diligence isn’t in place, that continuous feedback not only to ensure that you are maintaining whatever gains you may have achieved, but also identifying opportunities to continue to drive improvement, enhancement and whatever it is that you may be working on Y you absolutely have to have that discipline to continue to monitor and manage your performance improvement.
Speaker 1 (00:54:43):
And what areas specifically need to be monitored and what are some areas that tend to be overlooked? Eric, if you could.
Speaker 4 (00:54:51):
Yeah, I think one thing, we’re all accustomed to goals and initiatives and healthcare is a big, big organization with a lot of folks working in concert to ultimate provide care. I think one of the things that we need to be cognizant of is making sure that we understand how one initiative affects the other. It was kind of back to Trevor’s point earlier about trading out for a cheaper ring and the unintended consequences. You think about that from a supply chain perspective. Make sure that you don’t have an inventory team that’s incentivized to reduce inventory to a point that turns around and drives cost into the procurements budget with freight and transportation. How do all these different work streams who are out engaging on activities, make sure that they’re coordinated in a way that you end up with net value and not that you’re moving money from one bucket over here to another bucket over there From an expense perspective.
Speaker 1 (00:55:59):
This final monitoring usage question, I’m going to field it to you Trevor. So obviously this conversation we started by saying healthcare is in a tough financial situation. That’s kind of the reason some of these conversations get very heated that you mentioned. And so we’re really looking to identify cost saving opportunities and improve decision making. So what are ways to monitor that? We are doing that, ways to monitor that your processes are really driving cost savings and really making better, more informed decisions.
Speaker 2 (00:56:40):
I’m going to actually bring this up a little bit earlier and tie this in a different way, but I’ll do my best to tie it in here. We need to hold our vendors that we work with more accountable in producing patient outcomes and financial viability. So one of the ways, and I think Eric hit on this, Barbara certainly knows this from her roles and responsibilities, anything we monitor will get better. You can literally change nothing, just post it up on the wall, start actually monitoring and tracking it. It will get better. That may not get to where you want it to be. You may not get the kpi, but it will improve just by people knowing that piece of the puzzle when I say that we need to hold our vendors more accountable is we have invested a lot of time and money and energy into platforms, data analytics, robotic technologies, and we’ve got to start realizing that our patient outcomes are improving or not and where they are improving robotic technologies in one surgical specialty shows incredible outcomes while in another they’re, they’re negligible.
(00:57:41):
And with the investment of capital and understanding, we have got to start seeing recognition on the p and l, not just on what the proforma said, not on what we think we are happening, but actually bottom line results inside of our organization. And I only say that because of where we’re at financially as a healthcare organization nationwide, we have invested a lot of money in tech partnerships and memberships. And I think we are going to have to look at 2023 through 2025 in new risk sharing models with our vendors and our partners inside of healthcare in general in saying, look, we believe that our technology is the best in the market and we are willing to put our opportunity and name on the line just like you are with your capital dollars in a risk sharing model. I think some of those are the ways that we probably could monitor and track differently than we have currently been doing in the past in moving forward in healthcare and recognizing that our dollars are more limited than they have ever have been.
Speaker 1 (00:58:44):
Yep, absolutely. So we actually have a lot of great audience questions coming in and it’s unfortunate because we don’t have enough time to get through all of them, but I will ask all three of you to respond to this kind of wrap up forward-looking question. What is one takeaway from today’s conversation, maybe something you learned from your fellow panelists that you want our audience to remember when they get up from their keyboard and go take a walk?
Speaker 2 (00:59:13):
Can I go first,
Speaker 1 (00:59:14):
Trevor?
Speaker 2 (00:59:15):
Yeah, I’ll be concise this time. I hit on that. I learn every single time I do one of these, whether I am a guest or a presenter. And I learned more today. And the thing that I am taking away again today is that we are far more similar regardless of what we believe our little micromarket is in healthcare, we are far more similar nation, coast to coast, top to bottom. We are dissimilar and I think we continue to partner in strategic ways with each other, not only just in our own systems, but across systems. We’ll be stronger and healthcare will move forward in a more meaningful way.
Speaker 1 (00:59:49):
Great. Eric, what’s your take?
Speaker 4 (00:59:51):
Yeah, my takeaway is we’re certainly seeing tremendous advancement in tools and technology and opportunities to help drive better performance. But I think Trevor said it best early on, right? It really foundationally is all about relationships and connections. How to departments within an organization work together, how to supply chain partner with clinicians to be able to ultimately move forward, move the ball down the field. So,
Speaker 1 (01:00:23):
Great. And Barb, what is your one takeaway?
Speaker 3 (01:00:27):
Sure. I think my one takeaway is using data and truly using your data and sharing it with everyone that needs to know and be transparent to better understand what the needs are of the organization and work with others, developing those relationships and monitoring and tracking it to see what the needs are to truly enhance the bottom line.
Speaker 1 (01:00:51):
Great. Thank you all for those very important takeaways and for sharing your insights this past hour. We’ve had a really great conversation, a lot of dialogue happening and building on, so I appreciate that enthusiasm and insights that you brought to the table today. I’d like to give a final thank you to Surgical directions for sponsoring this webinar and to our audience, thank you for tuning in. A recording will be made available after the event concludes. Thanks so much and enjoy the rest of your day.
Speaker 4 (01:01:25):
Thank you. Thanks
Speaker 2 (01:01:26):
Y’all. Thank you.
