Fewer elective procedures, higher costs

A leader in the healthcare supply chain, LeAnn Born of M Health Fairview has learned from the pandemic to better identify the right leaders for change, pursuing action, not perfection.

The COVID-19 pandemic has been a challenge for health systems in many ways. But even supply chain leaders firmly entrenched in their roles have learned lessons that will improve their operations for years to come. LeAnn Born, vice president of supply chain at M Health Fairview is one of those leaders. Born has been the head of the supply chain for this Minneapolis system since 2010, responsible for the supply chain at eight hospitals, more than 40 primary care clinics, and outpatient services like healthcare transportation.

At some point, the pandemic will be in the rearview mirror, but it’s not there yet. “It was a career change and it dramatically changed our industry,” she said. On the positive side, the pandemic drew positive strategic attention to the healthcare supply chain, even though some of those strategies were the same.

Lower the costs

In 2019 and before, it was already wise to cut costs by using a single supplier rather than multiple suppliers for the same type of item. And it was good practice to engage physicians in standardizing the preference items. “I think the pandemic has brought a little more reality to what these strategic opportunities look like,” she said. Examining what was unique about an N95 respirator, the supply chain team consulted with doctors before deciding on the most suitable suppliers and models. They applied this experience and learning to orthopedic total joints and products also used in neurosurgery cases.

Learning to identify the right leaders to accelerate the decision-making process was vital, whether they were formal leaders according to their hospital roles, or informal champion doctors who could help bring projects across the finish line. “We have learned to do things quickly during the pandemic,” she said, while before it could take months to work on a project to reach consensus. “The pandemic has taught us to bring the right people together and not to strive for perfection. Instead, be good enough and move on.”

Finding these leaders can be difficult. In some hospital systems, it is not difficult to speak with a surgical supervisor to effect a change in supply. “I don’t have a head of surgery. I have eight,” Born said. With a recent merger of independent staff and contract physicians, “there are additional steps to the supply chain that I lead.” Born is working to develop a more efficient structure to identify different physician decision makers and physician champions, to avoid having to search for individual physicians or departments in each hospital. “This is where I am in transition, but I know other health systems are working very efficiently.”

Getting out of the pandemic

Supply chain leaders and healthcare workers are struggling to recharge their batteries and reflect on what happened in 2020 and 2021 because there hasn’t been much of a hiatus. While cost control has always been at the center of the supply chain, the pandemic has highlighted the need for additional cost controls at M Health Fairview. Lockdown meant fewer elective procedures, the very procedures that were needed to generate income. Born and the supply chain department are focused on standardizing products and negotiating better contracts with suppliers. They use fewer suppliers in cardiac, orthopedic and neurosurgery, which reduces costs. In addition, physicians are more engaged and better understand the economic demands of the hospital.

In terms of negotiations, the ministry wants suppliers to understand that the healthcare system can deliver the volume or market share needed to meet the proposed rates. “I want to make sure that we stay true to this commitment,” she said. It also means ensuring that the clinical partners in the system are involved in and comply with product decision making. “It is important that physicians and operational leaders understand our contracts, the commitments made and ensure that we meet those commitments. This means saying no to using new vendors when clinical requirements are met by existing contract vendors. It makes a difference when a clinical requirement cannot be met with the existing products and supplier, versus when someone just does not want to use the contracted supplier.

Communicate with physicians

Identifying good physician leaders is a task. But getting them on the phone or in the room to discuss supply issues is another. What has changed with the pandemic is that stakeholders now have a better understanding of how and why these changes are being proposed, and they are responding more quickly. “Before, we had to spend a lot of time gaining buy-in from people,” she said. Doctors have a bad reputation for resisting changes in supply, she said, but “when we engage them at the right time and back them up with information on how and why we do it, I generally find that doctors are more than willing to get involved. “

Guardians like operational leaders and support staff are excellent at blocking access to doctors. “Sometimes they try to block opportunities to go to the doctor, thinking the doctor will resist them,” Born said. Time is their biggest obstacle, and Born spends a lot of time figuring out ways to get five minutes with the doctor. When using formal channels, staff may wish to schedule six weeks of absence. By building relationships and finding the names of planners, it is easier to get in. It is also easier to request five minutes rather than a meeting with four people. “Talk to the planner and say [the doctor] is open to the meeting, ”she said. “It builds their confidence that the doctor won’t get upset if you schedule this conversation. “

Once in the room with the doctor, she delivers a clear, crisp message within minutes. “I like to give the whole context of the situation but that’s not what they want,” she said. Instead, it uses the SBAR formula: situation, context, assessment, recommendation.

Using data to inform internal practices

M Health Fairview uses data to monitor contract compliance and benchmarks. “Where we spend more time and get impressive results is looking at how the products are used and the variations that exist in the use of the products,” she said, including with leading physicians. “This leads to a wonderful dialogue. Often they are not aware of the price difference between different products and are ready to use the products which cost less and give the same results.”

Doctor-to-doctor conversations can impact how products can be used more effectively and efficiently, saving money and with less waste. “We are not at the point of directly relating the use of certain products to certain outcomes, but we can verify that the results are comparable or even better with the use of fewer or less expensive products,” she said. .

On the way to 2022

Planning for 2021 was reactionary, given the pandemic. “I feel like I ran after my tail,” Born said. “We now have the capacity to plan effectively for 2022 and we will come in more informed. One of the goals is to manage product interruptions and unpredictability. Container ships have been unreliable and production lines are closing due to labor issues and COVID-19 blockages in other countries. These are product lines she has never cared about before.

As a result, her supply chain team has created critical item lists that she tracks. They identified alternative products validated by their clinical teams. “Some of these items have alternatives that range from four to five depths,” she said. “Unfortunately, it is common for the first, second, third, etc. alternative not to be available when the main product is not available.”

While M Health Fairview traditionally uses as much automation and market intelligence as possible, they find that the experience and talent gained from members of supply chain teams is more effective than data-driven tools. that worked for them in the past. “People who follow their instincts or recognize a trend before it becomes obvious are the types of things that help us get the products we need today.”

Deborah Abrams Kaplan is a contributing writer for HealthLeaders.

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