As more and more health systems are looking for ways to bring the caregiver back to the patient bedside and away from administrative tasks, it is becoming evident that we have to rethink the way supplies are delivered in today's care setting. A 2011 study from the Robert Wood Johnson Foundation estimated that only 20-30 percent of a nurse's time is actually spent at the bedside, and as much as 70 percent of their time can be spent on documenting records, finding supplies and carrying out other duties, such as tracking down equipment. These tasks not only take the nurse away from the bedside, but in fact can result in the delay of care.
As we study the supply chain, it becomes clear that the patient has to be at the center of the activity. By automating the supply process and developing a supply chain model focused on the patient beginning at the point of admission – so that supplies are packaged and waiting in patients' rooms – we can ensure that caregivers are at the patients' bedsides. This will help to improve care and safety outcomes by increasing standardization, as well as eliminate delays in finding supplies and equipment.
In a typical nursing unit today, the supply chain closet is centrally located on the floor and can be a few hundred feet from a patient's room. Nurses have to make the trip from the closet to the patient's room numerous times a day, so they start being proactive, gathering extra supplies so that they don't have to return to the supply closet as often. This entire process is littered with waste, from the nurse's time making multiple trips to and from the room, to locating supplies in the room, to the excess supplies that have been taken into the room for convenience, which often have to be discarded upon the patient's discharge due to infection control practices. Further, supplies taken from patients' rooms, as opposed to the supply closet are harder to track in the event of product recalls.
The same process is repeated when tracking down equipment needed in the patient room, though sometimes it isn't quite as easy as checking the closet for a clean infusion pump. Nurses often need to look in many different places or make multiple phone calls just to obtain the necessary equipment;. However, unlike supplies, equipment on the floor isn't typically managed by a supply tech. Many times, hospitals can't find their own equipment and must rely on rental companies to augment their assets to meet demand, which can be a very expensive alternative.
Eugene Schneller, PhD, co-director of the Health Sector Supply Chain Research Consortium at Arizona State University's W.P Carey School of Business, explains how the supply chain management industry is constantly changing. In 1999, the goal was materials management, and the industry was transaction-focused and price-oriented. Ten years later, the industry evolved to focus on supply management and monitoring, and while transactions and pricing were still priorities, managers also focused on products and trends, as well as increased automation. In 2019, Schneller envisions another shift, this time towards supply network and strategy management for value, with the industry focusing on performance and outcomes, contribution to clinical and economic outcomes, and integrated technologies.
As we think about the design of the future patient-centered supply chain, we must ask ourselves that if the majority of healthcare visits outside the ER are planned, how we can help reduce caregiver involvement in routine supply items? If a patient shows up for a scheduled procedure can we, through the diagnostic code in the EMR, have those items selected in our central warehouse and delivered to the patient room? If a physician rounds/reviews a chart and determines the need for a procedure at the bedside, can we automate that notice from the EMR and have the necessary supplies and equipment pulled for that procedure and delivered to the patient room? It's possible, but in order to do so, first we must:
- Develop a standardized clinical bill of resource/material: As hospitals develop standardized evidence-based care pathways, they identify the supplies and equipment needed to deliver care. This process generates a clinical bill of resource/material for that procedure, which drives standardization and reduces variation.
- Fully integrate the EMR/ERP: Supply requirements (bill or resource) are driven by orders based on standardized care pathways, which are maintained by clinical staff in the EMR. When these systems are integrated, the order is triggered by the care staff so that the requirements are sent from the EMR to the warehouse through the ERP for personalized orders to be picked and delivered, saving time and ensuring accuracy.
- Enable real-time locating services: Real-time locating services automate delivery, allowing caregivers to quickly locate needed equipment and allowing hospitals to effectively manage their assets, saving both time and money.
- Build consolidated service centers: The consolidate service center is the cornerstone of the patient centered supply chain. Healthcare systems are able to utilize outside industry best practices and consolidate services to pool inventories of both supplies and pharmaceuticals. Many systems are consolidating other services, such as copy and mail services, IT reimaging, custom pack building and linen to increase efficiencies and reduce costs.
- Take advantage of the cloud: Deploying ERP technology in the cloud allows hospitals to focus their attention and resources on improving patient care and maximizing safety. Hospitals often maintain a large, costly IT infrastructure to host and operate the systems that run and connect their health information systems. Cloud technology offers a quick, safe and economical alternative way to run these systems.
Personalization of the supply chain is not a new concept to other industries; both Dell and Amazon have transformed their supply chains through the use of the personalized order. The healthcare supply chain can learn from this by adopting methods from other models, including the use of personalization orders, as well as the use of revolver warehouses the automation of pick-and-pack, and the use of vendor managed inventory (VMI). The VMI used by top vendors and suppliers is unlike the consignment inventory practices used at hospitals today because with VMI, the risk stays with the vendor and not the hospital. Using proven practices from industries outside of healthcare will be an important factor in the building the patient-centered supply chain.
As healthcare providers look to meet the ever-growing demand for efficiency, as well as respond to increased control measures and lower reimbursement rates, healthcare organizations must turn their attention directly to patients. But in order to develop an entirely new supply chain model that focuses on the patient, organizations must start by focusing on the patient and begin looking to other industries revamp the hospital supply chain to help meet demands and increase efficiencies.
i - Transforming Care at the Bedside (July 11, 2011). Robert Wood Johnson Foundation, Retrieved August 27, 2014, from http://www.rwjf.org/en/research-publications/find-rwjf-research/2011/07/transforming-care-at-the-bedside.html
ii- Schneller, E. (2014). Supply Chain Management Journey [PowerPoint slide]. Retrieved August 27, 2014.
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