How to Achieve Improved Outcomes with a Clinically Integrated Supply Chain
Siemens Healthineers hosted a panel discussion on the value of a clinically integrated supply chain at the Fall 2019 IDN Summit and Reverse Expo, which brought together supply chain executives to discuss key issues surrounding healthcare systems. Panelists LeAnn Born, MHA, VP of Supply Chain at Fairview Health Services, Shaun Clinton, MS, CMRP, Senior VP of Supply Chain at Texas Health Resources, and Gail E. Latimer, MSN, RN, FACHE, FAAN, Executive Nurse Consultant, shared their perspectives on the importance of including clinicians in the supply chain process, and how doing so can help providers achieve better outcomes that benefit their patients and their bottom line.
While the term “clinically integrated supply chain” means different things to different people, the panelists have a similar structure in place to help drive clinical participation in the supply chain process. Each structure is organized horizontally across care delivery (including ambulatory) and considers the supply chain as it relates to each procedural area. Clinton emphasizes the importance of working with clinicians to standardize care delivery to maximize safety, which inevitably leads to standardization of what’s used in the delivery of that care. Latimer agrees, noting that shared governance extends well beyond nursing to include collaboration across the continuum.
Clinton, who reports to the CFO of Texas Health Resources, explains that he is viewed as the steward across the channels (procedural areas), with a COO assigned to each channel, to help facilitate open communication, collaboration, and shared governance—all of which help determine success.
Clinical Involvement and Limiting Unwarranted Variation
The panelists agree that standardization is the optimal way to deliver care and improve safety. Clinical leaders are scientists at heart and rely on evidence-based practice when considering standardization. Through communication across clinical and business leaders, both medical evidence and cost need to be considered. Referencing the book Crucial Conversations: Tools for Talking When Stakes Are High, Latimer explains that she expects a supplier to provide her with appropriate evidence for discussions with board members and medical staff.
Clinicians remain on the critical path regarding clinically integrated supply chain and pose numerous challenges within new models and delivery systems. When asked how frontline caregivers can rely on the supply chain team to determine care standards, Latimer emphasizes the importance of communications and shared governance within the organization to provide trust and mutual understanding. Clinicians are more likely to focus on operational costs and the bottom line when they are “owners” in a joint venture. As such, they become more invested in delivering affordable, high-quality care so that funds can be reinvested in other clinical areas.
Standardization across the Health System
The panelists note that programs to reduce clinical variation are priorities for their organizations. Standardization limits unwarranted variation to improve patient safety and quality outcomes at lower costs. Clinton uses the term “reliable care blueprinting” when discussing process-mapping care delivery to develop standards. In fact, Texas Health Resource developed an algorithm to identify important/non-important elements when choosing supplies. Clinicians then provide input upfront on what factors should be weighted. While their reaction to the outcome may not be favorable, if they respect the process, they will be more likely to accept the decision and outcome. Clinton notes that it is not only who is part of the process but also which data are used. Data plugged into an algorithm makes sense for everybody.
This process leads to the importance of system-wide thinking. IDN growth drives this type of approach. The principles discussed apply equally to both small and large IDNs; the only differences being the numbers and the impact magnification across the system due to the size of the hospital and the community it serves.
Improving Communication with Supply Chain Vendors
The panelists comment that trust and good relationships with supply chain vendors are key to the success of a clinically integrated supply chain. Vendors must understand the organization’s imperatives, financial targets, and timeframes.
Risk-based agreements with suppliers are becoming more prevalent, but it is difficult to quantify what the clinical outcomes should be. Clinton explains, “When suppliers come to me and say, ‘We’re willing to go at-risk on this,’ oftentimes they only play a small part in that disease state, or that diagnosis, so it’s extraordinarily hard to pinpoint what they're going to solve. It’s very, very difficult to put what that dollar amount is on these different conditions. I'm not saying risk-based contracting won't work. But right now, it’s extraordinarily hard to find one that will.” With those incentives clearly outlined for them, they can form a common goal with the organization.
Through standardization across the care continuum, clinical staff and leadership can come together for a common purpose, limiting variation and improving the quality and safety of patients across the system.