supply chain best practices presented to society for arkansas healthcare
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Supply Chain Best Practices Presented to Society for Arkansas Healthcare Purchasing and Materials Management Fall Conference October 18 th , 2013. DEFINITION. What is a Best Practice?. SUPPLY CHAIN MENTALITY. Current Practice: Manage Materials Best Practice : - PowerPoint PPT PresentationTRANSCRIPT
Supply Chain Best Practices
Presented toSociety for Arkansas Healthcare
Purchasing and Materials ManagementFall Conference
October 18th, 2013
DEFINITION
What is aBest Practice?
Current Practice:•Manage Materials
Best Practice:
•Manage the Supply Chain continuum•Materials, expenses and resources
Rationale:•Establish strategic direction •Build effective overall controls
SUPPLY CHAIN MENTALITY
SUPPLY CHAIN INCLUDES
Internal process from need to disposalExternal process from manufacture to paymentIncludes product selection and useIncludes services as well as productsIncludes labor to effect the whole process
n Manage Expenses (Dollars and People)n Work with Supply Chain Partnersn Make Total Cost Decisions n Create Internal Alliancesn Integrate Policies and Proceduresn Focus on Interdepartmental Teams & Process Flown Start with the basics and develop a plan
SUPPLY CHAIN PERSPECTIVE
BECOMING MORE STRATEGIC
Current Practice:•Allowing routine operations to be on
cruise control and run themselvesBest Practice:
•Making sure that the nuts and bolts are being checked on a regular basis
Rationale:•Little problems can become big
issues•Customers have long memories
DON’T FORGET THE BASICS
View your operations through the customer:
•Visit others in their own departments
•Review par locations quarterly•Tour your own warehouse•Walk in your employees shoes•Monitor key indicators such as:
stock outs & pickup requests
DON’T FORGET THE BASICS
Current Practice:•Materials supports hospital
Best Practice:
•Supply Chain supports all entities like LTC, ASC, Satellite locations, Home Care etc.
Rationale:•Adds value to all•Process & product standardization
SUPPORTING ALL ENTITIES
Current Practice:•Inconsistent supply cost tracking
Best Practice:
•Supply Chain tracks and reports organization-wide
Rationale:•Supply Chain takes the lead•Will show trends that can be
addressed
TRACKING HOSPITAL INDICATORS
n Supply Cost/Net Revn Supply Cost/Total Costn Supply Cost per Adj Admn Supply Cost per APDn Supply cost per case
n Inventory turnovern Inventory accuracyn Invoice discrepanciesn Fill ratesn Case cart accuracy
SOME COMMON MEASURES
Current Practice:•Materials purchases supplies but
services purchased directly by depts Best Practice:
•All services go through supply chainRationale:
•Provides missing scrutiny•Establish competition•Significant savings possibilities
SERVICES THROUGH Supply Chain
SOME OFTEN NEGLECTED SERVICES
n Transcriptionn Banking servicesn Insurancen Landscapingn Cleaning services (outside buildings)n Dialysisn Mobile imaging servicesn Parking
Current Practice:•Company submits contract with their
terms and conditionsBest Practice:
•Establish Hospital specific Ts & Cs•Becomes basis for all bids and RFPs
Rationale:•Hospital takes control of the process•Results in more favorable framework
ESTABLISH HOSP CONTRACTUAL TERMS
n Gain leverage by presenting your terms firstn Establish control from the startn Eliminate undesirable clausesn Create consistency in all contractsn Reduce the overall contract time process n Avoid potential legal involvement and fees
ESTABLISH HOSP CONTRACTUAL TERMS
Current Practice:•Equipment dispatched to floors or
units maintain own equipment•Limited or No tracking controls
Best Practice:
•Establish and centralize control•Involve Clinicians in process
Rationale:•Decrease losses / Decrease rentals•Replacement cost avoidance
Reduce/Eliminate Pat Care Equip Losses
Reduce/Eliminate Pat Care Equip Losses
n Establish formal policy & proceduresn Control and account for all equipmentn Utilize RFID / Bar Code Tracking n Include regular BioMed check-ups n Evaluate 3rd Party Providers
L
Current Practice:•Fragmented and error prone
Best Practice:
•Integrate with MM•Utilize available technology
Rationale:•Inventory & Labor savings•“Right” people performing tasks•Reduction in errors
INTEGRATED CASE CARTS
Outcomes:•Preference cards more accurate•Minimal errors in case items•Minimal RN time•Consistent stock replenishment•Automated patient billing•Accurate patient billing•Data for standardization/update
INTEGRATED CASE CARTS
Savings:• RN time (pulling, ordering, maintaining
preference cards)
• Materials time (restocking)
• Supply cost (less waste)
• Inventory cost
• Case cost (standardization)
• Revenue
INTEGRATED CASE CARTS
Current Practice:•Nurses spend too much time on
supply activities Best Practice:
•Re-establish clear supply chain control over floor stock supply areas
Rationale:•Increase nursing patient care time
and materials management credibility
LIMIT CLINICIAN INVOLVEMENT
n Establish regular communication with cliniciansn Match expectations with realities n Publish formal schedule for restocking areasn Arrange products in treatment groupsn Locate high use products closer to user n Increase visibility of staff and selfn Communicate some more
Limit Clinician Involvement in Supplies
M
Current Practice:•Products pulled when expired
Best Practice:
•Manage proactively by schedule •Rotate and shift near date to higher
use departmentRationale:
•Improves patient safety •Build effective overall controls•Creates formal tracking process
ESTABLISH EXPIRATION REVIEW
Current Practice:•Pars set and rarely reviewed•Increases additions by user dept.
Best Practice:
•Frequent reviews and adjustments based on usage data
Rationale:•Clinicians have what they really
need•Pars easier to maintain
OPTIMIZE PAR INVENTORIES
L
Current Practice:•No Formal Linen Controls
Best Practice:
•Establish controls that monitor and educate the use of linens and textiles
Rationale:•Improves outcomes •Build effective overall controls
Establish Linen/Textile Guidelines
Establish Textile Guidelinesn Establish formal policy n Set quality standardsn Create data driven PAR levelsn Develop linen change policyn Control / educate linen usagen Control use and dispensing of scrubs
M
Current Practice:•Most price change notifications are
accepted Best Practice:
•Challenge virtually all •Require rationale/reasons
Rationale:•Many price increases can be
eliminated or reduced if you just question
CHALLENGING PRICE CHANGES
Current Practice:•Stuff Piles Up
Best Practice:
•Implement a program to properly manage excess equipment & supplies
•Involve all key departmentsRationale:
•Become a proactive environmental steward
ASSET RECOVERY PROGRAM
ASSET RECOVERY PROGRAM
•Policy needs to be in place and supported by all•Assets must be taken off books •Reuse, sell, recycle, dispose•Supplies are often needed by charitable
ventures•One hospital’s junk is someone else’s treasure
Supply Chain is in the best position to be the custodian:
Current Practice:•Issue a RFP or rely on GPO pricing
Best Practice:
•Key products and services are sourced directly with suppliers
Rationale:•Negotiate from a position of strength
•Market knowledge•Physician support
•Commitment brings best pricing
ESTABLISH STRATEGIC SOURCING
STRATEGIC SOURCING PROGRAM
AnalyzeSpend
Analyze Category
AnalyzeMarket
ImplementStrategy
ManageNegotiations
Award & Contract
DevelopStrategy
Traditional Contracting
Strategic Sourcing
n Physicians are able to use their preferred items thus they are more likely to be on your side
n Many supplier tactics are neutralizedn Negotiations are driven by facts and datan Establish target pricing based on information and
commitmentn Contracts eliminate middlemen and rebates
P
STRATEGIC SOURCING PROGRAM
Current Practice:•Little review of new purchases•No review or existing products
Best Practice:•Establish Formal Value Analysis
Rationale:•Reduces product variation•Identifies hidden savings•Establishes a savings culture
ESTABLISH VALUE ANALYSIS
Step 1Define Need
Step 2Assess Practices
Step 3Identify Alternatives
Step 4Select Best Option
Step 5Implementation
VALUE ANALYSIS THE STEPS
Education
POLICIES
Policies and ProceduresFacilitation
FIVE STEPS OF VALUE ANALYSIS
Step 1Define Need
Step 2Assess Current Practices
Step 3Identify & Assess Alternatives
Step 4Choose Best Alternative
Step 5Implement Choice
VALUE ANALYSIS TOOLS & TECHNIQUES• Asking Probing & Open Ended Questions
Step 1
Define Need
• Name the product, service, or procedure• Identify the functional elements • Determine specifications & requirements• Assess the necessity of what is being
considered• What is the real reason for the request
Needs versus Wants
Step 1
Step 2
Assess Current Practices
VALUE ANALYSIS TOOLS & TECHNIQUES
• Determine benefits of current use• What are disadvantages• Estimate cost impact of current use• Differentiate necessary and unnecessary
features• Assess the cost effectiveness of current
practice
Identify what is currently in use
Step 1
Step 2
Step 3
Identify & Assess Alternatives
VALUE ANALYSIS TOOLS & TECHNIQUES
Identify and Assess Alternatives
• Alternative ways to meet the need• Employ creative thinking• How do others meet the need• Conduct trials of products or services• Track the impact of alternatives
versus current practice
Step 1
Step 2
Step 3
Step 4Choose BestAlternative
VALUE ANALYSIS TOOLS & TECHNIQUES
Identify and Assess Alternatives
• Evaluate the benefits, cost and disadvantages of alternatives
• Which alternative meets the need and yields the most financial benefit
• No negative impact on quality
Implementation and Monitoring
• Value Analysis Worksheet & Action Plan• Communication to all affected areas• Utilize Clinical Champion• Involvement and commitment of Team• Documentation to track Savings• Quantification and monitoring of results
KNOW WHAT CAN GO WRONGBARRIERS AND PITFALLSh Lack of understanding and acceptance
h Lack of support
h The process is static
h Resistance to change surfaces
h Process perceived as not concerned with quality
h Physicians not involved
Supply Chain Best Practices
QUESTIONS???