Supply Chain, Sterile Processing Elite show why they’re the best and brightest
Two of three camps of opinion threatened to undermine the 9th annual “Worth Watching” series by Healthcare Purchasing News published each December that celebrates noteworthy supply chain operations.
Using the pandemic as context, one camp believed that because of the intense market pressures this past year – what with seemingly insatiable demand crashing into a rash of backorders and stockouts – every healthcare organization’s supply chain team should be saluted for weathering the storm to the best of their abilities.
For realists, it’s hard to argue with that assertion.
A rival camp, using the pandemic as context, felt that for the same causes already listed as justification for celebration, those reasons perhaps should prevent anyone from being honored and recognized because the profession and function, by and large, stumbled, if not failed, in their mission and task.
For purists, it’s hard to argue with that assertion, too. But it resonates as a harsh assessment of a beleaguered group trapped between crises as they apparently were not as prepared for a virus so dangerously and quickly contagious.
Instead, HPN embraced the third camp, which acknowledges that the show must go on, continuity necessary for morale, and because there are quite a few supply chain teams accomplishing great things because of – and in spite of – the pandemic.
But wait, there’s more.
This year, HPN decided to expand the “Worth Watching” franchise beyond Supply Chain Operations and extend it to Sterile Process Operations, too. After all, Sterile Processing & Distribution (SPD) departments, like Supply Chain, remain as unsung heroes in healthcare provider production, as SPD hunkers in much closer to Surgical Services, a key customer they share with Supply Chain.
The December edition of HPN traditionally spotlights “Supply Chain Operations Worth Watching” by soliciting nominations from all sectors of the industry (providers, suppliers, group purchasing organizations and consulting firms) and conducting background research to determine those that emerge at or near the top.
This year, 10 organizations join 100 other ongoing healthcare supply chain superstars profiled by HPN since 2011, bringing the grand total to date to 110.
Generally, once an organization’s Supply Chain department/team “makes the list” it remains “worth watching” unless its absorbed via merger or acquisition, in which case it’s possible for the “new” crew to make the list (if nominated, of course) under the “new” name because they may be accomplishing more “new” things. For the running list of 110 Supply Chain Operations Worth Watching, visit HPN Online.
This year, we add SPD teams to the pantheon with 10 leading the charge of recognized sterile processing superstars.
As always, if your organization – or one you think should qualify – didn’t “make either list,” be sure to let us know and then plan how to showcase the deserving organization for consideration in the 2021 compilation of Supply Chain Operations and Sterile Processing Operations Worth Watching.
Here’s a glimpse at HPN’s latest Supply Chain and Sterile Processing Elite lists, in alphabetical order by name, for highlights on what they’re doing and why they matter.
Supply Chain Elite
Dartmouth-Hitchcock Health, Lebanon, NH
www.dartmouth-hitchcock.org
Nothing like a global pandemic to rattle cages and bring out the best in supply chain executives and professionals. But that’s all about hindsight. Dartmouth-Hitchcock’s award-winning Supply Chain team (they earned HPN’s 2020 Supply Chain Department of the Year honors) didn’t rely on that so much as foresight, focusing on their people, technology, trade and innovation to keep them ahead of the curve in terms of demand planning. In fact, they were prepping months ahead of the crisis, complete with a dedicated Demand Planning specialist and a technology team of analytics specialists, along with a service provider that fortified sort of a functional “war room” that fused intelligence with strategies and tactics needed to remain operational. Armed with extensive internal strategic planning, they also worked with their colleagues across the state border, UVM Health Network, in promoting supply chain resiliency and supplier communication to prevent disruptions from being … disruptive. By the way, UVM joined the “Worth Watching” list in 2018 and one of its heritage organizations, Fletcher Allen Healthcare, was part of the inaugural class in 2011 – overseen by the same leader.
Dignity Health, San Francisco
www.dignityhealth.org
In the intricate – but oftentimes nebulous – realm of sustainability, little things can add up to a lot, regardless of how complex or simple efforts may be. Perhaps no one knows that better than the team at Dignity Health. Amid the plethora of “green” procurement guides, eco-friendly score cards, special certifications, carbon neutrality, Net Zero and Scope3 rallies and concerns about environmental footprints, Dignity’s team started with the fundamentals as foundational – a contract signing, followed by a system-wide conversion process to demonstrate their dedication to sustainable products. Part of their two-year effort involved working with a custom kit provider to ensure all surgical packs were updated to include sustainable products. The results have been nothing short of eyebrow-raising. Thanks to a small product change to a plant-based needle counter, they were able to eliminate 10 tons of plastic from their operating room supply chain. Making such a change system-wide required considerable negotiations with clinicians, kit packers and suppliers. And for context? Compare the thought of 10 tons with how light and small needle counters are. If they can do so much with so little, think about the replication.
HonorHealth, Phoenix/Scottsdale, AZ
www.honorhealth.com
Under the concept of “alchemy,” the supply chain shared services team at HonorHealth embraced structural integrity and clinical integration to morph operations into something “methodical and streamlined” from something that was “reactive and inconsistent.” They started at the ground level, concentrating on service lines, PAR levels and a new ordering system. They revamped their staffing levels around four major areas: Support Services, Operations, Innovation and Engagement. They fortified their business intelligence by setting up such processes as business planning, case cost programs, contract cycle to category management, data integrity and dashboards to record and measure key performance indicators, including clinical outcomes, physician relationship engagement and development, expense reduction targets and supplier performance improvement. HonorHealth also strengthened support services by automating technology management, biomedical engineering and facilities management under a unified ServiceNow platform that functions as a user-friendly gateway to clinicians and administrators. If the transformative first five years of HonorHealth’s development (following the merger of two health systems) is any indication of future success, the next five should see them turn precocious mettle into precious metal.
Inova Health System, Falls Church, VA
www.inova.org
Four years ago, Inova Health embarked on a rebuild of its own to transform its supply chain from the ground up. As with any rebuilding, the supply chain team began with a system-wide assessment, which identified more than $25 million in potential savings and a significant number of operational improvements across Inova Health’s five acute care facilities. Methodically, the team focused on standardizing their inpatient and storeroom supply chain. They relied on a combination of high-tech and low-tech strategies and tactics to do it, leveraging mobile supply chain technology to manage all inventory across the network and implementing a 2-bin Kanban system throughout more than 150 supply rooms. As part of their ongoing journey, Inova Health selected a new prime vendor and group purchasing organization to move them forward. In the current phase they are working to implement a new point-of-use inventory management system and switching their enterprise resource planning (ERP) system, which includes a new contract management system and a content cleansing tool. Once these systems and tools are fully implemented, they will explore centralizing services. Of the more than 40 projects that Inova Health’s supply chain team executed during the last four years they have exceeded their original projected savings target from the initial assessment.
Jackson Health System, Miami
www.jacksonhealth.org
Back in March, the supply chain team at Jackson Health recognized Miami as having the earmarks of being a COVID-19 hot zone. As a result, they immediately reached out to their primary distributor and manufacturers, explaining their needs to these key suppliers, using data on the surge in COVID-19 patients to justify their personal protective equipment (PPE) requirements for nearly 13,000 employees treating patients at six hospitals spanning three campuses. These direct appeals strengthened their relationships with suppliers to receive PPE above the allocation parameters to handle the surge. Jackson Health’s supply chain team also worked with its GPO to identify additional supply options for bolus orders and obtained commitments up front. Like a growing number of other facilities across the country, Jackson Health identified and credentialed alternative suppliers with long-term sustainability and capacity so they could build redundancy, with a goal to minimize reliance on non-traditional PPE suppliers. The team also kept tabs on raw supply fill rates from manufacturers, comparing that to their supply daily burn rates in reviewing cost optimization and utilization management. They identified and reviewed peaks and short falls, working on PPE conservation plans with infection prevention and nursing leads. Together, they set PPE guidelines and standards for the system, and even established ultraviolet decontamination for N95 respirators as a backup. The result? No stockouts.
M Health Fairview, Minneapolis
www.mhealthfairview.org
M Health Fairview may have earned HPN’s 2017 Supply Chain Department of the Year Award (as Fairview Health Services), but three years later the supply chain team continues to impress and innovate, refusing to rest on their laurels. They met with the professors and students at University of Minnesota ‘s College of Design, College of Science and Engineering (CSE) and the Medical School to examine the pandemic’s effects on supply chain product availability, researched options, designed plans and met with local manufacturers to facilitate production in a pinch for such PPE as isolation gowns. Early on, they turned to CSE-designed glass-enclosed COVID-19 testing booths and N95 respirator decontamination using ultraviolet light as part of a five-day mask rotation process. One of M Health’s pediatric intensive care unit physicians even led efforts to make face shields and ear protection for air purifying respirators. Through this experience, M Health’s award-winning supply chain team demonstrated how it can work locally and with the university to fill supply gaps and prevent stockouts.
OhioHealth, Columbus, OH
www.ohiohealth.com
A small but growing number of forward-thinking supply chain teams have been turning to their own ingenuity in developing software to solve problems. OhioHealth is no exception. Through innovation and collaboration, they created a homegrown predictive analytics tool to help them deal with COVID-19-related demands and PPE shortages. They mapped all areas within their organization to determine PPE inventory locations, pinpointing which areas needed reallocation of supply resources right away. Then they used predictive analytics to determine and fulfill demand based on patient volumes. In fact, even at the height of their initial patient surge, the team managed PPE consumption and availability for clinicians to have what they needed to treat patients safely. OhioHealth worked with state, local, public and private sector stakeholders, including nearby health systems, regardless of competitive status, to collaborate and respond collectively to serve their joint communities. One of their cooperative ventures included establishing a 1,000-bed field hospital in two weeks within the Greater Columbus Convention Center for COVID-19 patients. Another involved a novel PPE decontamination system through Battelle that uses concentrated, vapor phase hydrogen peroxide to decontaminate N95 respirators. The idea emerged during a dinner conversation between an OhioHealth nurse and her husband, a Battelle employee. OhioHealth and Battelle then worked together to develop a marketable process from the “proof of concept” to roll out industry wide. OhioHealth also is working with local businesses to support PPE manufacturing and distribution as well as sharing lessons learned with other networks and systems.
St. Luke’s University Health Network, Bethlehem, PA
www.slhn.org
Early on as the supply chain team at St. Luke’s University Health recognized that the COVID-19 surge was exhausting available PPE, they dispatched a dedicated PPE Purchasing Team to source product with a variety of alternative suppliers. Thankfully, they were able to buy enough to extend inventory to get by for a while longer as demand continued to ramp up. Next, they turned to 3-D printing technology to make N95 masks, PAPR hoods and a variety of other products. They also needed a way to extend the life of their N95 masks so a team effort began between physicians, biomedical engineering techs and sterile processing, along with a Lehigh University professor, to design and fabricate a machine to decontaminate N95 masks with UV-C light. The PPE team recruited local seamstresses to sew fabric masks and circulate them throughout healthcare facilities within the Lehigh Valley community. From this experience, the supply chain team learned how to meet virtually with local university and community leaders to create production lines when a crisis hits.
UPMC, Pittsburgh
www.upmc.com
Although UPMC’s supply chain team earned HPN’s 2012 Supply Chain Department of the Year Award, it’s still pushing out the boundaries of ingenuity and innovation eight years later. With the onset of the COVID-19 pandemic, UPMC needed something to reinforce its perpetual inventory system. As a result, they created a sophisticated supply monitoring tool to capture on-hand inventory quantities among its more than 40 facilities spanning several states. They designed, developed and launched a web-based crisis inventory management platform in partnership with software engineers, pharmacists and project managers. One of the key elements in this system involved a mobile-enabled user interface for use in hospitals and inventory storage rooms without having to access a browser. What’s noteworthy is that this product was launched to handle demand for COVID-19-related products, but it’s now being configured to cover additional items, too, and released to other health systems needing reporting tools to monitor and manage critical supply counts.
University of Utah Health, Salt Lake City
www.healthcare.utah.edu
The supply chain team at University of Utah Health wanted to reconfigure its inventory system enterprise-wide, standardizing processes in both the inpatient nursing areas in hospitals and non-acute care facilities, such as ambulatory clinics. As a result, they set up an open-bin inventory system with real-time supply quantities wedded to highly sensitive scales integrated to each supply bin that can measure something as light as a single alcohol prep. By using this open system versus a closed cabinet system, they were able to eliminate at least 75 percent of their implementation costs when compared to the closed cabinet system they had. Through this switch, they were able to centralize inventory management functions so that the nursing and respiratory teams could focus on clinical duties. Plus, they eliminated cycle counting and sped up restock times. Data are linked to the materials management information system (MMIS), which in turn, is shared with the distributor.
Sterile Processing Elite
Albany (NY) Medical Center
www.amc.edu
As part of an academic medical center, the SPD team at Albany Medical Center embraced Lean management to reorganize its departmental footprint to improve workflow. Because its operating room customers practice in a facility that is nearly the size of three football fields, SPD recognized it had to meet the challenges that space and surgical volume created. So it assembled a cross-functional team to design a current-state value-stream map that helped them redesign throughput and improve performance based on desired customer service outcomes. The new layout features standardized prep-and-pack workstations, huddle boards for open communication and task-based evaluations.
Centura Health, Centennial, CO
www.centura.org
The SPD team at Centura implemented its own performance improvement initiative, striving for consistency in quality and service from processing to storage to tray assembly and transportation. They reorganized set storage for improved visibility, streamlined the assembly process and improved instrument cleaning and sterilization. At the center of productivity is a “Lead Priority Pusher” who “ensures the SPD engine is consistent and focused,” sort of like a productivity traffic cop. The LPP determines instrument set priorities for assembly and adjusts staff assignments based on volume. SPD uses radiofrequency identification (RFID) to automate tray processing and software to assist with forecasting and standardizing of supplies via electronic checklists. They also use this software to help with development, education, training and career advancement.
Children’s Hospital of Philadelphia (CHOP)
www.chop.edu
The Central Processing Department at CHOP, which is regarded as the first and oldest children’s hospital in the nation, defines performance-based teamwork as driven by training and education, process improvement and quantifiable metrics. It’s one of the reasons why this team earned HPN’s 2019 SPD Department of the Year Award and debuts on the SPD-centric “Worth Watching” list seven years after its Supply Chain colleagues were so recognized. Unlike many SPD departments that report up through the OR, CHOP’s CPD team is one of two on this list that reports up through Supply Chain. CPD has consolidated and centralized sterile processing enterprise-wide for acute and non-acute care facilities, including focusing on pre-cleaning from the OR and tracking instruments through the system. And with an expansion hospital added to the mix, they redesigned their own footprint to handle the additional service requirements. They also created a centralized endoscope center to specialize in those minimally invasive tools.
Geisinger Community Medical Center, Scranton, PA
www.geisinger.org
The Central Sterile Reprocessing team at Geisinger Scranton developed a number of quality projects in the areas of point-of-use pre-cleaning instruments, tray-building accuracy and speed and monitoring productivity and workflow using software for OR scheduling and case tracking. CSR also tackled problems with loaner instrumentation by instituting multiple quality checkpoints and improving communication consistency with the vendors. CSR embraces the philosophy of C.I.Care as the basis for its customer service to user departments. C.I.Care represents an acronym that stands for Connect, Introduce, Communicate, Ask & Anticipate, Respond and End with Excellence.
M Health Fairview, Minneapolis
www.mhealthfairview.org
Believe it or not, the ingenuity and inventiveness of M Health’s System Central Sterile Services team can’t be traced back to a year, five years or even 10 years. You’d have to look back more than three decades ago when this team first embarked on an enterprise that “insourced” centralized sterile processing services for all of its member facilities. What was novel then may be rather familiar and commonplace now, but M Health Fairview’s CSSD developed and progressed, suffering the requisite growing pains to accommodate service expansions but routinely emerging a step or two in front of where they needed to be in the area of centralized processing services for multiple facilities. Not only did M Health Fairview become the first organization to earn both the SPD Department of the Year (2020) and the Supply Chain Department of the Year (2017) awards by HPN, but the two also joined HPN’s “Worth Watching” lists this year.
Lucille Packard Children’s Hospital, Stanford, CA
www.stanfordchildrens.org
Due to the opening of a new fully equipped hospital two years ago that included imaging and surgery integration, the SPD team encountered its own significant renovations to accommodate the clinical service expansion. But despite the assembly line reorganization and shiny new technology installed to improve workflow and throughput, the staffers still had to deliver. While few SPDs are afforded the opportunity of a redesign with the latest technology and tools, Packard Children’s SPD team didn’t miss a beat, hitting the ground running. They even had a clinical champion in a medical doctor who acted as advocate, educator and sounding board in a professional partnership that’s closer than many SPD clinical connections get.
Stony Brook (NY) University Hospital
www.stonybrookmedicine.edu
Years ago, the Central Sterile department at this academic hospital would recruit staff with limited experience and then ramp up education and training into overdrive, developing a crew in which more than 95 percent of technicians are certified. The team created a PAR level system to improve tray assembly quality, reducing the “missing instruments” rate to two percent on more than 100,00 trays per year. The CS team also worked with nurses and surgical techs in the OR to spray all instruments and endoscopes for pre-cleaning. Meanwhile, facility expansion added to their workload, but the C-suite approved fortifying their workspace with the addition of new and more efficient washer/disinfectors and sterilizers.
University of Louisville Health
https://uoflhealth.org
The SPD team at University of Louisville embarked on a rebuilding process to improve its relationship and service to the OR. Among the projects the two areas tackled jointly involved the OR and SPD leaders designing a core for neurosurgery trays that could be tracked by computer scan as they moved through and between departments directly to patients. SPD also reorganized its shelved inventory bins and racks for tray assembly to make it easier for technicians to find what they need. They standardized on one instrument manufacturer and shifted a certain amount of inventory to enclosed cabinets and other devices on vertical pegboards for easier visibility with everything labeled by catalog number for tracking and tracing. Average tray assembly times fell by nearly half. They extended the labeling system with colored luggage tags to sterilization containers to facilitate set and tray matches from one end of reprocessing to the other.
UPMC Horizon & UPMC Jameson, Greenville, Farrell and New Castle, PA
www.upmc.com
Imagine if three hospitals with separate campuses merged operations so that they, by and large, functioned as a single unit. Now imagine how SPD might function through the initial uncertainty. The SPD team at the tri-facility UPMC Horizon & UPMC Jameson campuses knows quite well as they had to coalesce into a regionalized service that involved efficiently maneuvering equipment and operating room supplies among the facilities without interfering with day-to-day operations and production. They also reconstructed SPD’s footprint at two of the locations, improving the layout to increase productivity throughout the merged system and standardizing instrumentation. This year, SPD has been pursing automation to track sterilized instruments and trays electronically.
Yale-New Haven (CT) Hospital
www.ynhh.org
The Central Sterile Supply team at Yale-New Haven initiated the four-stage problem-solving model, “Plan-Do-Study-Act” (PDSA), with Infection Prevention, Supply Chain, physicians and vendors to carry out emergent and necessary changes to and development of standard operating procedures complicated by the COVID-19 pandemic. This included reprocessing face shields, N95 respirators and other PPE products. They worked with the Food and Drug Administration’s emergency use authorization (EUA) for necessary revisions to reprocessing procedures for Filtering Facepiece Respirators using the Bioquell Hydrogen Peroxide Vapor system to achieve sterilization. The team also relied on PDSA cycles to mediate COVID-related supply distributions.
To read about past winners, visit: https://hpnonline.com/21074381.
Rick Dana Barlow | Senior Editor
Rick Dana Barlow is Senior Editor for Healthcare Purchasing News, an Endeavor Business Media publication. He can be reached at [email protected].
