The New Nominal

When NASA – or more recently NASA in conjunction with Elon Musk’s Space X Corp. – launches a rocket, the communication between the astronauts and those in Mission Control repetitively include an interesting response to questions about how systems are faring, how the humans are feeling.

Instead of responding that systems or the astronauts are faring or feeling “normal,” they respond – if applicable – that they are faring or feeling “nominal.”

What’s the difference?

When something is “normal” it is something for which we are used to experiencing. We have become accustomed to it to the point that we take it – whatever “it” is – for granted. A good example? When there are no supply shortages, administrators and clinicians tend to ignore Supply Chain. It’s only when things go wrong that suddenly lends credence and interest in Supply Chain.

In terms of aerospace engineering and spacecraft technology, the term “normal” cannot really apply because the persons involved aren’t really used to experiencing what’s about to happen. They may have precedence – like attorneys and judges using prior cases, laws and verdicts to adjudicate current and future legal opinions – in the form of prior launches and technologies. But therein lies the problem. As we move forward chronologically, the progress of technology and its useful applications tend to improve – typically at a faster pace.

As a result, researchers and scientists derive various scenarios that provide something of a baseline, a set of boundaries within them an action takes place. Hence, if a rocket launches from the pad in the “proper” trajectory to escape Earth’s atmosphere and gravitational pull, it is performing “nominally” or within those anticipated, expected, even acceptable limits.

This scenario is not unlike crisis/disaster planning – particularly in the case of supply chain during a pandemic.

Hallowed heroes, hollowed shelves

You’ve heard the phrase about healthcare that the one constant within healthcare is change. Well, that phrase is anathema to the context of constant. If something is constant, it’s experienced regularly, routinely, and therefore expected to happen. If something changes regularly, routinely, then it’s not really constant. However, something that changes so frequently might be “managed” more than “controlled” – think Forrest Gump playing ping-pong in his eponymous film versus the ping-pong ball remaining in its stationary packaging. A plastic ball in a box may be “normal,” but a plastic ball ricocheting between two paddles, a net and a table without escaping that environment and hitting the ground or the walls around the table tennis players is “nominal.”

Some point to managed care and its emphasis on payer-driven cost reduction as at least one cause of this year’s product shortages. (As an aside, how come we never hear about payers being forced to reduce costs? Just payers reducing reimbursement? Answer: Managed care’s enactment in 1983 shifted financial control of the industry to the payers.) Providers and suppliers responded in part with such distribution strategies as just-in-time (JIT) and low-unit of measure (LUM), neither of which keep pace with pandemic-induced and accelerated demand.

Others suggest providers stock three-to-four months of product on hand somewhere (either on site or with the vendor), but that costs money. So, too, does the notion of buying more product domestically.

The New Nominal has less to do with being normal; it has more to do with what achievements, outcomes, performance you’ll accept as, say, optimal against the backdrop of your environment.

What we really need: Renewal.

Forget about The New Normal. The healthcare environment never should strive for “normal” again because of the overwhelming lack of control over the environment and individual patient physiology.

Administrators and clinicians alike must renew their confidence in and support of Supply Chain doing their jobs as they navigate through The New Nominal.