Innovative Solutions in Hospital Supply Chain with Joni Rittler

As we sit down with Joni Rittler from the Children's Hospital of Philadelphia, get ready to explore the intricate tapestry of supply chain management woven throughout her impactful tenure. Joni doesn't just recount the tales of expanding and developing an off-site logistics center, she invites us into the world of strategic thinking, where fostering team credibility and collaborative problem-solving are paramount. Her narrative is a testament to the transformative power of connecting with those at the heart of healthcare, the nursing staff, and broadening the scope of supply chain services to support a growing hospital infrastructure. The backdrop of Joni's office, adorned with motivational quotes, offers a glimpse into her leadership style that consistently engages and elevates her team.

Transitioning to new facilities is rarely a walk in the park, yet Joni shares how her team turned potential stumbling blocks into stepping stones toward greater efficiency and staff satisfaction. The fruits of this labor are evident as we uncover the crucial choices behind the logistics center and their ripple effect on the hospital's expansion and resilience. As the bed count soared, so did the appreciation for improved workspaces, like windows in sterile processing and a tranquil creek setting the scene for the day-to-day operations. Joni's story is punctuated with strategic insights on securing C-suite buy-in, embracing supplier diversity, and the often-overlooked significance of understanding employee commuting patterns.

Transcript

Speaker 1: 0:05

Hello again everybody. This is Fred Krantz from St Onge, here for another episode of Taking the Supply Chain Pulse, our podcast series in which we talk to the movers and shakers in the healthcare supply chain. Today we're fortunate to have Joni Rittler, who is a supply chain leader at the Children's Hospital of Philadelphia, and we're going to talk about some of the problems that they were facing and the need to expand and the development of an off-site logistics center, the process, how she went through that, so that those of you who may be facing similar issues can learn from their experience. Joni, thanks so much for being here.

Speaker 2: 0:46

Hi, fred, good morning, good to see you.

Speaker 1: 0:49

Well, everybody, for those of you who don't get to see this visually, I talked with Joni a little while ago and I asked my friend Tom Redding if Joni, since she's from Philadelphia, was a Philadelphia sports fan, and he said yes, she is. And then you talk to Joni and she says everybody from Philadelphia is a Philadelphia sports fan. So today, in honor of Joni, I am wearing my Big Lebowski cardigan, which is often worn by Jason Kelsey on his podcast and where we share something there is. I live in Cleveland Heights and Jason Kelsey and Travis were raised in Cleveland Heights, so we've got that going. And then I'm also wearing my Philly Forever T-shirt with a picture of Jason Kelsey as he went shirtless in Buffalo in honor of the Eagles. So that was for you, Joni.

Speaker 2: 1:48

I have my hat, but I don't want it to mess up my hair.

Speaker 1: 1:53

There you go, You're looking good. So I noticed we're still in March, right? So we're still in Women's History Month. And I noticed that behind you you have a poster. Could you tell us about it, if you would?

Speaker 2: 2:11

Yeah, it's just a little quote by Maya Angelou saying that when you speak up, when a woman speaks up, they speak up not only for themselves but for all women. I've been putting a little background, a different one every week during Women's History Month. I find that when I do that, I put a little background on and I get on calls. It's a conversation starter. So people, before the meeting starts and it's kind of quiet, they'll go oh, what does your background say?

Speaker 2: 2:33

Or what's on your background, and you know you mentioned the service and logistics when we were building that I would change the picture every couple of weeks so they could see the progress of the building actually being built. So I use the background for conversation starters. That's great.

Speaker 1: 2:47

Well, I also told you in one of our previous conversations that Philadelphia holds a place in my heart because that's where I started in my actual patient care experience as a Navy Corpsman at the Philadelphia Naval Hospital down at the south end of Broad Street at Broad and Patterson no longer there, but I love Philadelphia. It's a great place for me to get my start and I really, I really. Anytime I get a chance to go by there, I do. It's a great thing. So you've been at Children's Hospital of Philadelphia for how long? 14 years and, as I think you told me before when you assumed your current role, there had been a parade of folks that had been in that position for brief periods of time before you, and you received a lot of encouragement from the people that were coming in that forecast you were going to be there for a long time. Is that right?

Speaker 2: 3:44

No, not exactly the exact opposite. They thought it would be a revolving door and they didn't have to pay much attention to me, but I've lasted.

Speaker 1: 3:54

That's good. So how did you do it? How have you lasted?

Speaker 2: 4:00

Yeah. So you know, I think first of all is just starting at the grassroots, like what do we need to fix why? You know, usually when you replace the leader, it's either someone's left because of retirement or they left because there was problems, right? So, starting at the grassroots, what was working, what wasn't working made some changes with some of our suppliers we have because we outsource some of our labor so made some changes there and really just focused on the fundamentals. But we did that while we engaged nursing. So we pulled nursing into the conversations Tell us what's working, tell us what isn't working and really just started to build a rapport with them so that you know they could start to rely on us. For me, it was around credibility. We focused a lot on credibility, right, and if you live in a hospital that focuses on safety culture, they talk a lot about high reliability you know relying that the same thing gets done right every single time, and so we spent a lot of time talking about that too, and I really tried to pull some of the safety concepts into supply chain. How do I take those safety concepts that are used in the clinical team every day to make sure every patient gets good quality care. How do we pull those same concepts into supply chain to make sure all of our service was the same and consistent all the time and if we had a miss, if we were short of a product or whatever that we can at least communicate that so that's how we started was just there.

Speaker 2: 5:19

We've expanded the program tremendously. I had maybe a little over 100 people when I started. We now have over. We have about 320 people in the supply chain right now, and the supply chain encompasses not just purchasing and procurement, but we have obviously the logistics, and we have three hospitals now and the service and logistics center, so four sites that we're servicing. And then we have start processing under us linen Mailroom Print Shop as well, and we have a pretty robust technology team too, because we have a lot of technology and tools that we use. So we've really grown and developed. I'm really proud of the program.

Speaker 1: 5:57

You know it's interesting. I got my my first director position when I was like 27, 28, too young to know that I didn't know anything as a director of central processing supply chain's ability to manage it. Cpd has transitioned to where it's come under the auspices of the OR many times. So how did you manage to keep that relationship intact and keep and your department was named by HPN the Sterile Processing Department of the Year a couple of years ago, right?

Speaker 2: 6:43

Yes, we were. So what I did was when I started I did not have CPD. They were struggling and the OR also had some leadership challenges, and so what we did was I went to the CNO and said give me CPD, I'll take it, I'll fix it for you, give it to me. When you think about CPD, yes, there's the very technical piece of you know the sterilization and knowing all those technical things, but most of it's a logistics right Product coming in, being produced, going back out again. So we transition, they transition.

Speaker 2: 7:16

To me, I would say initially the staff wasn't that excited because they felt like they were moving from nursing to supply chain, you know, literally like that. But but we spent a lot of time building that staff up. I brought surgeons down to paint the staff and talk to the staff and allow them to show off what they were doing. And I remember one surgeon apologizing to the team. He said I've been here, you know, I think it was 17 years at the time I've never been down here and I never knew that what I did impacted your work. So that meant a lot to the team, that they he actually appreciated what they did right. So, um, so we did.

Speaker 2: 7:51

You know I did things like that. I call them professionals every time I talk to my. Like your professionals, you're a professional team because they are. You know they have to have a technical skill. They have to be very knowledgeable and very diligent in the work that they do.

Speaker 2: 8:03

So they are now proud to be part of supply chain and, because we had such a big turnaround, we did apply for it and won the Department of the Year for HPN probably in 2017, I think it was. So, yeah, we were pretty proud of that. We made a big deal of that. So we try to just keep celebrating the wins with that department and keep really trying to build that relationship with the OR, making sure that we understand again what their needs are, how do we need them, as well as what their responsibilities are Like. We had them not spraying the sets when they came down, which you know caused a lot of problems, so we ended up switching products and a very easy product that's just a wand blue foam. You know it's sprayed, you know it's covered. So doing things that you know, not only just complaining to them to do it, but helping to make it easier for them to do the right thing.

Speaker 1: 8:53

That's good. I mean, I always felt that sterile processing was totally overlooked. As far as the last place to get any new equipment, any infrastructure, you had to wait. Sterilizers would last pretty much forever and when they did break, they'd fix them instead of thinking about coming up with new and emerging technologies, and it was a place where people served without any recognition. So it's a place that's got a special place in my heart. I know that you guys were sort of in a you're located out by Franklin Field, right, and so for those of you that don't know, that that's, you know, not Center City, but it's sort of close to downtown. It's in an area that probably faces some challenges, and you probably had space challenges. What led you to think of building an off-site logistical center? What made you think about doing that?

Speaker 2: 9:57

Yeah, yeah, so we're located. It's called University City in Philadelphia, so we are physically connected to the University of Penn Drexel's a few blocks away. There's also a VA hospital just across the street, so it is a pretty congested and busy little section of the earth, if you will. It amazes me how much they fit into there. But we were seeing that the hospital was growing. So we're now 698 beds. We were under 500 when I started. So now 698 beds and we had, you know, not expanded the storeroom and prior to COVID I had made a presentation and showed that we could only hold two to three days of supply in the warehouse. This is prior to COVID, two to three days of supply. So you know, we were concerned that we would not have enough space as the organization grew and I was concerned that if there were shortages we were going to run into some pretty serious issues. So we did end up getting approval and it really was based on the fact that we're building a new patient tower. So we have plans to grow to 800, 900 beds and we could not in our space at that time support an organization of that size. So we decided to really look at the entire A-level, if you will, everybody that was on the A-level, which included sterile processing and IT and food and nutrition, and really think about what services should we move off-site? So we moved off-site. We opened up in 2021. 2022, 2022, january 2022. And spent two years building it. So we actually, you know, survived through COVID with the small space that we did have Got some offsite, probably like everyone. This building that we have now is 175,000 square foot and it does include a 45,000 square foot distribution area. We also have sterile processing in there. We have biomedical food and nutrition, it. All of our bed storage is in there, as well as the bed repair area. I'm missing a couple of departments Mailroom, print shop and linen are all housed in this one area and there's still room for growth. We still have shelf space for growth with the thought that as the organization grows to 900 or more beds, that we will be able to support them with this building through 2035.

Speaker 2: 12:19

So it was a big project to not only design the building and make sure we had good workflows, but really think about what was going to be the experience with this building. What was going to be the experience for our end users. We had many end users who were worried about moving instruments and supplies off-site and what they have, what they need. So how do we work through that? And then, what was going to be the experience for the employees who were working there, who were not going to be in a hospital setting, and how do we keep them engaged to the mission? You know, caring for kids. So we had 26 different teams working at one point. Some of them were focused on building the building and some were focused on policies and procedures within their own department. We also had teams focused on the employee experience.

Speaker 2: 13:04

Right, and we chose our site because it's close to the hospital. Public transportation is right there. Actually, there's a subway or an elevated train exit right there, right on our site. You can come off and get right into our site, um, if you have your badge, and um, and because it was, you know, walkable. There's amenities within the neighborhood that they can walk and grab lunch and things like that.

Speaker 2: 13:26

So we really tried to think about the patient experience when we built this I'm sorry, employee experience when we built this and then spent tremendous amount of time both with the nurses as well as surgeons talking about how do we make sure they have what they needed, how do we get them comfortable with the fact that we were moving things off site? And it was a little easier, I think, for the nurses, because you know that their parts were filled. But the surgeons were really worried. They were very, very know how would I know that my instrument, if something hits the ground, am I going to have to have something here? So we learned that we had to even change our dialogue a little bit. We couldn't just say, well, 20% of the inventory is going to be here and 80% is going to be in service and logistics. The fact was 25 to 30% were on site and the balance was in transit somewhere. Right was either moving or being processed and coming right back again.

Speaker 2: 14:17

So getting them to really understand that was, and then taking into account, with their knowledge and their experience, how many more sets we had to buy. So we spent a lot of money buying more sets. So we had enough for that turnaround. But they had input into that too. So we are, we are fully live, fully functional. All divisions, all specialties in the OR are fully functional, both for our Philly Hospital and our King of Pressure Hospital, and now we service the Cedar Avenue Behavioral Health Hospital as well. So everything's up and running and we've expanded beyond medical supplies. So we have IT supplies in there now and we have respiratory and all of our OR supplies in there. So, yeah, we're just looking to see how we can continue to bring value.

Speaker 1: 15:03

Good, you brought up a couple of things in my mind Now. I talked to a lot of people so I may be making a complete mistake here, but I thought I had heard that when you were starting to do this that a similar thing had been tried with another organization and hadn't succeeded well, and the doctors were up in arms about the whole concept of even doing it. Was that true?

Speaker 2: 15:28

Yeah, it was true. Yeah, it was very true. It was a neighboring hospital, so our doctors had knowledge of what was going on there and so they were, yes, very, very anxious. But we ended up we pulled in like three or four surgeons and we pulled in the surgeons that we knew would be honest. Let's just say honest, they weren't afraid to give us the feedback, they weren't afraid to raise their concerns.

Speaker 2: 15:55

You don't go to the easy ones. You go to the people that you know are really going to challenge you, right? Because if you can satisfy them, then you can get the rest in line. So we went to them and then we, every month, presented at their monthly meeting you know what the status was addressed, all their questions, and again, we took guidance from some of the surgeons we were working on on what verbiage we were using, right, Like don't say that when you say it's going to be stored there. That's what worries them, right? So, really trying to hear what they were telling us and making sure that we were communicating in a way that they could receive the message we wanted them to receive. So it really was. Again, it came down to, again, credibility, reliability and, you know, know, building that relationship yep and uh.

Speaker 1: 16:35

the other thing is you brought a lot of departments that were sort of like independent. In my experience once again I keep going back to the fact that I'm an old guy that's a supply chain leader was that you have environmental services, you had linen room, you've all the all these standalone functions that were sort of operating independently, and you may have been friends, but you very seldom collaborated and most places it was a fight for scarce resources to get the senior leadership to give you some money to do something. How did you build? How did you build, first off, how did you get the senior leadership to think this was a good idea? And second, how did you get the folks in what might normally be considered competing departments to buy into it?

Speaker 2: 17:23

Yeah. So we enlisted the help of facilities to get buy-in from the senior leaders, because, as facilities was trying to plan for the new patient tower, I reached out to them and said well, what are you doing around support services? I know we need more space. Who else doesn't? So we ended up collaborating and then putting together a presentation that we presented together and said all of the support services need more right, so we have to look at all of them and what we can move off-site. So that's how we got the support from the senior leaders and it ended up being cheaper, less expensive to build off-site than it was to build in, you know, university City, which is pretty high real estate there, so it was easier to build there off-site. We're like five miles west of the city, so I'm west Philly now. Actually, we're just outside of Philly in Upper Darby area. So that's how we got the executive leaders.

Speaker 2: 18:22

In terms of my colleagues, those discussions started out just as you would have thought, just as you just played out in your mind, where we sat around the table and everybody had to have their own dock and they had to have their own trucks and they had to have their own people. Everybody had to have everything under them, no changes, just moving to a new location. And we just did a few exercises where we had everyone kind of map out like what do you do every day? Tell me what your team does every day. And we started to look at the commonalities and I pick, I deliver, I pick, I deliver, I receive. You know, lennon, they receive it, they pick it, they deliver it right. They stage the cards, they deliver. And we started to see that there was a lot of commonality. Lennon then moved under me, so that wasn't under me until 2020. That moved under me, so that became a little easier, and so the model that we have is for all the folks and there's like about 200 working there on a daily basis.

Speaker 2: 19:07

It still reports to the IT department, biomed still reports to the biomed department for their common work. But when it comes to how does the service for the service and logistics center work? How do we make sure that you know if biomed needs something over the hospital right away, that we can get it there? That's all within the service and logistics and there's processes, protocols that people follow when things need to move, and I think we've done a really great job of creating just a nice environment there where everybody's very collaborative and they are excited to work there. And they're excited because we designed the building again thinking about the patient, so there's a lot of natural light.

Speaker 2: 19:48

Most of these folks came from the basement in the hospital, so there's a lot of windows, a lot of natural light, parking, ample parking for them, which again at the hospital is a challenge. And just trying to make sure that they understood that, even though we were off site, we still have pictures of kids around. We have our mission statement everywhere trying to keep them connected. So I think they enjoy working there because it is a really good environment and a good community. We created a community there that we know we are all together trying to make this service really successful. So we came a long way, from everybody having to have their own to how do we do this together and make sure that we're all successful.

Speaker 1: 20:26

Yeah, and my next question you sort of have answered it a little bit is what the impact on your staff? I know that people that work in an urban environment are always. Many of them are taking public transportation to get to work and they've had a way that they've been coming every for and many of these people are they're not one, two, three-year employees, they're 15, 20, 25-year employees that have been at the place a long time and then to move what seems like a little distance five miles could be a major disruption. I know you put a lot of thought in that. What was the impact on the staff?

Speaker 2: 21:05

So when we chose the site again, we did think about the staff. We actually did a heat map of where folks lived and then we did another assessment of who took public transportation. So we could tell that because we have, you know, the program where we actually support public transportation and stipend folks. So we knew who was doing public transportation. So we knew that. We knew, going in where we put our site, majority of the people lived in that neighborhood within a mile and then, you know, we also knew they took public transportation. So that was really helpful just to do that. The staff was a lot of them were new. We had some that moved from the hospital. Some of them were new and I think initially folks were a little hesitant to move there because, as you're saying, they come to that same place. They had people they had lunch with, they were used to, you know, they were just used to the routine of being at the hospital. But once they saw the building, um, so we even have windows and sterile processing right, there's windows.

Speaker 2: 22:03

You can actually see outside right I've never seen that before I know, yeah, it's really nice and so, and there's a little creek right outside. It is a nice little setting that we have. But once they saw the building and they understood that it really was a nice environment, people want to go there. They want to go there. It's. It's not that, it's not that you still don't work, you know at a good pace, there's still productivity metrics. It just doesn't feel quite as hectic, as heavy as like a hospital environment. So, yeah, we if we haven't had a problem keeping people there, Well, that's great, that's great.

Speaker 1: 22:39

So I guess my next to the last question is how things worked out. Sounds like they've worked out pretty well.

Speaker 2: 22:47

They have worked out really well. Like I said, we've been live a little bit over a year and you know we took a little time to stabilize. You know, with any go live there's always a few little hiccups, few little road bumps, and we had some data issues and mainly it was around the OR where we had moved product that was typically non-stock into a stock environment and what we didn't consider was the fact that we bought by box and we didn't need to necessarily issue by box. So we had to clean up some data after we went live, retrain some people on how to pick and what to pick, what was the pack and what wasn't. We have pictures around so people know that they're picking the right packaging unit. So we had some of that Trucking. Actually we had no problems at all with the trucking. We do outsource that. That was another win for us because it was a diversity vendor, diverse vendor, small diverse vendor that we chose for that. We also have a small diverse vendor that does our pest control as well as environmental services in the building. So we tried to build our supplier diversity program there too and we really had no issues with that. I think data was our biggest challenge Just recently, probably in the late fall, we re-evaluated just the timeline and the structure of the schedule itself and did some tweaks and changes there to try to really collapse.

Speaker 2: 24:06

We were open 24 hours. We've cut it down to 16 hours because the pick mod that we have, the technology we have, allows the team to pick faster than we had anticipated. So we can pick faster and pick really for two deliveries. Because we do two deliveries to a lot of our big units, we can pick for two deliveries in a 16-hour day. So it actually, you know, helped us to condense the staff a little bit, which then we actually didn't transition staff. We moved them over to the hospital and took on more services, like the bedside carts in some areas that the nursing team was doing.

Speaker 1: 24:38

Great, two questions. Well, one question and one free throw. What advice would you give to a supply chain leader with a great idea who has to sell that idea to the C-suite and the workforce?

Speaker 2: 24:54

Yeah, you know. I would say that you have to think through it. Think through it from not only your perspective, but you know-user, the stakeholder and even leadership's perspective. How are they going to view this? And how are they going to view it looking at every other priority that's going on in the organization? We actually presented this more than we got approved in 2019, but we first presented in 2015 and I was told no, she's not in a 10 plan, it's not going to happen. So we came back a few years later. So you have to be persistent, but also think about everything that's gone in the organization where you might fit in so that you can help to align what you're doing with what's going on, which is what we did. We said new patient hour and we need more space. Let's connect here. But also I would say you know, involve people, Go and talk and find out what the need is and make sure you understand how you're going to meet the needs and how you can really build that case for whatever your idea is.

Speaker 1: 25:52

Yeah, I always use a process where I would go. I wanted people to be happy to see me coming, not to go on. Here he is again. Building friendships is a big, big part of everything and you know you've done a great job there. I was amazed, you know, thinking how, knowing how difficult it is to get commitment to projects and to be able to do what you did, I think you've done, really done, a great job. So the free throw question is what would you like to tell everybody that I forgot to ask about?

Speaker 2: 26:30

Oh geez. I would just like to just really acknowledge and, you know, give a kudos to every supply chain person out there, because I think that people don't always appreciate what we do and for me, my experience with COVID was that we got a greater appreciation of what we do. I think our, our clinical teams, our leaders, were like wow, we didn't realize your world was so complicated. But I think I know how complicated the world is, I know how complicated our world has become and continues to become. So I would say thank you, keep doing it.

Speaker 2: 27:04

You know, I tell my whole team, you're a caregiver, you're not a supply chain person, you are a caregiver. We may not be at the bedside, but we're there in spirit and we are, you know, supporting these clinical teams. So view yourself that way, make yourself important and don't be afraid to speak up. Don't be intimidated. Find the connections. You said make friends. That's what you got to do. Find the connections, find who's going to support you, find who's going to help you. Be the advocate for the initiatives that you have going on talking to you.

Speaker 1: 27:43

It always is, but your perspective is something that I think a lot of people can get encouragement from, because it's hard. It's hard out there to be struggling with everybody else to try to improve your particular function or operation that you have responsibility for within the context of an organization that's, you know, fighting to maintain a decent margin. So I think you've been, I think this has been a great conversation. I really appreciate you taking time to be on with us and if there's anyone in your organization out there doing some things that we need to know about, let me know, because we're always looking forward to talk to everybody that can pass on some knowledge to other people. So thanks, joni, very much.