Taking The Supply Chain Pulse
ENGINEERING A BETTER HEALTHCARE SYSTEM
Taking The Supply Chain Pulse
Barbara Strain's Journey to Excellence in Value Analysis and Healthcare Supply Chain Management
Join Barbara Strain and I as we look back on a fascinating career and life that covers a wide spectrum of experience and interests from Chicken Breeding to the development of Value Analysis from an upgrade of the Product Standardization Committee to the data and outcome-driven discipline it is today. Our discussion pays tribute to the Association for Value Analysis Professionals as they celebrate 20 years of steering the healthcare supply management ship. The conversation then sails into the storied halls of the Bellwether League, where we recall personal encounters with the healthcare supply chain's most illustrious figures and discuss the league's noble mission to recognize the unsung heroes who keep this vital industry thriving. Prepare to be inspired by tales of ingenuity and dedication that continue to set the bar in healthcare excellence.
Oh yes, we’ll talk a little baseball too.
Hello again everybody. This is Fred Kranz from St Onge here with another episode of Taking the Supply Chain Pulse. Today we're going to be exploring a topic that is interesting and has a special role in the supply chain. We're going to be talking about value analysis with Barbara Strain, who is one of the AVAP leaders and a pioneer in the value analysis field. So, barbara, we're happy to have you here. Thanks for joining us.
Speaker 2:Well, Fred, always a pleasure to talk to you, no matter what the setting is, but to have sort of a stage here with you and never know what you're going to throw at me. It's a pleasure to be here.
Speaker 1:Okay, barbara, the check will be coming right after we get done. Okay, so why don't you? You have an interesting background. Why don't you tell us about your background and your career path and how you got to?
Speaker 2:you know value analysis you know value analysis Right. So a little fact that people may not know is that I got really interested in science and if any of my science teachers were still kicking from high school they would have said, hmm, I don't think so. However, my father was in the poultry industry, was in the poultry industry the commercial poultry industry so I spent a lot of time with him learning how chickens were hatched and what all the science was behind vaccines with them, and how they actually had a computer back in the early 60s that were about as big as bedrooms were and they actually I call it the first AI because they would feed in all these nonsense cards those are things that you, you know put the little bubbles and circles into these computers and come out with these great formulas for how they could breed this chicken line with this chicken line to come out with great eggs. And then they sold all pretty good-sized laboratory. So I had taken science all through college, so I made vaccines, how to do sort of post-mortem and how to isolate organisms and a variety of things having to do with that whole process.
Speaker 2:So then I decided to be a medical technologist and to do that where I grew up in California. You had to have a four-year specific degree and you had to do a one-year training in a certified program. And all these positions in certified programs were very precious. So I interviewed a variety of them and got one of these training positions at a children's hospital. So I learned everything I needed to know about how to be a medical technologist in that setting and then decided had to decide between blood bank, which was very exciting, and microbiology. So I decided on microbiology, which was just so fascinating, and actually did a master's at some point in virology. So that's how I got started in health care and then turned to be a best supply chain model at the time in the mid-1980s. And to do that they hired an administrator who'd had experience in an IDN at the time with many hospitals and knew that you needed somebody with some type of clinical background to be there to be that liaison to clinical departments, et cetera. So that's how I got my start in healthcare.
Speaker 1:Wow, but as I you know, you lost me right at the start because you told me that your father must have been Frank Perdue. Is that right?
Speaker 2:Not really, he was a supervisor in this probably. You know, to a small child it looked really huge, but it was probably about a 15,000 square foot sort of like one of our big warehouses, like one of our big warehouses full of beautiful mahogany incubators in which these eggs would rotate, have the right temperature and stuff. So he was the wizard that kept all those machines going and what that operation kind of looked like.
Speaker 1:Wow, well, getting toward value analysis.
Speaker 1:It's interesting because my first director role was director of central processing and distribution at Baptist Hospital in Miami and I had responsibility for sterile processing, for distribution, internal distribution, for the linen room, the mail room, and I was in charge of the first.
Speaker 1:It was called the New Products Committee and then, as I went to different places, it became the Product Standardization Committee. Ultimately it became what we know as value analysis. And before I started talking to you today, I looked up the genesis, if you will, of value analysis and found out that Lawrence Miles Larry Miles at GE in 1945, founded the concept of value analysis based on the application of function analysis to the component parts of a production shop in view of the shortage of skilled labor, raw materials and component parts during World War II. So that's where value analysis and I thought that's not the way I got it, because I was in product standardization committee trying to limit the number of SKUs that the doctors were trying to get all the time. I thought a much better definition came from the noted industrial engineer, mick Jagger, who said you can't always get what you want, but if you try, sometimes you might just find what you need. And could you educate me on where I'm wrong on all this?
Speaker 2:Well, mick had lots of very good points in his life and he's still kicking today. Larry has left us, so you. So there's something to learn there. But whenever we give sort of this value analysis 101 or whatever, larry Miles is the first thing we list because he looked at everything and said how can we actually purchase parts better? How can we actually do quality in our system so we don't have waste, and so when things come on a production line they're actually fit for service? So he took sort of that value engineering, value analysis, look at things and then when healthcare in the like early 1980s or so really turned it on its head and said value in healthcare is really that overall quality that we're trying to reach, no matter what it is. So you can put whatever stamp you want on quality, whether it's an HAI or length of stay or a product or anything divided by the cost, in order to get that amount of quality. So if you look at products so that's why I think standardization sort of came about.
Speaker 2:Or even back in my day when I first started in healthcare, we were all profit centers, we weren't cost centers, and then miraculously, drgs appeared and the whole landscape changed. So you had to look at things differently. You couldn't just go out there and write a check and buy all the fancy stuff you wanted. It had to be based on a true need. And how were you taking care of patients and how could you rise to the level of I need to take care of them better? And to do that, how do I close that gap? And that's kind of the premise that you look at today. It's a need versus a want. So I grew up with product evaluation committees and so there'd be like 20 nurses and me from labs and a bunch of folks sitting around and a contract person saying we really like this, you know, we saw it somewhere, or a patient would like it and things, and we talk about it, but we wouldn't necessarily have literature or data or whatever to sort of look at it. So you mentioned AVAP way at the beginning. So I'm gonna go through a tad bit of history. That kind of reinforces all of this.
Speaker 2:So I became involved, as I said, with supply chain then back in 97. So this is not 1897, it's 1997. And they did want someone clinical and they said a nurse, respiratory laboratory whatever, just someone who knows how to talk to other clinical departments who have you know, maybe some analytical behind them, somebody who gets what we're trying to do and things. So I put up my paw and volunteered and got the job. So I was the very first one. I started to get things called emails because we did have them back then and phone calls from people like Brooke Burson at Duke and Melanie Miller at Cedars-Sinai and a few others around the country that said I have a job like yours, barbara, and what do you do in your job? This is what I do in my job.
Speaker 2:So there was some forward-thinking organizations that had folks that said we're looking at this so-and-so product and this is for cardiology and are you guys even talking about it? Have you learned about it? So this was sort of the vestiges of how AVAP got started. It was sort of a tin can and wire situation where we would talk to each other and then we started bringing in colleagues that we found from all over, from Terry Nelson at the Mayo Clinic and people in other different organizations throughout the country, and pretty soon we had a listserv that almost became spam because it was just huge. And so we did. And people on the audience won't get this, you and I will, but it's like Mickey Rooney saying let's put on a play. So it was like let's start an organization, so in 2004,.
Speaker 2:So remember, we're at 2024, so AVAP will have been in existence for 20 years this year. So we're having a fun time doing those great things but expanding what that really looks like out there, these standard sort of processes that you can build on through a lot of different educational venues, because you have to know how to talk to people, especially surgeons and things like that. So that's where we are now as this sort of big value-added process, because at our institution, not only did we look at new products, but we looked at everything we're currently using. But it involves so much data and you have to know how to interpret that data and make sure it's clean and clear and things. And then we did everything from parking to waste management, to services and products, and then standardization, but then got into that utilization per a DRG or whatever, so that you're making your own margins by doing things smarter and effectively. But so what's really needed for those outcomes? You turned on my passion button, fred.
Speaker 1:Yeah, I see I've got to explain some things to the younger folks that may not understand some of the stuff you're talking about. Number one prior to 1983, healthcare reimbursement was done on a cost plus basis. In 1983, the Tax Equity and Fiscal Responsibility Act was passed, which gave us the introduction of DRGs diagnosis, disease-related groupings, or diagnosis-related groupings in which healthcare organizations were paid prospectively based on a diagnosis as opposed to being paid retrospectively after things were done. Prior to that, tefra, every year our budget meeting would go like this Fred, how much do we need to increase our charges this year? That was it. We didn't care about cost, we didn't need to, and so that was a big deal. And the product standardization committee were always opinion-based as opposed to evidence-based, and that's another big change. So that is.
Speaker 1:There were the good old days. When we talk about the good old days, they really existed up until 1983, that's for sure. No-transcript. These are all people that I've either worked with or worked for, so that's a pretty good group. I think I've had some influence in there, you know. I can at least show them what not to do.
Speaker 2:Yeah, yeah, absolutely. Fred's always in some conversation with all of us.
Speaker 1:Oh, yeah, so as care models change. So as care models change, as we're now starting to become less acute care centered and more pushing out to the home, how is value analysis changing with those changes in care models and becoming more influential?
Speaker 2:Well, we've always tried to keep what I call in the know.
Speaker 2:Either you keep track of what's going on in the industry from continuing your education and things, or you make sure that you understand where your specific provider organization is also going, and that's really important. So we always had an ear to our executives, understanding where were we headed, where were we focused. And right now, with staffing shortages and the high cost of a variety of you name it and other things, value analysis is really critical in keeping in tune with that care, because you have to know, is your own organization establishing, you know, a hospital at home? Are they branching out and doing more home health? Are they branching out into those clinics that people would go to in various communities and geographically going out? Are they partnering with other companies or other organizations and establishing sort of minute clinics or whatever you want to call those dock-in-the-box type places?
Speaker 2:You have to know all that because what you're trying to also do is drive patients, when they do need acute or critical care, to your larger organization all along that, and when you do, you don't want them to show up at the ED and then they have to, like take out various catheters or insert their own or do a lot of other work. You want that streamlined thing, so value analysis is very critical in getting all those areas to sort of think on the same plane and really understand how what they do at one sort of ring around that circle from the patient has a ripple effect all the way. That could be detrimental to the patient, unless you're thinking of them all the way front and back across that continuum.
Speaker 1:So it's an increasing importance and increasingly involved. Just for an overview for folks, one of the big things about value analysis is and I was joking about we both sort of joking about the product standardization committee but controlling the number of storekeeping units, the number of items. In the 70s, when I started in supply chain, you'd have three different kinds of exam gloves. There's no need for that and because the doctors could, they got what they wanted. And when we do our work at St Onge, which is designing workflow, optimizing spaces and all these types of things, guess what? What's important? We're dealing with storekeeping units. So the better work that can be done to make decisions about the storekeeping unit leads to better things that we can do for our folks when we're in those areas.
Speaker 1:I want to switch to an entirely different thing. I know, Barbara, that you're an active leader in the Bellwether League. The Bellwether league is the national healthcare supply chain hall of fame and it includes uh, three different awards bellwether awards, the amber award and future famer awards. Tell us about the bellwether league, your role there, and it's important in honoring the past and helping us to inspire supply chain leaders of the future.
Speaker 2:More than happy to talk about the Bellwether League, so you're going to poke another passionate topic for me. I first learned about the Bellwether League at least 10 or so years ago and at some point in an arm meeting a live arm meeting there was a panel that was called the Bellwether Panel, and so folks that had gotten these honors through the Bellwether League Foundation did a whole panel discussion on some very prevalent topics and things and I said, oh my goodness, these are people that I have looked up to and now they're here, and it was like I was a groupie and I wanted autographs and that sort of thing.
Speaker 2:And what I've learned about the Bellwether League through those who have been honored in things is I actually got what I call the phone call one day it's been three years ago now and they said you have been not only nominated but you have been awarded a Bellwether honoree, and people that know me. I was speechless. I also don't cry very easily. I'm a tough nut and boy. It was like what it was like you like me, you really like me Sally Field moment. But seriously, it was just such an honor to be considered with names that have gone back through the history of supply chain. I was additionally honored when they asked me to do some interim leadership in the organization last year. To do some interim leadership in the organization last year and then they decided to keep me around. So I'm the current chairman of the Bellwether League this year and I'll throw it back to Fred's been very active and involved longer than I have with. You know, honoring certain individuals and things. But we really look at how do we look at providers, suppliers, gpos, distributors, academia, media and consultants. We all get together to do supply chain effectively, whether it's at that value analysis or the storekeeping units, from what I call the cradle to grave of products and how they affect the healthcare industry. So we look at folks in all those categories. So the future famers are those in their first years, up to about 12 years, and doing some amazing things, whether it's learning about AI or instituting certain things. The ammers are in that medium sort of between 12 years and 25 years and I tell you we don't give out many of those, but it's what they've specifically given as something so unique to healthcare supply chain and healthcare in general that it helps to elevate healthcare very disruptively or innovatively. To elevate healthcare very disruptively or innovatively, and COVID itself had a lot of opportunities for so much of that, and that Bellwether honorees those that have spent 25 years or more in healthcare supply chain in those areas that I mentioned.
Speaker 2:We go all the way back to Clara Barton, who knew how to get supplies out to the field during wars so that they could be able to bandage and, you know, heal those that were wounded, all the way through the vestiges of what we know today as inventory management and some of the vestiges of even some of the first you know, either computers or some sort of automated way of doing business, to things like Kanban and a variety of stuff, but a lot of that.
Speaker 2:I've read every single biography that's online at bellwetherleagueorg and I've read them all and it's amazing that even through the 40s and 50s and 60s, there is so much history that has laid that foundation for us to be able to stand on their shoulders and to do the great things that we're doing today and continuing.
Speaker 2:We're now infusing more of the current generation and the future generation by partnering with academia supply chain programs around the country that may or may not have a health care edge to them, but we're going to them and we have various bellwethers that are adjunct professors or give talks there, but we've partnered with them with a program we called the Capstone Project, in which those students get an opportunity to partner with a provider and potentially a supplier and really work on real-world issues through the way in which they get master's and PhD programs for their students and things. So, yeah, I'm very passionate about this, this and we continue to grow and build on those foundations and become more diverse in what we do, and we just want everybody in healthcare supply chain to know that we're just not an award organization. We're a rewarding organization for healthcare supply chain across the board.
Speaker 1:Well, that's great, Barbara. I couldn't have said it better myself. I'm so glad you said that. I think the thing that I really feel passionate about and important is the future famers. We need to be able to acquire and retain and grow people in what is a mission-driven and not a profit-driven lifestyle, and the Bellwether League can help with that. Two things left. Number one I know that you're a big baseball fan and I'm wearing this today. For those of you that can't see through the non-picture on the audio, I'm wearing a Brooklyn Dodgers hat. I had my friends over this morning with their dogs, as usual, and they're all the youngest one's 52. And I said do you know what hat this is? He had no clue. That's bad, but you grew up in the East Bay, so so East Bay is like code for Oakland, right?
Speaker 2:Well, oakland, san Francisco, that kind of stuff yeah. Bay Area, east Bay, that whole thing yeah.
Speaker 1:So what was your favorite team growing up?
Speaker 2:Growing up I had an aunt, my mom's sister, who was such a sports nut. She had season tickets to the Giants and this was when they were at Candlestick Park before they closed it in on the center field. So the coldest day you ever spent in San Francisco was August, during baseball season. During baseball season, so when I was 10, which was just a few years ago she would take me to not every game but enough games that I just fell in love with baseball and so we would listen on the radio. They started coming on TV but going to games. There's nothing like it. Willie Mays in central and center field and Juan Marichal pitching, orlando Cepeda all these folks. So I grew up with the Giants until the A's came across the bay, as you said, in Oakland. Now you have to know that Oakland in 2027 will be moving to Las Vegas, so don't think they're going to be called the Oakland A's anymore.
Speaker 2:But I went to some of those games that were a hoot. Charlie Finley was just imaginative and he even had a rabbit that would come out of the behind the umpire with the balls for the umpire and then they go back into the ground and all that sort of stuff. So I became a super baseball nut early on. Then I went to games when they closed in candlestick. It made it tad warmer, not much. And then I've been to the new park in San Francisco. That's downtown, and wherever I go to a meeting or we go to vacation we try to plan it around ballparks. So I would count it up because I knew Fred would ask Not been to that many, but we've been to 14 ballparks. Some of them are repeats, because we went to the old park, then we've gone to a new park, but not many of those. So we've gone to 14 and we're on track here to do another three or four over the next year or so wow, that's cool.
Speaker 1:A couple things about that is. Uh, candlestick park probably cost willie mays from breaking bay bruce record because, uh, the winds out there were so terrible. They used to have this little pitcher named Stu Miller and he literally got blown off the pitching mound during a ball game out there one time. And the second thing is Mark Twain once said the coldest winter I ever spent was a summer in San Francisco.
Speaker 2:Yeah, so I turned that into a baseball game. Sitting out there you had to bring every sweater and blanket you owned and you're sitting out there in august and that wind did come from the bay through center field towards you. So, yeah, there was a lot of interesting things, but it was the days when a pitcher pitched the whole game. There was no free agents. You knew you're going to see those players and stuff. So now we're down to we have a not advertising for MLB network, but we now have MLB and every night we go through and we watch where everybody is on the games and it's just a great sport it is, so final thing is a free throw.
Speaker 1:What would you like to talk about that? I didn't ask.
Speaker 2:You know I was thinking about that. Of course you're talking free throws in its NBA season and stuff. We used to watch a lot of that. But I'm thinking that in health care I'm just going to go with the free form about health care because I'm just still so passionate about it, even though I retired five years ago and I'm still working with suppliers and providers.
Speaker 2:These days is especially since COVID. We have to capture all that innovation and the fact that we did things in a. This is what we can get to fill our needs. But we're kind of turning back a little bit more to the, you know, putting more money out there and maybe not looking at those things as much. So I just like to continually sort of bang the drum that we have to be vigilant and diligent, but you have to learn about everything that's going on so that you're not like organizations having to say we cut 1,000 positions last week, we're laying off 50 people, 100 people, but it's going on across the whole industry. So it's very difficult now to really keep following that bouncing ball almost every single day. So stay diligent, learn as much as you can, support those who started in the industry and then just go out and keep making it better and better.
Speaker 1:Well, barbara, that is great, and I want to thank you so much for appearing on our podcast. It's always a pleasure to talk to you. In fact, I enjoyed it so much I think I'll probably be talking to you again in another hour and a half.
Speaker 2:All right. Well, take care then, Fred, and thanks so much for all you do for healthcare supply chain.
Speaker 1:Okay, everybody, and we'll see you all next time when we will be taking the supply chain pulse. Thanks, and have a good day. Take care.
Speaker 2:Bye-bye.
