Taking The Supply Chain Pulse
St. Onge’s Healthcare Hall of Famer and industry icon, Fred Crans, chats with leaders from all areas of healthcare to discuss the issues of today's- threats, challenges and emerging trends and technologies in a lighthearted and engaging manner.
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Taking The Supply Chain Pulse
Al Johnson talks about his career in the U. S. Air Force, and the challenges he has faced as an interning supply chain leader in a rural IDN.
From his early days honing his skills in Saudi Arabia, Germany, and Japan during his military tenure, Al Johnson's journey through prominent academic medical centers in the U.S. and rural Integrated Delivery Networks (IDNs) provides a treasure trove of insights. His diverse experiences have uniquely shaped his approach to leadership and logistics, making this episode a must-listen for anyone interested in the complexities of healthcare supply chains.
Hello again everybody. This is Fred Kranz from St Onge, coming to you today from our remote facilities in Galena, illinois. Today I'm talking with my friend, al Johnson, who has had a long and interesting career in the military, working in academic medical centers, and now is doing consulting work for a smaller regional IDN, and it's very interesting the differences. So that's what we wanted to talk with Al about. Al, thanks for joining us.
Speaker 2:Hi, brad, glad to have you and, of course, someone like yourself, as someone who's always been my mentor, is glad to be aboard. How can I?
Speaker 1:help man, okay, well, why don't you just tell us about yourself, your background and how you got to where you are today?
Speaker 2:Sure Again. As you just stated, my name is Al Johnson. My background is healthcare logistics. I've been doing it, believe it or not, almost 40 years now. I'm a career, active duty medical logistics, medical logistics Air Force vet who has deployed to Saudi Arabia during Desert Shield, desert Storm, and you know. What else I wanted to say is I truly honed my logistics skills during assignments to Ramstein Air Base over in Germany, as well as during my stint at Yokota Air Base in Japan, and since leaving the Air Force, I've spent stints at, as you said, prominent academic medical centers on both the East Coast and the West Coast.
Speaker 1:And now you're doing independent interim leadership work. You know, one thing I wanted to say is a couple years ago I met General Alfred Flowers Jr. He's a brigadier general and his father was the longest serving African-American in US military history served for 47 years. But when I was going through General Flowers' resume on LinkedIn, it really showed me about the military, the Air Forces in particular how they have a plan for people who are career people, how they start, they change assignments every year and a half or whatever, to get people in different positions, different roles, doing different things, so that by the time they become senior people they've got a breadth of experience. It was pretty, pretty interesting to see that.
Speaker 2:Is that what happened to you too? Yeah, absolutely, and so when I look back at the beginning of my career, I actually started off at a very small Air Force installation in San Antonio, texas, called Brooks Air Force Base. It's the home of aerospace medicine. So essentially everything that has to do with supply chain from a logistics standpoint that supports our military flying industry or flying organizations, it all starts at Brooks Air Force Base, from the hyperbaric chambers to the centrifuge that pilots get training and spend time in Air Force Drug Detection Laboratory. There's a lot of organizations that actually start at, from a supply chain perspective, start at Brooks Air Force Base, and even though I was there during that time I was only 20 years old at the time you know, one thing I realized is that how vast supply chain is. You know, oftentimes when we think of supply chain we think it as a warehouse or a manufacturing plant that's moving goods back and forth from one point to another and end up in the customer's delivery location. But it's much broader than that.
Speaker 1:Yeah, it really is. Well, you know, you've sort of crossed what I call three different types of healthcare organizations that you work for. You've worked in the military supply chain and then you've worked for a couple of large academic medical centers and now you're working in a private, not-for-profit system. How are those things? How are they similar and how do they differ as far as supply chain goes?
Speaker 2:Well, first and foremost, I want to say the commonality is that you're dealing with professional people in all of these organizations and they're committed to the work they do, which is health care. But one of the things I do love about the academic side is, as one would understand, it's like a teaching environment. Everyone is very studious about the work that they do. They're really concerned about what does the professional organizations throughout the country state and indicate how to do things, not just from a supply chain perspective but from the clinical side as well, whereas in the military, I think what's unique from that is we have the training from day one. We have the exposure with those particular career fields and specialties that we're going to do our work in, unlike the civilian side, we don't necessarily have, if I could say this, the experience. But I think, again, there is some commonality, because in the military we get a lot of training, whereas on the civilian side you get your experience through time.
Speaker 2:And here in a rural IDN, one thing that I've learned is that the people really care about the work that they do. It's more unique than just coming to work for a nine-to-five. There are a number of individuals that are very connected, friends and family members. You see a lot of those individuals work in the workplace and they're really, really committed to the work that they do. One thing I will say that stands out, however, is I don't see the underlying depth of experience that you may see from an academic side, where you would have multiple disciplines that work in industries within a within an urban area, because you'll see individuals bounce back and forth between organizations. So they're getting a lot of experience, whereas in an urban area, typically those experiences are only what they endure at those hospitals, because their tenure is typically a lot longer at those locations than you may see for someone who's in an urban area, because they can probably get promoted and move up a lot faster.
Speaker 1:Interesting, interesting. So what did you learn from your previous experiences that you bring to your current role?
Speaker 2:The first thing that comes to mind with that question is probably people just learning how to deal with people and understanding that every organization is unique, um, and what drives that uniqueness is more likely the culture, and the culture, as one would, um could, believe, is something that has and exists, existed in the organization for a long duration of time.
Speaker 2:And my current location, for instance, in the organization for a long duration of time. In my current location, for instance, in the industry, where we have lots of coal mine industries, this health care system was built on the backs of the coal miners that work in this part of the country, with the premise that they would be able to have healthcare for themselves and their families for a long period of time. And, as we can also believe, over time, industry has changed right, and so healthcare, the way it is executed today, isn't the same healthcare system that was put into place about 50 years ago, and what I mean by that is when you talk about the level of care that one can receive from some of your insurance companies. Your pair mixes Medicare, medicaid supported insurance companies don't necessarily provide that 100% coverage for the patients today, as they may have done 50 years ago, and that is a culture that was created long ago. In many cases, those patients on the receiving end of healthcare. They believe that that should still happen today.
Speaker 1:Interesting. But as far as the supply chain specific stuff, what did you learn from the Air Force and the big places that you can bring to the smaller place that they may not have known about before you got there?
Speaker 2:With my logistics background, I think I can provide them that vision, and so when you talk about logistics, I think of it, for instance, from the point of origin, the genesis or the bedrock of wherever that product is coming from and having a lifeline all the way to the customer In healthcare, that's to the point of use. In many cases where I've seen the individuals that I work with on the civilian side, they don't necessarily understand the big picture, and what I would always try to do for the individuals that I mentor is give them like a 360 vision or viewpoint of the work, that they do not just the day-to-day work but at least two or three levels above that and get the bigger picture, and so that brings and instills with them a vision and something that they can work towards and understand all the moving parts that will make them more successful day to day.
Speaker 1:Interesting. So let me paint a picture for you. This is an imaginary picture, but I think it probably applies to where you are. You're called in to be an interim leader and everybody knows that interim means until the next guy comes in, until the next regular hire comes in. So you walk into a place, whether it's big or small and I've been a non interim leader at some places that didn't think you were going to last very long anyway. So it's almost like being a de facto interim leader. So when you walk into those places, the people that are there, as you said, are loyal people that have probably been there for many years. They've been working at their jobs. They really care about them. How difficult is it to build a team with those folks when they know that you're only there as long as it takes to stabilize things and they can hire a long-term leader?
Speaker 2:Well, fred, I think my military experience gives me a significant edge from that perspective, because I've traveled all over the world, I've been assigned to many supply chain functions. In many instances, I'm the new person on the block, especially on this latter half of my military career, where you walk into the departments from day one, you're in charge and those individuals expect that. So they expect for you to execute and carry your job in a certain way, and you expect the same for them. And what I typically do for it, too, is, instead of being someone who comes in and identify those shortfalls and things that could be improved after an initial assessment, I like to identify who is it that I have on my team.
Speaker 2:Initial assessment, I like to identify who is it that I have on my team. What is their levels of experience? What are their skill sets? Do we have any shortage of resources? Do we need additional resources? What's the current technology that may exist? All of these factors play into how I pull together a successful recipe to make that department successful. You know I'm looking at data analytics, I'm looking at reports, I'm looking at all my department leaders on the peripheral levels, those that work closely with supply chain on a day to day basis. There's a significant amount of conversation and communication that goes on, but at the end of the day, it's the people that work directly. For me, that will be the main emphasis for why that department would be successful. So it's critical to have great people around you.
Speaker 1:So, that being said, you walk in. Have you been first off? Have you been well accepted by the folks that are there?
Speaker 2:Oh, 100%, just like any other place I've been. You know, one of the things they would always tell us when in the military is when you're stationed abroad, you're serving as ambassadors right for the country that you represent the US military and so I kind of carry that same mindset with me too when I go into a new organization, no matter where it is, if it's two blocks from where I grew up in my hometown, or if it's on the West Coast, whether it's on the East Coast, and so that's the same mentality that I brought to my current role, and I think it's very appreciated.
Speaker 1:Well, yeah, and my thing is whenever, when I was with Cap Gemini, for example, we would do a lot of non-salary expense reduction projects and when you walked in as a consultant, you know they weren't looking at you in a very friendly way. They were not. They knew that someone had called you there because someone thought that things weren't being done well, and they were most excited about the time when you were going to leave, if you know what I mean, and you've been able to overcome that there, right.
Speaker 2:Yeah, so I did see some of that when I came in, but that wasn't one of my roles. It was never said that we were overstaffed and that productivity wasn't high. I think our main issues here was with the resources that we have. We didn't use those resources in a way that you see a supply chain function operate. Today, as we know, with elevating costs in the healthcare arena, supply chain has to always find ways to reduce costs and there in my particular role, there wasn't a bona fide game plan on how to do that.
Speaker 1:Have you been developing you report to this chief financial officer right that?
Speaker 2:is correct.
Speaker 1:So, as I see it, one of the things here is your role is to inform him or her on what is needed, what a well-functioning supply chain should look like, what resources are needed there, what a well-functioning supply chain should look like, what resources are needed there, what people he has now that could fill some of those resources that could be developed into those resources where he's got gaps that he has to fill, and all that kind of stuff. Is that fair to say? That's what you're doing.
Speaker 2:Yeah, for the most part.
Speaker 2:There was an audit firm that was here before I got here and they looked at the entire organization from the ground up to look at opportunities to reduce costs, how to remove waste across the organization.
Speaker 2:And just over the past two 12 months since I've been here, you know, two of the largest endeavors that we've taken upon ourselves is we've changed gpos, a group purchasing organizations, and we've also are in the midst of uh 30 days or so into changing our distributor as well, and anyone in healthcare supply chain knows that these are um initiatives that are generational in itself. You know, you don't do those very often. I'm certain that there are many individuals that have spent an entire career in healthcare and they've never changed GPOs or they've never changed distributors. I think we've been very successful thus far. When we look at our benchmark pricing, our pricing has decreased at least 15% just based on where we are today, and we're doing great things as far as getting our initiatives aligned with our distributors as well. So I'm very happy to be where we are today, and I think our CFO is as well.
Speaker 1:Great, so do you like being an interim leader? Great, so do you like being an interim leader.
Speaker 2:I do like being an interim leader because it gives me an opportunity to escalate my skills, meaning that when someone brings in an interim consultant or leader, they're looking for things to happen very quickly. So what I'm able to do, and what I actually did when I first came here, was I did an assessment of the organization, identified where we could improve when compared against industry benchmarks, prioritized those, and those are the ones that we're tackling first and foremost those are the ones that we're tackling.
Speaker 2:First and foremost. Many of those initiatives are tied to the GPO and the distributor, but what I'd like to say, too, is I'm also impacting the culture, and by doing so, what I mean by that is saying hey guys, when there is a problem or something is broken, this is the process to make sure you're successful, not just for today, but tomorrow as well. And, by the way, in health care, it's very important to communicate and connect with your clinical leadership on all things that impact patient care, because, if you don't guess what, someone's going to be knocking on your door very, very loudly and we do everything possible to mitigate those circumstances. So I have a legitimate, bona fide way of problem solving and problem resolution and communication that I think they've never seen before, and there's nothing secret about it. It's no secret sauce, but it's tried and it's true and it's very consistent, and I think it works for us.
Speaker 1:Just to give our listeners some sense of perspective how big is the system that you're working for? How many hospitals, how many clinics?
Speaker 2:It's a 14 hospital system, well over 100 outpatient clinics, and it's in eastern Kentucky and we have some hospitals in West Virginia as well.
Speaker 1:Wow. So to characterize that is. Perhaps I was wrong in characterizing that as a smaller IDN. That's a pretty good sized place with 14 hospitals and over a hundred clinics, but it is, however, more rural than urban. Is that fair to say?
Speaker 2:Very much so I would say too, fred, that a couple other things that's unique about this health system, not to say that no other health systems have their own physical laundry plant, so we do our own laundering. Every other place that have been, those services were outsourced here. We do our own laundry. So, um, in that area I wouldn't say I was green because I did have, uh, relationships with the companies that we outsource our learning with in my past locations, but, um, it's definitely a learning experience and we also have we do our own logistics. So we have a fleet of vehicles that we push around the state every day to push supplies. This is a state that or this is an organization that is represented by the steel workers. So it's always been a lot of discussion on whether or not that is the most efficient way of doing business. I'm happy to say that that's not part of why I'm here to look at that side of it.
Speaker 1:But the logistics thing is a key and one of the. This is an aside and we'll get back to my regular questions in a minute but if I were to ask somebody coming up in my time and I'm old what is the central part of what is now called supply chain, without question they would answer purchasing and contracting, because that's what it was. The whole idea was to get the stuff to where it was needed, when it was needed, and not get yelled at by the doctors. That was the way it worked, not in the military, that's way different, but the way it was in private, not-for-profit healthcare. But now I mean you just identified to me that you have 14 hospitals that need to be served over 100 other outpatient clinics. The key to being successful in what you do is at least equally transportation and logistics as it is to those other parts of the discipline. Would you agree with that?
Speaker 2:Oh, absolutely, those are the parts, too that also gives me keeps me up at night, because we have guys that are out on the highways around the clock 24 hours a day and all it takes is something as simple as a repair that's required. A truck breaks down, especially during the winter months, when there's a lot of snow on the road, traveling conditions are very hazardous. These are all things that I normally wouldn't necessarily have to deal with, but here it's unique. Yes, so the logistics operation is a very, very critical component of us being able to execute successfully from a logistics perspective.
Speaker 1:Yeah, I can only imagine. I agree. So, given the fact that you're big but you're rural, it's got to be difficult to find folks on their way up the career ladder that want to be the senior vice president of supply chain someday at either the Mayo Clinic or the Cleveland Clinic or Kaiser Permanente or UCLA Medical Center in LA. Is it tough to find people to come to work where you are?
Speaker 2:Absolutely, and I say that because, when you look at so, the closest urban city from here is Lexington and that's about three hours going west. Louisville, memphis is rather close, but still, when you look at the logistics and the difference between here and the urban areas are the most populous, of course. So those are the locations where you're going to get a larger selection of individuals from a number of experiences and backgrounds and unfortunately, we don't have that here in this demographic. It's one that our HR department I've had some, you know, brief conversations with them about it. They're clearly aware of it. But what can you do? It's a challenge that I'm sure all industries in this locality have an issue or a problem with.
Speaker 2:What we can do, or what we do very well is, people remain very open minded, right, and so when we hire them, they understand that you may not your job description from your prior jobs or positions that you have, that you've held, may not align 100 with what we're asking for, but we understand that oftentimes we need to put in the time and commitment to bring you up to speed on how we operate.
Speaker 2:You know, for instance, you know, for instance, you know and I know, to get a seasoned or grown person who's, for instance, is a buyer or who's a contract manager. Those are two key components that you had mentioned earlier when we talk about the critical areas within logistics and still to this day they're very critical. But oftentimes when we bring those individuals on board again, we have to train those individuals. So you're using a lot of time and resources that's being taken away from those that already know the work, more so when we hire someone, versus hiring someone with that experience already. But on the positive side of that, the tenure is typically very good as well. So individuals, their tenure and the time that they've been here, usually when they get in they don't leave, or if they leave, they leave the organization to move up and they stay within the organization. So it's not like there are a lot of competitive hospitals in this locality where someone else could take their skills and move.
Speaker 1:So it's sort of a win-win. Yeah, myself I had been through something similar to that. Um, I had a friend named Fred Jackson who was the president of King's Daughters Hospital in Ashland, kentucky, right, and we'd worked together at Meridian Health System in Cleveland. He was a former Navy Corpsman. I was a former Navy Corpsman. He had a position open up down there and I I, you know, I knew that I could have really made something out of it. It was ashland, kentucky, though right across the river from uh, from ohio, and uh, I was married at the time and uh, I got the. Uh, you can take this job as you if you like it, but I'm not going to go along with you. So that's the problem. You're dealing with it, isn't it?
Speaker 2:absolutely. We um, I think it's safe to say that we are prepared for it mentally. We know what we're up against, we do our best, and even our customers on the other end. One of the things that I always try to make sure that I do is, when we have new folks, I'm mindful of just letting the leadership team know that, even though this position is filled, this person is still very green. So we would love to give you that top-notch service. But understand, there are going to be some miscues very likely. But I still believe that if you over-communicate, you can fill a lot of those gaps, a lot of those service gaps.
Speaker 1:So if you were in HR and your job was to find the new vice president of supply chain for this organization, how would you sell that to someone Today, or tomorrow.
Speaker 1:Any, I mean right now. I mean say, hey, we have Al Johnson here and his contract is up and he's got someone else out there that wants to hire him. We know he's going to leave. We've got to get someone in here right now. Who do you know? And you knew some people and you wanted to talk to them. How would you sell the organization to them?
Speaker 2:That's a very great question. That's a very great question. I guess where I would start off is I would look to see if those recruiters out there could potentially solicit someone who is perhaps from the region or in close proximity and maybe offer them a package that they couldn't refuse to be able to come back home and service the region that they most likely grew up in. Because one thing I will say is, when you're in rural America and this isn't my first time living in rural America thanks to my Air Force career a lot of the amenities that you may be used to coming from an area such as some of our larger hospitals that are in urban areas, like you know when I was in LA or when I was in Baltimore, or you know times when I spent in Texas those are areas that have large hospitals.
Speaker 2:It's actually not over challenging to recruit, but here I think you have to have a certain skill set and you also have to have a great deal of resources to go after those new recruits. You know, um one of the things that we would always have when I was in the military I always wondered why, when we were stationed abroad, why we always had it seemed to have more FTE or more people, and that reason is because of the geography and the demographics Right, and so in a rural area, you also have to be cognizant, as an HR person, that you're dealing with elements that are unique, that bring unique circumstances and if you want to have an organization that's well run and you're trying to do those best in class industry best practices.
Speaker 2:Bring that knowledge and skill set to your organization. It's a very good likelihood you're going to have to reach out and reach beyond the walls of your organization.
Speaker 1:Yeah, that's true For me. I'd much rather work where you are than in LA. I can tell you that right now. To me, that place is daunting. Well, as you look back on your career, al, what accomplishments are you most proud of? Well, back on your career, al what?
Speaker 2:accomplishments are you most proud of? I would have to say that I'm just proud of being able to be a servant leader. I'm one that I could care less about any accolades that come to myself. I'm always concerned about and you do this very well, fred, and I mean it in many ways I'm always concerned about those that I leave behind. You know, I'm concerned and I care about those that want to come through the profession, that want to do a bang-up job.
Speaker 2:I think that applies to any career, field or discipline or specialty. We're always concerned about those that are coming up behind us and looking out for those that may pursue those routes in fashions that or manners that aren't necessarily viable ones. For those that do have interests and and what I mean by that is someone like myself, you know came up through the air force, military, as an enlisted person, and you know I got all of my education while I was in the military. And had I not pursued my education, or had I not had an inclination to want to be able to put myself in a leadership position, or had I not had individuals such as yourself, whose paths I crossed, to become fantastic mentors? A lot of this doesn't, just doesn't happen, you know, and so when you seek or I seek someone who has that desire, it's safe to say that you know I want to be that person that helped facilitate those person's personal goals, careers and desires.
Speaker 1:Well, that's good, alan, and you've you know, I saw that. I saw that about you from the first time I met you out in California. When we went, we met Afshin Fatola.
Speaker 2:He's our son yeah.
Speaker 1:And I had a sunburn that was so bad that I couldn't see. But yeah, you've you. That's the way you've lived your professional career that I've seen. So what do you want to talk about that I forgot to ask about.
Speaker 2:Well, you know what, fred, If I could just take a page out of your book. Like I said, you've always been a mentor of myself. For myself, I think it's been probably close to 15 years now and you've got an amount of energy that is unsurpassed by anybody that I know, fred, and it's unparalleled that someone like yourself has been going the way that you've been going. And you know, I always say to Alexis you know, I always say to Alexis, you know, fred and I had a conversation today and Fred and I talked about this, fred and I talked about that she remembers you and, um, she goes. Man, fred's still hanging in there. I was like, is he hanging in there?
Speaker 2:He's in there and he's not going to cope.
Speaker 1:now he's the coat, okay, al I know I'm old, that's for sure, but I'm not dead yet, so we got I got that going for me. Um, al, it's been a pleasure having you on the podcast. I'm glad you're doing well. I. I think that I think that this whole interim leadership thing is something that is a good topic to have talked about, and I think I think you bring out the fact to people that are out there that just don't look for these, these, these perfect jobs.
Speaker 1:Someplace you can find jobs in other settings where you can develop your career, and that's why I was asking you so much about what it's like there and how difficult it is to get people in and what what they could gain from, uh, from being there, so, al, and how difficult it is to get people in and what they could gain from being there. So, al, thanks for taking time out on a Sunday afternoon and for joining us in our remote studio in Galena, illinois. It's been great to have you on Taking the Supply Chain Pulse and hope to talk to you soon, dude, take care Likewise. Thanks, brad. Take care, buddy. Thank you for your time.
