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
Unlocking Healthcare Efficiency: Sherri Mason on Nursing, Supply Chain Integration, and The Impact of COVID-19
Unlock the secrets to transforming healthcare delivery as we sit down with Sherri Mason, an experienced nurse practitioner with an inspiring career that spans from paramedic to her significant contributions at Space Coast Volunteers in Medicine. Ever wondered how supply chain management can directly enhance patient care? This episode is a must-listen as Sherry shares her unique insights on the crucial role of collaboration between clinical staff and supply chain professionals, particularly during the unprecedented challenges of the COVID-19 pandemic.
Learn how eliminating outdated procedure cards can revolutionize perioperative care, reduce waste, and boost operational efficiency. Sherry explains how switching to efficient systems with procedure and preference cards tailored to individual surgeons' needs can enhance both purchasing power and care delivery. By fostering a strong partnership between supply chain and clinical teams, organizations can ensure these systems are comprehensive and highly effective, ultimately leading to streamlined processes and reduced costs.
Discover innovative strategies to optimize surgical workflows, improve the utilization of electronic medical records (EMRs), and minimize disruptions in the operating room. Sherry emphasizes the importance of integrating supply chain stakeholders into clinical discussions and leveraging technology to reduce administrative burdens on caregivers. This episode also highlights the transformative potential of quality data and academic partnerships in managing healthcare supply chains, suggesting practical ways to prevent case cancellations, avoid rush orders, and maximize operational efficiency.
Hello again everybody. This is Fred Kranz from St Onge coming to you today with another episode of Taking the Supply Chain Pulse. Today we're happy to have with us Sherry Mason, a person who brings a wide variety of experience and training in the healthcare field, to discuss the importance of the supply chain at the point of use in key areas like surgery or the bedside and places like that where the work that the supply chain Medicine in Melbourne, florida. That's interesting. Can you tell us about that? What is the Space Coast Volunteers in Medicine?
Speaker 2:That's interesting. So my clinical side is I'm a nurse practitioner and so when I stepped away to take a little break this summer, I had learned a few months ago about a volunteer-led clinic here in Melbourne. So it's sort of a catchment between those folks that are eligible for Medicaid, or children who will be eligible for Medicaid and pregnant women, and then there are those that are eligible for Medicare and those in between may be working but even the premiums that are on the affordable care market are just too much for them to afford. So this SCBIM, space Coast Volunteers in Medicine, it's a nonprofit and it provides health care to those folks that are in that middle area that just can't still afford premiums for health care. So it's all volunteer providers, it's volunteer pharmacists, nurses and front office staff, and we also, our pharmacists, actually also run a lot of patient assistance program, sort of fielding, so that they can get a lot of medications that those patients need. So we can provide as much as we can to them at no cost.
Speaker 1:Excellent, so you're providing assistance to a group that sorely needs it. Really, that's great. So tell us about your journey from where you started to how you ended up in Melbourne Florida.
Speaker 2:I'll try to condense that as much as possible. It's kind of a big journey, but I started out as a paramedic many years ago. I've been a nurse for 30 years, a nurse practitioner. I've worked in a number of types of hospitals. My spouse was military, so we had several moves. I worked in the emergency room, critical care areas, academic military hospitals, community hospitals. I even did some case reviews and litigation support for big class action litigation trials. And then for about the last 11 and a half years I worked for a large health care consulting firm in the United States and many of the initiatives that I work to provide advisory and consulting services for were around peri-op supply chain.
Speaker 1:Very good.
Speaker 1:You know I'm writing an article today I just started it.
Speaker 1:I'll probably have it done by tonight, but I'm hoping to get some material for it from here called the Healthcare Supply Chain Backwards from the Bedside, and I think when you look at the supply chain, you really want to start your looking at it from where it ends, which is at the point of care, which is where everything that you know it's both starts there, because that's where demand is created, where you identify what you need for the patient, and it ends there when that care is rendered right.
Speaker 1:And part of the focus of the article is that the pandemic we had in 2019-2020 really decimated healthcare in the sense that it wore out a lot of people. It caused many people who weren't trained who were trained to treat people and get them well, and had to deal with scores and scores of people dying in their care. That just overwhelmed them and a lot of people left, and we're stuck now with trying to find ways to acquire and retain people, and a big part of that is how can you make someone's life easier and the care better at the point of the use, and how can supply chain have an impact on that? So, based on your experience both as a caregiver and as a consultant, where do you see opportunities, either in regular nursing unit patient care or in perioperative care, for things to be done better by the supply chain that can make it better for those rendering care?
Speaker 2:Oh, I think there's a big yes in there. So, yes, there are opportunities. And back to your point about some of the downstream effects from COVID. Unfortunately, we still have to talk about that, even though a couple of years have passed. Right, it even took out some schools that were training those people that we would want to fill the positions that have since been left because of that burnout you described. So we're at a disadvantage that we lost people, but we also lost the ability to train people to fill those positions.
Speaker 2:Right, so what we're left with are the people that have really made it through, you know, the pandemic and they've stuck with it. And I think that one of the biggest things that we can look at is ways to enhance collaboration between the clinical folks and the supply chain spectrum. There can be a little us-them kind of thing, because they are very focused and dedicated to their role and not necessarily always appreciating the role on the other side of that supply chain piece. So I think bringing them together and creating much more of a partnership between supply chain and clinicians would be a really worthwhile endeavor for any organization.
Speaker 1:Yeah, I know I think that's one of the things that you and I share is, you have been a caregiver. I started out as a Navy hospital corpsman with the Marines and I had seven years of caregiving experience before I had one day of management experience in supply chain and I knew what the work I was doing in supply chain, where that was going to and how that was going to be used. Once it got there and too many times people are only trained in one end or the other of that chain and that leaves a great deal of misunderstanding or finger pointing or whatever. How have you seen people form teams that work together to improve that?
Speaker 2:Well, that is really a great question. Some of the projects that I'm most familiar with in the last few years were they kind of centered around preference cards, where we were able to build up those teams that would the workflow that they were going to be utilizing to provide the supplies necessary for the case carts and to get them into the ORs. And we also needed, on the other side, we needed the support of the clinicians to tell us how we were going to address changes, to tell us how we were going to address changes. And one of the organizations that we did work with employed, for one example, they employed a liaison so, and that was a full time position, it was like maybe two.
Speaker 2:There were two FTEs and it was either it could be a supply tech, it could be a surgical tech who was, you know, not not working at the bedside any longer, but that was the person who connected the dots between, hey, we didn't get these things on our carts and this is becoming a problem for this procedure, or hey, you know, the supply chain is like, well, we're not getting these order requests for replenishment in time to get them where they need to be order, you know, requests for replenishment in time to get them where they need to be. So this liaison was sort of the go between the departments to help smooth that out and they had great success with that. And then other ones were kind of similar roles that they made this intermediary role to improve communication between those the different areas, and I think that was very effective. I'd like to see that a lot more, I think, in big organizations especially.
Speaker 1:Yeah, interesting. You talked about preference cards, and a phrase that comes to my mind all the time is you have time to do it over. Why don't you take time to do it right? You have time to do it over, why don't you take time to do it right? And with preference cards, I think we talked a couple weeks ago and I said that I'd done a project in a Midwestern hospital that had I think it had really over 20,000 preference cards, and when we were pulling cases, I was supposed to go in and shadow people while they were pulling cases.
Speaker 1:And the people that were pulling cases, they completely ignored the preference cards because they said, oh, Dr Smith is doing this procedure and she uses this, this, this, this, this. I don't need the preference cards. And then, at the other end of that spectrum, at another place, 45% of the supplies that were being sent up to surgery for cases were coming back unused. That doesn't count the ones that they threw away, that's just. 45% was coming back unused. And we made recommendations there and 20 years later I found out that they've got that number down to 42%. So when you look at those opportunities saving time and making it easier for people is one thing. How do you go about improving that, Because that's one of the most essential elements of the whole supply chain activity in perioperative care.
Speaker 2:Yeah, preference conferences. It's a hotline, right, it's the critical communication piece between those two areas and sort of the. The general project design we would always begin with is getting rid of all the obsolete. You said twenty thousand. We've seen seventy thousand cards. So when you look at a number, the first thing you just say is well, you have 70,000 cards.
Speaker 2:That's really indicative of a big process problem. It hasn't been maintained, they haven't been reviewed. There's no way you're pulling the right one. You probably have 50 of them for the same procedure now and it's not even the right position anymore because of you know turnover procedure now, and it's not even the right position anymore because of you know turnover um. So you get rid of the garbage, you know you. You pick your parameters, you know how old are they going to be, are going to get rid of? Are you going to inactivate the ones that are more than 12 months old? You know that's except for emergency cards, right, that's a. That's a really good line to draw. Some, some, aren't as comfortable with that line. Maybe they go 18 months or 24 months. But then there's a.
Speaker 2:There's a big push and a really good push going into these larger organizations where they're looking at procedure cards. Sometimes the physicians that have been in practice a long time they kind of bristle at that notion just a little bit, because that takes away my preference to do my procedures the way I want to do and at least that's their initial thought and it really isn't. That isn't the intention. It is to create a more streamlined process. It's not necessarily withholding what they would prefer to use. Withholding what they would prefer to use, it is just not delivering everything for every procedure, which creates that 45 percent supply returns that you get every day. Would you rather have your supply chain staff doing more meaningful work than being a restocker?
Speaker 2:And that's really what it comes down to. So there and you have a lot of dead inventory, you have people overstocking, you know the bins and the OR with stuff instead of sending it back to be put away. Then you result in results in a lot of expired product, a lot of damaged packaging which, as you know, if it's damaged it has to be discarded, right. So there's a lot, of, a lot of benefit to cleaning those cards up, and there's also a ton of benefit into moving as many as you can to a procedure card, a base card that you that you launch from every procedure and there's no confusion when you have 60 travelers, about which of the 20, 20 surgeons does let coley's, how do I set it up by rote, because the person training me doesn't. They don't trust the preference cards anyway, so they're not really telling that 10th person oh, go, look at a preference card. It's always right, but you've never heard that before.
Speaker 1:You're right. So a procedure card? Just for people out there that are trying to sort of grasp this, it may not work in perioperative care. A procedure card is something that would probably always be used in a procedure where a preference card is the stuff that Dr Smith wants to use but Dr Jones doesn't want to use. It's the extraneous stuff. The extraneous stuff, I mean the procedure card might have 90% of the stuff that's there and the preference card is a 10%. That's used not every time. Is that fair to say?
Speaker 2:Yeah, exactly, but the key to it is that that procedure card isn't created without input from the surgeons.
Speaker 2:It isn't something you want your supply chain folks to go and, you know, put a bullseye on their forehead over, right? You don't want your supply chain people to go and make all those decisions in a vacuum. This is another place where you talked about collaboration between supply chain and clinical people. This has to be a conversation that we would always start with sort of the easy mark stuff at the beginning. You know the trays and the, you know the minor disposable items or whatever, and then we need to bring the surgeons in and they need to do some collaboration and maybe some negotiation and streamline them, because that helps to make the processes in the OR more efficient. But guess what else it does for supply chain? It will improve your contracting power because now we've narrowed down the number of the preference items and you might be able to eliminate a couple of vendors in that space, which will help, you know, with your purchasing power. So a lot of benefits in moving toward procedure cards.
Speaker 1:Yep, and you know at St Onge our expertise comes in managing and optimizing processes. And one of the big things about process if you're looking at black belt languages, muda, the waste, the stuff in there that causes problems, and getting that stuff out of there by taking the time to work together is a key thing. The other thing in surgery tell me if I'm wrong, as a nurse is number one you want to have. You want to have the maximum number of cases that you can get done effectively in a day and number two you want to have the minimum amount of disruption of the staff having to do rework. Is that fair?
Speaker 2:Yes, because that's exactly right. And imagine if you could refine your process in each of, say, 20 ORs and you could get one more case per day in there without wearing out your staff. What would that do to your revenue? Yeah Right, what would it do to not delaying patients their procedures? They you know some of those patients may be suffering because they can't get on the schedule soon enough. You know that improves their satisfaction. It improves physician satisfaction. So all around, it's a great idea to improve the OR processes.
Speaker 1:Yep. Well, let's go into this just one step further. From your experience, from my experience, as you know, a really old guy that's been in the healthcare supply chain, I say this, I'm not joking, I'm not demeaning myself anyway, but the door to the perioperative supply chain was always closed to us and often closed on us by people that were upset. The person that was in charge of everything was the director of the OR I'm going to say she, because it was almost always she and RN that was reporting to and taking the beating from the physicians every day, that communicative bridge to start being able to address those supply chain issues that need to be dealt with, to improve point of care.
Speaker 2:I think anytime you are creating a project an internal project or one that you're going to work with a consultant on either way is that you make sure that those stakeholders on the supply chain side are included in the discussions around the clinical projects they have. Giving them line of sight, making sure they understand what's going on and why they might see different things coming, you know, in their communications or requests, really can help alleviate some of that confusion, really can help alleviate some of that confusion. I think that it's also important. You know we were on consulting side, we were remote long before COVID and then we were more remote but you don't get the luxury. Really important to know.
Speaker 2:Hey, I know that Fred down in supply chain knows where everything is and I just don't know what this thing is called in my system. I can call him up if I'm having trouble looking up something I need to charge on the case. You know Fred's like hey, sherry is up in the OR and I'm not quite sure why they're asking for this thing today, because I only saw in the schedule these cases. You know, maybe I'll just ask her what's going on up there. That's different. Knowing that there's like somebody that you can call. Having relationships established is, I think, could be very, very beneficial.
Speaker 1:Yeah, I couldn't agree with you more, and I think that was one of the things that I took on myself as a person that was in management was to break down those doors and go in and talk with people just having conversations, so that when they see your face they don't go, oh no, here comes that guy, they are going hey, you know, let's talk about these things. So if you get to the point where the people at the point of use come to you before there's a problem, asking for help, then I think you've accomplished a lot.
Speaker 2:Yeah, how much time did they save fumbling around trying to figure it out when they already knew who to go to?
Speaker 1:Yeah, exactly, exactly. So as you look at once again, the point of view is get to the patient in a room. Another thing there is what kinds of things happen. I saw a report that said as much as 40% of our average caregiver's time every day was spent doing administrative processes that had nothing to do with rendering care to the patient, and a lot of that was in supply chain. Maybe it's accounting for supplies that have been used, finding stuff that they don't know where it is. How could the supply chain improve work satisfaction and effectiveness at the point of use in those areas?
Speaker 2:Utilize the technologies that are out there. There is so much technology that is really underutilized. There is so much technology that is really underutilized. One of the things that I kind of learned over over developing these different projects of the years is that you've spent, as a hospital system, millions and millions of dollars in an EMR Right, just for one example. But every time you turn over a new person into a department and they don't get full training on the capabilities of that EMR, they're just they're using like 10 percent of its brain. Essentially Right, they say we humans only use 10 percent of our mental capacity. I think that happens a lot. So I think that ensuring you know ongoing training and education, making sure people who transfer over they, they use their different technologies to the full capacity, scanning supplies in and out, all of them, as many as and things that nurses are, we always have a big heart.
Speaker 2:You know we we don't want to think we're scanning more stuff on the case because it's going to rack up the patient's bill. That really isn't how charging works. You know, when you scan stuff in, you're telling supply chain I use this thing, bring me another one, right, so you know the charges. I would love it if clinicians were listening to this to say, clinicians, all the charges that you put in there, they don't increase the bill, the charge for that procedure has been set and you're not going to change it, no-transcript.
Speaker 2:So scanning, that scanning returns in when you send stuff back. Click, click, click, click, click. I'm putting these back in my case cart and it's all going back and it's all going back and associated with that patient record. So we know where things are coming and going and it may seem like you know an extra burden, but it's another one of those activities that I believe that once you've gotten used to doing it, it just becomes rote, it becomes part of your part of your normal. You know your natural process and that motor, that muscle memory, and would really improve accounting for supplies.
Speaker 1:Yeah, and it's interesting because number one, no matter how easy you make it for people to do their jobs and no matter how much you respond thoughtfully to their needs and requests, there are going to be people that see the product that wasn't used and they see the wastebasket and they choose the latter instead of doing the former work necessary to put it back in, instead of doing the former work necessary to put it back in. I've seen that too many times myself, but you know that's the way it goes. Our job is to try to make things measurable so that we can find out what is effective care. That's. Another thing about the measurement is how many of something is used, how you know, just to be able to tie product usage to outcomes, all these things in quality outcomes. And I don't think a lot of times people we communicate that well enough. They think that we're just, you know, we're just trying to put the thumbs down on them to control costs, which is not the case at all. It's entirely different.
Speaker 2:No, and I love it when I'm trying to look for supporting data to build a new project design and I go out and I find a very forward-thinking supply chain group who, at whatever IDN, is like, hey, this is a problem, we need to study it, and they actually do a really good study design and they pull in.
Speaker 2:Maybe they're they're usually from academia, you know, from university related systems, and they'll get their statisticians involved and they'll get, you know, some really good quality data and measurements done and they publish data and measurements done and they publish. But I can't tell you the number of times I was really wanting to solve a problem and I can't find any of the any supply chain related studies. I would say, hey, call to action, anybody's listening. There is lots of room for you to to go out and look for data and the more technology tools you have, the more measurements you're learning and the more studies that you're doing on your own to publish. I mean I think that's helping everybody. That's like a really great place. I think supply chains can beef up their participation in health care.
Speaker 1:That allows us to do a better job of forecasting demand, of reducing unnecessary supplies, of getting things to the people that need to use them when they need to use them correctly, eliminating those people from having to do rework, and it all gets down to just being able to accurately record usage.
Speaker 1:As I said at St Onge, we do an awful lot of process flow projects and the part of the process flow depends on being able to clearly identify the process so you can know that you're improving it. One thing we didn't talk about and I talked about that system in the Midwest when about 2000 is about 25 years ago now these folks knew that they they had a tremendous amount of obsolete supplies. They had and I'm not making this up they had a huge room full of stuff but it was all inventory items and surgery and inventory is carried on the books as an asset until it is used and then it becomes expensed. So literally in this hospital for years this room just kept getting more and more filled up because they knew that if they threw it away they're going to take a big hit on their bottom line. And the point I'm trying to make is what we've talked about is if they, if they accurately recorded usage, they knew what was going on, they wouldn't have had this problem with these obsolete items that had to be tossed away.
Speaker 2:Yeah, absolutely.
Speaker 2:One of the things I think that I'm hoping is coming soon I've been working with a couple of other leaders in different supply chain supply areas is to try to put together a way to get a more complete view of all of the inventory that seems to be playing hide and seek between the OR and supply chain.
Speaker 2:We have a ton of technologies and it's kind of like supply chain and clinical sometimes. Sometimes it's hard to get them to talk to each other. Well, our technologies aren't really any different. So we're working on an opportunity to try to get those technologies to learn to talk to each other better, where we can pinpoint where all those items are, when they are, and what we need to order and what we shouldn't be reordering just because we're not sure where it lives right now. So you know the cost of rush orders, the cost of case cancellations when you don't have what you thought you had. You know rebuilding case carts, upsetting your favorite surgeon. You know there's a lot of real costs and a lot of sort of tangible costs that go along with those kinds of things happening too. So nobody wants to be out of stuff but at the same time you don't want pallets of stuff that you're not going to burn through before they expire either.
Speaker 1:Right that upsetting your favorite surgeon sort of sets the stage between defining the difference between cost and price. Yes, you pay a price for upsetting your favorite surgeon.
Speaker 2:And the cost of it may be your sanity by the end of your shift.
Speaker 1:Oh yeah, I mean I don't know anybody that I've always had a great deal of respect for the perioperative care folks because they are in a pressure cooker every day, every 40, 50 times a day, it's every procedure is potentially something that can go wrong.
Speaker 2:Now they go to the ER and the OR and the ICU because they like pressure cooker. They like, as they used to call it, running around with my hair on fire. But nobody likes to do that every minute of the day and nobody likes to be doing that just because they can't find stuff. They want to be able to rescue people and what we want to tell the supply chain people to engage with them is that they are as big a part of rescuing that patient and saving lives as the person holding the scalpel.
Speaker 1:Yeah, and you know, I think what would be a sort of a low cost, easy thing to implement in a lot of places is provide some time for your supply chain folks to go upstairs and gown up and stand around and watch what goes on sometimes to get an idea of what the other folks are doing, why they might get frustrated and yell at you sometime. You know what I mean.
Speaker 2:My favorite tactic was to add those liaison people to the huddles every morning in the OR, but I also think it would be just as important as part of the orientation of new OR employees is to go and walk behind the case. Card builder.
Speaker 1:Right, right so.
Speaker 2:I think that's very useful.
Speaker 1:So, Sherry, what would you like to talk about? That I forgot to ask.
Speaker 2:For the projects that I've always been a part of, whether I was called in to be a participating consultant or I was doing the project design and the project lead. I think what's really important is what we talked about with actively engaging both sides of the supply chain spectrum. But we know that these organizations we work with they have the talent to work through big projects and complex projects. What they don't have is the bandwidth, especially with staffing challenges. Don't be afraid to bring in a consultant, whether it's me or it's fred or it's what, whoever, whatever you know consultancy that you're working with, don't be afraid to bring someone in and let them help you set up and guide it and keep it on task. We know that your people are smart, but I think that you probably want them at the bedside as much as you would like to have their input. So you can have the best of both worlds if you bring some other folks in to help out. That's great.
Speaker 2:Yeah, I've seen a lot of the big organizations take on a project like you know workflows or supply or your preference cards or whatever and they'll get them started and they really know what to do. They just can't they can't find the time to follow it through and get it done in time. So it is really important to just acknowledge where your bandwidth limitations are.
Speaker 1:Yep, when your demand is taken up as 120% of your resources, you don't have time to add any extra things to it. The one thing I would differ from you on is I wouldn't hire Fred as a consultant anymore, because Fred hasn't been consulting for a while. I would hire St Ange to help out in a heartbeat, but not Fred. I'd leave out of the mix, I think.
Speaker 2:But Fred still brings a lot of value to all this, so we all appreciate you.
Speaker 1:Well, Sherry, thanks so much for joining us. It's been a pleasure having you on our podcast and I hope to be talking to you again in the future. I'm pretty sure we will, okay, take care, thank you so much. Bye, thanks Bye.
