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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We provide comprehensive planning and design services to develop world-class facilities and highly effective support services operations. Our capabilities in hospital supply chain consulting include applied industrial engineering, lean methodologies, systems thinking, and operations research to enable improved patient care and staff satisfaction. We are proud to have worked with over 100 hospitals, including 18 of the top 22 in the US, utilizing diverse design strategies, post-construction implementation, and change management.
Taking The Supply Chain Pulse
Innovative Approaches to Healthcare Facilities: Eddie Egea's Vision
Could drone technology be the key to revolutionizing hospital supply chains in disaster-prone areas? Join us for a compelling conversation with Eddie Egea, the VP of Regional Healthcare Market Sector at Leo A Daly, who shares his fascinating journey from San Juan, Puerto Rico, to becoming a leading figure in healthcare facility design. Inspired by his mother's battle with cancer, Eddie delved into healthcare architecture, and in this episode, he discusses the importance of data-driven decision-making in hospital planning, as well as the crucial role of user interaction at the initial stages of design.
Hello again everybody. This is Fred Kranz from St Onge with another episode of Taking the Supply Chain Pulse. Today we have Eddie Egea. Eddie is I have to read this because it's the most complicated title I've seen lately the VP of Regional Healthcare Market Sector, leader for Leo A Daly. Did I get that correct, eddie?
Speaker 2:That's correct. That's correct.
Speaker 1:I've met Eddie. Eddie saw me with my Miami pants on and Eddie is a Miami resident and he was impressed a couple years ago and we've been friends ever since. So it's a pleasure to have you here, Eddie, and, as I said to you just a second ago, we're going to be talking about something I know absolutely nothing about today, so I'm going to count on you to clue us in and sort of help lead the conversation.
Speaker 2:Absolutely Happy to be here.
Speaker 1:Okay, well, tell us about yourself, eddie, your background and the path that you've taken to where you are today.
Speaker 2:Well, fred, pleasure to be here with you and thank you for inviting me to be part of this. You know I recall meeting you and you were a strong representative of everything that is University of Miami. And you know I am also representative of everything that is Clemson, which is my alma mater, which I decided to attend after growing up in the most beautiful place on earth San Juan, puerto Rico. And while I was wrapping up my undergrad studies, one of my buddies was sharing his insight on what it is like to be a student at the graduate program for architecture and health at Clemson, and this happened to be at a moment in time where I had learned about my mom being diagnosed with cancer and just I was just, you know, sharing the situation with my buddy. Sharing the situation with my buddy, he says, you know, you don't have to search any further to be able to help people like your mom continue your path of architecture and focus 100% on healthcare facility design. So I decided to get a master's at Clemson University for healthcare architecture, one of the very few programs in the country. It's a two-year program. It was only a two-year program back then. Now it has a PhD with a strong emphasis on research, which I am involved with often because I like to bring the folks from the Center for Healthcare Design and Testing into projects and to me, every project has to be based on data and factual research. So I've dedicated my career to working on the front end and people ask me what do you mean by front end planning or front end campus planning or design?
Speaker 2:And that is when I graduated and started my first project, my first job with a firm in Ohio called NDBJ, working under Dennis Brandon and Peter Bartwell, two veterans of the industry. I often ask you know, why does this hospital have a unit of, you know, of 20 beds per floor and why does the X-ray department, you know, imaging department have two X-ray machines and not five, for example, x-ray machines and not five, for example? And they said well, everything's based on data, workable utilization, analysis, flow and how you integrate all that with the delivery of care and materials, management and the ideal patient experience. So I became very curious as to why. I became very curious as to why the decisions were being made and how and these two gentlemen, dennis and Peter, took me under their wing and brought me to every single client meeting.
Speaker 2:I'm just a kid, you know, fresh out of grad school, and while others were still at the office drafting and producing CDs, construction documents, I was being brought in to be part of that dynamic, that workshop, that interaction with the users, trying to collect data, analyze it and then develop a program and subsequently layouts and concepts. So that's what front-end campus plan or front-end healthcare designer is all about. I could talk for hours about it, but that gives you, that should give you, a glimpse of it, while others are focusing on, you know, detailing. You know here's the, here's the wall that divides the two patient rooms I'm focusing on, you know, do we need, do we need that room or do we need more rooms to take care of the client's needs? So I had the opportunity to work under these two gentlemen on some very important projects, not only in New York and in Denver. In New York we worked on a project in Valhalla for Westchester Medical Center and in Denver for Denver Children's.
Speaker 2:We landed a project in Santiago, chile, in 1996, 1995, 1996. So the fact that I'm bilingual came in very handy. And they said, hey, do you have a passport? I said yeah, yeah, I have it right here with me. Uh, get ready. We're leaving in two days for santiago, chile, and I'm like, yay, let's go. And um, we our first meeting with the ceo of the hospital. We we asked him if he had any data on the on the operations of the hospital that he could share, because we were going to be basing our programming off of it. And about 45 minutes later, the accounting department walked into the conference room with a full stack. They dropped it in there. I haven't seen many hospitals here in the US be as quick at sharing such data to a consultant or architect and go ahead.
Speaker 1:Yeah, I was going to say, as I said earlier, I know nothing at all about how hospitals go about deciding they're going to build a new hospital. So let's talk to our folks. I'm sure our folks listening are more like me than they are like you. We know nothing. So I'm a CEO of a hospital and say, hey, you know, I think we need to build a new building or whatever. Do I have any foregone ideas? Or what do you do when you get the word that XYZ is talking about building a hospital? How do you make contact? What's your process? How much of an idea about what they want to do to the people at that system have? Tell us about that.
Speaker 2:Well, you could choose to do several things. If you choose to walk in there and sell or offer these signed services, you may be falling short of what's really needed. And what do I mean by that? You can easily go down the road by proposing the wrong thing and doing it well Meaning. You know, I can provide you with a beautiful hospital, but it may not be the right amount of beds, it may not be the right amount of treatment rooms, it may not be in the right location. So how do I approach?
Speaker 2:A new project or a new opportunity is working directly with the C-suite. And let's look at some demographics and try to forecast what the growth is justifying a new hospital or a new facility or a new expansion. So there's several sources out there that gather data from admissions or population growth. That are tools that programmers use to help assess the true need of a facility and you work with that hospital leadership to see okay, so this area is going to need more. Let's say, for example, more, more spaces for birthing.
Speaker 2:Is that a service that this hospital is interested in? And they say, well, it's one of our center of centers of excellence. Let's say it's one of our focus to, to, to take care of high risk births. And that's something that you know's, something that we are known in the industry and we want to capitalize on it, we want to excel on it and focus our growth on it. So we come on board as an advisory and not waving the badge of architect yet, but mainly as folks who are going to help assess the need and determine the scale, magnitude and the components needed for a successful facility to take care of that specific service line.
Speaker 1:It's interesting because you look at a place like Cleveland Okay, cleveland, we have three systems left in town that are large. We have university hospitals, we have the Cleveland Clinic Foundation and we have Metro Health, which is the county hospital. So each of those places do different things and different service areas and if I'm at Metro and I want to grow and they're building a new hospital, I probably have different needs than if I were the clinic. When you guys are looking at a place, you're researching the whole demographic area and what the other folks are doing too right To sort of help guide people as to where they need to go with the buildings they want to make.
Speaker 2:That's right.
Speaker 2:That's right.
Speaker 2:All hospitals report information, or they should be reporting information, and you know the level of detail may vary, but we take everything into consideration and you know there's some hospitals that have specific alliances or agreements with physicians who feed patients to those hospitals, or some hospitals bring those physicians on board as employees of the hospital, which guarantees that patient population coming into that facility sees that patient population coming into that facility.
Speaker 2:So it varies by the type of business model that that hospital may have. But we need to start with not because people said, oh, we're going to design this because I think it's a good idea, good idea. We design our projects because we know, based on data that is, telling us what the needs are in conjunction with that hospital's business strategy, and they weigh what are the other competitors doing and some decide to compete you know, compete against them and build facility at a specific area that's growing before the others so that they can capture that market. Others are, you know, willing to partner up with other facilities or competitors, to join forces and develop a program. Some of our clients are even inventive enough to be partners with hospitals that lack that type of service model expertise and they bring it on board and they become, some even become tenants inside other hospitals.
Speaker 1:So if you're building a hospital today, what is the effective horizon that you want that what you build today to still be working 5, 10, 15, 20 years? I mean, how far are you planning for possible expansion so that the building you build today will still be viable in the future?
Speaker 2:That's the million-dollar, the billion-dollar question how far in the future do you want to predict? And there's no crystal ball that's truly, truly accurate. And in our calculations we tend to go between five and 10 year horizon. Further than 10 is just too far out there to be able to provide something that is reliable. We, you know, in my experience, we tend to stay within the five to ten year. But then you know, in five years let's approach that client and say do we need to update that master plan? Do we need to update those analysis? What has changed in the market? What has changed in your business model or models of care that may impact, you know, a difference in the demand. So again, no one has a true crystal ball.
Speaker 1:Right, but you just brought something interesting up. So when you get a client, is it your goal to make that client a lifelong client, so that you continue to work with them as they, as their needs change.
Speaker 2:Absolutely, absolutely, we, we. My goal is to become not just a trusted advisor but a person that, or a, a team lead that they can count on, not just for the you know, the advisory but the execution and implementation of their capital needs. So if we start the relationship with campus and master planning, I want to be the guy they call to when you know phase two of that master plan is on cue to be executed.
Speaker 1:And how successful have you been at building those kind of relationships?
Speaker 2:You know, quite successful. There's some that due to distance and the development of other local talent you know has been established. Talent you know has been established. For example, I worked with the California Pacific Medical Center in San Francisco for several years and worked on the institutional master plan with the now CEO, hamela Kawanaki, and that you know. That master plan turned into a 400-bed new facility in the heart of San Francisco. I moved. I moved to South Florida because of family and they need to use local talent. Same thing in Chile. I served both a facility assistant called Bammedica in Santiago, chile. I did a master plan and designed their first expansion. But since then the local firm with whom we teamed up for that first expansion gained the reputation as the healthcare architect in that country. So the following expansion, the second expansion, that local architect took. So shame on me for working so closely with associate architects and being such a good collaborator that they become experts.
Speaker 1:Yeah, there you go.
Speaker 2:And then they take the next contract. But you have to be present at all times. And same thing with my clients here in Miami. I'm visiting them frequently, more than four times a month. I am in front of them out of sight, out of mind. They say, hey, you know, you know we have a project in mind. Would you like to give me your opinion on this? If I'm not there to be, to be engaged in that conversation, then then the other guy will. So I try my best to be, you know, the guy they call, but if not, the guy that they see in front of their office and is willing to assist them.
Speaker 1:Well, here's something that happens a lot. Now I'm going to ask you later. You know how do you decide when to bring in specialty folks like St Ange to help you with what we do. But I've seen a lot of what I call in capital equipment for hospitals, what I used to call jeopardy purchasing, where a doctor would want a piece of equipment that he had to have. So he would tell the CEO that I need to have this big piece of equipment, and my job as a supply chain leader was to ask the question so that I made sure he got it, whether he needed it or not. To ask the question so that I made sure he got it, whether he needed it or not. How many times do you go in and see people who want some kind of design thing that is absolutely wrong and you know it's wrong from the start. But they've seen this somewhere and they want to be the next picture on the front of some magazine and your job is to talk them out of it.
Speaker 2:Fred, it all comes back to data analysis. I gave a presentation for the International Hospital Federation in Rio in 2009 about that same approach and a member of the audience after the presentation came to me and said could you visit us at the Catholic University in Chile next week? And I'm like what's going on? Oh, we have some cardiologists who are well-known, they have a great reputation and they want a third cath lab. And a physician can be very assertive and you can have someone at the other side of the table pounding on the table saying I need that new cath lab, that biplane machine, otherwise I'm leaving. Look at a projection to see if the data is justifying that third piece of equipment and help the hospital guide their decision-making in terms of future equipment and in terms of materials management. That additional piece of machinery or equipment or that adding a few more ORs have a direct impact on central sterile, on receiving everything. That's materials management. So we rely on folks like Sananj to help us. Number one ask the right questions. It all starts with the initial questions how are you scheduling the operating rooms, are you doing case card systems or what is your approach to materials management? And based on that and the guidance from, you know, a solid materials management advisor. We map out the right flow, we identify any potential hurdles on the way and we try to, you know, define if the equipment is really needed and, if it's needed, what's the right approach for efficiency.
Speaker 2:Some hospital systems that I've worked with have more than one facility in town. They may have five facilities or hospitals in the same county. So is a centralized distribution center the right approach? Or, you know, do the scale of the operation justify that? You know, each hospital would be served independently from a distribution standpoint.
Speaker 2:And that led me to an idea that I had several years ago in how to make hospitals or facilities more nimble, and specifically when you are running into a natural disaster like a hurricane and this has no connection to the Miami hurricanes whatsoever, but it's just the fact that we live in the tropics and then I witnessed a hospital firsthand being isolated in terms of supply, first-hand being isolated in terms of supply and I dreamed up an idea of a drone-powered hospital for which you would be receiving everything from food supplies, medications, via drone, and I think this is something that is gaining more and more momentum in terms of the industry, and there's some parts of the country and other parts of the world that they're looking into. You know, drone, drone assisted delivery because it would eliminate, in a way, the strong dependence on having a large storage space in a hospital for supplies and materials management and would allow you to bring in just-in-time needed supplies to serve the facility and the operations.
Speaker 1:So how far along have you gotten with that? When I think of a drone delivery, you know I'm thinking delivering relatively small packages. What's the capacity of a drone number one? What's the capacity of a drone number one? And?
Speaker 2:number two how do you guarantee the safety and security of deliveries throughout the whole process? Well, I haven't gotten that far into the details of it. It was mainly a programming exercise. That would tell me hey, I would be saving around 25 to 30% in square footage in that hospital, which means that I will be saving in cost of construction. But there's several companies out there, new startups, that have been testing drone technology. I don't claim to be an expert in drone technology, only a hospital programmer and designer. But those drones that I'm seeing out there, they're huge, they're humongous and they're carrying packages of you know. God knows how heavy they are it could be 80 pounds, I would guess. And the question is where do they drop them off? Are they dropping them off at the parking of the hospital, at the roof of the hospital? So having a facility that is designed in a way that it would allow for access to a drone delivery throughout multiple locations, multiple departments, would be what I would be looking into.
Speaker 1:Interesting, so tell us about some of your favorite projects. You know what were you trying to accomplish in the design. What did you accomplish and why are they your favorites?
Speaker 2:There's many, many great projects, great clients that I've been involved with. Again, Sorter Health, california Pacific Medical Center in San Francisco, francisco, was ahead of everybody when it came to many things, not only with the design for seismic but also blurring the boundaries of cath, interventional radiology and surgery. With that client, under the leadership of Hamila Kaunaki, we were looking at blending in physically and operationally those departments, as many departments as we could, and develop a platform surgery interventional floor. And it was challenging. The demarcation or the location of the red line the famous red line that if you cross that you know you have to be in your bunny suit and scrubs, or if you don't cross it you can be in street clothes was not drawing the solution but actually having that conversation with the end user about a culture change and convince them, the cardiologist, that they have to put on scrubs to perform a procedure. So that was an interesting, a very interesting project.
Speaker 2:Others are some of the ones we're working on today with clients such as Mount Sinai Medical Center in Miami Beach where we are designing for a unique circumstance. There is the occurrence of multiple births, of folks having, you know, twins or three babies or four babies, and I reached out to my friends at Clemson University and said you know, would you be interested in doing a research project that will turn real Meaning? Let's research the current conditions, evaluate them, identify areas for improvement and develop a prototype for the biring space of the future. And they said yes and the client immediately loved it. Working closely with Ben Davis and Matt Bernard there at Mount Sinai and the end users, like Kylie Rowland, who's the person running the maternity program the person running the maternity program we have developed a prototype room in which you have that designated zone for the anesthesiologist, the circulating nurse, the neonatologist and the neonatology area. Inside that room is designed and equipped for more than one baby to occur at the same, to be born at the same time. That was a really fun project and we're wrapping up permits for it at this moment and it's going to start construction hopefully by before the end of the year.
Speaker 2:Another great project was in Sao Paulo, brazil, with the Santa Catarina Hospital. It was a hospital in the heart of the you know data analysis, workload utilization analysis in combination with a physical assessment. So I had a group of people you know all kinds of engineers assessing the existing building infrastructure while we were running the data analysis with operations. While we were running the data analysis with operations and we developed this roadmap for the future for them to be improving and replacing facilities, improving some of the existing and then building on for the next five to 10 years. That was really exciting.
Speaker 2:There's many, fred, from a master plan for a brand new hospital for a developer who had never been involved with healthcare in Puerto Rico. A high school friend said hey, my grandma is ill and I just don't want to have to put her on a plane and send her over to somewhere in Florida or Minnesota or New York for care. We live on the island. We want the best care for her on the island. So he said you know he has the financial backup. He wanted to build this brand new facility on the island and we went for it. We started with getting the CEO, helping them get attained a certificate of need, which was needed back then, and then program and master plan this brand new facility, which another architect ended up, a local architect ended up designing, and is now being operated by a system from from Orlando.
Speaker 1:Well, that's pretty cool. You know you've hit on a few different things. I know that, excuse me, florida is in danger of going underwater in 100 years and California is in danger of going, just falling off the face of the earth every few years. What states have the most difficult requirements when you're working to design?
Speaker 2:Well, you just hit it right there. My concern is not who has the most stringent requirements, it's who doesn't is what scares me. We know that California has its requirements, florida does as well, but Puerto Rico, where I'm from. I want to make sure that the Department of Health in Puerto Rico is interpreting the FGI guidelines the way that all the other states interpret them. There's current information out there that ASHI and other entities are continuously involved with helping everybody have access to and being aware of. So again, my concern is not who has the stringent. That's good that they have stringent requirements. I just want to make sure that no area of jurisdiction is left behind.
Speaker 1:Well, eddie, this has been an excellent conversation. I got a couple of personal things at the end, though. Okay. A few years ago, the Cleveland Indians played the Minnesota Twins down in Puerto Rico, and it was just after the big storm, in fact the second game they played down there. The electricity went off about a half hour after the game was over and it took a while to come back on. That was one of the greatest vacations I've ever had in my life. You can't go to Puerto Rico without falling in love with the place and the people. They're just wonderful folks, and the greatest baseball player from Puerto Rico is Roberto.
Speaker 2:Clemente number 21.
Speaker 1:What was his last name?
Speaker 2:Roberto.
Speaker 1:Clemente Walker.
Speaker 2:Walker.
Speaker 1:So tell me, is Walker his mother's name? How does that work? Why is his name Roberto Clemente Walker?
Speaker 2:I would assume it's his mother's last name. I have cousins who are Egea Walker. I don't think we're related to the Clementes. I had the great experience of my uncle having played with Roberto Clemente years and years ago, my uncle Perfecto Ocasio. He was a catcher, a very great catcher, and he's a Hall of Famer in Puerto Rico baseball. You touch upon the issue of the infrastructure issue in Puerto Rico and the power grid, which is unreliable. And again, hospitals in the island are investing in cogeneration plant. Hospitals in the island are investing in cogeneration plants and you're going to see more and more and more FEMA-funded projects throughout Puerto Rico to help them be resilient and just so that a patient doesn't have to see the power go out like you saw that power go out during that Cleveland Indians game.
Speaker 1:Yeah, that was something. So finally, you know, the one thing I learned by going on LinkedIn that I did not know about you is that you are a triathlete.
Speaker 2:I am a former.
Speaker 1:Tell me now if you did it once. You're better than 99.99999% of the people in the world. Just tell us a little bit about that.
Speaker 2:You know I've always been, you know, into sports. I did American football. I played American football in high school, both peewee and club. I played American football in high school both Pee Wee and club. And then, when I was in Clemson, I just thought that, you know, william the refrigerator Perry was way, way too big for me to. You know, you know he had long graduated when I got there, but, but there were more kids his size, so I didn't even venture into walking into the team because I it was about self-preservation more than anything else.
Speaker 2:So, um, after, you know, after years, you know, working and traveling, I had gained some weight and my buddy, arturo arturo diaz he's now a program project manager with CBRE said hey, if you really want to lose that weight, you need to join me as I train for Ironman triathlons. And at that time he was starting a business venture, which was he was the race director for ironman puerto rico. And he said, uh, it's my race, uh, you're going to train with me and I'm going to make sure you're finished. And I said, okay, well, let's do it, uh, and we start training and it became, it became a lifestyle, fred.
Speaker 2:It was something that really, really inspired me to be involved, take care of. You know what I ate, how much I slept, how much time I spent in training, and you know. Then my wife went like so who's going to help me with the kids? So after over six or seven races, I retired from, you know, ironman racing and just focused to be a full-time, 150% dad to my kids. So I've transitioned from being that triathlete dude to being that lacrosse dad in the sidelines or that soccer dad in the sidelines making sure my kids are getting the right support.
Speaker 1:Well, that's really something. I was so impressed. I mean, triathlete is geez. You drive a bicycle around the world and then you run 400 miles and then you swim the. Atlantic Ocean and that's just one event for crying out loud. I don't know how you do it, that's great.
Speaker 2:Well, every time I landed at a different location before a meeting, I would get up at 5.30 am and go for a run or go for a swim. I remember arriving in Santiago, chile, and going on runs throughout near where the hotel was, or in Sao Paulo, running to the park and back. It becomes a part of your DNA.
Speaker 1:Okay Well, hey, Eddie, thanks so much for being a guest on the podcast today. It's always a pleasure to talk to you, my friend, and I look forward to seeing you. Are you going to be going to Arum this year, or will the ACE Summit be the next time I see you?
Speaker 2:Are you going to be going to ARM this year or will the ACE Summit be the next time I see you? I am going to the former ACA seminar, the OPC, in Orlando. Almost 30 days from now, I'm going to be going to Health Design in Indianapolis. So those are going to be my most immediate events and you will probably going to see me throughout events in the Atlanta and Greenville South Carolina area, as I am now, you know, traveling in that throughout that part of the country.
Speaker 1:Great. Well, I always, I always look forward to catching up with you. Eddie, it's great to see you have a. Have a great day, a great week, and thanks again for being on the show. Take care.
Speaker 2:You too, fred. Thanks, bye-bye.
