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.
ENGINEERING A BETTER HEALTHCARE SYSTEM
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
Collaborative Strategies in Healthcare Supply Chain Management by Aimee Watson
Join us as we uncover the often-overlooked yet vital role of supply chain and support services in healthcare facility design. Aimee emphasizes the necessity of early involvement, creativity, and collaboration to ensure hospitals remain adaptable and efficient. We highlight the importance of proactive planning and ongoing communication with stakeholders to optimize inventory management and supply chain spaces in new construction projects. Listen to how Aimee's advocacy and data-driven decisions can transform healthcare environments, ensuring supply rooms are future-proof and projects are executed flawlessly from the start.
Hello again everybody. This is Fred Kranz from St Onge, coming to you with another episode of Taking the Supply Chain Pulse. Today we have with us Amy Watson, senior Manager of Healthcare at St Onge, one of my colleagues. Amy, we're happy to have you here, and I know today we're going to be talking about the design process and a lot of things that folks may not have thought about. But before we do that, why don't you tell us about yourself, how you got to St Ange and what your role is here?
Speaker 2:Are you ready for the long, winding, bumpy road? Well, it's up to you. Here we go. Yeah, no, thank you for having me.
Speaker 2:My background is probably a little unorthodox. I got into supply chain when I when I do the supply chain classes in the spring at Tennessee, I always say I'm accidentally, but always supply chain. So I did attend the University of Tennessee, knoxville, got an undergraduate degree in international business and Spanish, because I was headed to law school and instead took a detour and got a master's in communications. So how did I make it to supply chain? People ask me a lot of times and it was really, honestly, by accident and by happenstance, I think. I think things happen for a reason. But I went to interview with Johnson Controls in Plymouth, michigan. It was for a marketing PR job and somehow my resume made it across the state to Holland where Johnson Controls had just acquired this corporation called Prince. They were doing all car interiors and they had the patent for what we know as the lighted vanity mirror. So I got hired by them in June 2000 and started working at the Meadowbrook plant. So that was my first kind of inroads into supply chain. I was responsible for a large portfolio of products, making sure that they were there obviously on time and the right quantities so that we could build the products to service our OEMs. I spent four years doing that, as well as doing some training and development, because I really love the teaching and mentoring aspect of supply chain as well.
Speaker 2:I had my daughter back in 2003, and we decided to relocate south to be closer to family, so in that I kind of transitioned into a new role where I was doing just-in-time seating now versus doing just automotive interiors. So I worked for the Shreveport Louisiana plant supporting three platforms for General Motors. So we were doing the Canyon and Colorado trucks you might be familiar with, and then we launched the Hummer 3, which that launched back in 2006. So that brought on a lot of different insight into just what just-in-time really meant from a tier one perspective, from a seating perspective, and it provided me the opportunity to start kind of managing projects at that point and I was moonlighting as a packaging engineer, not really knowing what I was doing the whole time. I think an overall good opportunity. While I was at Johnson Controls, over the seven years that I spent with them I did internal audits and that kind of led me to my next phase, which was then supporting five vehicle platforms in Madison, mississippi. It was a Nissan plant, so I became the assistant materials manager there. I was commuting, though, about six hours a week back and forth between Louisiana and Madison.
Speaker 2:You know that more challenging career choice, I think, proved to be challenging, with a toddler obviously, as you can probably imagine. So that was at my seven year point and I decided, you know, I was looking for a little bit more work life balance, and that's when, I think, the calling to health care really came. I came across this job posting for a purchasing OR materials manager for Christus Health in Shreveport, so right in my backyard. I never applied to anything online before, so it was all new, but I think it was meant to be. I remember going into the interview and I came out of it and the person who became my co-worker she said to me she said you've been in there the longest of anybody that they've interviewed and we've interviewed a lot of people. She's like you're going to get the job. And sure enough I did. So I joined them in the summer of 2007, I think, which was a blessing and really my first introduction to health care, and I loved it so much that I've stayed here obviously for the last 16 years 17 years.
Speaker 2:But you know, fred, you've been in hospital operations before and I think, having that manufacturing background I had, I came, I came into it and it was like I stepped into kind of the twilight zone. It was pen and paper, pencil inventory galore. Right, it was very manual, very antiquated, but I was overseeing the materials team as well as the procurement team. So from your experience you probably know those are probably two very diverse groups and really hard to manage because each of them really needs their own kind of set of expectations and, you know, making sure that you're overseeing those functions appropriately. So I dug into spending a lot of time in the OR space learning about surgery and learning about anesthesia, working with the clinical teams, really understanding how everything kind of clicked together. I was picking cases, you know, as the manager I was performing inventory, all of that, and so today all of that really helps me in my role because I really credit to all of that. And so today all of that really helps me in my role because I really credit a lot of my product knowledge to doing all those inventories I did throughout my career.
Speaker 2:So I did that for a few years and then I took on several roles within Christus Health so I was eventually moved to the state procurement manager director so I oversaw seven hospitals because Christus was growing at the time. So that really introduced me to more around ERP management and GPOs value analysis, which I think has really served me well over the last decade or so. I was able to implement value analysis across the health system, which was a first, and I was loving health care Like to this day. I kind of joke because I remember standing on the manufacturing floor at JCI and I said to a very dramatic production supervisor at the time we're making cars, we're not saving lives. And now at Christus we were actually. I was actually, you know, affecting the lives of adults and children through the work that my team was doing. So I think joining that faith based organization was a really good transition for me. And then in early 2014, you know I had some really great mentors, you know, while I was in my Christmas journey, you know I miss Ed Harden all the time and you know I can't be more complimentary of Tina Hansen, you know, who was also part of that team, who guided me.
Speaker 2:And I think, as I started to think about the next phase. That's what Ed approached me, along with Dr Joseph Barsi, about this new role. It was this director of international supply chain. So I said yes. I went to Chile, to Santiago. Chile, took my daughter. We did our whole House, hunter International to find a place to live because it was going to be a two year stint down there.
Speaker 2:As we started to onboard a new hospital to Christos, life interfered, you know, intervened or whatever you want to say, but I think that led me to Pennsylvania. So, long story short, I married my college boyfriend. He lived here in PA and that led me to St Christopher's Hospital for Children in Philadelphia. From there I was, I was a senior director supply chain. They were outsourced to MedAssets, so now Vizient. So again I had that tie to the GPO and then eventually I landed at Penn State Health before coming to St Onge.
Speaker 2:You know, I think at Penn State Health I was brought on there really to look at not only building a health system but also improving the current operations at Hershey Medical Center.
Speaker 2:And I think I started right around the time that we had just inked the deal on St Joseph's in Reading. And I think for an organization it's hard enough, you know, fred, coming into a new organization and trying to absorb it all, but the acquisition to, I think, was an opportunity to quickly learn what was going to not what was going to work and really what was not going to work. One of the things I noticed, though, is that supply chain did not have a seat at the table when the acquisition planning began. I think it would have been helpful to assess, kind of our current state situation and the vulnerabilities that we had as we thought about onboarding a new health system, and this is when I started to consider how could I take all my manufacturing experience, coupled with my healthcare operations knowledge and experience, and engage in a more impactful way, helping others kind of achieve their goals in a relatively short amount of time, and that led me to St Onge in my current role on the healthcare operations team.
Speaker 1:Very good. Well, you know, ed and I were inducted into the Bellwether League the same year, so Ed was a great guy and it was unfortunate that he left us way too soon. So in your current role, you do get involved in a lot of new construction. So let's talk about that. How can supply chain teams influence the design of their spaces? My experience has been many times that things get done to us, not with us, and when the doors open and we haven't had any input at all and we're expected to make it work, it's not necessarily a good thing. So talk a little bit about that.
Speaker 2:Absolutely yeah, I think, when I think about there's a couple of things, like one there's what are some opportunities for us, and then how do we influence that, right? So there's a couple that stand out to me, and it really is about creativity and about collaboration. You know, supply chain and other support services are really, to your point, left behind when it comes to that whole planning and design. We are in the basement, in the dark, you know, on the ground floor, kind of forgotten In projects. We hear a lot about the campus needs to withstand, like the next 70 years, or it's the hospital of the future. What does that really mean, right? So I think it's a chance to really think big about being flexible and being adaptable as best you can, right, because we can't foresee what's going to happen 75 years from now. But one of the things is, as you're thinking about being creative, is, you know, there are project budgets involved as we go through this, but don't let those budgets or those past constraints really define how creative you are. You know, at some point in the project there will be plenty of time for that value engineering activity, but you know, kind of taking that and forgetting how you operate today, creating something completely new and more efficient, and you know very well, having been in multiple hospitals. You know change is really hard for many folks in health care, and so a lot of times I'll see bad processes just being carried over into this beautiful new building.
Speaker 2:Collaboration is the second piece of this and I think it has to do with collaborating with other support services, like how can I and supply chain positively influence and affect the operations for environmental services or for pharmacy or for other folks that I work with tangentially? I think to accomplish this, like, all of those parties need to have a seat at the table and be involved from start to finish. And when we think about how we really influence that is not only that collaboration and that creativity, but it's about using data. You know, use data to validate your requests. You know space costs a lot of money when we're thinking about building a new hospital. You know space costs a lot of money when we're thinking about building a new hospital. I think without having that compelling data based case, it's difficult to achieve those ultimate goals for a lot of folks, and some folks, you know, don't have the ability to be able to do that because they're doing their day to day no-transcript.
Speaker 1:Yeah well, you know it's interesting about what you just said, especially the last part, is that so much of the work that supply chain folks or any clinical folks do is transactional that there is no extra capacity to become involved. And yet the biggest mistake you can make is not to have those folks involved completely throughout the process. I just finished an article that came out, I think, about a week ago, where Tom and I had a discussion about the activation process, and the activation process doesn't begin when the construction is done and the doors are opening. It continues when that happens is done and the doors are opening. It continues when that happens. And so you know at what point should supply chain folks get involved and how involved should they be.
Speaker 2:Yeah, absolutely. I recommend the sooner the better. I've had a really great experience working with the health system for the last five years. I got involved right during the height of COVID and everybody's had a seat at the table. So I recommend, you know, if you're able to get a seat at the table to talk about even master plan, that's fantastic. If not in master planning, then the next logical step would be during concept level planning. So it's kind of ground zero, if you will.
Speaker 2:I think from an involvement perspective, though it depends on it depends on the group right. Some folks are more heavily involved. Supply chain's always got a very heavy lift when it comes to the design. Some folks you know are tangential and maybe don't have as much space. But I think being involved from concept design through the next phase of schematic design and then into design development is really critical so that they're able to influence not only the workflows but the space, the adjacencies, you know all of those things. I think to your point you just mentioned. You know that whole new construction process is really it's always that, in addition to on our, you know, job duties, right, they're trying to execute their day-to-day, and so I would recommend, if possible, that there's some sort of project champion that can represent and advocate for supply chain.
Speaker 1:Yeah, that's interesting. So what are some of the benefits of having a voice?
Speaker 2:Yeah, I think the advocacy is probably one of the biggest the opportunities to just rethink your operations, like I mentioned before, and being really transformational in how you approach your future state. Again, I mentioned, you know, bad processes sometimes transfer into that. I think clearly articulating how you as a department are going to work and how you are going to service the clinical areas is really important Again, so the clinical areas understand what's going to happen when those doors do eventually open. I think that cross collaboration kind of leads to, again, supply chain influences a lot of how other areas work and how we design the dock and all of those things Early in the design phase. All those key stakeholders, though, again are part of that kind of tabletop exercise to review those adjacencies and discuss, like, how they need to perform their work, because in the end, you know, in one of our designs we decided that the pharmacy needed to be directly next to central distribution, just from a workflow perspective. So again, it's having that seat and having that open dialogue back and forth.
Speaker 1:Yeah, you know, what is occurring to me as we go along, just closing my eyes and remembering where I've been involved in some of these things is I would say that at the start, when you know you're going to build a new place, okay and. I'm a supply chain leader. That means I'm a generalist. Really is what a supply the leader is really a generalist.
Speaker 1:I don't know enough to be effective. So I would imagine that you're taking people that don't know how to become involved. They probably need outside help from someone who's done this before to help them learn how to get involved and then, as they go along, they become more effective in their contribution. Is that fair?
Speaker 2:That is absolutely fair and you know, I mentioned one of our health systems. We work with they through the engagement they're building more of a playbook so that then for the next hospital that they build, they go into concepts, they go into those initial discussions, having a sense of like I do need this much space and here's why I need it. So, yes, they do become much more savvy if they work with somebody you know initially.
Speaker 1:Yeah, and the other thing is many times I think one of the reasons that we have some, we get so much business is that there's so much aging infrastructure in the health care industry that places just can't wait any longer to do things. And when you walk into those aging infrastructure places, you'll see the hallways crowded with stuff because things have changed over the years. There's no place to put the stuff, and the opportunity you have at the beginning through the process is to try to think forward far enough to make that something that might not happen to the folks looking at it 30 years from now too, you know.
Speaker 2:Yeah, I agree, and we see that now. You know we go into these projects sometimes and they're like what can you do with our existing? And you know we want to use robots. Well, you know, to use the automation there, you need to have wider corridors than you have in your existing footprint. You need to have, you know, wi-fi capabilities. You know different things that you know you realistically don't get when you're trying to retrofit something. That's where the new construction, you know, really comes into play to give you what you need. And proper planning, you know, for the future is always considering all of the growth Right. So again, if we, if we look at it, we say 75 years from now, you know our projections are X. If we can at least build something to you know it's going to be protected for the next 20 years.
Speaker 1:You know I think we're doing really great, you know, from that perspective, yeah, you know, what's really funny is I think about that and the oldest major league baseball park is Fenway Park, 1912. And that's been revised several times. The second oldest baseball park is Wrigley Field in Chicago. The third oldest baseball park is Dodger Stadium, which was built in 1962. And now a new build may last 20 years and they have these fantastic giant up-to-date things and they're rebuilding after 25 years. So, you know, I don't think healthcare ever thought of it that way. Number one and number two systems didn't exist. So what you basically have with a system is four to 25 individual stand-alone community hospitals that were doing everything by themselves. So it's an entirely different process, an entirely different set of requirements for people to look at. Is that fair?
Speaker 2:It is fair, you know, and for some of those systems that are doing those acquisitions and you know some are shutting down because you know financially it's not viable anymore but they're looking into alternative ways to try to support you know financially it's not viable anymore but they're looking into alternative ways to try to support, you know, the overall system instead of doing it in such a siloed way. So that's where some of the you know, consolidated service centers come into play and you know planning and doing design and construction for those with kind of that overall service model being the system as a whole.
Speaker 1:So once you've gone past the planning stage and you got the approval, and they've broken ground and the building is being built. What are the next steps for supply chain?
Speaker 2:That's when that activation comes into play, right? You mentioned activation goes well beyond when the doors open, and that's absolutely true. You know they're going to be making changes for months after they open. But the activation starts and that's where you start working with the clinical users on supply needs. You start looking at how you're going to procure, how you're going to replenish. You know how many staff members do you need for this building, because you might be going from a very small building that is six stories high to an 18-story building and now I need more material technicians to be able to do the distribution. It's a chance at that point to level, set expectations related to future service levels.
Speaker 2:Many times when we go into these projects, the activation phase is you know supply chain is going to be going through a metamorphosis per se and they're going to do things very differently than they do today. You know, take on more responsibility, greater levels of service. You know, from a, from a customer perspective, all of that and I think that's a chance to sit down with those folks and decide like, what does that look like? You know, what are the what is realistic for us? Day one versus maybe day 20,. You know, after the hospital opens. It's kind of that out with the old and, you know, in with the new.
Speaker 2:Think about inventory cleansing at that point as you're going through this activation, getting purging what you don't need, you know, proper planning from an ERP and systems perspective. It's a chance in activation to to think about how you want to do things differently. So you do want to want to deploy a new inventory management system. If you do, you start vetting some of that out, you start doing some of those technical builds, you start designing those supply rooms. All of that kind of happens in that piece and that happens well in advance of, you know, the hospital's opening and unfortunately, sometimes we get involved in this, which is fantastic. Sometimes we don't get involved until it's closer to that activation time when we could have used another good, you know, 12 months to really really dig in and do it with with great accuracy.
Speaker 1:Yeah, you know. Another thing that is uh uh to be considered is the average build can take four to six years. So by the time you break the ground. It's almost like my parents worked in a factory that made vacuum tubes. Okay, so, so if, if, in 1960, they're going to do a rebuild, well, they probably hadn't planned for transistors, which came out to replace them, and and there can be emerging technology that exists and would supplant what you have thought you were going to do. How do you guide people through that?
Speaker 2:How do we plan for that? Yes, so one of the things is, if we go into planning how we're going to move stuff right, so if we want to use an AMR, we look at again. Amr technology is only what we have visibility to today, but we do have a pulse on kind of what is coming up and coming through discussions with the vendors, so we try to be able to incorporate that into the design. I think from an inventory management perspective, you want to be able to protect for whatever you're going to deploy, right, so maybe it's the most conservative solution at the time and then, as new technologies come out, we've at least preserved the space within that supply room that you are a little bit more flexible in. Whatever you decide you want to deploy, you know five years from now that we just don't have visibility to. Does that kind of help answer that?
Speaker 1:Sure. So what happens if you get done and the space that you thought you were, the space that was planned, doesn't meet the needs of the operation, when the building is finished?
Speaker 2:It's a really good question and I wish I had a magic, you know, eight ball mirror ball, whatever we want, a crystal ball, whatever we want to call it to kind of look into that. But one of the challenges is when, when we're faced with that is, we have to be able to have some conversations, you know, with the client, sometimes with the supply chain folks, sometimes with the clinical folks, to identify you know what, what can we live with and what can we live without. You know, because at the end of the day, you know, the clinicians want, you know, everything at fingertips, which rightfully so to be able to take care of the patients. That's, that's absolutely understandable. I think the space constraints become a reality of if we want to be able to put supplies into that room, what needs to come out of it, right? So sometimes supply rooms are planned not only for supplies but to hold, you know, linen or warming cabinets or you know just kind of ancillary equipment and stuff, and so we have to have a conversation of you know, if we were to do this the way you would like it designed, like, what do we do with that extra, those extra items that we need to pull from that space. We get creative also in.
Speaker 2:Not only you know the SKU counts, but maybe the days of supply. You know, maybe you've wanted to target five days of supply and the room is just not going to be able to hold that. So you know, what is that rightful target? Is it three days now? And with three days we can fit it? We've done things where you know we wanted to deploy a two-bin Kanban and the room was just not large enough. So instead of two-bin we have single bin to be able to accommodate everything. So there's different ways to work through that. I think the important thing is you don't want to get to that point. You don't want to get to the activation process and you walk into the room and you're like this is too small. You want to be at the front end, where that room is rightfully sized for that technology and storage solution that you wanted to deploy from the beginning.
Speaker 1:Yeah, and, as we've talked here, the one common theme is, if you keep the stakeholders, the people that are going to be using the space, involved from the planning point to the time that they activate and after they've activated, when they make refinements, you're going to be able to mitigate and reduce the amount of surprises you're going to find along the way. Is that fair?
Speaker 2:That is absolutely fair and I think you bring up a really good point because you just mentioned, you know, these new construction projects can go four or five. You know some of mine are getting pushed to seven, eight years long, right. So at the end of the day, that supply chain leader who might have made decisions about the design of the space and how things are going to operate may not be there in the end. So there has to be some sort of either knowledge passed down whether it's through an operational narrative of sorts, or there are some staff members remaining that are really close to it in order to actually affect that the way you described.
Speaker 1:Yeah, and other things. I think that I've seen, and you may have seen this a lot of organizations get enamored with something and they do what I call jeopardy purchasing, where they will tell you we want to have this, this and this, and then you have to figure out how to ask the question so that they get this, this and this, or they commit to something and when the time comes to turn the key and make it work, it doesn't work and they have wasted their money and have to do it over the old. Yeah, you've got time to do it over. Why not take time to do it right? Has that been something you've seen on occasions?
Speaker 2:Yeah, we have. You know we come across that where again those teams have transitioned and maybe you know, the mindset is different now. You know somebody signs to your point, somebody signs a contract and kind of binds you to do something and so you kind of have to make the best of the situation and utilize it. You know, for the, for the now we'll say for kind of day one. But yeah, I have encountered that in a few projects over the last seven years where you know it's not the most ideal solution and at the end of the day that's where involvement up front or having somebody else kind of doing that advocacy for you, I think is really critical to get what you want in the end.
Speaker 1:Yep, I mean, I was at a meeting a little while ago where I met a supply chain leader who was really you know, he was really proud of what he had done. He'd come into a place that had planned something and he said this is all wrong and he started to do it over three-quarters of the way into the process, which, you know, cost time, money and who knows if this guy is going to be there five years from now too. I mean, there's a lot of investment in financial and human capital and everything type of investment into these projects, and doing it right is the most important thing. Is that fair?
Speaker 2:That is very fair, I think, doing it right, making sure, again, like you've got the right folks making some of the decisions. You know that they're well informed and again it's not I'm shooting from the hip, because I saw this at my last hospital it's like I've got data to to go back to justify why I need, you know, 200 square feet for the supply room and you know supply rooms are not all created equal. So I think folks need to consider that as they're going through this exercise too. So you know, icus are not the same, as you know, routine med surgery, the same as a support service space.
Speaker 2:I think where sometimes we falter too is, you know, in the design process. There's this thought of okay, well, I have this offsite warehouse and so I'm going to be able to get stuff from them whenever I want. So I don't really design a small stat. I designed such a small stat supply space that it's really not going to sustain much in the hospital, especially when the hospital is, you know, 450 plus beds and, you know, has tons of clinics and things like that attached to it. Like I think there's there's just some operational things that should be explored before we really decide on that space and what it should look like.
Speaker 1:Yeah, you've, you know, given us a lot to think about. So if I'm a CEO and I think I'm going to be here next year we don't know how many mergers are going to be taking place. You know, that's my number one. Concern really is probably as much keeping my job as it is what are we going to do? But I know that we need to upgrade and bring our facilities up to modern standards. What should be my first step? Who should I call first?
Speaker 2:I would say call us right. Yeah, I think one of the things I've seen from some of those C-suites, they've, you know, not only they've engaged, you know, external folks which, in all fairness that's you know, that's really helpful, I think, whether it's somebody from facility planning and design, that is like that one point of contact and can be that continuity through the entire process. I mean, I think it's really important for the ultimate success of the project and everybody who's involved, from all of the design and construction teams that touch the project.
Speaker 1:Very good, you know this has been an interesting discussion. You know, one thing that occurs to me you're talking about the product acquisition side and then the operation side, and I think there's a real key thing that gets overlooked Supply chain is about controlling and managing and correctly processing SKUs. Right, yes, value analysis, more than anything else, can have an impact on making sure that the correct number and kinds and amounts of SKUs are put in place, and controlling the number of SKUs really gives you information. To get back to design spaces and everything else, Is that fair?
Speaker 2:It is, it is, and we and some of the work we do when we do some new design and construction is just to that effect. We take a look at everything that you're using today and we say you're using six different small nitrile exam gloves. We need to consolidate to one. We're planning for one SKU moving forward. And that's where that value analysis team comes in, comes into play from a system perspective, and then that's where the procurement, the contracting team really needs to be partnered at the hip with them through that.
Speaker 1:Yep. So what did I forget to ask that you'd like to talk about?
Speaker 2:I think we covered kind of everything, fred, I appreciate it. Thanks for the time.
Speaker 1:Well, and who's the greatest basketball coach Tennessee's ever had?
Speaker 2:Pat Summitt. She was a great lady lady and I had the pleasure of meeting her when I was there.
Speaker 1:You got that one right, amy. Thank you so much for taking time out to talk with us. I think there's a lot of good content here for people to consider, because it's not a cavalier thing to build something. It's a long-term commitment and, if you do it right, it should increase the skill sets and the capabilities of your whole team as well, if they are included along the way.
Speaker 2:One hundred percent. Thank you, fred. Okay, thank you, amy. Have a good one Take care.
Speaker 1:Thank you too. Bye-bye.
