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
From Warehouses to Hospitals: Logistics Insights with Hue Roach- Part Two
In Part Two of our conversation, uncover the transformative journey of healthcare logistics with Hue Roach, a seasoned director at St. Onge Company, who brings 45 years of unmatched experience to our discussion. Discover the often unseen yet vital role logistics play in healthcare, from supply chain management to waste disposal. We traverse the evolution of logistics from straightforward operations in standalone hospitals to the intricate systems of modern decentralized healthcare services like the Cleveland Clinic. Hue offers invaluable insights into how the consolidation of healthcare systems and the expansion into rural areas, alongside innovative concepts like healthcare modules in retail spaces, are redefining logistics. He underscores the necessity of both design and operational enhancements to cater to these shifting demands.
Experience the cutting-edge advancements in healthcare logistics technology, with a spotlight on the burgeoning role of drones in medicine delivery. Explore the intricacies of integrating AI and robotics to counteract labor shortages and the historical progression from early automation to today's high-tech solutions. Hue also contrasts the logistics strategies of affluent Middle Eastern countries with the Pacific Asian market, highlighting the need for integrated operations to eliminate inefficiencies. As we close, we emphasize the critical importance of precise data and the imperative of flawless design execution to avoid costly inefficiencies, drawing an analogy to the seamless structure of a wasp nest. Join us for a compelling exploration of the future of healthcare logistics.
Hello again everybody. This is Fred Krantz, back with another episode of Taking the Supply Chain Pulse. Today we're going to have our first two-time guest on the series and that is Hugh Roach. Our previous episode sort of took Hugh from the time he started in healthcare 45 years ago to today, talking about what Hugh called, at one of our meetings last year, the group we were in Los Olvidados the forgotten ones, and the forgotten ones in this case are transport and logistics necessary parts of the supply chain but often overlooked. In our first episode, hugh told us how things were when he started and he brought us up to the present, and in this episode we're going to have Hugh take us into the future. But before we do that, hugh, why don't you just once again, for folks who may have missed the first episode, why don't you refresh us about yourself, tell us your background, how long you've been in health care, how long you've been at St Onge, what your role is and what your responsibilities are?
Speaker 2:I will do that. Thank you, fred. Again, my name is Hugh Roach. I'm a director at St Onge Company. I've been with St Onge for 10 years. Previous to that I was actually with another consulting firm it was actually the competitor of St Onge and before that I was with an equipment supplier for health care. All in all, my background covers over 45 years. My background covers over 45 years. I've been fortunate enough to have worked on probably over 300 facilities, 350 facilities in 14 different countries.
Speaker 2:And the reason I wanted to do this podcast with Fred is because much too often the back of house when I refer to the back of house logistics is kind of overlooked operationally.
Speaker 2:You know from facility owners, as well as a design standpoint, and I think you know I wanted to take the time with Fred to discuss, you know, what I've seen in the importance of supply chain, ie logistics, and how it's going to move in the future. Now when I say logistics it's kind of all that back of house support services that we understand in facilities, health care facilities. That includes supply chain, which is of course, you know Fred's expertise course, you know Fred's expertise, but you know, to me it begins at the service doc includes that, coming in to supply chain material management, it kind of you know goes into housekeeping linen, food service, which includes bulk food, patient meals, central sterile processing instrumentation, sterile supplies. It takes a look at pharmaceuticals, but also, when I refer to logistics, it's outgoing soil commodities, including soil linen, as well as the different waste streams. So when we talk about logistics it's kind of holistically all those areas.
Speaker 1:Okay, so that refreshes people along that line. You know we've talked about the past and logistics. In my opinion, like I said in our earlier, thing was pretty easy for us in the past when we were standalone hospitals. We just had to unload the truck and push stuff to where it needed to go, then push our waste out to the dirty part of the dock and hope someone came and picked it up on time. Same with dirty linen. If we had our own laundry, we handled that separately.
Speaker 1:But now things are becoming more and more and more complex as logistics becomes more and more complex. As logistics becomes more and more complex because care is moving from an acute care-based system to a system in which probably 80%, I'd say, of the facilities in the Cleveland Clinic here operation in Northeast Ohio are not in an acute care setting. There's over 100 service areas in Ohio alone for the Cleveland Clinic and so with each one of those you know that's 100 different logistical problems and when they acquire a new entity into the system that exacerbates things and changes demand. I was going to ask you that. I didn't ask you the last time. Is your work limited to just new design or do you get into operational improvements for existing facilities too?
Speaker 2:My expertise actually lies in. Well, I kind of straddle both, to be honest with you, because for me, my know supply chain, spd pharmacy, and we basically evaluate what they're currently doing and when we talk to them regarding the new design, we talk about best practices. So you know, occasionally what we'll see is, of course, we don't want to replicate you know poor operations, poor processes, and we'll recommend new ones for the new facility. But occasionally we see existing facilities go back and update you know processes and their older departments, as well as equipment and systems. So it's kind of both.
Speaker 2:But, as you mentioned, we're seeing a lot of now consolidation of healthcare systems, which basically has their flagships. I think we'll see continued, you know migration to rural areas. That includes ASV, mobs. At a health care symposium this past week I saw these health care modules, you know that could be dropped in shopping centers like Walgreens that we've seen the you know doctors based in Walgreens. These would actually be pods with the drop, these would actually be pods with a drop and then you could basically close it up so you could talk privately to your physician, your you know health care provider in a more remote location.
Speaker 1:So logistics are going to become more complex as really the migration goes out, you know, further and further from downtown, center of the city, yeah, and of course it gets exacerbated too by the fact that a lot of what you do has got to deal with or be aware of the greater support infrastructure. You know, moving stuff has to have roads to move it on, it has to have truck drivers to move it on, has to have a lot of stuff. When you're doing what you do, do you pay attention to those things?
Speaker 2:too, we do, but it's changing as we speak. You know we in the past have not looked at, you know, the suppliers coming in, the roads they take. We have been focused on really what's on campus. You know, where are the routes that the trucks have to take, how big is the service dock. We kind of you know limit our you know view of that operation only to that extent. View of that operation only to that extent.
Speaker 2:Recently, with these consolidation of hospitals, ASCs and MLBs to these healthcare systems, what we're seeing now is them consolidating replicated operations like supply chain, like linen, like SPD, like pharmacy, and instead of having, you know, 10 independent operations, they're consolidating it and taking it off-site, so we would be called a off-site service centers.
Speaker 2:So when we do that now we're starting to take a look at how do we move between that off-site service center to the hospital. So again, we're starting to look a little further down that supply chain to see how we move back and forth. And that's one of the things that we are seeing now and we're going to continue to see is, consolidated in the support operations, how to take them off-site. Consolidated in the support operations, how to take them off-site, these off-site you know operations are now taking a look at how do we support our membership and that includes taking a look at what we refer to as patient equipment, you know, and how do you consolidate that on the off-site you know service center and take it outbound and deliver it, you know, to houses, you know, via truck. We're going to take a look at retail pharmacies supporting their membership. We're going to look at maybe drones going from these service centers out to residential areas.
Speaker 1:So we're going to see a lot of changes in the next 10 years. Yeah, you know. Speaking of drones, what type of challenges and requirements do they present that you never had to deal with in the past?
Speaker 2:Right now one of the restrictions you have at least the applications and drones we see in campuses today. They're typically moving medications, limited medications. We see them transporting lab specimens, we see them transporting organs and that's like within campus or intercampus. But to do that you have to have line of sight. So that's one of the big restrictions we're seeing now. Now Amazon and those other larger companies are kind of breaking through that you know requirement because they want to basically go from a warehouse outbound to a residential area. When you do that you lose line of sight. So we see that as the next development. You know where we can basically take drones further out, from either flagship hospitals or centralized service centers.
Speaker 2:The one thing that you know, we've heard, you know from clients regarding off-site service centers is what happens if we have a hurricane like the one that just went through Florida? What happens if we have a hurricane like the one that just went through Florida? What happens if we have a blizzard? How do we transport from that off-site service center to the hospital? And the one thing we're seeing being developed now is autonomous air taxis and they've already been approved in China. They're going to be approved in the United States in the next five years, and that's really to transport passengers like Uber from point A to point B. I'm visualizing those as they can carry payloads 300, 400, 500 pounds. Why don't you basically transport items from the service center to the hospital using these larger drones? I think that's going to happen. Then you don't have to worry about road conditions and so much weather. So, again, that's something I see in the next 10 to 15 years.
Speaker 1:Those things are mind-boggling, though. How do you develop a level of confidence that suppose I need to have a heart? Okay, and I were in a hospital here in Cleveland that's six miles away from the hospital where the heart became available, and you were going to transport that from that hospital to the hospital I was in by drone. How do you develop a level of confidence that that thing is going to make it there safely and intact and protected correctly, etc.
Speaker 2:I think it's going to be. You know the development of technology. To be honest with you, I can't give you a finite answer on that one. I can only tell you that you know from the older systems I found within hospitals they were very unreliable. People lost confidence in their using those systems to transport items, but it was through advancements in technology that improved their reliability and their accuracy. So I think the same thing we're going to see with things as drones. You're right, if I was the first one on an operating table to receive a heart and they're going to do a drone today, I'd go time out. I want to hear it first before you open me up, right?
Speaker 1:Yeah, I mean, to me it's mind-boggling. The thing that really gets me is the logistics of delivering medicine to people in their homes. I mean, if you go on YouTube and watch all the videos about porch pirates, I mean, how are you certain that the stuff is going to get there and that the chain of control is checked off at each point so that I know that you are the one that got the medication that was delivered to your house and not some kid going by on a bicycle?
Speaker 2:Well, my, and again I'm Well, my thought behind this and I'm not designing the systems, but I would tend to think that you could start delivering, instead of on the front porch, typically, you know, behind the facility, behind the house, you know in a more secured area chest that would basically open up, you know, at the command of the drone and then, once it dropped, it would command it shut and then it would lock until there was a code, a passcode, to put into it. That's something I would think they would develop to basically promote that retail pharmacy concept out to the residential areas.
Speaker 1:Yeah, and you know I mean, these become increasingly difficult problems because we haven't thrown in the fact that you're delivering this package to Fred Kranz, who's about to be 79 and is facing daily cognitive decline and won't know where the hell to go to pick it up or open it once it got there. So how are you going to deal with the dumb patient part of the formula? These are all things you have to figure out, right?
Speaker 2:They do, they do. The technology is coming, though. They'll figure it out. You know what I was surprised about is, you know if you've ever read about technology and advancements in technology? The increase in technology and discovery is basically shortening, like every you know, four, three to four years. So you know what we've seen in our lifetime. You know, for me it was basically getting off the drawing board onto AutoCAD, into Rivet, and seeing how that advanced within the last 20 years. It's going to be phenomenal what we see in the next 10.
Speaker 1:Well, I agree, it's still scary to an old guy like me, though you know. So you know, in the future, why should logistics become of greater importance to designers than it is today?
Speaker 2:Well, a couple reasons. You know we're seeing a change in the supply chains, like I just mentioned, is we're taking a look at consolidation of health care systems. You know, from these 2,500 hospitals and I forget the exact figure and they're basically merging into these larger healthcare systems. We're going to see them basically change to where we have center of excellence when it comes to logistics. They're going to consolidate. So designers basically have to plan for that. You know there's things that they have to do. That's, you know, not typical. What they did two years ago, five years ago, you know, 45 years ago. They're going to have to change their approach.
Speaker 2:The other thing that I see basically really impacting healthcare designers is AI. You know, when we take a look at artificial intelligence, you know that has the ability to basically look at options and alternatives when it comes to design. Where it would take us and the designers months to basically go to three, four, five concepts for a design of a health care facility, concepts for a design of a healthcare facility, ai is going to be able to do it in minutes and hours to say here's all your options given. You know, what needs to be supported from this healthcare facility. Ai is going to be able to do it in minutes and hours, where the designers and the consultants used to do it in days and months. So I think that's we're going to see a true advancement in that.
Speaker 2:But I mean the other thing that we have to look at is increase in technology and healthcare period. You know we talked about drones, but the real challenge in today's market is labor availability. Market is labor availability. Everyone's facing not having enough staff to basically support the clinical operations. And when I say that I'm specifically looking at logistic operations, support services. So how do we get around that? And that's through incorporation of technology. And that's through incorporation of technology. You know we're going to start looking at robotics now going up on the floor and potentially transporting patients instead of transportation staff. We're going to look at robots picking up supplies out of the supply room and taking directly to the room to hand off to the nurses. So we're going to see those advancements and those are going to impact both operations as well as the design of facilities in the next five, ten years.
Speaker 1:Yeah, you know, what's interesting about that is that back in I'd say it was about 1978, when I was director of central processing and distribution of Baptist in Miami we pioneered an automated guided vehicle from the Mosler Company. It was called Transcar. They called it Kranskar because I was in charge of CPD but it would run on a one-inch wide aluminum strip on the floor. It would go to the elevator, call the elevator and, uh, get on the elevator, go to the floor we're supposed to go to offload itself, make a noise and people would come down and disengage the cart from it and put the other cart back on, send it back.
Speaker 1:But it was, uh, it was limited by the, the functioning of the elevator itself. If the elevator came up too low and the door opened, the transcar would run into it, smash in the back of the wall and stop itself and wouldn't unload itself or wouldn't do anything, just sit there. If it came up too high, it would stop itself outside the door and knock it in. So you really have to. There are really some design problems that have to be specifically solved to make these things work, aren't there?
Speaker 2:There are, and I just want to take a moment to say that kind of links us back a long time because, as I mentioned, when I started my career in material handling with the manufacturer, one of their products was a transcar, by the way. So I completely know what you said when you said transcar. But you're correct on that and you know, when you start taking a look at designing automation within health care facilities, you have to take in consideration those systems and their requirements. And I'll give an example. You know you were talking about the leveling of the car, the elevator that if it wasn't properly leveled, the trans car couldn't load on. Now that's a function of ensuring that you design that transcar system correctly with the elevators. Historically they would be from two different manufacturers One would be from the material handling company, one would be from the vertical transport elevator supplier. So there's kind of a disconnect. If you don't get both right, that will continue to be an issue as we move forward.
Speaker 2:I think you know, as I mentioned in our first podcast, facilities are basically taking a matrix approach to the transport of commodities within their hospital, and what I mean by that is there's not one size fit all when it comes to movement of commodities with hospitals. You're going to have something to move specimens and laboratory items, like the pneumatic tube systems. You're going to move scheduled bulk items like AGVS, as we mentioned before. We're potentially going to look at smaller automated machines up on the floor called autonomous mobile robots that are probably going to support the clinical staff and taking care of the patients, and they all have to be integrated. You know, and that's going to affect the design you know of the facility. This all is going to impact current operations. The facility owners now are basically have to change from what they're doing today now to vary their operations with automation.
Speaker 1:Interesting.
Speaker 1:So we're just sort of painting a picture for those folks out there that are wondering what's going to be happening and probably we're scaring them to death too, because I mean these what's going to be happening, and probably we're scaring them to death too because I mean these things are going to be costly, they're going to require a lot of thought and a lot of planning.
Speaker 1:You said earlier that you've worked in over 350 facilities or systems and in 14 countries, and I know that, for example, when we develop new drugs and new medications, the standards of clearance in the United States to be able to put something in use are a lot more stringent than they might be in foreign countries. I'm wondering, and also I know that you're working with some big non-healthcare projects in some foreign countries that have a lot of money, and when you have a lot of money you can be developing sort of bleeding edge things that would never make it here. We usually get things after they've been pretty much proven to be effective rather than at the front end. So, given your experience with all this outside work and working outside the country, what kinds of things can we expect to see in the future coming down that we don't even know about now?
Speaker 2:Well, what's interesting is you mentioned those countries that have a lot of money and they do pretty much anything they want to do because they have the money, like ski slopes and shopping malls in the middle of the desert, but when it comes to health care, they kind of basically lean towards either a British standard or American standard, but they really haven't embraced automation.
Speaker 2:They still kind of look towards, you know, and they can bring in workers that are very, very inexpensive even though they have this tremendous amount of money. Now, when you take a look at the other side of the world, in this case the Pacific Asian market, you know they embrace technology a lot more and more quickly than other parts of the world, and I think it's really again that's being dictated by labor shortage, but they also, basically, are developing advanced technologies themselves. So they're embracing it quicker because they're developing advanced technologies. However, it's in non-health care, it's more like us in manufacturing and a commercial arena, but they have the mindset that they'll accept it. Both countries still look toward the United States for our codes, our operations and our best practices.
Speaker 1:So, that being said, what do you think needs to be done operationally to optimize healthcare logistics in the future?
Speaker 2:Well, the one thing I've seen for the last four decades almost for the last five decades is really a silo of operations and back of house. It's everyone does their own thing. I've got supply chain. That's what I'm going to focus on. It's my cost center. I'm going to take a look at you know how do I drive revenue at this operation? And the same things happen with, you know, evs, housekeeping, same thing with waste management, same thing with SPD, same thing with pharmacy. So everyone has these standalone silos that are operating independently.
Speaker 2:I think you know what needs to be done in the future. We need to take a look at this as a holistic back-of-house operation because there's commonality that kind of springs through everyone. Everyone basically has, you know, when it comes to supply chain, comes to linen, when it comes to food service, when it comes to pharmacy, they all have to get items up to the floor to support patient care. So why do they have separate runners? Why do they have separate transport systems and schedules? These are all duplications because of these operational silos.
Speaker 2:I think what needs to be done in the future and I hope I have the ears of these, you know, healthcare system operators start looking at basically a holistic view, consolidating these operations and basically establishing, you know, what's common and basically how you can basically take this commonality and basically support it through one centralized resource, be it manual transport, be it automated transport.
Speaker 2:But really there's some efficiencies to be gained out of that and I see that as one of the big glaring things that hasn't been done in the last 40 years. And I'll go a little bit further on that. How many times I've been in the hospital and seen pharmacy personnel run towards the elevator at the same time as linen supply chain, everybody else Because everybody, you know, wants to work, you know 630 to 4 o'clock and basically says this is where we're going to transport. They all run towards the elevator. They basically put the elevator systems at capacity and basically you have people standing in the lobby. You know, if you have this holistic view where you could basically, you know, have a common transport schedule, you could basically reduce these peaks, the demand on the elevator, thus the equipment needs of future builds, right yeah absolutely.
Speaker 1:You know, I used to tell people speaking of that holistic concept that if you ever saw a wasp nest or a bee's hive, you see these, the wasp nests are wafer thin, wafer thin, the wasp nests are wafer thin. But you do a cross-section and they've got all these hexagonal-shaped things that hold them together structurally and they can withstand and survive gigantic storms. And I used to tell people, if you asked a hospital system to build a wasp nest, they'd fall down because each department would build his own, it wouldn't be connected to any of the others. There'd be no continuity, because all they ever learned to do is take care of their own function. And I think what you're pointing out is we need to foster this idea of collective thought as we go about what we do in the future that we're all important. None of us is more important than the other, and in order for it to work well together, we need to keep that in mind. Is that fair?
Speaker 2:That's fair. That's a good way of saying it.
Speaker 1:So you know this is we're reaching the end of our second episode here. Hugh, what message would you like to pass on to the designers and owners? An episode here, hugh.
Speaker 2:What message would you like to pass on to the designers and owners? I like to you know the one thought that you know I kind of tell people if it's programmed and designed incorrectly the first time, it's wrong forever. You know, make sure you get things right the first time around. You know, if you you get things right the first time around, you know if you don't, there's going to be, you know, operational inefficiency, increased operational costs, decreased patient care. It's a long list of items that if you don't do it correctly, you're going to suffer this the next 50 years of life with the building.
Speaker 1:Yeah, that's true. I mean and you know all of the stuff we've talked about gets down to this whole deal of it all depends on having accurate and complete data to begin with, and then giving that data to people and systems that are proficient. So my final question, I think, would be what types of rigor do you go through on a project to make sure that you have dead accurate data to be able to figure out what you need to do?
Speaker 2:Our approach is, you know again, I go back to you know the old days when we used benchmarking. It was, you know again I go back to you know the old days when we used benchmarking. It was, you know, one size fits all and that's an incorrect, you know, presumption as you move forward in a healthcare design. So when we basically, you know, come forward to a client, you know we're asking them to give us the data, know we're asking them to give us the data.
Speaker 2:So my recommendation to these healthcare systems if you're envisioning basically to move forward with a new facility, evaluate your existing facility, gather the data, make sure you gather it for an extended period of time. It could be as simple as you know, doing a truck activity study at your service docks. It could be a trade demand, you know, from your SPD. You could be taking a look at your preference cards, you could be taking a look at your procedure schedule. But collect the data and then, basically, as you move forward, utilize and leverage that data basically to determine your needs and demands in the future, because that will really dictate how to move forward, you know, be it, you know, adding equipment, adding systems or adding a new facility.
Speaker 1:And when you go in knowing, like I say, you're 350 projects over 14 countries, you realize, of course, that whatever data they give you, you still have to back check and make sure that it's verified and that the data they've given you is accurate. Is that correct?
Speaker 2:That's correct. What we do is, you know, we typically ask for a year's worth of data for the models we run. And then you know, when we go through and analyze that data, we see if there's any kind of outliers in there from the norm and basically you know, talk to them and why these outliers exist. But we run the model based on the years' worth of data. Then we go back to them and the you know stakeholders to look through our analysis, basically to verify that we have it right, that they feel comfortable with it, and it's only until then that we move forward.
Speaker 1:You know saying, projected on your, you know, future anticipated volumes, this is the equipment, systems and space you need to support those functions, yep. And you know I'm reminded of something the importance of data and getting things right the first time, as we talked about. Like you say, if you screw it up at the beginning, it's always going to be screwed up. The old saying is you've got time to do it over. Why not take time to do it right? And I think that's especially true in what you do.
Speaker 2:Yeah, you know I'll go back and say typically the approach that I just outlined takes a little more manpower, a little bit more effort to do and you can basically shortcut that. Well, what happens? It impacts really the space and thus costs the construction in the long run. So if you do it right the first time, in the correct way, it may cost you a little bit more money, but you don't live with maybe inefficiently planned floor space of your new facility which affects operations for the next 50 years.
Speaker 1:Absolutely Well. Hugh, thank you for spending the time to do these two episodes. I think that folks that are out there planning new builds and what they're going to do in the future will probably be given an awareness of, and an appreciation for, transportation and logistics that they may not have had before you shared with us. So thanks again. Thank you for your 45 years. You're just a rookie 45 years in health care and hopefully you'll have 45 more. We appreciate it.
Speaker 2:Well, thank you, Fred. I guess when I put another 20 years in, I'll just start doing podcasts.
Speaker 1:That's right. Well, hey, you and I are probably the only two living human beings right now who know what Transcar is. Okay, thanks, Hugh, and thanks so much for allowing us to you know, listen to your experiences and gain your knowledge. So, thank you, Thank you.
Speaker 2:Fred, and we'll talk to you later.
Speaker 1:Okay, take care.
