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
Innovative Facility Strategies for Modern Healthcare Needs
The healthcare landscape is undergoing significant changes driven by labor shortages, technology integration, and the need for efficient operations. This episode emphasizes the importance of designing hospitals with adaptable systems that leverage technology for improved patient care and operational efficiency.
• Labor shortages shape healthcare design and operational priorities
• New construction allows for greater flexibility in incorporating advanced technologies
• Existing hospitals face unique challenges in integrating updated systems
• Effective dock planning supports operational efficiency and supply management
• Robotics play a crucial role in both back-of-house and patient-facing operations
• Differentiating distribution needs for clinical items vs. pharmacy supplies is vital for compliance
Hey everyone, this is Lindsay with St Onge Company, welcoming you to this week's episode of Taking the Supply Chain Pulse. Today we're joined by one of St Onge Company's very own, ryan Mayer. As a director on our healthcare team, ryan brings deep expertise in technologies and systems. We'll be diving into his insights, experiences and what's shaping the future of healthcare tech. So grab a coffee, settle in and let's get started with your host, the one and only Fred Kranz.
Speaker 1:Ryan, why don't you tell us a little bit about your specialties and the types of clients you serve?
Speaker 3:Absolutely. Yeah, Thanks, Fred. Thanks for having me on, Appreciate the opportunity. So it's any sort of you know, the loading dock, how things are received, how things move throughout the hospital, any systems associated with that, whether it be pneumatic tube systems, robotic systems, elevators, all of the different systems that help things kind of move and operate within a hospital is an area that I really enjoy and a part of I've been really focused on new construction services, although we do have some of our clients that are looking at audits of their existing system or opportunities to enhance, but a lot of it is associated with new construction.
Speaker 1:You know there are several topics in there New construction to me and I know nothing about what you do, okay, but new construction to me sounds easier than trying to adapt existing situations to new technology. So when you talk about the concept of adaptable design and you tied that in a conversation we had with the idea of the changing labor force, how does that work in a new build and maybe a little bit in an existing build?
Speaker 3:Sure, yeah, absolutely so. When we look at hospitals and if you go back in time, you know, go back 20 years ago you know people were flocking to hospitals to work. There was good benefits, the labor you know, the salaries and reliability of working within healthcare was really great. It was unbeatable actually and what we're finding now is that the labor force is actually shrinking. We've got less people, less labor available to be able to support the operational needs of the facility, and we're also finding that we've got competition within health care. So, you know, several of our clients have recently talked to me about, you know, the challenges with Amazon. Just as an example, you know building a warehouse down the street and their labor force is finding a new home with Amazon, who's paying them more money and giving them benefits that will support. In fact, I just had one hospital that told me that, as an example, they have a sterile processing technician in their hospital that makes less who. You know, in sterile processing you have to be trained and certified and understand the IFUs and everything else related to how to process instrumentation, but they're getting paid less than the guys that work at Starbucks, than the same hospital, and so it's those types of things that are really starting to shape and form to, whether you're an existing hospital or a new hospital you really have to be thinking about how are really starting to shape and form to whether, whether you're an existing hospital or a new hospital, you really have to be thinking about how are we going to find labor and people to be able to support our operations moving, moving forward.
Speaker 3:And you know, in an existing hospital I think it's, there's opportunity, there's always opportunities to find process improvements. How can we do things better, more effectively, how can we institute or leverage technology to help us within an existing facility? But you're always challenged a little bit with the existing infrastructure. Do we have enough ceiling height? Do we have the right number of elevators, the support to get there? New construction, I find often is a catalyst or an opportunity to really leverage change in a facility and to really start to think differently. And so that's where I think you know we might find it different with an existing hospital where we're trying to just work within the existing infrastructure. There's always opportunities. But I would say with new construction, oftentimes there's greater opportunities to really, you know, understand the opportunity or enhance the you know systems and processes to be able to provide a reduced labor need, moving forward.
Speaker 1:So when you work with new builds, which is more common, that they've had some previous discussion about what type of automation they might want to have in, say, sterile processing or just automated guided vehicles delivering supplies on the floors, or have they just X'd out X amount of space and leave it up to you to figure it out with the customer and them?
Speaker 3:Yeah. So I think, like a new construction, generally we start with a programming phase and part of that phase we'll do a business case to look at does it make sense to implement an AGV or an AMR or a pneumatic trash and linen system or a gravity shoot system or an electric track vehicle system? There's all sorts of systems that can help support their operation. And so we have to go through and develop, you know, look at the options that are right for the facility and then develop a business case to help the hospital to make that kind of decision.
Speaker 3:It's always a tough decision because it's you know, on one hand it requires space, which is cost. On the other hand, you know these systems are going to help operationally, which is also cost. But those two costs often aren't related. It's here's how much capital we have to build the building, and then there's this other side of it that says, okay, now how much do we need to operate the building? And tying those two together is where we really feel like that business case can do that to help owners make good decisions. And then, once they make a decision, then we start to look at the space required to be able to support their operations. So where do we want to use this technology? What is the benefit of it? And then what are the spaces you know needs for that particular system?
Speaker 1:Well, you know, I've never been visiting a site with what I call you real supply chain folks because, I ran supply chains but I wasn't a supply chain guy. I've never seen, I've never been on a visit where your mouth didn't water when you saw the dock, because it was always screwed up right. Every place you go. The dock is a big opportunity. Talk about dock planning and considerations when you get called into a customer.
Speaker 3:Yeah, I mean docs are challenging, right. I mean it's the age-old winter trucks coming. How many are coming and how long are they going to be there at the doc? And then a lot of times it's not just the doc People like to think of. How many doc positions do you have? Oh, you have five, that's great, that will support your hospital. But the reality is it's not just the dock, it's all the support space to be able to support that. So how much receiving space do you have? What is the process, flow and connections to the linen room and to the you know, waste management, and how much space is associated in the adjacencies for all of that? So, as you think about the loading dock and we do get on these docks, and some of them you know it amazes me I was just looking at a hospital the other day that you know very large institution.
Speaker 3:They have two dock positions. How they operate is beyond me. It's, it's, it's. They have trucks in the street and it's just, it's just incredible how they're able to operate. But is it really? You know, we have to kind of step back and say what's the right solution for the hospital. It's not always in the best interest of the owner to have trucks parking in the street and offloading and you know how things are coming into the facility. So the loading dock I often think of is kind of that support services entrance to the hospital. And if you can funnel all of that through there, it helps from an understanding of who's coming into your building from a security perspective, but also you can manage what's coming into your building and how much. And the supply chain folks do a wonderful job of looking at the dock. But you know, from my perspective it's really understanding how many trucks are coming to the dock, what's their dwell time, how long are they going to be there, and then all the support spaces to be able to support their operations. Moving forward.
Speaker 1:And do you often? I did a project at a hospital in Cincinnati where they had they're building a new hospital across the street from a giant mall and it was a children's hospital and they had one formal receiving dock bay and then they had another space where you could unload stuff on the ground and run it up a ramp right. So they had a heck of a problem and we had to do all kinds of studies and almost do 24-hour-a-day delivery movement. Do you encounter that a lot?
Speaker 3:Yeah, I mean the challenge is there, right, and you kind of alluded to that what you typically, or what you saw at that hospital, in the children's hospital, in that you know a lot of times if you don't plan enough dock space, then it'd be.
Speaker 3:You know, people often say, well, it's just a scheduling exercise. But the scheduling of a loading dock isn't as simple as it sounds. It often ties to the vendors that are making the deliveries. And then what people don't realize is those vendors that are making those deliveries are often tied to other customers in the region or in the area, so they're not just coming to Hospital A to make a delivery. They might be going to a university, they might be hitting a clinic somewhere, they might, you know, and you might be one of six stops or seven stops that that truck makes. And so the timing of that is oftentimes not always as predictable as we'd like it to be. You can generally get it in zones of operation, but it is hard, to your point, to really kind of get the scheduling down right. But it is nice to be able to maximize it if you can. So that scheduling is important and the timing is important from a design perspective.
Speaker 1:Yeah, and I made a mistake, it wasn't a children's hospital, it was a community hospital. But also, since it was right next to the giant shopping mall, you had to deal with all the incoming freight that was going to the different stores in the mall too. So it really really became a difficult problem. So on that dock you have trash, you have linen, you have all kinds of stuff. Environmental services takes up a huge amount of space and many different senses in the design of a facility and many different senses in the design of a facility. How?
Speaker 3:do you go about designing? You know designing for EVS, yeah, so I think from my perspective, I think you know EVS is one of the largest. If you think about EVS, they're one of the largest staffs in the hospital. You know there's a lot of people trying to keep that hospital clean, maintained and operate. And then you know all of the waste that's generated in the hospital.
Speaker 3:There's a lot of different forms of waste. It's not just like if you're at a mall, like you were just talking about, where you've got your you know general trash that's coming out and you've got some recycle that's coming out In hospitals. You've got regulated medical waste, you've got your chemo waste, you've got your RCRA waste, all sorts of different specialty waste forms that are coming out of the hospital, and so you do have to understand their waste volumes and then plan the space appropriately so that you can stage those in the facility. And the other thing I would say a lot of hospitals they don't do a really good job from a design perspective of thinking about a separation of their inbound clean and their outbound soil, and you know the flow of those materials. If you can separate them as much as you can, that's you're much better off as soon as you start, you know, bringing your supplies right past your compactor. That's where you run into trouble and it becomes really hard from an infection prevention perspective to really keep you know things operating smoothly and effectively.
Speaker 1:Yeah, and it can be a joint commission violation quite easily if you do things really wrong. So, yeah, so the buzzword out there today? Of course, there are two buzzwords actually AI and robotics. We tend to we tend to learn terms before we learn what they mean or how to effectively use them, but robotics comes in there. Tell me about the difference between front of the house robotics and back of the house robotics and the considerations you have to look at for both of those.
Speaker 3:Yeah, absolutely yeah. So there's when I think of back of house, you know I'm thinking of a service corridor where you might have things like big linen carts or big supply carts. You might have your large trash carts that are moving through those facilities or through the facility. A lot of times you might look at a system that, historically, if you look at some of the institutions, large institutions out there, they've implemented what's called an agv system, an automated guided vehicle system. These are systems that can move very large carts, over a thousand pounds and and and they're historically meant to move through back of house corridors. You know service corridors, and so the robotics is is you historically, has really been focused on that back of house service.
Speaker 3:However, there's, you know, a great influx of the desire to get robotics to also go to the front of house. You know some of the hospitals, like I did a children's hospital where you know recently, where they had an AMR that you know looked like a train, you know that was moving right through public spaces. And the biggest challenge with the technology is there, and has been there for years, to move through public spaces. The challenge is is are people ready for it? And I think people more and more. I mean, you go to the grocery store, you go, you know, to hotels.
Speaker 3:You're seeing robotics being used in a lot of different applications and people are getting more and more used to the idea that they're out there. But a lot of times within front of house, we're starting to see robotics used for transferring supplies or food or medications or picking up lab specimens, you know, right from a nurse's station or right from you know the point of generation. So, moving into the front of house, generally the robotic systems are smaller and can articulate and move better around. You know objects that are in the way or even people that are in the way. Versus the back of house robots, where they're big, they're robust, they're hard to kind of articulate sometimes around. You know, obviously, a patient floor with all the things that are happening on that particular floor. So there is something to think of when you think of both of those. You know, when you're thinking of front of house versus back of house, you have to kind of think about those a little bit differently.
Speaker 1:Have you been in? I have not ever been in a place recently. I just I back in 1978, we tried out automated guided vehicles at Baptist Hospital in Miami, way before anyone else was doing it. But that was in the service that was in the service corridors. Okay. Have you been in places where, in public corridors, or where you've seen people that are patients or visitors interacting and witnessing the robots?
Speaker 3:And what is? What has been the response or the reaction from them that you've seen? Yeah, yeah, I think. I think that there are hospitals Again, we're talking about front of house robots where they might look like a train or sometimes they, you know, like to decorate those robots. But, yeah, there are several facilities that are using it more for that front of house and people generally are okay with it. They look at it and they go gosh, this is really cool.
Speaker 3:I like this technology, but I think the real benefit is, you know, if you can move through a space. You know, generally we still don't want robotics going through a public, you know, like an entrance to a hospital or areas like that. Our families might be going to visit a patient in the room while this robot's moving down a corridor. You know, we see that all the time because, really, if we can get our materials closer to the point of care, the better off the nursing staff's going to be able to take care of the patient, and so I think there is a need to look at going further in and absolutely there are systems all over the country that do that.
Speaker 1:Yeah, some of those AI-type robots actually are designed to help give pharmaceutical information to the patients, and things like that will come into the room and sort of interact, talk with the patients. It would be interesting to see what their visitors think when that happens, you know.
Speaker 3:Yeah, yeah, I think it's interesting because you know there are. You know we're talking about staffing shortages earlier and it was really focused on support services, but we've heard similar complaints and challenges relative to nursing. You know, nursing is really there's a huge shortage in nursing and traveling nurses are three times the cost and they're not used to the hospital. They're coming into an unknown environment. There's challenges with it and so, as you think about the nursing staff and the challenges there, you know where can robotics really help? You know moving forward to allow hospitals I attended a HIMSS conference, you know, a year ago, and there were two or three robots that the intent of the robots was just to socialize with the patients. So you say that jokingly, but the reality is is a lot of times, you know, interacting with the patients and creating that bond between a nurse or a technician and a patient. You know robotics might be able to help with some of that and help them to feel comfortable.
Speaker 1:Yeah, and automation as well. I think I know Tom Redding one time made a statement that the largest, single, largest component of a caregiver's day is unnecessary or redundant paperwork, which makes it makes it impossible for those people to actually interact on a personal basis with with the patient. So if you can use either technology or robotics or AI, whatever to create more time, that's a great thing. Tell us the difference between distribution concerns for clinical items versus pharmacy.
Speaker 3:So yeah, so like, if you, you know, obviously, when we deliver supplies, a lot of times supplies depending on how the supply chain for the hospital is working. A lot of times it's a just-in-time or lump delivery system where supplies are picked by a distributor off-site. They'll put it into totes. Those totes will get brought to the hospital. Those totes, you know, once it gets to the hospital get put you know on a cart or maybe they already come on a cart. Those carts are taken up to supply rooms and put away. The ability to leverage the technology there is pretty easy because it's just taking that cart of totes and having it go up.
Speaker 3:The difference with pharmacy is that a lot of times where we see pharmacy finding the greatest use with robotics is more on things like your hourly runs or distributing medications that can't go through the pneumatic tube system, or maybe it's a first dose that you need to get up and you don't have a tube system that goes to that area.
Speaker 3:You know it's things like that and so it's very patient specific. It's not bulky, big totes that we're moving or big carts that we're moving, but rather smaller items, and so some of the systems out there actually have cabinets that as you pull, pick your pharmaceutical that needs to go to a particular patient, you'll plug it into the control software. Drawers will open up, specific for that patient. You'll drop the medications in, close the drawer and that's all that goes into that drawer and that robot. Then you know, after it fills up or over a certain period of time, then goes up to the floor and only certain people that have either biometrics or scan their card are able to actually open that drawer and get that medication out specific to the patient. So it's a different, maybe different way. It's still technology that moves stuff, but it's how you get that chain of custody and really maintain ownership of the medications all the way from the pharmacist who issues the medications, all the way to the patient, throughout that process.
Speaker 1:So this has been an interesting conversation, and what I've gotten out of it is that, as time goes by, we are designing more responsibility into the operations, as opposed to just, you know, pulling the boxes off the truck, throwing them on the shelves in the warehouse and having someone take them up later or taking the boxes to wherever they go. We are now actually designing full scope, from point of reception to point of use and even up with waste to point of disposition when we do new designs, something that, when I started in the business, certainly wasn't there, and now you guys are doing it every time you make a new build. So you have a really exciting job. I mean being able to design solutions like that. I think it's great. Well, ryan, thank you for taking time out of your busy day to join us. It's been great having you on, and this is an area that I'm sure a lot of people would like to learn more about, and I know that we'll have you on in the future for some other stuff to talk about, so thanks again.
Speaker 2:That's it, everyone. Thanks for joining in to this week's episode of Taking the Supply Chain Pulse. Please make sure you subscribe and follow along, and we'll catch you on the next episode.
