Supply Chain & Clinical Specialty Areas: The Challenges

By Sophie Rutherford

Recently, I had the pleasure of co-hosting a webinar with Rita Antis, CMRP, Materials Manager, Perioperative Services, Materials Management, Chesapeake Regional Medical Center, in which we looked at the gaps and challenges, relationships and opportunities for improvement between a hospital’s enterprise-wide Supply Chain Management team and Clinical Specialty Areas. For people who weren’t able to attend, in the next few blog posts, Rita and I will recap some of the key discussion points from that webinar.

I've been in healthcare supply chain my entire career, and have worked with single hospital systems as well as large IDNs. I’ve seen supply chain in many shapes and sizes, and the approach to supply chain workflows have varied tremendously across these organizations. However, one thing I’ve consistently seen in Clinical Specialty Areas is that inventory, especially patient chargeable items, is not managed by supply chain and has workflow independent or outside of supply chain systems.  

Let me give you an example – an OR has an inventory coordinator who is specific to the department. There’s a good chance this person works for the OR, not for supply chain, and their workflow may be completely different than supply chain.  It’s common that in Clinical Specialty Areas, purchasing and occasionally even contracting is independent from the rest of the supply chain, operating in an isolated fashion within each area. Often there is no technology used to manage the inventory, and the workflow is highly manual. A recent industry survey reported that nearly 20% of physician and nurses' work week is spent on supply chain management, including replenishment activities, tracking, locating and managing product expirations. As you can imagine, this use of clinical resources is very costly to a healthcare organization.

As we understand how costly and important this gap is, and begin to understand the drivers, we can build more collaboration between supply chain and these clinical specialty areas.

So here are some of the common gaps and challenges –

  1. Items in these areas are specialized. For example, in the Cath Lab you have catheters and guide wires – items are not typically carried in central stores, with a very short shelf-life. Clinicians in these areas tend to feel more confident when they can manage the supplies, because they believe they’ll have the correct items (size, quantity, combination of items) available when needed. Unfortunately, this often results in overstocking, a higher percentage of expiration (especially if the items aren’t rotated) and even stock-outs if the inventory is not managed effectively.
  2. Clinicians don’t have a foundation in supply chain methodology and techniques. Their clinical skills are what qualifies them. Things like inventory rotation, understanding item velocity, and par level management – not so much.
  3. Good inventory management technology is lacking. To the credit of supply chain teams in hospitals across America, supply chain – a non-revenue generating department, has not been provided with the robust technologies we usually see on the clinical side of the house. Often it’s the clinical system requirements that determine what the ERP system will be, and the supply chain or materials management module is an afterthought.  Many of the materials management information systems in use today are purchase order and contract management systems, and not true inventory management systems. These technology gaps result in workarounds and manual processes outside of the system.
  4. Often clinical systems and materials management systems are purchased separately and do not integrate or interface well, leaving a gap between data moving back-and-forth effectively. Many hospitals have implemented robust EPIC- or Cerner-type systems for medical records, but what we’re seeing now is that these systems don’t integrate with other legacy systems, causing a lack of interoperability.
  5. At the core of these gaps is the lack of data continuity. The lack of visibility to data at an enterprise level causes ongoing challenges around inventory-related topics such as standardization and forecasting. You probably don’t want your only utilization data coming from your suppliers.

But with the right amount of supply chain engagement, alignment and collaboration, an enterprise-wide process consistent with commodity item management can be developed. In the next blog, Rita Antis will provide the clinicians’ perspective on building collaboration and clinical pathway utilization that will help you create a roadmap to bridge the gaps of supply chain and clinical specialty areas.