Over the past 10 years, I’ve been working closely with leading healthcare organizations as they strive to improve their supply chain operations. So, I was intrigued to see a new AHRMM18 track this year focused on “Clinically Integrated Supply Chain” (or CISC).
During the event, supply chain directors, clinicians, and CEOs all addressed this enormous—and enormously important—subject and pushed the dialog forward from a multitude of different perspectives.
And therein lies the intrigue.
When addressing supply chain integration, we are inherently talking about connecting the traditionally disconnected, and it becomes a complicated—and often messy—state of affairs.
What Is a Clinically Integrated Supply Chain?
At a high level, having a clinically integrated supply chain means different departments and stakeholders work together to improve the quality of care that results in better patient outcomes while reducing cost.
But the perspective of each stakeholder is understandably different based on his or her goals and responsibilities within the organization. To shed more light on how a well-oiled CISC can impact a health system, I caught up with a few AHRMM attendees to get their take on what this new concept is all about. Let’s start with the definition from AHRMM and follow with four perspectives: Clinical, Supply Chain Professional, Researcher, and Solution Provider.
1. The AHRMM Perspective
At the Annual Meeting, AHRMM issued the following definition of CISC:
Clinical integration from the perspective of the healthcare supply chain is an interdisciplinary approach to deliver patient care with the highest value (high quality, best outcomes, and minimal waste that results in the lowest total cost of care); this is achieved through assimilation and coordination of clinical and supply chain knowledge, data, and leadership toward care across the continuum that is safe, timely, evidence-based, efficient, equitable, and patient-focused.
2. The Clinical Perspective:
Betty Jo Rocchio, Chief Nursing Optimization Officer at Mercy
Those involved in a CISC work collaboratively with clinical leaders to improve patient care with an advanced supply chain strategy. The supply chain is the foundation, and this operations team supports the partnership by making decisions jointly with the clinical team. An important facet of a CISC is that it is recognized by clinical leaders to combine a successful business strategy with improved clinical workflows for frontline staff.
At Mercy, our CISC is about augmenting both clinical and supply chain workflows so they make sense for everyone involved. You need well-designed processes that work well in real-world scenarios and then the right technology that supports these processes.
Our CISC approach has enabled us to solve problems that have been in the industry for 40+ years—and we’re getting to the bottom of important issues. Our strategy spans products, instrument trays and tissue tracking in the OR, regulatory requirements, cost, and outcomes. Right now in perioperative services it wraps around everything that affects CQO: Cost, Quality, and Outcomes.
Some of the results from CISC work at Mercy include:
- Improved visibility of supplies across the system
- End-to-end lot and serial number tracking
- True tissue tracking—we know what is where at all times
- Improved access to real-time information
- Improved relationships with manufacturers
- Expiration control through FEFO (First Expired, First Out) functionality
- Better support of and response to patient needs
- Enriched clinician engagement—happier nursing staff!
3. The Supply Chain Professional Perspective:
Brent Johnson, Vice President of Supply Chain at Intermountain Healthcare (Retired)
The CISC is a very noble quest. Another way to say this is “How do we put the patient at the center of supply chain?” It’s not difficult to imagine. At the last 10 feet of the supply chain is a clinician with a product or tool in his or her hands helping a patient.
Healthcare is very complex and costly. It’s not run like a business; hence there are many stakeholders involved and all with varying opinions and incentives. Clinicians care about outcomes. Hospital administrators care about efficiency. Supply chain cares about costs. Suppliers care about profits. Patients want cost, quality, and outcomes. There is no single force that pulls all this together.
Warren Buffet said: “Cost is what you pay. Value is what you get.” As an industry we must learn to integrate cost, quality, and outcomes to get the true patient value. Patient-centered excellence requires teamwork, coordination and collaboration among hospitals, physicians, payers, and suppliers. Supply chain is very well positioned to champion this effort because we are at the center of these stakeholders.
At Intermountain Healthcare, as a supply chain organization, we tried to connect supplies and products to outcome. Intermountain’s care processes and protocols were very well organized with strong data analytics. Even with this the results were minor and often inconclusive. However, as a supply chain organization we were driven by value beyond price.
Here are some of the efforts we pursued that connect the dots between supply chain and patient care:
- Worked with clinicians to find the best supplies and standardize on them
- Educated medical professionals that personal preference was not clinical excellence
- Gave emphasis on how supplies are selected, moved, and delivered to patients
- Pushed for product standardization, reducing variation
- Developed a formal program with key suppliers to develop collaboration in obtaining value beyond price, such as patient safety and outcomes
- Created a professional, respected Supply Chain Organization and Supply Chain Center that brought credibility for supply chain to integrate throughout the company for increased value.
Notice that not one of these efforts was accomplished in a silo. A CISC requires teamwork between all of the stakeholders. It is extremely important and needs to be a top priority!
4. The Research Perspective:
Anne Snowdon, Professor at the University of Windsor
What is a CISC? It is an organizational strategy whereby leadership views supply chain as a strategic asset that can advance the performance of the organization. The strategy in systems to date have been driven by patient safety events that have galvanized leadership support to strengthen system transparency (ex. Alberta Health Services, NHS, UK). Clinically integrated supply chain strategies introduce supply chain processes, tools and technologies into care delivery settings to enable clinician teams to reduce risk of adverse events, track patient care processes, the products used in care to individual patients to identify the best outcomes for patients and the conditions under which best outcome are achieved.
Supply chain technologies (ex. inventory management software, point of care scanning, RFID) enable automated capture of product data, care process data, patient and provider data, all uploaded into patient health records. Supply chain staff become fully integrated into clinical program teams whereby the supply chain staff are an integral part of the clinical team to advance and support quality, safety, and cost containment strategies informed by the integrated flow of data that captures the patient journey, outcomes and care trajectory.
What are the outcomes of a clinically integrated supply chain?
- Safety: up to 70% reduction of “never events”, the most serious patient safety events have been reported by two global health systems.
- Quality: patient outcomes provides objective evidence of what care processes and products are achieving the best outcomes for which patient groups. Clinician leaders can readily identify variation and related patient outcomes which motivates decisions on standardization of care pathways and procurement of products.
- Cost reduction: substantial cost reduction is achieved within 18 months of implementation of point of care scanning and inventory management due to the dramatic reduction in waste of products due to expiry resulting in 30% reduction in supplies cost/case. Point of care scanning also streamlines documentation in patient records resulting in reduced labor costs/case as staff workload is reduced.
5. The Solution Provider’s Perspective:
Nancy Pakieser, Sr. Director of Industry Development at Tecsys
After hearing from AHRMM and the other attendees, I thought about how I interpret CISC based on my role as a solution provider. I believe that underlying the successful adoption of a clinically integrated supply chain is data. It is the critical component to the metrics that will be leveraged and elevated to analytical platforms that, in turn, produce frameworks for actionable outcomes. There are several aspects of data that need to be addressed when working toward clinical integration.
The data needs to be clean, and it needs to be captured accurately. This is an ongoing and ever-evolving effort in any clinical setting. Technology and standardized process are helping accelerate these types of initiatives.
The data needs to be standardized across multiple platforms to be usable. This is highlighted in the global work around interoperability. The result is the ability to determine the total cost of care delivery, which can be combined to achieve the next level of analytics that can then support reduced variation.
The relationship between clinical and supply chain data needs to be established. These bridges enable consistency in metrics and analysis—and align all the stakeholders.
Finally, there needs to be a reliable and robust data infrastructure. This will ensure that the clean data is captured, stored, and parsed accurately and slotted into the algorithms and databases to provide the analytics to assess outcomes and reduce variability.
Let’s continue the conversation! How do YOU define the clinically integrated supply chain?