Involving clinicians in procurement decisions

April 01, 2020
By Valerie Dimond

As the healthcare landscape continues to change, supply chain professionals will also need to change the way they conduct business.
Historically, supply chain’s main focus was on cost, negotiating contracts and getting the best deal. While those goals are still dominant when making purchasing decisions, success also requires the inclusion of a lot more people, namely clinicians. Clinical-supply integration is an end-to-end process focused on shared accountability for care delivery, alignment with the system’s mission and values, and patient outcomes. However, the process can stall and get complicated if parties are misaligned.

For example, surveys conducted last year by Nexera and Acurity asked senior healthcare management professionals if their clinicians are officially included in supply chain utilization and procurement decisions. Most said yes, yet the majority of clinical, operations, and materials professionals polled said no. Moreover, only 5% of administrators cited clinical integration as their supply chain’s current priority. Clearly, health systems have more work to do when it comes to engaging those on the front lines.

“Clinical integration is really saying what is supply’s role in the total equation of managing outcomes or managing the total episodic care; it’s taking a more intentional approach to the holistic view of connecting supplies to outcomes,” said Steve Kiewiet, CMRP, FARHMM, FACHE, chief commercial officer, Intalere, and former vice president of supply chain at BJC HealthCare in St. Louis. “I don’t mean supply chain is in charge. Some people feel that way, and I do not. Supply chain is a key contributor, a key integrator, and a key facilitator. Supply chain doesn’t make the strategy, but we enable strategy. There are all these other inputs that don’t involve supply chain that are part of the equation, too, which is around care pathways and patient compliance, procedure variation and stuff like that. It’s integrating supply chain into the total conversation, and supply chain playing its appropriate role in that conversation.”

Steve Kiewiet
Yet, for many, there still exists a sizeable gap between supply chain and clinical leaders if those conversations fail to deliver fresh awareness and knowledge that can be used to solve problems more effectively and sustainably. “We don’t have an understanding of the impact we’re having on the clinicians,” said Kiewiet. “One of my friends is a surgeon who talks all the time about how sick and tired he is of having supply chain conversations because all they ever want to do is switch a product, not understanding the impact constantly changing products had on clinician burnout, and then the impact clinician burnout has on the quality of care, and the impact on the patient. We don’t measure it from a holistic point of view. Is it worth saving $1 million if you have no positive result on patient outcomes, because any potential positivity is eaten up by more stress on the clinical team? I just think that, fundamentally, we’re asking the wrong questions when it comes to measuring the value of supply chain activity in the connection to the mission and strategy that comes from the C-suite, beyond just ‘pay less for stuff, use less stuff, use less suppliers’. What should we be answering that we aren’t? Maybe the product isn’t the focal point. Maybe the widget or the service is not the focal point.”

To arrive at some of those answers, healthcare supply chain knows the value of good data, with most using data analytics to make their case, but Kiewiet suggests that the way in which data is presented could improve. “Bring the data that you have and bring it in a way that is actionable and meaningful, and add it to the other book of data that doesn’t come from supply chain so you can help to contribute to the bigger picture,” he said. “A lot of that starts from ‘go out and ask, find out what questions your data should be asking that you’re not asking’, which involves really getting into the other stakeholders and other interested parties to really get at, from their lines, where is this journey? What is value? How do you classify value? What is cost savings? What is not cost savings? What is relevant or not relevant? And it starts to build out.”

As the journey to integrate continues, advances in augmented decision-making technology — artificial intelligence, machine learning, intelligent automation — are the tools many health systems will depend on, but their usefulness will also depend on how willing healthcare organizations are to make significant cultural changes. Kiewiet says Amazon — whether you’re a fan or not — is the model healthcare should emulate.

“What Amazon has shown the ability to do relentlessly well is that everything they do starts at the consumer — the perspective, usability and experience of the consumer — and builds backwards,” he said. “If healthcare did the same thing, I think we would ask different questions and we would build tools and capabilities to answer them. Anything supply chain can do to make itself more present — and I don’t mean put a supply tech in the room, I mean supply chain leaders being more present in the care environment, not to tell but to ask and listen and observe, they will start to become more relevant.”