by: Karen Wagner
Being responsive to the supply needs of a demanding department requires determining who can manage supplies most efficiently and what tools and storage methods can offer the greatest benefits. Here, Texas Children’s Hospital shares four strategies for success.
Effectively managing a supply chain is an enormous undertaking for any healthcare organization, but add in the unpredictability of a labor and delivery environment and the challenges multiply.
A case in point is the Pavilion for Women at Texas Children’s Hospital, Houston. The 100-bed facility, opened last March, specializes in multiple births and high-risk pregnancies and can accommodate 5,000 births annually. Evidence of the unpredictable environment came one morning last April: One minute, the hospital was quiet; the next, a patient was brought in who gave birth prematurely to sextuplets.
According to Rick McFee, Texas Children’s Hospital’s director of supply chain management, being ready for the unexpected is the focus of his department, which also manages supplies for the 555-bed pediatrics hospital and a 24-bed pediatric acute care facility on Houston’s west side.
“It’s very difficult to have any kind of consistent supply utilization. You may have three days where you have very low volume activity, and then you may have four days in which you’re really struggling with capacity,” McFee says. “You may have days where supplies are barely used at all; then, you’ll have days where they’ve used everything we’ve got. So we’ve got to be very nimble. We’ve got to be able to respond very quickly.”
Determining Where to Focus
At the Pavilion for Women, McFee’s department manages supply functions for one four-suite surgery department, where emergency C-sections and other OB/GYN surgeries are performed. The department also manages supplies for the two-suite labor and delivery unit.
McFee says key steps for managing such a demanding supply chain include the following.
Remove supply chain functions from clinical staff. Previously, to replenish special-order, low-volume supply items, Texas Children’s Hospital nurses would have to complete a purchase requisition and then follow up with the purchasing department to make sure the supplies were ordered and received. “We’ve tried to remove as much of that activity from our clinical users as possible and have supply chain manage those items,” McFee says.
In preparation for opening the women’s pavilion, supply chain staff worked with physicians and nursing staff to understand needs, select appropriate products, and determine par levels. The clinical and supply chain staff collaborated to identify opportunities to standardize some items, such as surgical gloves, between the pediatrics hospital and women’s pavilion to reduce costs. Supply chain now manages these direct-purchase type items as if they were stocked, inventory items.
These items generally include those supplies that are infrequently used or not conducive to being stored in a warehouse-type facility because of temperature restrictions. A handful may be kept on a supply room shelf on a nursing unit or in an operating room suite. The only difference between these items and other supplies managed by supply chain is that the direct-purchase items are not stocked in the warehouse. Nurses are not aware of which item is a just-in-time purchase and which is a regularly stocked item. “All they know is it’s on the shelf and ready for them to use,” McFee says.
The process matches skill level to tasks, freeing clinical staff to focus on clinical tasks only, and can even reduce clinical staffing, McFee says.
Provide immediate visibility into utilization. Because most deliveries are unexpected rather than planned, having up-to-the-moment visibility into supply usage is extremely important. “Using automated systems is an absolute must,” McFee says. Texas Children’s Hospital uses a bar-coded system to automatically inventory items as they are used. The bar-code system interfaces with the supply chain department’s enterprise resource planning system to automatically generate purchase orders or inventory orders when items drop below a certain quantity. A supply clerk inventories items to validate quantity on the shelf versus quantity in the information system.
The automated ordering system removes many of the repetitive steps in the purchasing process, such as filling out and placing purchase orders. Products have already been sourced and pricing is negotiated upfront, so that every item can be automatically ordered. “That’s been our focus, to try and get as much of what we’re doing to be able to go out the door electronically without a lot of buyer involvement,” he says.
Makes supplies easily accessible for clinical staff. The Pavilion for Women has 42 supply stock rooms. The rooms themselves are locked, but the supply bins are open for easy access. Using the scanner to scan the barcode on the item, nurses must identify themselves, the item that is being removed, and the patient. The system automatically charges the item to the unit or patient as applicable, and puts the item in a queue for reorder.
Although the open bins are easy to use, the downside is that compliance can be an issue because harried nurses can more easily grab an item without documenting that it was taken. This causes more work for supply chain staff, who must then conduct additional cycle counts to ensure that the quantity on hand matches what is documented in the system.
When the bins were first installed, McFee says, only 46 percent to 52 percent of transactions were being captured. Two months later, after nurses became more attuned to the new system, rates improved to about 80 percent. What has also improved compliance is informing nurses of the compliance rate and which products are in low compliance, he says. Nurses receive reports generated by the bar-code system, showing such information as utilization, par levels, and items replaced versus items documented.
Adding Capacity, Not Staff
Maintaining a nimble-yet-sufficient supply chain in labor and delivery has its special challenges, but creating an overall environment that meets the fluctuating demands should enable clinicians to focus on what they do best—provide care.
For example, enhancing supply chain management in labor and delivery has had a positive impact on the supply chain’s ability to take on more work. “We’ve been able to absorb an extreme increase in activity and volume with the same staff,” McFee says. With the addition of the women’s pavilion and the adult facility, volume increased 42 percent. “Because we were able to get some of those commodity-type purchases to be more automated, it gave us the capacity to be able to handle the additional workload,” he says.
Karen Wagner is a healthcare freelance writer, Forest Lake, Ill., and a member of HFMA’s First Illinois Chapter (klw@klw.ms).
