How to Clinically Integrate Supply Chain
For years Supply Chain has understood and discussed the need to integrate evidence-based approaches and to focus on utilization management. It is difficult to obtain data that reveals utilization information and evidence-based studies that support or oppose supplies; however, there are some steps that you can take to clinically integrate supply chain.
The first step in this journey clearly must establish product standards that support clinical standards of care and associated care guidelines. As nursing care design teams establish standards of care the supply chain value analysis process needs to integrate evidence-based standards for products and services. The supply chain approach may vary depending upon your institution’s approach to clinical paths or standards of care design. For example, if your organization is working at the DRG level then the complexity of mapping supplies to the specific DRG may be a bit overwhelming. A simpler approach may be to consider standards of care and associated products and services in three buckets.
Start with basic care that which is administered to every patient regardless of diagnosis or length of stay. These would be items associated with taking a blood pressure, temperature or conducting a risk assessment for falls. The second type of care would be specific to a need. This would be an IV or indwelling catheter management; perhaps a chest tube or PICC line. The third category of care would be disease-specific or by DRG.
From a supply chain management prospective create three buckets of supplies or services that align themselves with these three categories of care. Basic care includes commodity items. Specific care includes clinical preference items, and DRG items would be traditionally called physician preference items (PPI).
This categorization of products according to care makes standardizing products a bit less ominous and more reasonable to map supplies to care. For example, think about commodity items as bedpans and blood pressure cuffs, clinical preference items as those supplies and services that a physician may order but clinicians use, and physician preference items as supply items used every day by physicians, such as trocars, sutures and implants.
When discussing DRG-level care with physicians there is no need to discuss commodities or even clinical preference items. Doctors typically lose focus and interest very quickly in this level of supply. Focus on items that they use and leave the other two types of product categories to clinical care teams. Clinical and commodity items may become the focus for your more traditional value analysis teams to tackle for standardization and cost reduction while DRG-related items may be part of bundle or risk agendas with doctors.
The clinical integration of supply chain will add value to all three of these care teams by providing standards for products that will support the standard of care. If there is one standard indwelling catheter tray in your organization it stands to reason that it would be easier to drive a standard of care. Partnering with your suppliers on evidence-based research and published clinical protocols for the use of products will help achieve a consistent standard of care, resulting in better outcomes. Thus, the clinically integrated supply chain has driven cost, quality and outcomes for our patients and ultimately for our organizations.
Once clinical and product standards are established, cost per adjusted discharge (CPAD) can be studied and we can begin to set utilization goals. By identifying variation in CPAD by unit or hospital, within an IDN, we can begin to see variation in practice by variation in products used. We must first have a standard product and practice so we can accurately measure variations in utilization and ultimately outcomes. Otherwise, there is always variability when using different products or following different clinical protocols. Our goal for a clinically integrated supply chain is to help drive better outcomes through the standardization of products and services and the identification in variation in products being used. It’s a big job and one of the emerging values of the clinically integrated supply chain.
Please contact me for help on preparing for your race to clinical integration in supply chain.