In my last ED-itorial, I wrote about how we need to do a better job of documenting/tracking/tracing supplies so we can keep patients safer. It is a difficult, tedious and potentially costly endeavor, but there is a significant return. The return comes in several ways.
First, I have never been involved in a project that didn’t generate at least a modest payoff in the data-gathering phase. Historically, most organizations have never attempted to truly understand the actual cost of goods on a case-by-case basis. Just the process of gathering the data and assembling it against patient consumption inevitably identifies cost savings and/or revenue generating opportunities (e.g., price leveling, waste, utilization supply savings and/or lost supply charge revenue or other billable charges evidenced by the use of certain supplies). A secondary benefit associated with this exercise is the development of an understanding of the role the various supplies play in the overall process. A macroscopic understanding of a process can often lead to the asking of “why” questions as opposed to the “how” and “what” questions that are associated with the microscopic approach of looking at individual supply items and their cost. My personal favorite, often heard when running a detailed procedure report for the first time for leadership, is: “Why are there so many more items on the preference card?” This is sometimes followed by an astute observation: “The preference card has the items that are pulled for the case, right? So, there is wasted labor in that activity. What about the extra supplies, do they all get back to the shelf?”
Now the process rationalization can begin (using the how and the what) and you’ve deployed a means to measure and monitor ongoing success.
The second return is rooted in the old adage “measurement drives behavior.” I actually studied this in college. After receiving my engineering degree I recognized that I often used technology to inform or influence behavior change, so I went back to school and studied behavioral science. Tell me I don’t use both of those degrees every single day in the healthcare supply chain. You’ll be surprised what comes from a little transparency. Simply creating and publicizing actionable dashboards of cost/case data will drive down the cost. When outliers have the ability to utilize data to conduct peer reviews and make decisions on their choices (there’s the actionable part) the need for excessive or habitual (“that’s the way we’ve always done it”) items evaporate. One COO I worked for placed a PC loaded with the dashboards in the surgeons’ lounge. Her intent was to be sure that the surgeons knew that the hospital was tracking cost/case. What we found was that the surgeons were using the dashboards to conduct real-time mini peer reviews between cases to improve their supply utilization, time per case and outcomes.
Third, there is benefit of the process itself – the outcomes-oriented collaboration of folks with different skills, points of view and relationships to the process being examined. The benefits from this part of the process are probably the greatest as it relates to the overall operation of the organization. Done correctly, the collaborative approach brings diverse folks together and aligns them to the solution of a common problem. Done without pre-existing conclusions and in good faith, it has the very real possibility of building a collaborative organization – one in which common goals and objectives supplant personal ones. This goes beyond engagement to an organization enfranchised.
In an environment that is ever more driven by the documentation of hard dollar cost savings, the collaborative approach (supported by the right technology) will be able to document the totality of a process and will be able to measure and report on the benefits of all possible interventions within a process as they relate to all costs and outcomes.
The multidisciplinary, interrogative approach, on a foundation of synchronized data from various databases already present, can help the organization discover the answer to the true question: How can we deliver the best possible care at the lowest possible cost?
