Tuesday, August 23, 2016

Tower Power

Fast  Foreward

During the Independence Day holiday this past summer, the Barlow family visited the Smithsonian Air & Space Museum at Dulles International Airport in Washington, DC.

One of the exhibits was a replica air traffic control tower. Visitors were able to watch airplanes take off and land as well as read detailed displays and watch videos that explained what air traffic controllers and operators do, how they do it and why they matter.

We all have a general idea of how they operate, of course. A station at the exhibit stated that "the air traffic control systems main purpose is to prevent collisions by separating aircraft from terrain, obstacles, and other aircraft.

"Air traffic controllers organize the flow of traffic; keep the traffic flowing smoothly, safely, and efficiently; and coordinate the movement of aircraft around bad weather… provide information about weather and unexpected events and advise pilots about more efficient routes."

In short, their efforts can make the difference between life and death.

Thoughts of the healthcare supply chain leaders operating in a similar manner came to mind. How so?

"Supply chain leaders organize the flow of products and other resources; keep the products and resources flowing smoothly, safely, and efficiently; and coordinate the movement of products and resources around changes in demand and usage… provide information about consumption and practice patterns and unexpected demand changes and advise clinicians about more efficient product and service options to help them improve business and clinical operations, their individual practices and patient care as a whole."

In a way, their efforts can make the difference between life and death, too.

Supply chain leaders - just like air traffic controllers - function as advisers and facilitators, continually amassing and analyzing data on resource consumption patterns, clinician practice patterns (doctors and nurses) and supplier production patterns so that they can provide useful information to their clinical, financial and operational customers when they ask for it, if not before they ask for it.

Such applications of data science from a supply chain control tower represent the litmus test for the supply chain executive and leader of the future.

Of course, whether you’re ready may hinge on the maturity of your supply chain operation. A few weeks ago, Healthcare Purchasing News hosted a webcast sponsored by Ryder Systems Inc. where Ryder supply chain pros highlighted the importance and magnitude of supply chain operations as the second-largest cost center behind labor with the gap between the two closing as the years advance. (To access the webcast,visit http://www.hpnonline.com/webinars/HPN-RyderWebinarVideo-Login.htm.)

One key element for success? Effectiveness as a baseline before efficiency for supply chain practices. Basically, perform it right before you decide to improve it to the point of doing it well — or at least better.

The challenge? Ryder execs cited research from the Center for Innovation in Healthcare Logistics at the University of Arkansas that showed more than 50 percent of supply chain execs surveyed classified their operations as "ad hoc" and "defined," which CIHL and Ryder termed as "immature."

The bottom line: You have to walk before you run, and apparently many organizations have miles to traverse.

So the question remains: Do you have what it takes to build and maintain a supply chain control tower operation?

Doctors, nurses, your healthcare organization and the patients you serve — not necessarily in that order — depend on it.

Rick Dana Barlow

Thursday, August 4, 2016





Bondo, Kenya

Daniel had a huge growth over one eye when Ralph and Linda Bartholomew firrst met him in Bondo, Kenya. They also met a young woman who was blind as a result of cataracts. Two di erent people that needed medical intervention and had been in need for a long time, but could not be helped. Daniel because his illness had taken over his entire body, and the young women because the medical personnel did not have the expertise or instruments to remove cataracts. Daniel passed soon after while the young woman continues to struggle with lack of sight.

When Ralph and Linda left for Kenya with the help of their local church, The Way International, they went under the guidance of Foundation Stone Ministries who operate an orphanage in Bondo and support free clinics for the people in and around Bondo. They knew the mission trip may bring di culties their way, but they did not expect to feel so helpless as they worked tirelessly to treat thousands of wounds.

Bondo, and its surrounding communities, is made up of about 30,000, many of whom live in the bush. Medical care is rarely available, and if so, it is beyond the means of most, and often not given the priority it should. During their time in Bondo, Ralph and Linda helped out in a medical clinic generally treating wounds that had been ignored., several a result of complications from diabetes. With the supplies they brought, over 2,500 patients, including a woman with leprosy, were treated.

Another woman with elephantitis had open, festering wounds that had not received treatment to the point that her leg was going to be amputated. With the much needed supplies and time, her leg was saved. She is one of many who benefi tted greatly from treatment. Ralph & Linda know good was accomplished, that their presence and the vital supplies they brought made a di erence in so many lives, yet the fi rst thing Ralph will say is, “There are still so many that we can’t help.”

Please keep Globus Relief in mind for any excess medical supplies, instruments or equipment you may have available.

Thank you for your generous donations that make it possible for Globus Relief to supply Eyes4Zimbabwe with equipment and supplies in this manner. To continue supporting healthcare and humanitarian efforts throughout the world, please contact Globus Relief.

Globus Relief is Your Humanitarian Non-Profit Inventory Solution. Please contact us if you have medical or dental equipment, instruments, and supplies or other resources available for donation.

Wednesday, July 20, 2016

Supply Chain Inc.

Fast  Foreward

CHICAGO - Whenever someone mentions that Supply Chain should be concerned about revenue, eyes tend to roll and lungs heave sighs of resignation. After all, Supply Chain doesn’t generate revenue. That’s a top-line concern. Supply Chain manages expenses. That’s a bottom-line concern, best left to those boys and girls in the basement.

Not so fast, posit a number of speakers at Eye for Transport’s 3PL Summit and CSCO Forum in Chicago. Time to hop into the elevator to control and manage a considerable piece of the organizational pie: Data.

Powerhouse IT companies, such as IBM, Oracle and SAP are spending billions of dollars on data analytics firms, according to Steve Banker, Supply Chain Services Director, ARC Advisory Group. Banker argued that "supply chain people" need to recognize and understand that analytics is being used across departments and processes. Data should be the link that balances supply and demand to help an organization meet its growth objectives. In fact, that’s why companies are spending money on systems to improve revenue and not necessarily to reduce costs, he added.

Even CHRISTUS Health, the 2016 Supply Chain Department of the Year, has invested in data analytics and informatics that is paying dividends for operations and patient-care delivery. And the recent Pensiamo joint venture announced at press time between IBM Watson Health and UPMC (the 2014 Supply Chain Department of the Year) signals this developing trend in healthcare that already has planted roots in industries outside of healthcare.

On the dais with Banker, Competitive Insights CEO Richard Sharpe cited that by 2020, 35 zettabytes of data will be produced annually with data volume doubling every 18 months. That’s not just Big Data; that’s Big Data on PEDs. "Data is growing exponentially so we need to find value in it," Sharpe asserted.

No kidding.

Banker and Sharpe both posited that data analytics fused with data management - fueling the blossoming profession of data science - will prove to be a boom and boon for Supply Chain to wield this asset (data) around the administrative, clinical, financial and operational realms of the C-suite.

"Supply Chain is having a hard time putting their hands around revenue generation," Banker said, but controlling the data card may be the answer to driving changes throughout the organization. It’s one thing to know what happened when and why; it’s another thing to know how to respond with intelligence.

Supply Chain pros should not dismiss this informatics notion as an IT project. IT builds the clock; data science via Supply Chain reads the time and figures out how to manipulate and use it to support business functions throughout the organization - not just the warehouse, stockroom or operating room and nursing floor supply closets.
This extends well beyond the trite "show docs the data" refrain. Through data science, Supply Chain effectively can demonstrate to the C-suite how a service line, care offering or business decision can be profitable for the organization - clinically, financially and operationally.

Fortified with an enterprise-wide view, end-to-end access and a cognitive ability to analyze anything, predict behavior and demand and prescribe workable comprehensive solutions that "make money" along a "net-X" mindset versus a more limited "save money" mentality is just what the Supply Chain profession needs to deliver - and what the C-suite needs Supply Chain to deliver.

Breaking through that artificial barrier should propel Supply Chain from relevance to reverence. It’s about time.

Rick Dana Barlow

Wednesday, June 22, 2016

Think of your loved ones

Fast  Foreward

The most expedient policy covering validation of the twin components of sterile processing procedures — cleaning and disinfection/sterilization — calls for good parenting skills.
Actions lead to consequences.

When an auto racer fails to follow the rules and commits an error on the track — accidentally or flagrantly — he or she earns a black flag. That driver then must leave the track, regardless of position, return to his or her pit, bring the car to a complete stop and then return to the track. The risk? The driver may lose hard-earned positioning and be taken out of contention for the win. But that’s the price you pay for violating a rule.

Within the last few weeks, we’ve spotted several news reports shining a spotlight on breakdowns in the sterile processing field.

For one article, a reporter and her editor questioned whether bioburden left on a surgical instrument after the cleaning process poses any problems once the instrument exits the sterilization process. Certified, experienced and forward-thinking sterile processing experts know the answer.

In another article, a hospital failed to notify patients that contaminated duodenoscopes were used on them, leading to post-operative infections. Furthermore, the hospital failed to follow proper cleaning guidelines. To wit: They used canned compressed air from an office supply store to dry scopes.

In yet another article, the FDA issued mixed messages about a prominent manufacturer of automated washers, originally ordering a recall based on questions about the equipment’s effectiveness and how it handles duodenoscopes, but then backpedaling from that recall to allow the equipment to be used on "instruments including most endoscopes — just not duodenoscopes." Call this "in-dispute" technology.

For both cleaning and sterilization, effectiveness should be the prerequisite for efficiency — and certainly cleaning first and foremost. Nothing should be left behind in the cleaning process; only a completely clean instrument can be sterilized with the finished product being an instrument ready for duty with absolutely no residual moisture. Many sterile processing pros know this. Others apparently need reminding: Only a completely clean instrument should be sent through the sterilization process.

This philosophy has been the mantra for decades, even before the debut of more complex minimally invasive instruments in the 1980s.

One challenge with MIS instruments is that their guts cannot be visualized easily, typically requiring disassembly and/or running a tiny camera through them, if necessary. But that can add time to the reprocessing process, which affects patient throughput and revenue. To compensate, facilities either invest in more costly MIS instruments or cut corners and hope for the best.

It’s more important to be effective first than to be efficient. Once you can demonstrate effectiveness, then and only then should you concern yourself with efficiency. If you don’t accept that then you should not be allowed to practice medicine or be in the business of delivering healthcare. Quibbling hospital executives who tacitly value revenue over safety should be forced to partake personally in this game of surgical Russian roulette. Ask them to think of any of their loved ones on the surgical table. Or themselves. Watch how fast opinions, policies and procedures change when their long-term health security is called into question.

This is as it should be. The only way to make change is to personalize the consequences of doing nothing.

Everyone needs to share in the responsibility.

First, the FDA must require validation of cleaning and sterilization of all surgical instruments and the sterile processing equipment through which they’re run — preferably via certified independent, third-party laboratories.

Second, hospitals should be required to tell patients in advance of a surgical procedure whether they are using recalled or "in-dispute" products.

Third, to influence patients with their decision, the insurance companies — including Medicare and Medicaid — should issue a directive denying reimbursement (e.g., coverage) for any procedure where recalled or "in-dispute" products are used or any product is used without proper validation credentials. This gives the patient the opportunity to choose another healthcare provider or assume the risk if they don’t.

We need to act responsibly. And fast.

Rick Dana Barlow

Tuesday, May 17, 2016

Airing out dirty hands

Fast  Foreward

On Cinco de Mayo, the day that this “Fast Foreward” column was written, the healthcare industry was “celebrating” World Hand Hygiene Day with the launch of the Centers for Disease Control and Prevention’s new “Clean Hands Count” campaign.

At the Premier Safety Institute, veteran safety advocate Gina Pugliese RN, promoted this clever and creative campaign to remind all of us about something so fundamental, so basic.

“The science is clear: Clean hands protect patients from life-threatening infections!” Pugliese wrote in her “SafetyShare” newsletter. But if you continue reading her column, you’ll find some disturbing nuggets to give us pause.

“Dirty hands are a contributing factor in the spread of healthcare-associated infections that affect 1 in 25 hospital patients on any given day,” she wrote. Apparently, a 4 percent ratio is not alarming enough to cause behavioral change.

“Despite the success in achieving 100 percent compliance with hand hygiene in many healthcare organizations,” she continued, “studies show that some healthcare providers perform hand hygiene less than half the time they should. So our work is not done yet.”

No, it’s not. Shame on us.

Despite the detailed research, reporting and presentations by noted and well-respected infection prevention expert Elaine Larson, PhD, RN, FAAN, CIC, going back two decades at least, and the continuing campaigns of federal, state and local agencies and providers and suppliers, clearly the message is not resonating.

In fact, the message is fine. We have all the data and justification we need — clinical, financial, operational.

We just need to act and change our behavior.

Surely as infection preventionists assemble in Charlotte this month for the Association for Professionals in Infection Control and Epidemiology (APIC) annual meeting, this issue continues to hover as a sore spot that they struggle to enforce.

Education and information can work, so long as both are understood and heeded. So far, many seem to “get it,” but they largely don’t comply, tacitly rejecting it with a variety of excuses, such as daily distractions and duties to downright forgetfulness.

Nonsense. This is one area where experts — such as Larsen and Pugliese and countless others — have connected the dots and demonstrated cause and effect. To ignore that is nothing short of stupidity. Ultimately, we all suffer.

Federal regulators and public and private payers have refused to penalize lax hand-washing practices by denying reimbursement. Unfortunately, among those “Never Events” they target, the link to hand-washing deficiencies remains fuzzy at best.

We have access to a variety of tracking mechanisms that slam up against privacy issues and IT connectivity concerns, among others. Anti-shaming attitudes and bandwidth bias trump unnecessary exposure to micro-organisms that can harm and kill us.

It’s high time to change direction and discourse.

The only logical solution? The air around us.

Obviously, even the most intelligent experts and the most creative educational campaigns won’t motivate us to change our behavior, and compensatory and punitive actions won’t be accepted or tolerated either.

We need something ubiquitous: A device that emits a form of light, sound or aspirated chemical compound that’s safe to breathe in or touch our skin but absolutely lethal to the micro-organisms that can hurt us. This device can be affixed to doorframes, on ceilings and walls, in vents or maybe even worn on your body. Just like high-tech real-time location system technology, they’d always be on, always doing what we apparently refuse to do — clean us as we seem to be so incapable of cleaning ourselves.

This device would be different than those room decontamination “robots” that emit pulsed light beams to kill microbes but cannot make contact with or be in proximity to humans.
While we have the scientific and technological know-how to create such a device, however, we most likely would be sending the wrong message by “legalizing,” if not rationalizing, poor hygiene habits.

Perhaps it’s a Catch-22 situation, but we’re all catching bugs for it instead of killing them.

Rick Dana Barlow

Wednesday, April 20, 2016

The V word

Fast  Foreward

In the byzantine world of policy and polity, the valiant Sterile Processing and Distribution profession may be classified as victims of forced befuddlement.

Our March cover story about manufacturer instructions for use (IFUs) inspired one devout healthcare executive to commend the coverage — story and writer — but also to ask why the adjective “validated” failed to precede the term “IFUs” for clarity and emphasis.

To HPN’s credit, the coverage did raise the idea about validated IFUs — just not so overtly. Hindsight being 20/20 and all, we could spin this perceived slight as more of a sleight because the ensuing email exchange with this executive proved to be enlightening, engaging and educational.

As a service to HPN readers we will post an edited transcript of that email exchange on HPN Online as an exclusive. (Click here to read.)

Here’s the crux of the matter in a nutshell:

  • To ensure device cleaning, disinfection and sterilization effectiveness, SPD staffers should use VALIDATED IFUs provided by manufacturers.
  • Device manufacturers should provide VALIDATED IFUs to their healthcare organization customers so they know how to clean, disinfect and sterilize products effectively to prevent patient infections from improperly reprocessed devices.
  • The Food and Drug Administration (FDA) stipulates in its guidelines that device manufacturers validate the design, functionality and end-user operation of the devices they make, including reprocessing instructions.
Yet too many questions remain.
  • For starters, who serves as the final authority on the validity and reliability of validation claims? The device manufacturer? The testing lab the manufacturer uses? The FDA?
  • Who actually validates that all of these devices work as intended and can be reprocessed effectively and safely in most, if not all, cases?
  • Are validation requirements standardized? How can they be for myriad devices? Should they be?
  • Who validates the validation testing labs’ procedures as effective?
When there’s a breakdown in any of the procedures these questions raise, who pays? The patient/victim, provider, supplier, payer and ultimately, you and I as the taxpayer who helps fund the FDA.

The FDA does not require healthcare facility SPD departments to validate IFUs but to use “validated” IFUs. Further, the FDA may require device manufacturers to validate the required IFUs but those IFUs are not standardized, and the testing labs used to validate the IFUs are not FDA-vetted and certified.

The FDA specifies the need for validated IFUs without providing standardized parameters for neither validation procedures nor instructions on how to obtain them and from whom. The FDA also does not vet or certify (it cannot endorse, of course) any testing labs performing validation studies for IFUs. So how can device manufacturers obtain validated IFUs from testing labs not vetted and certified by the very agency calling for all of this testing and validation? Meanwhile, healthcare SPD teams merely follow what they receive from manufacturers, not realizing that they will be legally and financially liable for the consequences.

Supply Chain and SPD pros (and GPOs) must demand that any and all devices and products include authentically validated IFUs as a requirement for contract consideration or they won’t be acquired. Device manufacturers must obtain validated IFUs for all products they make (past, present and future) as a condition for obtaining FDA pre-market approval (PMA) or 510(k) clearance to sell those products. Device manufacturers must use FDA-vetted and certified testing labs that rely on standardized testing parameters — either through AAMI or ANSI — to issue validated IFUs. The FDA must establish guidelines that specify the use of certified testing labs that employ standardized validation testing parameters as a condition for device clearance, sale and use. Payers should not reimburse for clinical procedures where devices without validated IFUs from certified testing labs have been used.

Regrettably, we all will pay more for this intensified scrutiny. But we can’t afford perplexity from complexity any longer.

Rick Dana Barlow

Wednesday, March 23, 2016

Mr. & Mrs. Supply Chain

Fast  Foreward

Amid the cultural chattel about what defines and constitutes “traditional” marriage, one business media outlet explored the institution in a creative way.

Bloomberg Business tapped into the data stream from the U.S. Census Bureau’s 2014 American Community Survey, which polled 3.5 million households, to see the type of professionals other professionals wed.

In the business of match-making, who did the career-minded in selected professions seem to attract? Were they similar in category or management level? Or were they part of the so-called “opposites attract” romanticism, highlighted by polarizing pundits James Carville (that liberal Democratic icon) and Mary Matalin (that conservative Republican idealist) who periodically speak at healthcare conferences, particularly during presidential election seasons?

The answers may surprise you. Or not.

Bloomberg promoted its clever story, which injected some life into what an esoteric slice-of-life project by a federal bureaucracy, as a chart that showed “who marries CEOs, doctors, chefs and janitors.” And the interactive chart it developed for online exploration is downright cool. You can play with it here: http://www.bloomberg.com/graphics/2016-who-marries-whom/?cmpid=BBD021116_BIZ.

There were some yawn-inducing revelations. For example, the “most common” pairing involved grade-school teachers marrying each other. Cue the chirping crickets. Meanwhile, high-earning women, such as doctors and lawyers, tended to attract their economic equivalents. No surprise there.

Yet the data also showed that middle- and lower-earning women “often marry up.” Bloomberg’s reporting duo who penned the story about the survey — a man and a woman, no less – injected the following keen analysis sure to tickle your cockles: “In other words, female CEOs tend to marry other CEOs; male CEOs are OK marrying their secretaries.” NOW we’re getting somewhere. Of course, cynics will snort their surprise that male CEOs actually marry their secretaries. Maybe it’s a second marriage. You get the drift. Moving along now.

Curiously, survey data showed that female dancers seem to prefer male welders, but also lawyers, judges, CEOs and legislators. Male firefighters most often marry female nurses, while female nurses seem to prefer truck drivers, managers and retail supervisors. Hmm.
Explosives workers tend to pick elementary and middle school teachers, secretaries and administrative assistants, registered nurses, cashiers, maids and housekeeping cleaners, librarians and hairdressers, hairstylists and cosmetologists.

Not surprisingly, physicians and surgeons tend to pair up with nurse anesthetists and registered nurses, but also retail salespersons and secretaries and administrative assistants.
Covering the healthcare supply chain industry for a quarter-century now as a journalist, writer and editor, naturally I wondered who might pair up with Healthcare Purchasing News’ heritage readership?

Their decision? Mildly surprising but chock full of common sense. Most refreshing, however, is that Bloomberg included a supply chain entry at all and didn’t short-shrift this important and valuable profession like so many other education and media outlets do.
Okay, technically they listed “purchasing managers,” which remains acceptable outside of healthcare but fell out of fashion in healthcare at least two decades ago if you remember that short-lived “resource manager” craze.

Purchasing managers pair up with miscellaneous managers, nonretail sales supervisors, registered nurses, nursing, psychiatric and home-health aides, elementary and middle school teachers and secretaries and administrative assistants, according to census data.
Noticeably absent: Supplier sales representatives, revenue cycle managers or information technology managers as suitable suitors for supply chain folks.

Perhaps HPN could include a question in its annual salary surveys for responders to list the top occupations of their spouses or significant others. Stay tuned.

Still, the connection supply chain has with nursing should be considered a positive sign as supply chain in healthcare seems to be plunging more deeply into interactions with clinical operations in this decade than in previous time periods. The Great Awakening and Reformation in Healthcare should welcome it as a necessity.

Rick Dana Barlow