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Opening Up New Supply Chains A Massachusetts economic-development agency assembled a diverse team to help manufacturers open up new supply chains and start producing materials needed to alleviate c...

The purpose of this article is to shed light on hospital supply expenses, which form the second largest expense category after payroll and hold more promise for improving cost-efficiency compared to payroll. However, limited research has rigorously scrutinized this cost category, and it is rarely given specific consideration across cost-focused studies in health services publications. After reviewing previously cited estimates, we examine and independently validate supply expense data (collected by the American Hospital Association) for over 3,500 U.S. hospitals. We find supply expenses to make up 15% of total hospital expenses, on average, but as high as 30% or 40% in hospitals with a high case-mix index, such as surgery-intensive hospitals. Future research can use supply expense data to better understand hospital strategies that aim to manage costs, such as systemization, physician–hospital arrangements, and value-based purchasing.

The Mercy case study documents evidence of a clinically integrated supply chain strategy implemented in the peri-operative programs in three of the 46 hospitals in the Mercy system. Mercy became the first US health system to achieve "the perfect order," a supply chain industry standard with end-to-end integration of supply chain best practice in the Mercy system. To date, the Mercy strategy has demonstrated revenue growth of $8 billion, a 70% reduction in Never Events, a 33.3% reduction in supplies cost/case and a 29.5% reduction in labour costs/case in the perioperative programs in three hospitals.

Introduction Little is known about the prevalence of conditions potentially amenable to cellular therapy among families storing umbilical cord blood in private cord blood banks. Methods A cross-sectional study of families with at least one child who stored umbilical cord blood in the largest private cord blood bank in the United States was performed. Respondent families completed a questionnaire to determine whether children with stored cord blood or a first-degree relative had one or more of 16 conditions amenable primarily to allogeneic stem cell transplant (“transplant indications”) or 16 conditions under investigation for autologous stem cell infusion (“regenerative indications”), regardless of whether they received a transplant or infusion. Results 94,803 families responded, representing 33.3 % of those surveyed. Of respondent families, 16.01 % indicated at least one specified condition. 1.64 % reported at least one first-degree member with a transplant indication potentially treatable with an allogeneic stem cell transplant. The most common transplant indications reported among first-degree family members were Non-Hodgkin’s Lymphoma (0.33 %), Hodgkin’s Lymphoma (0.30 %), and Acute Lymphoblastic Leukemia (0.28 %). 4.23 % reported at least one child with a regenerative indication potentially treatable with an autologous stem cell infusion. The most common regenerative indications among children with stored umbilical cord blood were Autism/Autism Spectrum Disorder/Apraxia (1.93 %), Other Developmental Delay (1.36 %), and Congenital Heart Defect (0.87 %). Discussion Among families storing umbilical cord blood in private cord blood banks, conditions for which stem cell transplant or infusion may be indicated, or are under investigation, appear to be prevalent, especially for regenerative medicine indications. Electronic supplementary material The online version of this article (doi:10.1007/s10995-016-2110-1) contains supplementary material, which is available to authorized users.

Covid-19 Notes: In Pursuit of PPE A chief physician executive finds himself involved in the complexities of trying to secure a shipment of much-needed personal protective equipment for his hospital...

Healthcare organizations are increasingly examining the impacts of their facilities and operations on the natural environment, their workers, and the broader community, but the ecological impacts of specific healthcare services provided within these institutions have not been assessed. This paper provides a qualitative assessment of healthcare practices that takes into account the life-cycle impacts of a variety of materials used in typical medical care. We conducted an ethnographic study of three medical inpatient units: a conventional cancer ward, palliative care unit, and a hospice center. Participant observations (73 participants) of healthcare and support staff including physicians, nurses, housekeepers, and administrators were made to inventory materials and document practices used in patient care. Semi-structured interviews provided insight into common practices. We identified three major domains that highlight the cumulative environmental, occupational health, and public health impacts of medical supplies and pharmaceuticals used at our research sites: (1) medical supply procurement; (2) generation, handling, and disposal of medical waste; and (3) pharmaceutical handling and disposal. Impacts discovered through ethnographic inquiry included occupational exposures to chemotherapy and infectious waste, and public health exposures to pharmaceutical waste. This study provides new insight into the environmental, occupational, and public health impacts resulting from medical practices. In many cases, the lack of clear guidance and regulations regarding environmental impacts contributed to elevated harms to the natural environment, workers, and the broader community.

Do you find supply item charge stickers in shocking places in nursing units? Capturing supply item charges to increase net revenue or achieve break-even are based on efficiency. To determine practical efficiency for a hospital in supply charge capture, the authors examined the quantity of supply charge capture items, volume, and relative size of the hospital in 10 hospitals in the midwestern and southeastern United States. What differences in supply charge capture information can determine if a hospital can break even? Results show that hospital size and number of supply charge capture items to manage are important factors.

Objectives: The use of radio frequency identification device (RFID) technology within the healthcare industry was researched and specific instances of implementation of this technology in the hospital environment were examined. Methods: The study primarily makes use of ideas from operations and supply chain management, such as work flow diagrams, value stream mapping, and poka-yokes (mistake proofing measures) for investigations of processes, failures, and solutions. Results: This study presents a step-by-step approach of how to implement the use of RFID tracking systems within the entire hospital. A number of poka-yokes were also devised for improving the safety of the patient and cost effectiveness of the hospital to insure the success of the hospital health care delivery system. Conclusions: Many players in the hospital environment may be impacted. This includes patients, doctors, nurses, technicians, administrators, and other hospital personnel. Insurance and government agencies may be impacted as well. Different levels of training of hospital personnel will be required based on the degree of interaction with the RFID system. References to costs, Return On Investment, change management, ethical and legal considerations are also made to help the reader understand the benefits and implications of the technology in the hospital environment.

Loaner instruments often do not arrive at receiving facilities in the time frame or the condition that is needed to use them safely. Their cleaning and decontamination status may be unknown. There may be no inventory of what has been loaned or information about processing requirements for the instrument's use. These situations can create problems for both the loaning facility and the receiving facility and must be addressed to reduce costs from damage to or loss of instruments. The use of documents and checklists to verify the cleaning, decontamination, and sterilization processes used allows ambulatory surgery centers to solve these problems, cut costs, and protect staff members and patients. AORN J 89 (May 2009) 861–866. © AORN, Inc, 2009.

Hospitals face a daunting challenge: providing safe, effective care in complex organizations strapped by heavy patient loads, limited staffing, and shrinking financial resources. Hospitals are improving their ability to provide safe, effective care, but experts agree that further gains must be achieved (Leape and Berwick 2005; Pronovost, Miller, and Wachter 2006). To achieve this goal, the patient safety literature advises managers to improve faulty work systems rather than blame individuals for poor outcomes (Institute of Medicine 2001; Bates 2002; Cleary 2003; Leape and Berwick 2005; Shannon et al. 2007). However, the literature offers less insight into what work systems are, which ones should be prioritized for improvement, and how to utilize employees’ expertise. In addition, rather than targeting faulty work systems that may affect all patients, many improvement efforts focus on specific clinical issues or patient populations, such as deploying bundles of evidence-based interventions for heart attack patients (Leape and Berwick 2005; Bradley et al. 2006). Finally, health care professionals may perceive a tradeoff between investing scarce resources in safety-related improvements as opposed to productivity-related changes. This belief can reduce progress toward both goals because of the assumptions that improving safety will reduce staff efficiency (e.g., through double-checks and redundant systems) and that improving efficiency will increase safety risks as staff are stretched thin (Pauker, Zane, and Salem 2005). The intervention that provided data for this study required senior managers to elicit safety-related concerns from front-line staff about hospital work systems. Hospital work systems are sets of interconnected routines through which specific patient care services are accomplished. Work systems include the employees, technologies, and organizational environment required to provide the services (Carayon et al. 2006). We refer to breakdowns in the materials, information, or equipment necessary for safe patient care as “operational failures” (Tucker and Edmondson 2003; Frankel et al. 2005). We enlisted senior manager participation because managers can facilitate both resource allocation and organizational change necessary for resolving problems that cross departmental boundaries (Frankel et al. 2005). We focused on user-identified operational failures because research has shown that front-line employees are an excellent source of work-system improvement ideas (Mukherjee, Lapre, and Wassenhove 1998; Field and Sinha 2005). In addition, high reliability organizations, organizations that operate under hazardous conditions with extremely low rates of failure, rely on front-line expertise to address system complexities (Roberts, Stout, and Halpern 1994). Thus, an essential element of work system improvement is empowering front-line staff to identify and prioritize issues that need to be addressed (Frankel et al. 2005). Similar to other studies that have considered the front-line perspective of patient safety (Pronovost et al. 2004; Frankel et al. 2005; Rathert, Fleig-Palmer, and Palmer 2006), our methodology yielded concerns that were grounded in the context of direct patient care. Our findings suggest that front-line workers experience routine breakdowns in work systems that impede safety and efficiency. Therefore, both safety and efficiency—which together create value for patients—can benefit from improving work system performance.

Background: Double-digit health care inflation, coupled with widespread reports of poor care quality and deadly medical errors, has caused private sector employers to reevaluate their health benefits purchasing strategies, with a focus on supply chain management approaches. In other industries, this strategy has proven to be an effective method for simultaneously reducing costs and increasing quality. Purpose: This article describes four current applications of supply chain management network methodologies to health care systems and identifies potential ways to improve purchasers‘ return on investment. In particular, information exchanges, purchase decision, and payment agreement components of integrated supply chains are described. Approach: First, visual depictions of the health care supply chain are developed from a purchaser‘s perspective. Next, five nationwide programs designed to realign incentives and rewards across the health care supply chain are described. Findings: Although several nationwide efforts are gaining traction in the marketplace, at this time, no cost reduction and quality improvement program initiative appears to systematically align the entire health care supply chain from providers to purchasers, raising doubt about the ability of supply chain management network techniques to significantly impact the health care marketplace in the short run. Practice Implications: Current individual efforts to coordinate the health care supply chain do not act on all of the actors necessary to improve outcomes, promote safety, and control costs. Nevertheless, there are indications that several of the individual efforts are coming together. If national efforts touching on all critical elements can coordinate with purchasers, then the health care supply chain‘s performance may improve significantly.

worth fixing. Or maybe your electrosurgical unit is being replaced with a newer model. Or your facility has just purchased a new imaging system. What should you do with your old equipment? Throw it away? Recycle it? Donate it to charity? Or sell it? Every day, in healthcare facilities around the world, medical technology professionals are asked to make decisions about how to properly dispose of unwanted medical equipment. In this article, technicians, engineers, and manufacturers provide guidance on disposal options and what factors you should take into consideration when recycling, donating, or selling equipment. Ultimately, the decision on how you dispose of equipment may hinge on several factors such as: • The condition of the used equipment • The financial benefits of selling a piece of equipment • Liability concerns • Your time • State regulations • The disposal policy at your facility

Reports from the Food and Drug Administration (FDA) and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) have emphasized the potential for injury to patients caused by failures in oxygen supply systems. This article presents a model of patient risk related to the process of supplying oxygen at a single university hospital. One of the goals of the article is to illustrate how probabilistic risk analysis (PRA) can be used by hospitals to assess and mitigate risk and, therefore, to meet JCAHO requirements. PRA techniques are useful to 1) model the reliability of a complex system and 2) assess the cost-effectiveness of different risk mitigation measures. The authors focus on the risk estimation step, describing in detail their modeling of the oxygen supply system and analysis of the results. For the hospital that the authors study (20,000 admissions yearly), the total expected number of fatalities from oxygen system failure is 44 over a 30-year time horizon. The greatest contribution to the risk (94% of the expected number of fatalities) comes from problems that involve the supply network (e.g., damage to structure and poisoning) as opposed to incidents that occur inside patient rooms. Although the threat to patient safety is not dramatic, health care organizations should be concerned about potential failures of their oxygen system because improving this system could avoid low-probability, high-consequence failures at a low cost

•ONE OF THE MOST resource intensive areas in many hospitals is the OR, which often accounts for more than 50% of a hospital's materials management budget. •SURGICAL SERVICES MANAGERS often have no formal training in materials and financial management, but they are held accountable for one of the most costly clinical areas in the hospital. •A PROGRAM PROPOSED for Navy perioperative nurse managers is a five-day course that covers the basics of Navy medical materials and financial management as they apply to the OR. Application strategies for the civilian sector also are discussed. AORN J 81 (April 2005) 801–812.

This is the third in a series of three articles about reprocessing medical devices labeled as "single use" by the manufacturer. The goal of reprocessing single-use devices (SUDs) is to save money and decrease environmental pollution. Reprocessing can be performed on SUDs that have been used on other patients or opened but not used. This article discusses the roles of the involved regulatory agencies and organizations guiding the process. The first article in the series, published in the May 2002 issue of the AORN Journal, discusses the ethical component of reusing SUDs. The second article, published in the June 2002 issue of the Journal, discusses the procedures for reprocessing (e.g., cleaning, inspecting, sterilizing, tracking, testing, validating) and establishing a reuse program.

There are many factors to consider during design including a balance between patient-centered features and ergonomic considerations that can prevent workplace injuries. This facility design department aims to expand nurse leaders' knowledge and competencies in health facility design and enables them to take leadership roles in design efforts. Part 1 in this 2-part series focused on ergonomic designs for patient care areas to enhance patient and nurse safety. The focus of part 2 is ergonomic designs for nursing stations and support areas that can prevent worker injury.

Background Timely stocking of essential supplies in an emergency department (ED) is crucial to efficient and effective patient care. Objective The objective of this study was to decrease wasted nursing time in obtaining needed supplies in an ED through the use of Lean process controls. Methods As part of a Lean project, the team conducted a "before and after" prospective observation study of ED nurses seeking supplies. Nurses were observed for an entire shift for the time spent outside the patient room obtaining supplies at baseline and after implementation of a point-of-use storage system. Results Before implementation, nurses were leaving patient rooms a median of 11 times per 8-hour shift (interquartile range [IQR], 8 times per 8-hour shift) and 10 times per 12-hour shift (IQR, 23 times per 12-hour shift). After implementation of the new system, the numbers decreased to 2.5 per 8-hour shift (IQR, 2 per 8-hour shift) and 1 per 12-hour shift (IQR, 1 per 12-hour shift). Conclusion A redesigned process including a standardized stocking system significantly decreases the number of searches by nurses for supplies.

A panel of hospital leaders and other experts discuss how organizations can reduce costs and enhance the value of their supply purchases--an imperative at a time of rising prices and tightening reimbursements. One major challenge: How to gain greater physician support for those efforts.

In September 2014, the FDA will establish a unique device identification (UDI) system to aid hospitals in better tracking and managing medical devices and analyzing their effectiveness. When these identifiers become part of patient medical records, the UDI system will provide a much-needed link between supply cost and patient outcomes. Hospitals should invest in technology and processes that can enable them to trace supply usage patterns directly to patients and analyze how these usage patterns affect cost and quality.

This article describes the responsibilities and objectives of the pharmacy officer for the U.S. Army Medical Materiel Center, Europe. Pharmacists' experiences and knowledge offer advantages in the ordering, storage, and distribution of medical materiel. Exploitation of new technology and a customer-focused attitude encourage a working environment that capitalizes on pharmaceutical expertise. The use of temperature monitors, enhanced automation opportunities, expired drug return credits, and other customer-focused initiatives exemplify pharmacists' value to military medical logistics organizations. An overview of the pharmaceutical pipeline to U.S. military and State Department customers in the European theater is provided.

A quick tour through an average U.S. hospital gives pause to anyone with even a rudimentary concern for environmental issues. To a careful observer, the typical U.S. hospital presents an array of challenges to the health of ecosystems. For example, hospitals consume vast quantities of natural resources. The most obvious of these are fossil fuels, which form the basic building blocks of the industrialized medical care industry. Aside from the worry that our healthcare systems are technologically and functionally dependent upon nonrenewable, relatively scarce, and politically volatile resources, our heavy reliance on fossil fuels has important ill effects, including unfavorable health outcomes for humans. For example, the combustion of fossil fuels is the driving force behind global warming, which will likely result in increasing heat-related mortality and morbidity and may contribute to the spread and resurgence of infectious diseases around the world. Also, the combustion of coal and oil releases pollutants such as sulfur oxides, nitrogen oxides, and ground-level ozone that contribute to various respiratory ailments. In addition to being energy intensive, the modern hospital uses a great deal of water, wood, paper, metals, minerals, plastics, chemicals, food, and land.

As hospitals strive to be more efficient, the first step is a thorough review of operations. Here are some basic steps.

Computerized maintenance management systems (CMMS) are used by clinical engineering departments to collect, store, analyze and report data on the repair and maintenance performed on medical devices and other equipment. Evaluation of commercial CMMS require a careful requirements analysis and then a comprehensive evaluation of the products available in the marketplace that can come the closest to meeting those requirements. This paper provides a comprehensive list of evaluation questions to use to determine the best software system for a clinical engineering department's needs.