Bravo’s team not only infused its IT capabilities but also added muscle to its value analysis process last year.

To improve purchasing, contracting, distribution and inventory management, CRMM developed stronger business partnerships with internal and external clients, including clinicians and consultants through multidisciplinary value analysis teams.

To date, value analysis spans four teams that cover products, technology and services. A steering committee oversees the other three that focus on nursing, surgery and lab. "Everyone at the table has a voice in the process and there is a common goal," Bravo noted. "Ownership of the process and the actual end results belong to the group, hence there is a vested interest for a great end result." They may launch two more in the future to focus on radiology and new technology.

"Prior to 2009, this structure did not exist and there was no support or buy-in to the value analysis program," he said. "The value analysis team was not productive and did not produce results. By bringing a strong value analysis leader on board, Broward Health was able to successfully drive the overall program and gain the support of senior administration, physicians, department managers, clinicians and other personnel as necessary. Members of teams were changed, processes were updated, goals were set by the teams and effective organizational communication were the first steps in turning the value analysis program into a successful respected function of the supply chain."

A procurement steering committee oversees and evaluates capital acquisitions, which Broward Health defines as being valued at $50,000 and above.

Last year, the value analysis program generated more than $2.7 million in annual savings with another $1.2 million pending.

Bravo convinced and recruited doctors and other clinicians to participate merely by promoting what value analysis was and how it could improve the supply chain, presenting good data at administrative meetings to show areas of opportunity. "It was not difficult to recruit clinicians," he acknowledged. "They all really wanted to help. The clinicians just did not have the chance [in the past]."

Bravo extolled the value of supply chain leadership, too, something the CRMM team strove to attain and earned to the extent that they have been labeled the organization’s "Purchasing University" by Broward Health.

"We are actually teaching others what we do," Bravo said. "We take pride that many hospitals call and visit us to see how we are doing things here at Broward Health. My goal has always been to teach others the success we have made here and see if others can be successful as well."

Broward’s CRMM team may have invested considerable efforts and funding in technology and value analysis but they also overhauled the fundamentals – contracting, purchasing, distribution and inventory management – that comprise the supply chain’s framework.

Their efforts so far have generated $7 million in cost reductions, including value analysis-driven efforts; physician preference item contracts for orthopedic, cardiac rhythm management, interventional cardiology and spine products; and the remainder in special initiatives, such as freight management. It also changed GPOs to MedAssets three years ago.

Bravo started with a dedicated sourcing team that monitors, manages and maintains its contract portfolio for clinical and non-clinical products and equipment, reviewing pricing and ordering accuracy.

"Once items are placed on contract, these items are then subject to continual fiscal review to obtain the highest level of cost savings," Bravo noted. "This should provide a sense of assurance that once the client chooses to order an item, the unit of measure, the cost and description is accurate, ensuring the order will be expeditiously placed. This assurance will also assist those maintaining their departmental budgets to ensure accuracy of orders and final invoicing."

CRMM’s sourcing team uses ECRI Institute for financial and qualitative comparisons for clinical products on a local and national basis to benchmark performance.

For distribution, Broward works with Medline Industries Inc., which delivers products on a just-in-time basis. CRMM plans to go "completely stockless" sometime in the future, Bravo told HPN, to help decrease costs and increase inventory turns.

One key CRMM internal distribution win involved blood and specimen test results. Broward requires all specimen samples to be transported to a central repository for testing so a courier service was needed. When Broward received numerous complaints about the vendor, including no shows, lost specimens, lateness, poor communication, ineffective route scheduling, lack of training and certification of drivers and massive billing issues, it turned to CRMM to intervene and take control of the process.

After consulting with lab managers, risk management, contracts and physicians, CRMM developed a blueprint to handle the service, enabling the clinicians to focus on patient care, according to Bravo. The results so far? "With the appropriate management, governance and oversight, service satisfaction and compliance are at a 98 percent," he chimed. "This is a victory for patients and an important element in achieving high levels of patient satisfaction."

When CRMM debuted as a Broward Health department under Bravo they started to work on product and equipment evaluation, selection, pricing and outcomes but also noticed something crucial was missing – a freight management strategy.

"Not only did a freight management program not exist, there were no tools in place to effectively identify the annual freight spend, vendors were capitalizing on excessive freight charges, accountability measures and audit processes were the missing link and freight budgets were out of control," he said. "With the understanding that freight charges forms a huge revenue generating scheme for many suppliers and manufacturers, materials management wasted no time in putting controls in place to manage freight cost, while reaffirming our commitment to hold our vendor partners accountable to our guidelines relating to freight."

CRMM reached out to a third-party freight management firm, FDSI, to manage the process, including determining the best shipping and transportation modes, tracking freight charges and transactions by vendor, carrier, service level, weight, origin and destination. CRMM shares audit process data with Accounts Payable and Accounting Services to ensure product invoice and freight payment accuracy. So far, CRMM is generating 80 percent vendor compliance for inbound shipments and 99 percent employee compliance for outbound shipments, according to Bravo. To date, CRMM has reduced its freight expense by approximately $180,000, he added.

CRMM also tackled what Bravo called a "systemic problem" in vendor access.

"One of the biggest challenges healthcare organizations face is their inability to control the flow of products outside of the procurement process," he noted. "While many may see this as a failure of the procurement process, the focus needs to be on vendors that have free access to display and promote their products to our physicians, clinicians and other key personnel without following established procurement guidelines."

Without proper evaluation, demands for new products outpace the use of existing products, transferring control to the vendors.

No longer. CRMM tapped the IT and contract administration departments to develop an in-house vendor registration system to streamline communications with the nearly 3,000 vendors conducting business with Broward Health. CRMM also installed REPtrax kiosks at facility entrances that require vendors to sign in before entering the building, eliminating "free access without authorization and reducing the peddling of products outside of the procurement process," Bravo stated. Properly credentialed vendor representatives sport badges that grant them access to patient care areas.

The vendor credentialing system also reinforces mandatory adherence to Broward Health procurement policies, according to Bravo. "Vendors are now informed that any product introduced to BH faculties without prior authorization by corporate materials will be considered a gift to the organization," he said. "This has been an effective method so far and vendors are adhering to the policy requirements." To date, the system has certified more than 4,600 vendor reps from more than 2,200 companies.

Because healthcare organizations have a "fiduciary responsibility" to the public, and particularly to patients, they must effectively manage product recalls, according to Bravo. That requires clearly defined standard procedures and expectations to monitor product lifecycles.

Before Bravo’s revamped CRMM team took charge, "the recall process was very limited in scope and largely ineffective," he said. "No effective process was in place for managing FDA-mandated recalls, high risk levels or waste from expired products," he added.

Consequently, CRMM established an automated process with ECRI Institute to facilitate communication, share intelligence, foster accountability, and manage specific audit trails for all internal notifications, strict reporting guidelines and timely removal of all affected products from supply areas.

In addition, CRMM set specific inventory management standards for supply lifecycle management. The policy, which contains specific inventory reporting matrices, mandates monthly reporting requirements for all products that have a shelf life, according to Bravo. These reports help CRMM measure the effectiveness of inventory management, safety standards, financial impact and the overall effectiveness of the supply chain process. All clinicians and physicians support this process, Bravo assured.

When Hurricane Wilma slammed into Florida in mid-October 2005, the violent Category 5 storm tested Broward Health’s supply chain disaster preparedness plans as well as Bravo’s mettle in that he was relatively new to the organization.

Hailing from New York where he spent the bulk of his career, Bravo was ready. And so was the CRMM team in making sure critical supplies for every patient care area were available when any disaster struck.

As part of Broward Health’s strategic emergency/disaster supply distribution process, CRMM worked with the Emergency Preparedness department and its JIT distributor to maintain and stage 96 hours worth of disaster supplies that can be deployed within a very short window if necessary, according to Bravo. To prevent product expiration, the distributor rotates the stock into Broward Health’s inventory.

When an earthquake rocked Haiti, CRMM launched into relief mode to aid the Haitians. It started with "a simple phone call that materialized into a massive outreach effort," Bravo indicated. "This effort grew into many phases that included regular conference calls that were sometimes conducted at midnight, collaboration with vendor partners, hospital executives, clinicians, physicians, relief agencies and many other groups that were willing to assist.

"I remember being out sick that day and as I was watching the news I felt we needed to do something," Bravo recalled. He scheduled a conference call with all of CRMM’s supply chain leaders and the executive staff, including the CEO. "We all agreed to make something happen so we started to blitz every vendor, asking to help and we also looked at our own supplies to see what we could donate," he continued. "We had some old equipment that was out of commission and got a rental company to give us the parts. [Broward Health’s] Biomed department repaired the equipment and we shipped it via Partners In Health."

Bravo personally secured CEO approval to travel to Haiti via Partners In Health Haiti to assess some of the logistical hurdles that were affecting the flow of critical supplies and equipment from the airport to supply staging areas, as well as distribution from the supply staging areas to makeshift treatment facilities within Port-au-Prince.

In the end, CRMM secured approximately 161 pallets of medical supplies and multiple pieces of medical equipment, including anesthesia machines, physiological monitors and pulse oximeters for physicians and clinicians saving lives on the ground in Haiti. Bravo specifically credited Medline, Broward Health’s JIT distributor, for stepping up to the plate.

"We all have a duty and we must help all those in need," Bravo explained. "This is the reason why I got involved in healthcare."

The CRMM team dedicated much of its off-hours time to aiding Haiti without sacrificing service to its internal customers, according to Bravo.