For decades supply chain leaders and professionals have been advised, lectured, nudged and prodded about the need to work directly with clinicians – surgeons, physicians, doctors and nurses – as business, contractual and economic consultants and facilitators molding and shaping decisions based on clinical evidence, patient outcomes and anything else of clinical mindedness.
They weren’t to dictate product selection based on costs and/or price alone but could work with clinicians on managing usage, minimizing wasteful practices and procedures and making sure the patients’ best interests are at the forefront – central tenets within value analysis.
Through the years, a small minority of healthcare organizations have incorporated this philosophy into their financial and operational modeling while the vast majority continue to inch their way toward what many believe will emerge as inevitable – the clinically integrated supply chain with all the rites, privileges, parameters and definitions therein.
As Healthcare Purchasing News has recognized the emerging and growing participation by genuinely engaged clinicians in the supply chain process it decided to identify and salute those truly making a difference by presenting them with an award and profiling their points of view. CURE signifies Clinicians Understanding, Respecting and Engaging Supply Chain professionals. HPN bestows its CURE award on those clinicians who have made solid contributions to supply chain operations – activities, practices and thinking. HPN designed the award, which also incorporates the PURE recognition given to 10 physicians between 2016 and 2019, to further solidify and strengthen the bonds between clinicians and supply chain professionals.
Supply-chain physicians that made the grade
HPN’s 2021 Supply Chain-Focused clinicians are: Kimberly Amrami, M.D., Vice Chair, Department of Radiology, and Medical Director, Office of Supply Chain Management and Healthcare Technology Management, Mayo Clinic, Rochester, MN; and Suzanne Smith, RN, Senior Solution Advisor for Value Analysis, Lumere, a GHX company, Chicago.
In addition to an array of academic and clinical accomplishments and management excellence in radiology, Mayo Clinic’s Amrami serves as an accomplished, progressive advocate and thought leader for advancing, integrating and optimizing the physician leader’s role in the healthcare supply chain. Amrami routinely “collaborates at the local, regional and national levels to promote an integrated focus on quality, safety, cost and market considerations in the thoughtful stewardship of resources to ultimately impact the health of the patients and communities these provider organizations serve,” as written in her nomination.
One of Amrami’s latest projects involves partnering with a group of physician supply chain executives from across Vizient’s Large IDN Supply Network (LISN) to establish a new national forum for clinical leaders of supply chain. The forum is designed to explore the challenges and opportunities for “physician supply chain leaders as resource stewards” in the delivery of safe, high-quality, cost-effective care.
“LISN Supply Chain Physician Collaboration (SCPC) connects physician leaders in supply chain management to create a genuine and relevant open forum for engaging,” according to Amrami’s nomination. “The focus is on exploring the best models for the integration of supply chain and clinical care. By sharing leading practices, reexamining traditional processes and exploring innovations, this community of supply chain physician leaders aims to meaningfully impact the combined value and quality of care provided to our patients and communities. Through the LISN SCPC, Armani helps raise awareness of the unique opportunities for physician leaders to contribute in advancing the clinical relevance – and effectiveness – of the healthcare supply chain.”
Lumere’s Smith dismisses the notion that any problem is too big to solve, choosing to tackle client challenges head-on rather than avoid or sidestep them. “Suzanne believes in meeting her clients where they are, seeking to understand their unique challenges and working closely with them to help achieve their aim of improving patient care while lowering the cost to deliver it,” according to her nomination.
This should come as no surprise because Smith has spent the bulk of her career working just like her clients do. She possesses more than three decades of experience as a registered nurse and 13 years as Director of Value Analysis at MaineHealth, all of which enabled her to gain insights into the clinical and supply chain worlds and where they intermingle.
At MaineHealth Smith advocated for governance and built long-lasting, trusting relationships with clinicians and executive leaders united on lowering supply costs while maintaining clinical quality and achieving favorable patient outcomes.
Back in the fall of 2018, Smith left MaineHealth and joined her husband on a year-long sabbatical in Alaska’s North Slope. But she turned the “respite” into a learning experience, recognizing an “urgent need for more public health professionals to serve Alaska’s indigenous population [because] they had just two nurses serving more than 9,000 residents.” With her healthcare and value analysis acumen, Smith quickly recognized and worked to solve the logistical challenges of getting medical supplies to the Arctic area.
Smith’s experience motivated her to pursue elevating the strategic role of Supply Chain in healthcare – even before the COVID-19 pandemic hit a year later. She since has helped develop comprehensive value analysis processes and programs for several prominent healthcare systems and integrated delivery networks (IDNs) as well as a “COVID recovery” program for all Lumere clients to re-launch standard processes and re-engage with clinicians following the clinical, financial and operational pain points of the pandemic response.
HPN’s brief but pointed interviews explore how both recognized the need for and value of supply chain strategies and tactics as an integral component of effective and efficient patient care and a critical contributor to optimal outcomes.
AMRAMI IN REAL LIFE
What makes her lose track of time: Email! I get about 300 a day, and if I am not careful, I miss meetings trying to catch up. Since COVID hit I am getting to work a little earlier than usual to get a head start and that has been helping.
For what other people (within Supply Chain or outside) always thank her: For representing them to my clinical colleagues – a large part of my role is to be a bridge between the clinical practice and SCM. When I can make that happen it makes me feel useful and I think it benefits my SCM colleagues. I am very fortunate to work with such fantastic people who always are appreciative.
What motivates her when she’s most productive: I want to say cupcakes, but really for me it is when I can sit down and really concentrate. Getting things done is a huge motivator. It’s very satisfying to have things fall off of your to do list.
Best compliment she ever received: The best compliment I have ever received was from my oldest granddaughter when she was three. She told me I was her favorite person in the world! She is 15 now, and I hope she still feels the same way.
What she loves to do for others: At this stage of my career what I really love is mentoring others and helping them with their career development. That is just so satisfying, seeing people grow and learn. And I have to admit, I really, really love getting better pricing and discounts on equipment and supplies when we are negotiating with vendors. I just wish I could apply that skill to all of my shopping experiences.
KIMBERLY AMRAMI, M.D.
Vice Chair, Department of Radiology, and Medical Director, Office of Supply Chain Management and Healthcare Technology Management
Mayo Clinic
Rochester, MN
HPN: In context of the success with Supply Chain you have cultivated and enjoyed over the years, why do you feel it has been – and sometimes still is – so challenging and divisive for clinicians to become more directly involved in supply chain issues? What are some of the issues that clinicians may have with Supply Chain (the department) that makes them so resistant to Supply Chain advice and recommendations?
AMRAMI: I think that supply chain management (SCM) issues have sometimes been seen as “administrative” functions not requiring clinical input – and sometimes SCM professionals have not understood the added value that clinicians can bring to SCM in healthcare. It is more about a lack of communication and mutual understanding of the benefits of the engagement of both groups than anything else. Sometimes physicians have the impression that SCM is there to get the lowest price without regard to quality or clinical preferences or to push back on physician preferences for brands or specific tools. Again, this is a lack of understanding of what drives both sides of this equation – which is procuring the best tools for the best outcomes at the best price. It’s important to recognize two things – that SCM in healthcare exists because physicians care for patients – and that physicians cannot care for patients without the support of SCM. You can’t turn the light on in your exam room unless you have the light bulbs someone bought, but you don’t need the exam room if you don’t have patients to care for.
One major friction point between Supply Chain and clinicians tends to be product brand preference. Why do you believe clinicians are so hesitant – if not resistant – to change product brands if/when necessary, particularly if patient outcomes and user safety are comparable or equivalent? Conflicting perceptions? Control and influence? Something else?
Physicians are like other people – they are comfortable with what they know and may be particularly concerned with using tools they are trained to use. It takes time and effort to assess new tools, to get evidence or data about equivalence or improvement and then to train, especially when we are talking about physician preference items like catheters or surgical tools. Also, these assessments need to be made in the context of the practice you have and not the practice the vendor or others think you have or should have. We had an in-depth review of suture vendors that was broadly rolled out in our practice. Transplant surgeons had a very different need compared with neurosurgeons. It is not one size fits all, and all parties have to be prepared to put in the time and effort to really be sure that a change makes sense. In a fee-for-service model that can be a challenge. Our model of salaried physician compensation at Mayo makes it easier, but most of the time when physicians are included in these processes they participate. Cost alone cannot be a motivator – that really is a problem for physicians who are ultimately accountable for the care of their patient. If there is a failure with a new tool, it won’t be the contract manager who is sued. I think sometimes SCM professionals wanting physicians to make changes don’t appreciate that part of the equation.
Looking back, what do you feel has been your proudest moment in working with Supply Chain to date and why?
My proudest moments in SCM are in two categories. One, of course, is the way that SCM really stepped up during the COVID crisis to make sure that as a practice we had all of the personal protective equipment (PPE) and other tools we needed to continue to care for patients safely during a worldwide pandemic. I am in awe of the incident command processes set up in response to COVID and how well it worked. I spent some time seeing the actual command center, which had an element of controlled chaos as the team looked at non-traditional sourcing options for PPE and other supplies, but that never was visible to providers who never had to individually worry about any of this. I also saw their ability to rapidly pivot away from what had been a just-in-time approach at some of our sites to a more resilient warehousing model. In the practice we really never felt the kind of shortages that other institutions may have had and we really have the diligence and commitment of our SCM group to thank for that.
The other category of pride is less of a moment and more of an ongoing pride in how SCM at Mayo is integrated into the practice as a partner, directly in some of our high-spend departments and in general as a resource and support for all of the activities at Mayo. I am so proud to be part of an organization that is so committed to the Mayo value of the needs of the patient always coming first.
What is the most surprising thing you have learned when working with Supply Chain and why?
I had been involved in capital equipment selections but had not really worked directly with SCM before becoming their Medical Director. What really surprised me was the depth of subject matter expertise, especially for the people involved in contracting for physician preference items and category management. They have broad clinical knowledge and deep knowledge of the industry, [including] what is happening at other sites and what is under development or newly on the market. In many cases their knowledge equals or exceeds that of individual physicians. This is critical in order to do their work at the highest level, but also for the credibility it gives them with physicians who understand how helpful and important this is when dealing with vendors and the industry.
You work with a leading and prominent Supply Chain team at Mayo as well as a top-flight group of physician supply chain executives within Vizient’s Large IDN Supply Network (LISN). What advice would you give clinicians and Supply Chain professionals outside of Mayo who potentially would like to replicate, if not emulate, the model and working relationships you experience?
The main advice I would have is to always remember that we have the same goal – to deliver the highest quality care at the best possible value. If you accept that premise then working together and appreciating the skills and viewpoints we all bring to our work naturally leads to collaboration. That and communication means that we can sometimes disagree but ultimately can get to solutions that make sense. Partnership is key – and that means developing a high level of mutual respect and trust. If we put in the time and the effort to really talk to each other we can get there. It takes commitment and authentic listening on both sides.
SMITH IN REAL LIFE
What makes her lose track of time:
Cooking and baking.
For what other people (within Supply Chain or outside) always thank her: That I’m always willing to help no matter how small the task or how big the obstacle.
What motivates her when she’s most productive: Meaningful and fun activities/work projects.
Best compliment she ever received: I worked with an OR Budget Director for many years at MaineHealth who told me I had the rare quality of someone who could be trusted to follow through on their word and that I always had the patient at the center of every conversation.
What she loves to do for others: Make them laugh.
SUZANNE SMITH, RN
Senior Solution Advisor for Value Analysis
Lumere, a GHX company
Chicago
HPN: In context of the success with Supply Chain you have cultivated and enjoyed over the years, why do you feel it has been – and sometimes still is – so challenging and divisive for clinicians to become more directly involved in supply chain issues? What are some of the issues that clinicians may have with Supply Chain (the department) that makes them so resistant to Supply Chain advice and recommendations?
SMITH: There are three core issues I’ve seen most often contribute to division between Supply Chain and clinicians:
• Lack of a clear understanding of one another’s motivations and priorities (assumed misalignment across supply chain and clinical programs).
• Time constraints leaves little room for collaboration or relationship-building.
• Lack of healthcare data sharing between clinical and operational systems erodes trust. Without interoperability, it’s challenging to bring reliable data together to tell a relevant, compelling story so siloes are created rather than bridges.
One major friction point between Supply Chain and clinicians tends to be product brand preference. Why do you believe clinicians are so hesitant – if not resistant – to change product brands if/when necessary, particularly if patient outcomes and user safety are comparable or equivalent? Conflicting perceptions? Control and influence? Something else?
Oftentimes, a clinician’s unwillingness to switch brands comes down to personal comfort level, ease of use and confidence in the product. It’s also important to acknowledge that many clinicians form strong, trusted bonds with their supplier reps, which can influence their decision. Additionally, some clinicians may not believe there is strong enough evidence or data to support a decision to make a change.
Looking back, what do you feel has been your proudest moment in working with Supply Chain to date and why?
On June 18, 2003, Maine’s governor signed into law a comprehensive healthcare initiative known as Dirigo Health. The Maine legislature also included a request for voluntary price restraints from providers and insurers. The bill asked all healthcare practitioners to limit net revenue growth to 3%, and hospitals were asked to restrain cost increases to 3.5% in the coming year, and to limit operating margins to under 3%. Health plans were asked to limit underwriting gains to 3%.
I started working in Supply Chain in 2005, and we took our voluntary participation very seriously as Dirigo Health took hold. We knew if we could execute on major cost savings initiatives by working with physicians, clinicians, hospital administration and suppliers, we would chart a path for MaineHealth’s contribution to lowering the cost of healthcare for its communities.
Our breakthrough project was total joints (hips and knees). We started with purchase data and a savings target and armed with system-wide leadership support. We took our message on a road trip across the State of Maine, asking physicians if consolidation was possible. Surprisingly, they said yes and were happy we asked their opinion. We brought cross-functional stakeholder groups together in the same room and asked, “what are the most important elements to include in a total joint contract?” Their answers informed one of the most comprehensive contracts I’ve ever been a part of negotiating. We moved from line-item pricing to constructs, included specific language around support and instrumentation and kept our suppliers informed and engaged throughout the process. The result was consolidating all eight hospitals under a single agreement and achieving large cost savings that were tracked and reported on each month.
What is the most surprising thing you have learned when working with Supply Chain and why?
Physicians are easier to work with on supply chain projects than we nurses!
What did your value analysis leadership at MaineHealth and your experience in Alaska teach you about the importance of logistics and supply chain, particularly against the backdrop of the current pandemic?
I learned that the relationships you form along the way are crucial to performing well during a crisis. Establishing simple, repeatable processes with a clear rationale creates a sense of purpose and teamwork between clinicians and supply chain. Excellent planning and communication ensure that the right product is available for the right patient at the right time – even when the delivery happens via barge in the Arctic Ocean!
