Since 2019, and each year following at City of Hope National Medical Center, Duarte, Calif., patient volumes have increased by more than 20% due in large part to the number of expansions to the organization’s service lines, the opening of new clinics and an increase of inpatient services. As a result, medical and surgical supplies stocked in clinical periodic auto replenishment, or PAR, systems have struggled to keep pace with both volume and the diversity of care needs.
City of Hope’s supply chain challenges have affected the availability of primary items configured on PAR systems. To meet the growing demand, it has been necessary to replenish inventory with nonstock substitute items and expand the breadth of substitute items available. The stocking quantities of most supplies, however, has been too low to adequately meet patient care needs.
This led to an increase in the time the clinical staff spent on tasks peripheral to their core responsibilities. Those responsibilities include requesting, waiting for, and locating medical and surgical supplies that were unavailable or not found within their respective department’s PAR systems.
Overall Program Objective
To address the supply chain management issues within the PAR environment, City of Hope had a two-fold objective. The first was to enable clinicians, especially those within the nursing department, to perform at the top of their license to provide the best patient care experience and achieve professional fulfillment in the process. The second part of the overall program objective was to foster an environment that is operationally efficient and excellent in its practice. This would be achieved by reducing the supply chain resource time on ad hoc and unplanned activities by having the correct items stocked at the correct levels on each PAR. Furthermore, to sustain this efficiency and time management, the organization established standard operating procedures.
The goal established was to reduce the time clinical personnel spent on requesting, waiting for and locating supplies to fulfill their duties. This, in turn, would yield a reduction in delay of care provided to patients, minimal clinician time away from the patients in their care and optimized use of supply chain resources, which would drive improved supply availability and stabilize the timely delivery of that inventory from central supply.
Ad Hoc Supply Request Call Volume
Issue and Root Cause Identification
The impetus for the supply chain initiative initially surfaced during an interdisciplinary rounding exercise, when the clinical staff identified the availability of the right supplies at PAR locations as a challenge. Subsequently, members from the supply chain team performed an in-depth root cause analysis to quantify the identified challenge and determine the key factors contributing to the ongoing issue.
A 12-month baseline of data was used to establish an average number of daily ad hoc supply requests, as well as the impact on resource utilization, clinician satisfaction and patient experience. From there, the root causes for the significant number of supply walk-up calls were determined using a series of activities such as supply chain rounding of the clinical areas, daily huddles, bed meetings and one-on-one engagement with select front-line clinical staff.
A Pareto analysis, based on the idea that 80% of a project’s benefit can be achieved by doing 20% of the work, was then developed based on the
clinical feedback and documented observations. The program scope and implementation plans were built with the focus on addressing the root causes identified in the analysis from the proposed parameters by applying the 80-20 rule to prioritize efforts on those root causes driving 80% of supply walk-up events.
Implementation
Working collaboratively, supply chain and clinical leaders developed the program plan and implementation methodology. The following activities were included in the initial implementation:
- Determined preliminary stocking levels at each PAR location for supplies recommended to be maintained in stock inventory, based on historical usage and patient volume projections.
- Engaged with front-line clinical staff to understand operational workflows that would need to be factored into stocking level calculations. For example, supplies that are being pulled from PARs to stock carts inside clinic exam rooms.
- Reviewed data-based recommendations for supply quantities with clinical staff, incorporated their input and obtained their sign-off.
- Developed consistent space design to better organize supplies across all PARs, in collaboration with staff nurses and their managers. Doing so enabled easier location of supplies for clinicians who are moving across different patient care areas.
- Updated the enterprise resource planning system with revised PAR quantities by location so that replenishing supply quantities was more closely aligned and managed with user demand by location.
- Implemented agreed-upon changes to the supply PARs, as per the project plan timelines.
- Initiated and sustained change management efforts, including clinical staff communication, clinical and supply chain staff training, and tracking of key performance indicators.
Robust change communication and training efforts were activated to drive successful adoption of the program with over 1,500 members of clinical and supply chain staff across three shifts.
Key elements of the change management efforts included public sponsorship and endorsement of the program by nursing executive leadership.
The program became a standing topic for updates and discussion at various clinical forums such as inpatient and outpatient nurse manager meetings.
Several metrics and KPIs, including daily ad hoc supply request volume by service line and clinical staff member and nightly supply fill rates, among others, were activated to monitor the adoption and success of the program and gather data to inform and provide insights for continuous improvement efforts as the program becomes more ubiquitous.
Outcomes
The qualitative benefits from this program included improved quality of communication and strengthened collaboration as well as partnership between nursing and supply chain departments. Also, nursing leaders adopted shared goals with supply chain leadership that are focused on ad hoc supply call volume reduction to demonstrate the strategic and collaborative nature of the partnership.
These collective efforts helped reduce delays to patient care, especially at the clinical lab and outpatient clinic service line locations. In addition, the supply chain department became a strategic partner to clinicians and clinical leadership in their efforts to create a top-of-license environment.
Quantitative benefits included a 25% reduction in ad hoc supply requests during the first three-month period post-implementation. Ongoing continuous improvement efforts have led to further supply call volume reduction, which now stands at 30% below the 12-month program baseline. This reduction has helped free up the equivalent of one full-time supply chain resource, which has been repurposed to support regular and proactive assessment of PAR demand. The call volume reduction has translated to a 30–45 minute-per-day reduction in nursing time spent on peripheral tasks.
Supply chain teams in healthcare systems can play a critical role in supporting the creation of a top-of-license environment as the systems continue to navigate the challenges with labor shortages and increasing cost of care. s
Sree Duggineni is executive director, supply chain operations, Supply Chain, City of Hope National Medical Center, Duarte, Calif. (sduggineni@coh.org), and an ACHE Member. Richard Flask is director, supply chain operations, Supply Chain, City of Hope National Medical Center, Duarte, Calif. (rflask@coh.org), and an ACHE Member.