Process Makes Perfect

Chris Meyers Janda is a driving force in the mechanics and operation of the healthcare industry.

Having finished her undergraduate work in physiology, Chris Meyers Janda was looking ahead to medical school. “But I stepped back and said, ‘What do

I enjoy doing?’” says Meyers Janda, who is vice president of supply chain at Fairview Health Services, Minneapolis, Minn., and the Journal of Healthcare Contracting’s first Contracting Professional of the Year.

“I enjoyed healthcare and being in the hospital, but I was more curious about the mechanics of how a hospital works, how decisions are made, and what drew people to work in healthcare,” she says. “I found that rather than focusing on the clinical process itself, I was interested in everything wrapped around the clinical process.” So she switched gears, applied for admission into the University of Minnesota’s graduate program in healthcare administration, and decided to see if it fit. It did.

At Fairview, Meyers Janda has responsibility for product selection and specification (in conjunction with clinical teams), purchasing, contracting, purchased-services contracting, receiving, accounts payable, inventory and equipment management at the IDN’s metropolitan facilities. (Fairview is organized into five care systems in the Twin Cities, each comprising inpatient and outpatient facilities; and two hospitals in outlying areas in the state – Hibbing and Red Wing.)

“One thing that people would say about me is this: I’m always seeking ways to do things better,” she says, adding that she’s no fan of the “If it ain’t broke, don’t fix it” school of thought. “My motto is, ‘There’s always a better way to serve our patients, and it’s incumbent on us to figure out better, faster and cheaper ways to get to the outcomes we’re after.’”

It’s all in the process
Indeed, Meyers sees many things in terms of process. “To some people, that sounds like fingernails on a chalkboard,” she says. “But when I have conversations with people, I’m seeking to understand what process we’re talking about and how we can break it down into discrete activities, and then understand who the people are we need to engage. If these are the things we’re trying to improve, and these are the activities we need to do, then how do we bring together the people so we can work through the problem or issue?”

Immediately after getting her graduate degree, she went to work as a corporate fellow for Don Wegmiller, president of what was then called HealthOne Corp. Wegmiller was an acknowledged leader, and served as chairman of the American Hospital Association in 1987. “To this day, I credit him with helping me understand the broader aspects of how an organization is run,” says Meyers Janda. “I attended board meetings, which gave me a sense of how an organization makes decisions.”

Meyers Janda had worked for Wegmiller for about a year when she was asked by United Hospital CEO David Jones to be part of his team. Her five years at United (now part of Allina) would prove to be a fertile training ground for her career in healthcare administration, continuous quality improvement and supply chain management.

Supply chain
It was at Allina Hospitals and Clinics – which she joined after United Hospital – that Meyers Janda got the opportunity to apply her skills in total quality management to the supply chain. “I was asked to manage a systemwide quality initiative to redesign the supply chain,” she says. She agreed to take on the project for a year, and was given responsibility for a seven-person team. The project proved to be an important learning experience for her.

“I came to realize how complicated the supply chain was,” she says. She became convinced that the supply chain represented a huge opportunity for improvement, and agreed to help implement the plan that the team had drawn up. She hasn’t left the supply chain since. “I have a fervent belief that supply chain has been undervalued as a core strategy for organizations to improve their performance and care delivered at the bedside.”

Four years ago, she left Allina to join Fairview, drawn in part by the opportunity to report to finance. “This was an opportunity for me to enhance my finance skills, and to be an operations representative on the finance team,” she says. “I felt I had established a pretty good supply chain process at Allina, and that Fairview was a place I could add more value. There were some things I thought I would do differently the second time around.”

Clinical background helps
“I believe everyone in the supply chain should have experience managing a clinical setting,” she says. “Our business is patient care. If you haven’t been part of that patient care experience, I’m not sure you can truly understand our business. It’s like any learning: You have to go to where the action is and be there for a period of time in order to organically understand the issues.

“If your experience has allowed you to be in the presence of direct patient care providers, to troubleshoot for the patients you serve, and to be as close as possible to them, you get a different perspective on what really matters and why. You get re-focused on why you’re really there. And that’s what I try to bring to my team – [the idea] that we’re here to serve patients. Every time we place an order, we do it to serve a patient.”

Perhaps it is her clinical management experience, or the training in continuous quality improvement – or both – that has helped Fairview’s materials team build a strong product selection program in conjunction with the IDN’s clinicians.

Fairview has 19 supply-chain improvement teams, 16 of which are clinically oriented (for example, anesthesia services and cardiovascular services) and three of which are non-clinical (such as environmental services.) A project manager, who is a registered nurse, and a contracting manager from the supply chain department is assigned to each clinical team.

The teams examine contracts that are up for renewal, as well as product areas in which supply chain has identified an opportunity for standardization. Sometimes they initiate their own product or contract review. Then the members work through a value analysis process, in which they define the product criteria and the outcomes the clinicians hope to achieve. The supply chain department then takes that criteria to the market. “Our commitment is to examine products under Premier contract first,” says Meyers Janda. “If our needs cannot be met, we go to the broader marketplace.”

“We have stellar attendance at most of our meetings,” she says. The clinicians are excited, and the unions that represent some of them support their participation.

One reason could be the fact that the teams really do make the decisions. “The team is accountable and responsible for the decisions they make,” she says. “Even if the decision-making process wasn’t perfect, it will not be overridden. The team is the best aggregation of experts we have. If, after reviewing the clinical, non-clinical and cost issues, the team comes up with a decision, I won’t come in and assume to know all the issues. I don’t want to violate their trust.”

Technology assessment
Meyers Janda applied her training in continuous quality improvement to technology assessment, when, in 2003, she helped develop a new model for the process. As with product selection, technology assessment is built on breaking down complicated issues into discrete activities, then involving key people to move them forward – all the while keeping focused on the intended outcome.

Co-chaired by two physicians, the committee wrestles with the age-old question, “How do we know something is great technology or great salesmanship?” says Meyers Janda. The answer is, simply, that the answer isn’t simple. It takes a lot of research. “What we’re looking for is evidence by disinterested third parties that something performs better than what is currently available,” she says. “It’s a huge job, but we’re blessed to have one of the nation’s leading people from a technology perspective – Jan McNelly – as our director of new technology.”

McNelly, who is in the office of clinical affairs, is a 30-year healthcare veteran who “loves data,” says Meyers Janda. With the support of a data analyst, McNelly produces reports for physicians and administrators to consider when making new-technology decisions. Once the data has been compiled and presented to the physicians, some “very challenging, thought-provoking conversations” take place, says Meyers Janda. “We now have a way to talk about the clinical evidence and how a technology will impact the patient. Then, after we gain an understanding of what it can or can’t do clinically, the economics are discussed. “It’s a privilege, from my perspective, to sit on this team and listen to the clinical conversations and rationale,” she adds.

Fairview has applied this process to technologies that cost more than a thousand dollars. But what about those that cost less? “We have tended to deal with those issues one by one at each of our care systems,” says Meyers Janda.

Service Line Solutions
Recently, Meyers Janda participated in a pilot project for Premier Inc.’s “Service Line Solutions,” which attempts to leverage Premier’s repository of hospital clinical performance data with supply chain utilization, labor and staffing, and quality and safety. Working with Fairview, a Premier team came to the IDN to look at the clinical indicators of Fairview’s cardiovascular service line. They examined such things as length of stay, outcomes, complications and readmissions. Next, they looked at the costs associated with those outcomes. Finally, plugging those findings into Premier’s national clinical and supply chain database, the team helped Fairview identify opportunities from both a clinical perspective and resource-management perspective.

“[The process] grounds you in how you’re performing clinically,” she says. “That’s the key to what we do. Once you understand clinical performance, you can explore the questions, ‘Given those outcomes, how are we managing the resources, and how can we do that better?’ It’s not about cost; it’s about clinical care first and then allowing us to create a platform to manage resources. That’s why this is different.

“I’m not sure that we, as supply chain professionals, think enough about – and seek to understand – the clinical results the organization is achieving or not achieving; and then ask, ‘How do the resources we supply help or hinder the outcomes we’re seeking to achieve?’”

Looking at problems and processes, breaking them down into discrete activities, engaging stakeholders in examining them and instituting procedures to improve them. It’s a process that never ends. And Meyers Janda wouldn’t have it any other way. “I have a core belief there’s always an opportunity to improve something,” she says.

About a year ago, a person on her team looked at her and commented, “You’re never done.” For Chris Meyers Janda, that was a compliment.