Nursing shortages, high agency costs put the onus on health systems to find ways to relieve the burden.
Sponored: Hollister; August 2023- The Journal of Healthcare Contracting
A recent survey conducted by the American Nurses Foundation and Joslin Insight found that 64% of nurses reported feeling stressed and 57% said they were exhausted. The survey also identified an increase in verbal abuse toward nurses in the workplace with 53% reporting an increase in verbal abuse since the start of the pandemic. Ultimately, 84% of nurses said they are stressed or burned out.
Four healthcare supply chain executives recently joined Publisher John Pritchard and The Journal of Healthcare Contracting to discuss the issues surrounding the stress of front-line healthcare workers and how the supply chain can help.
The executives were:
- Ed Bonetti – Vice President of Supply Chain Services for UMass Memorial Health Care
- John Dockins – Executive Director of Sourcing & Vendor Management for Cleveland Clinic
- Nate Mickish – Vice President of Strategic Sourcing for Texas Health Resources
- Alissa Strange – Contract Portfolio Manager for Froedtert Health
The discussion was sponsored by Hollister, an independent, employee-owned company that develops, manufactures and markets healthcare products and services worldwide.
Nursing shortages and high agency costs
“There’s a national nursing shortage and massive burnout,” said John Dockins, executive director of sourcing & vendor management for Cleveland Clinic. “We saw the same thing during the pandemic and like most, we had to close floors due to staffing issues.”
Dockins says floors have reopened but staffing agency costs remain high.
The average weekly pay for a travel nurse at the beginning of 2023 was 67% higher than the rate three years earlier at the beginning of 2020, according to a report by Vivian Health. The peak was in December 2021 at $3,782 per week. Wages have dropped since then, hitting a floor in July 2022 of $2,997 per week.
“We’re struggling with labor costs and recruitment and we’re trying to manage burnout,” added Ed Bonetti, vice president of supply chain services for UMass Memorial Health in Worcester, Mass. “And dealing with supply chain resiliency adds a layer of burden and complexity on the staff and we’re attempting to ease that through some operational improvements.”
Alissa Strange said they are seeing the same at Froedtert Health in Wisconsin. “It’s gotten better but there’s still plenty of work to do with nursing turnover, satisfaction and recruitment,” said Strange, a contract portfolio manager for Froedtert Health. “Our nursing leadership has removed some documentation off of the nurses’ plates so they can focus on patient care.”
Nate Mickish added that it was a little easier to source masks than it was to find a qualified nurse during the pandemic. “For as uncomfortable as I might have been as a supply chain professional, our HR people, like many HR leaders around the nation, faced a bigger challenge during the pandemic. They deserve just as many bows as the supply chain people do,” said Mickish, vice president of strategic sourcing for Texas Health Resources (THR).
Cleveland Clinic’s supply chain team has partnered with its talent acquisition team and nursing team to tap into local universities to create a pipeline of candidates who want to be nurses. According to Dockins, Cleveland Clinic is asking what economic and social aspects are preventing certain populations from getting into school and how does Cleveland Clinic partner with those universities to create a job share program for students during their four years.
“How do we subsidize it? How do we pay for transportation and meals? How do we address the entire problem of someone wanting to be a nurse but can’t make it through or doesn’t have the opportunity,” Dockins asked. “This is a longer-term play for us to address the staffing shortage.”
A transparent supply chain can help manage front-line caregiver stress
THR has continued some of the processes implemented during the pandemic. Its supply chain is transparent throughout the organization and inventory on hand and burn rates are clearly communicated.
“It’s important to manage not only the actual safety of staff relating to PPE but also to manage their perception to reduce their anxiety,” Mickish said. “Any anxiety a caregiver is having is probably going to be seen by the patients. So, transparency and operational sensitivity have been a pathway for a long time.”
THR has collected over 2,000 survey responses from front-line staff during the past year on a variety of different product categories in order to guide its sourcing strategy and decisions. But according to Mickish, there are many categories it hasn’t touched because they might be too disruptive and could add another stressor to the environment.
At UMass Memorial Health, Bonetti says they use what they call a critical supply SWAT team. “We’re still dealing with a little less than 50 disruptions per week,” he said. “We have a monthly meeting and have representation from many of the nursing floors. We’re able to manage those disruptions and find resolutions with an average of two and a half per week that we have to escalate up to the clinical team either for conversions, substitutions or changes in practice.”
“We’ve created a repository of all our substitutes, shortages and changes in protocol and we’ve posted them on our intranet,” Bonetti added. “There’s a link on our intranet for our clinicians to see what’s happening.”
UMass Memorial Health is also engaging its supplier community to help alleviate stress on its front-line staff. Bonetti says it’s a combination of engagement with its clinical staff and its vendors.
The value in value analysis
“There’s work surrounding value analysis to make sure we aren’t putting undue burden on it,” he said. “While we need to be mindful and manage, we still need to find savings. We’re intentional about it and hoping it gains traction with the clinical staff.”
UMass’ clinical staff is engaged in the committee structure of its value analysis process.
“We want the appropriate feedback from the clinical team,” Bonetti said. “Much of what’s happened the past couple of years has created a lot of interactions and touchpoints and trust. We’re trying to continue that.”
Bonetti says when dealing with low-cost items, for example, UMass Memorial Health doesn’t want to introduce any unknown struggles downstream for the clinical team. When evaluating a product, they ask if there’s a clinical care gap or if there are quantifiable savings that can be realized. They also ask about business continuity and maintaining operations.
Clinical staff at UMass preapprove substitutes and if they get three approved substitutes, then they start the process of sourcing. “We can tell the clinical staff if their primary substitute isn’t available and if their secondary substitute is. So, we’re trying to proactively hardwire some of these new processes,” Bonetti said.
Supplier metrics and fixing a dysfunctional process
At Cleveland Clinic, supply chain is heavily focused on how to help its clinicians spend more time with patients through supply resiliency and metrics like on-time in-full (OTIF) or a supplier’s ability to deliver product within prescribed delivery windows and at full quantities ordered.
“Before the pandemic, you thought ‘I’m dual sourced so I’m safe,’” Dockins said. “Well, if your Tier 4 supplier within those two primaries come from the same part of the world, you aren’t dual sourced at all. So how do we start measuring supplier performance and hold them accountable? We’re implementing world event monitoring, so we get a heads up around the world.”
According to McKinsey & Company, the consumer industry began using the more rigorous OTIF delivery metric, moving away from the traditional case-fill rate, in an effort to optimize its supply chains. It measures the extent to which shipments are delivered to their destination according to both the quantity and schedule. OTIF is now widely used to judge the performance of the supply chain, especially in inventory planning, inventory optimization and order fulfillment. But many challenges remain in the supply chain process.
“Part of it is just making sure you are securing product in the first place,” Mickish said. “We’re working with some interesting data sets that are helping us map the world by category. There are certain parts of the world where a big portion of the production is right there and it’s not just China.”
Mickish added that THR is still maturing on the predictive side of things.
“But it’s amazing what we can get done with clinicians in developing different care pathways if a two-week notice turns into a six- to eight-week notice,” Mickish said. “Our team is structured with category managers that are assigned specific categories and it makes it easier to mobilize and connect with the clinical staff. And our system safety briefing every Friday gives us a forum to get ahead of these backorder issues.”
“Hopefully, the pandemic taught us we don’t live in a post scarcity world,” he added. “I think many of us thought we did in 2019.”
“You learn quickly that if certain items are out, it affects patient care,” Strange said. “If we’ve been burned in the past by suppliers, there have been times we’ve gone off contract to find someone else. We’re not dealing with backorders on test tubes or something like that. We’ll go to someone else.”
Strange says the pandemic shed light on where things come from. “You can tell a difference with a supplier who is great at communicating when backorders are coming up versus one who isn’t,” she said.
Bonetti says it’s still about trying to fix a dysfunctional process.
“All of the disruptions add to it but we’re making progress,” he said. “At UMass, we’re being consistent with things like the colorization of our bins, the placement of products and even our labels. We’re trying to be clear in our communication with nurses so it’s obvious to them where product is when they enter the room, and we have some nurses who travel to different hospitals so we’re trying to develop a level of consistency across hospitals.”
“When you stay at a Courtyard by Marriott, you might not know what city you’re in, but the room is laid out the same way,” he added. “We’re considering doing that as well.”
Click here to watch the discussion: https://smmcontent.s3.amazonaws.com/Video/06-08-23_VideoTrim.mp4
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