By shifting from a top-down management structure to a team approach, Baptist Health South Florida’s supply chain team was able to pivot nimbly to proactively address challenges.
By George S. Godfrey
The COVID-19 pandemic strained healthcare supply chains across the country in unprecedented and unforeseen ways. Suddenly, the ability to acquire appropriate supplies wasn’t only a matter of meeting patient needs – medical caregivers also were completely dependent on the supply chain for their safety.
At Baptist Health South Florida (BHSF), we were positioned to respond because of an alternative management strategy already in place before the first coronavirus case was detected. That comprehensive team approach, which is designed to continually evolve as part of our culture, got us through the crisis and promises to yield further improvements in process, communication, use of technology and improved partnerships with vendors and end-users.
The groundwork for changing from a reactive operation to a culture of excellence began by connecting team members through bi-weekly huddle meetings for a holistic view of the supply chain pipeline. These transformational huddles encouraged self-directed individuals and work teams to anticipate, detect and deal with a wide range of challenges. Infrastructure was implemented to give each team member the data, processes, responsibility, and authority to contribute toward common goals.
Emulating clinical best practices
The supply chain huddle was designed specifically to solve issues unique to supply chain but in fact, was modeled after a clinical process developed and implemented in the Department of Radiation Oncology at Miami Cancer Institute. While the daily radiation oncology topics were very different, the goals of delivering treatment vs. delivering products needed for treatment were similar. Furthermore, the sense of urgency required to determine appropriate treatment for patients on a daily basis is the same sense of urgency needed to ensure goods and services are available to the clinical teams. Issues must be resolved immediately so as to not jeopardize quality of care.
The supply chain team began observing the Radiation Oncology daily huddle to understand the value of cross-functional collaboration to deliver excellence in patient care and determine how to leverage these observations to develop a world-class supply chain by building excellence in much the same way as the radiation oncology team.
Connection, communication and collaboration
The groundwork for changing from a reactive operation to a culture of excellence began with connecting with the team members. Daily contact between the team members and leadership became the norm to break down communication barriers that previously existed. Communication became bi-directional, allowing leadership to better understand the strengths and weaknesses of the supply chain and then assigning who was best prepared to tackle issues among the team. It was important that the team members understand they were empowered and were key to process improvements and innovations.
Every supply chain huddle begins with connecting as a team. Over 100 team members participate in the huddle, including representation from each hospital site, contracts & sourcing, distribution & logistics, informatics, and HR. It would be impractical to physically gather twice per week, so the huddles began as virtual meetings, even before the pandemic necessitated social distancing. Whomever is leading the huddle begins with a positive and motivational greeting, setting the tone for an interactive meeting.
The huddle follows a pre-defined agenda, but after every topic, the presenter of the topic pauses to ask if there are any questions or feedback. This is an important part of the dialogue, because the team understands that if they have an idea to improve or solve an issue, they have a responsibility to speak up! Communicating twice per week allows ideas to flow to the top rapidly, and having all supply chain departments involved in the conversation allows the team to work through the details in the moment without requiring additional meetings.
However, some ideas are more complex than others, and the goal is to keep the duration of the huddle at 30 minutes or less. If the problem can’t be solved during the huddle, smaller workgroups are formed to focus on innovative solutions. These cross-functional collaborations bring team members that may not have previously worked together into an environment in which they fully outline and document the current process, evaluate weaknesses in the process, and develop alternatives for trial, and if successful, deploy the optimized process to the supply chain team, and if applicable, the enterprise. The workgroups are initially comprised of supply chain team members, and as the ideas are progressed, other department team members and team leadership may be added to the workgroup to find the best possible solution for the organization.
An obviously important part of the supply chain is vendor relationships. The supply chain team assigns work by commodity, and many vendors provide products that span several different commodities. During the bi-weekly huddles, it became apparent that specific issues could be attributed to suppliers responsible for several different commodities. Highlighting these issues with the entire team results in a more focused approach and fosters collaboration to resolve the problems more holistically. Metrics have been developed for each vendor covering all commodities, enabling objective conversations with suppliers relative to opportunities for performance improvements.
COVID-19
As the pandemic cases rose, so did the number of products on backorder with suppliers. Backorder management became a key focus during the huddle and spawned an entirely new team structure to focus on demand management moving forward. Emphasis was placed on vendors who could not provide the goods needed, and alternatives were efficiently evaluated and implemented.
The BHSF clinical leadership and front-line caregivers were critical to this process. The medical professionals within BHSF were not only dealing with the challenges of delivering the highest quality care to a rising number of patients, but they were also concerned about their own health. During this incredibly difficult time, the clinical teams were great collaborators in looking at alternatives, and evaluating operational effectiveness and safety for the caregivers that would be using these products. Their willingness to explore options given the many other issues they were facing served to deepen the partnership between the clinical teams and the supply chain team. The synergy created during this time has continued to be a catalyst for innovation to this day. The BHSF clinical team is highly respected and appreciated for their service to all the communities in which they support.
COVID-19 has impacted what is measured and reported in the huddles. Measuring daily demand and incoming supply based on hospital census has become a standard process. Each huddle begins with an update on COVID-19 statistics, including patient census, allowing the team members to anticipate if demand levels are likely to increase or decrease. The next item on the agenda is a report from the inventory team of any critical shortage items. This topic allows the team to openly discuss any potential alternate sources of supply, or items that may
be substituted.
What’s next
As the team continues to tackle greater levels of complexity, the ability to collaborate on a broader platform will become the next goal. Innovating with the clinical teams and IT on multi-faceted solutions will continue to build upon the culture of continuous improvement and accountability at all levels. Propagation of this model onto other disciplines throughout the enterprise will enable improvements in process, analytics and increase speed to drive change and make course corrections as the environment changes.
Huddles have been transformative in the way in which the team communicates. Each topic discussed results in a clear call to action. Information is now disseminated directly, eliminating dilution or misinterpretation. Having a touchpoint with the entire department twice a week eases some of the uncertainly brought about by the pandemic, and provides a direct level of contact among all levels within the department. Having a platform to share and discuss ideas makes the hierarchy of authority irrelevant as innovative approaches are explored. Ambiguity is eliminated, allowing a shared understanding of the issues and how the team plans to address upcoming challenges.
Through the evolution of the huddles and the improved internal communication channels, the supply chain team is not only meeting but exceeding the needs of the end-users in a timely and more customer-focused manner. Clinical and administrative departments are now true business partners with whom the supply chain team collaboratively seeks solutions to address the continuous shifts in the healthcare supply chain arena. Speed of resolution has improved dramatically, resulting in noticeably improved service levels, which in turn meets the ultimate goal of enabling our caregivers to provide the highest quality of care to our patients.
Benefits of the huddle
At Baptist Health South Florida (BHSF), the groundwork for changing from a reactive operation to a culture of excellence began by connecting team members through bi-weekly huddle meetings for a holistic view of the Supply Chain pipeline.
Adapting to an unprecedented event with no finite timeframe was only possible because of the mechanism and culture put in place to measure, collaborate and lead within the supply chain team and BHSF enterprise. Through improved internal communication channels, the supply chain continues to not only meet, but exceed, the needs of end-users, which ultimately supports the highest quality of care to our patients.
George S. Godfrey, corporate vice president, chief supply chain officer of Baptist Health South Florida, offered the following ways the supply chain team – and overall organization – benefited from the huddle.
Culture of accountability
An important part of the strategy to achieve supply chain excellence using the huddle was to build a culture of accountability. Within the Supply Chain huddles, every area and every level of authority had to be represented. Initially, the Supply Chain huddles were very top-down driven, and there was apprehension to speak up to address issues among the team members, especially if addressing higher levels of leadership. Leadership had to reinforce the concept of continuous improvement to the team members to help them understand that accountability exists both at an individual and team level and that every individual on the team would be part of achieving excellence. The goal was to shift from a top-down approach to self-directed work teams. The infrastructure had to be put in place so that each team member had the data, processes, responsibility, and authority to reach common goals based upon his or her areas of expertise. Leadership provided very clear objectives, and the team was empowered to develop solutions without further direction from management. Once the team members were empowered and knew exactly what they needed to do to be successful, the culture began to evolve.
Measuring what matters
What gets measured gets done, so deciding what should be measured was of paramount importance. Leadership collaborated on the metrics that would drive the business in the desired direction, starting with measurements that impacted the fundamental health of the supply chain. Sourcing activities such as contract expirations, pending requisitions, and invoice discrepancies were the initial targets.
Leadership development
The bi-weekly huddle provides an excellent opportunity for team member visibility. The huddles were initially led by senior leadership, but soon thereafter the format was changed so that each topic in the agenda is covered by either a team member or a mid-level manager, on a rotating basis
Innovation
Integral to continuous improvement is the ability to innovate – to make changes to something established, by introducing new methods, ideas, or products. The ability to innovate to solve supply chain problems can make the difference between being able to deliver patient care or not. Therefore, it is imperative to find viable solutions, however unorthodox. If a vendor can’t provide a product that is needed, alternate vendors are sought. If an alternate vendor is not available, the team looks for a new manufacturer, possibly collaborating with other healthcare systems. If raw materials are not available, the team looks for potential substitutions that will provide the same level of quality.
One such example of innovation was isolation gowns. The team was trying to source gowns at a time when supply was non-existent, and the demand for these gowns was exploding. Every supplier was facing the same issue – all traditional raw materials were in China, and due to the outbreak of the COVID-19, products were not flowing to the United States. Given the complexity of the issues, finding solutions to these problems was beyond the scope of the supply chain huddle. A smaller workgroup was spun off to focus on alternate sources of isolation gowns.
The team learned of a company that typically manufactured seat belts and airbags for automobile manufacturers, but given the downturn in the automobile industry, the company was looking for an alternate product line. The sourcing team reached out directly to the supplier to learn more about their products and process. The raw materials needed to make gowns were sourced in the United States, and therefore were not subject to export delays. The supplier was able to manufacture a gown that could be washed 50 times before disposal. The significance of a re-usable gown is that it addressed the increase and variability of demand as the number of pandemic cases reached new heights. The result of this innovation, and the vast collaboration required to deploy it operationally, was a sustainable solution for a critical PPE item. In the past, supply chain would have reacted to the demand created by the clinicians and fulfilled that demand with existing suppliers at the levels the suppliers could provide. But in these unprecedented times, the supply chain team learned to pivot and innovate and collaborate with the entire pipeline, from raw materials to end user, to provide a solution that not only saved money, but also saved lives given the severe shortages of PPE during the pandemic.
Celebrating success
The bi-weekly huddles provide an opportunity to reinforce excellence by celebrating success as a team. As new processes are developed, issues are resolved in innovative ways, or a new leader effectively facilitates the huddles, the team publicly celebrates that success and congratulates all involved in their achievement.