Building a Supply Chain Business Case for Change!
I have found that the best way to get your supply savings ideas (especially those big creative ones) approved by your senior management, customers and stakeholders is to make a formal written business case for change. Why? Because too much is left unsaid, misunderstood or lacking in logic when you try to verbalize your savings ideas on complicated issues that need to be internalized before they are put into practice.
I have followed this same advice in my own career where I have proposed big business changing savings ideas at every healthcare organization I have worked in my supply chain management employment. For instance, I have proposed (in writing) a new supply value analysis program at every healthcare organization that I have worked and NEVER once have my proposals been turned down by senior management, customers or stakeholders.
I once decentralized the centralized buying function that had been in place for 46 years at my multi-hospital system and then replaced it with a GPO model based on a written business case for change that saved my healthcare corporation millions of dollars — almost on day one.
I proposed in writing, and eventually received approval from my board of directors, to move forward with a group purchasing program for their 27 long-term care facilities where I was Vice President of Support Services. This reinvented the way they had done business for decades.
I’m sure you get the idea! Developing a written business case for change in order to introduce, test the waters and then to gain approval on your big and even little supply savings ideas is a powerful instrument for the changes you believe are mission critical to your healthcare organization.
Here’s how it works! This business changing and decision-making instrument begins with a written document that would give the background of the problem or opportunity and description of what you want to accomplish. It would describe how it benefits your organization, how it fits into your organization strategic plan, the risk and rewards, the resources required, the responsibilities and the timing and the operational and financial considerations.
Your business case for change doesn’t need to be elaborate, but it does need to be thorough, concise and well thought out. Most importantly, it needs to be your tool of choice that you employ when you want to “change the way we do things around here”.
Actionable Hospital Supply Metrics Will Make Change Happen!
We all deal with metrics everyday (statistics that measure or quantify our data), but is this information ACTIONABLE? For example, most hospitals use the metric supply cost/net revenues to compare their hospital’s supply chain performance to their peers to see how their hospital fits into a regional or national norm, but what does this information really mean?
Let’s say this exercise shows that your hospital is on the high side of this metric. Does this information allow you to make decisions or take action to reduce your supply cost? The answer is no! This metric is only directional. Meaning, it only shows if your hospital is going in the RIGHT or WRONG direction on your supply expenses. However, it doesn’t tell you why or how you can change the direction you are going if results are unfavorable.
That’s why you also need to have ACTIONABLE metrics that will help you make informed decisions and take immediate action to correct the defects in your supply chain. For instance, we just had a quarterly review with one of our Supply Dashboard clients where we talked about how his lab reagent metric (total reagent cost/Billable Lab Tests –CMI adjusted) has been going up. He then told us that he picked up this fact on his supply chain radar screen too. After some research, he found that he had a few reagents that he was buying that weren’t under contract that was causing this anomaly, which he said has now been fixed.
That’s what ACTIONABLE metrics can do for you (enable you to make informed decisions and take immediate action) vs. generic metrics that ONLY tell you that you are going off course. For this reason, if you want to make positive change happen at your healthcare organization you will need to establish ACTIONABLE metrics at the ground level to greatly enhance your supply chain decisions. Otherwise, you will be nibbling around the edges of your supply chain expense savings when a windfall of savings is just waiting for you to take action.
Toyota Has Got Value Analysis Right…Do you?
I just read an article in the December 23rd edition of the Wall Street Journal titled TOYOTA ACCELERATES ITS COST-CUTTING EFFORTS. The article proclaims that Toyota’s goal is to reduce its parts expenses by 30% within three years by employing the strategies, tactics and techniques of value analysis.
Specifically, the article states that “Hit by financial crisis, (Toyota) last year launched a “Value Analysis” program to cut the cost of producing existing models. I believe this is the same financial crisis that healthcare organizations are facing today: reduced reimbursement, lower census and increased bad debts? There is no doubt in my mind that Toyota has “got it right” when they decided to utilize the time-tested value analysis methodology as their tactic of choice to push to return to profit after a very bad year.
Do you see the similarity with healthcare? Our industry faces the same challenges as Toyota: slow growth, reduced profits and an uncertain future. That’s why value analysis is more important than ever before.
Our industries’ price savings are slowly disappearing, but there are still billions of dollars in value analysis savings still available in the healthcare industry. This could be uncovered if we as an industry focus on the wasteful and inefficient consumption, misuse, misapplication and value mismatches in our supply streams.
Bottom Line: If you aren’t vigorously applying the techniques of value analysis to discover your next big savings opportunities, then you are losing out on this gold mine of new and better savings for your healthcare organization. As I see it, if healthcare organizations are to be profitable, viable and thriving in 2010, they need to take a lesson from the Toyota playbook and accelerate cost-cutting efforts with value analysis.
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Why Does Value Analysis Fail at Some Hospitals, Systems or IDNs?
Value analysis is a best practice in 93% of hospitals, systems and IDNs in the country today, but why do so many VA programs fail to reach their full potential and reap the complete benefits of this supply chain discipline? To answer this question, I have prepared a FIVE point check list that you can use to measure your own VA program against to see if it is meets, exceeds or is missing the grade:
Steering Committee
If you don’t have a value analysis steering committee, chaired by the highest level of management you can recruit for this position, who will guide, monitor and arbitrate disputes in your VA program, then you are missing a key ingredient to your VA program’s success.
Balanced Scorecard
What is visualized and measured happens should be the mantra for your VA program. This is best achieved with a balanced scorecard that measures in real-time your savings vs. goals, milestones, meeting attendance, team and project status, etc.
Executive Champion
No real progress can be made with your VA Team(s) without an executive champion being assigned as an administrative representative to your VA team(s). This individual’s job is to represent senior management, guide VA process, arbitrate disputes, remove road blocks and smooth the road when political impasses arise.
Extensive Training
Team leaders and team members need extensive training in value analysis (it is a real discipline like LEAN Six Sigma that has a defined process, practices, tactics and techniques), or your VA team leaders and members will just WING IT, resulting in poor or unrealized savings and quality improvements.
Project Management
All team members need to be accountable for their results. This can only be accomplished by assigning VA studies to individual project managers who then are responsible for defining, planning, investigating and implementing VA savings opportunities.
As you can see by this checklist, value analysis isn’t a group of individuals meeting monthly to discuss new product introductions, GPO contracts, or product failures. It’s a formal and disciplined process that requires executive management leadership, continuous measurement, monitoring and control, extensive training and stringent project management to be successful.
If you are missing any of these ingredients, you are forfeiting the opportunity to be the “best” of the best in value analysis. Don’t leave these success elements to chance, but instead incorporate them into your current VA program so you can be assured of success – not failure!
Incentivize Your Physicians to Save on the Cheap
There has been a lot written about “Pay for Performance” (PFP) programs to incentivize your physicians to save, but very little has been written about how successful it can be while spending very little money.
That’s what I’m hearing from the marketplace; it doesn’t take a lot of money to incentivize your doctors to save. All you need to do is to find out what products, equipment, training, technology, staff, etc., that they desire to do their work more effectively and productively, but don’t have these resources now. Then offer to purchase or obtain one or more of these “wish lists” items as an inducement for them to save money for your hospital, system or IDN on a particular initiative that you are proposing, such as, orthopedics, neurosurgery, cardiology, etc.
The operative words here are that these incentives must effectively and productively improve your hospitals operations. You don’t want to give away incentives that are just NICE to have but are not required. They must actually be beneficial to your hospital and your physicians to be a win-win scenario for all involved parties.
Naturally, these “Pay for Performance” programs can’t be arbitrary, ill-defined or unverifiable. To the contrary, they must be highly organized, truthfully measured and value-based. For example, you might find that your cardiologists have been requesting a new piece of equipment in their capital budget valued at $28,396, but it has been denied for years. Your task then is to have your cardiologist agree — in writing — that they will be required to save three times ($85,188) the value of this equipment by assisting you in the evaluation of your hospital’s pacemakers and difibrillator’s cost, product mix, and applicability for this new equipment to be approved for purchase.
Considering you would have a minimum return-on-investment for your hospital of 200% for this hypothetical project, I believe that this is what I would call “savings on the cheap” when you consider doing nothing is costing your hospital hundreds of thousands of dollars a year in lost opportunity costs.
So don’t be apprehensive about incentivizing your physicians to save (it’s a good business practice), since it is one of the best investments you can make with your hospital’s money. Keep in mind, your physicians have no incentive to save money today — unless you give them the incentive to do so!
Profitability is More Important Than Any Other Buying Factor
I’m’ hearing that more and more supply chain professionals are evaluating their new product, services and technology requests with a new, yet a very old buying criteria – profitability! Or, if it isn’t PROFITABILE why should we buy it? This is a significant emerging best practice you need to know about and then employ at your own hospital, system or IDN.
Hospitals have always been the “kings” as loss leaders, when it comes to buying anything. Their justification or logic in making these decisions has always been that we will make up for these losses on volume or on some other procedure(s) that a particular physician will be performing at our hospital –so what’s the BIG problem!
The problem is that your hospital NEVER really ever makes up for these losses (big and small); hospitals just eat them on the promise of future profitability in some other area of their operations. As an illustration, the average pacemaker total procedure reimbursement from Medicare (supplies, pacemaker, labor and overhead) is about $10,000, so if you are buying pacemakers that cost you $9,000 (or 90% of your reimbursable fee), I can guarantee you that you just lost money on every pacemaker procedure you perform. You will never make it up with volume – your losses will just get worse.
So what progressive supply chain professionals are doing to eliminate this extreme misadventure is to add the criteria of profitability to each and every one of there value analysis studies that they perform. This way, if your executive management wants to buy a product, service or technology that NEVER is going to make or save them money at least they know these undisputable facts from the get go. This is the only hope we have for our healthcare organization to self-correct this flagrant practice.
Never Underestimate the Power of Measurement
It’s relatively easy to identify that you have a hospital supply chain challenge (higher cost, lower quality or poor service levels), but it’s quite another thing to uncover the root cause of why this situation is happening.
Instead of pointing fingers, becoming defensive or accepting the uninformed opinions of others, a much better way is to trust a statistical methodology such as Supply Six Sigma® to identify and address the real source of the problem.
For example, I just read about a hospital that realized that their cardiothoracic unit (CTU) cost per discharge for supplies was $66.11, which they identified as too high. But they didn’t RUSH to judgment on why this was happening. They instead formed a team to define, measure, analyze and improve this situation with the goal of reducing these costs by 50%.
Once this cross-functional team was formed it developed a high-level process map of their CTU discharge process to understand the current system and then gathered baseline performance statistics for analysis. Based on their statistical studies the team found after counting the supplies that were discarded on 52 discharges that on average 67 unused items were discarded, ranging in price from pennies to more than $1.00 per unit.
They also found that medications that were stocked in the CTU’s lock box and which should never have been discarded unused were being discarded. It was estimated based on these statistics that were compiled by the team that this wasteful practice of discarding unused supplies and drugs was costing their hospital $55,185 annually.
The team’s observation and investigation found that there was no uniformity or consistency on how the CTU staff pulled and restocked supplies, confirming that this was the root cause of this excessive cost. The team and CTU staff decided to institute a supply cart system for all CTU patient supplies that would be restocked daily and any unused supplies discarded. It was calculated that after buying seven additional carts, that the ROI on this project was 163 percent!
This is what an organized, methodical and step-by-step statistical approach to your supply chain challenges is all about: No short cuts, no guessing, no opinion just accurate and precise measurements to uncover the root cause of the problem being addressed and then implementing the right solution for sustainable and measurable results.
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Learn the advanced methods and strategies to analyze your utilization trends, patterns and variations in your supply spend categories so you can move to the next level of savings performance beyond price.
Webinar Overview
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Are You Flying Blind?
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A Road Map for Success
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Why Not Incentivize to Save with Value Analysis?
I have been fighting this battle for 22 years now to get healthcare organizations to incentivize their value analysis teams to save EVEN more money. Nonetheless, I seem to be loosing this battle, but not the war!
It has been proven beyond any doubt with our own clients that if you incentivize your value analysis teams to save MORE by giving them rewards and recognition you will increase your savings yield by as much 300+ percent. However, in the 22 years we have been working with healthcare organizations in the value analysis arena only one in eight of our clients has opted to do so.
The question is why? After thinking about this question for some time now, it seems to me that there is a “cultural Bias” in healthcare organizations against incentivizing any of their teams (LEAN, Six Sigma, value analysis, quality improvement, etc.). They believe that team members are already getting paid a salary to do this work so why should we give these individuals any extra incentive to do what they are already being paid for?
What is missing from this decision “not to incentivize teams” for their new, harder, different and time sensitive work (that they are assigned to do beyond their normally assigned duties) is that this work is a HUGE distraction from what these hospital employees think they are getting paid for. The result: Most staff members only give 40% of their time, energy and effort when assigned to teamwork – not 100%!
Change the paradigm! If you want to change this pattern of behavior in teamwork, you will need to change the perception of this work as burdensome by emphasizing that it is important, mission critical and essential to the financial health of your hospital. This is accomplished by incentivizing all of your hospital’s teams, including your value analysis teams, with rewards and recognition when they reach predetermined goals and milestones.
Believe it or not, by doing so you will quickly discover that your staff members will line up to become members of your value analysis teams (and all other teams), not avoid them. Better yet, it won’t cost your hospital a whole lot of money (about 3% to 5% of the savings) or time to establish and manage a team rewards and recognition program.
You will be repaid for your efforts with new and better savings that will generate as much at a 35:1 ROI on your investment. Doesn’t this sound like something your hospital and thousands of healthcare organizations around the country should have been doing for years? If not, why not…
DATA GAPS: The Data You Have Vs. Actual Use
Most supply chain organizations have at least three trillion bytes of data in storage but they only have the analytical capability to analyze two trillion bytes due to their data gaps (e.g. missing data, inaccurate data, unclassified data, vague descriptors or inadequate classification of data). In fact, most supply chain organizations have only the capability to execute Value Analytics™ to their completion on only one trillion bytes of data.
What does this technical lingo mean to you? Most supply chain organizations are only capable of analyzing one-third of their data, at best, to uncover hidden utilization savings opportunities. Just imagine what you could do if you had ALL your data analytics steps in place to uncover these new and better savings.
Just the other day a supply chain manager told us that his spend manager didn’t give him the visibility into his supply spend vs. our Utilizer Dashboard, since our Value Analytics™ went deeper and broader into his supply chain than his spend manager did. The bottom line was $7.7 million in utilization savings that were hidden from his view since he was looking at only one-third of his data
So if you want to move to the next level of savings performance beyond price I would encourage you to implement these seven steps:
- CLEANS your data so that it is usable and defect free.
- HARNESS the latest technology to make your job easier. If you tried to perform these analytic studies without software your job would never be done.
- DEVELOP or use a third parties’ Value Analytics™ methodology to hone in on your utilization misalignments.
- ANALYZE the data that your analytics system spews out.
- ESTABLISH and/or utilize your current value analysis teams to ferret out the savings you have identified.
- FIND an executive sponsor or sponsors to champion your initiative and to remove the roadblocks you will encounter along the way.
- INCENTIVIZE your team members to keep them at peak performance.
I know that you are thinking to yourself that “this seven step roadmap is a tall order when you consider I’m already swamped with work.” However, these seven steps only look overwhelming to you if you try to do everything I’m suggesting — at once.
It took Strategic Value Analysis in Healthcare almost 10 years to be able to have them fire on all eight cylinders. What we would recommend you do to get started with your own Value Analytics™ Program is test the waters, since Value Analytics™ in my opinion is the future of supply chain expense management.
LEAN and Value Analysis Work Better Together
I would estimate that 79% of our nation’s hospitals, systems and IDNs have value analysis teams in place to evaluate the appropriateness and cost effectiveness of the products, services and technologies that they buy. However, is our job done when we complete these studies?
Not Quite! We still haven’t attacked the waste and inefficiency of these same products, services and technologies in our value streams. This can represent 7% to 15% in new and better savings for your healthcare organization if you add LEAN Management techniques to your value analysis model.
The LEAN Management techniques were introduced by Toyota into their manufacturing process in 1934 to eliminate waste from their production process. LEAN’s core concept is to “eliminate anything that doesn’t add value to your products or services”. LEAN techniques have been so successful that they are now being applied in every industry (including healthcare) in every country around the world as a waste eliminator.
It’s no longer good enough to just obtain the best price for what you buy because price is just the tip of the iceberg. You must now “LEAN” the products, services, technologies and the processes that support them if you are going to wring the towel dry on your savings.
A good example of LEAN thinking is when one of our clients eliminated all of their operating room custom packs, since they couldn’t VALUE JUSTIFY how they added value (time, labor cost or savings) to their surgical suites operations. This might seem like a radical change to you but I’m sure you will agree that it illustrates that “leaning” your operations means not accepting the “conventional wisdom” about anything that you are presently doing. It means thinking and doing differently!
We have proven over the last twenty-two years with our LEAN Value Analysis System that LEAN and value analysis work better together, since we have found that value analysis searches out lower cost alternatives to what you are doing now. While LEAN eliminates the wasteful and inefficient consumption, misuse, misapplication and value mismatches in your value streams. It is the perfect marriage of complementary tools!
So if you are looking for even deeper and broader savings with your value analysis program than ever before, may I suggest that you add LEAN Management techniques to your value analysis model to get the job done end-to-end.
Save Time and Money with Virtual Value Analysis Teams
Everybody’s busy, frenzied and swamped with work but this isn’t a good enough reason for not holding value analysis team meetings. It isn’t unusual for me to hear from MMs that they haven’t had a VA meeting in months, sometimes years because everyone involved in their VA process is too busy to have one. This always makes me flinch!
Think about it! VA meetings are where your customers, stakeholders and experts give their input, guidance and support for your hospital, system or IDN’s buying decisions that run into the millions, sometimes tens of million of dollars annually. Consequently, how can you eliminate, dispense with or skip these important VA meetings without risking the erosion of your credibility, saving yields and innovation?
No doubt about it everyone’s time is limited in our fast paced healthcare environment, but this doesn’t mean that you can’t carve out some quality time each month for your VA team meetings. One way to do so is with virtual value analysis team meetings that save time and money!
One of our multi-hospital facility clients has been conducting virtual value analysis team meetings for one of their VA teams for three years now, since some of their team members must drive an hour or more to attend their bi-monthly VA team meetings. They have one meeting a month face-to-face and one meeting a month that is virtual without missing a beat. In doing so, they have save hundreds of thousands of dollars in one year that would never have been captured if they decided everyone was too busy and had to drive too far to have VA team meetings.
If this client of ours can have successful virtual VA team meetings whose members are statewide, then you surely can have virtual VA team meetings right in your own facility. All you need to do is leverage the technology to do so. It’s a cheap, effective and efficient way to save time and money for everyone you need to attend your VA team meetings!
New Activity-Based Costing Model Makes Huge Supply Utilization Savings Happen!
Activity-Based Utilization Costing is a new utilization savings model that assigns the cost to natural classifications in supply chain expenses to identify their actual consumption by each category of purchase. By doing so, a healthcare organization can establish the true cost of the utilization of all of their products, services and technologies so they can eliminate any and all wasteful, inefficient, unneeded or unnecessary supply chain practices.
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I have just given you the definition (above) of a new and emerging best practice called Activity-Based Utilization Costing that can revolutionize the way you save money. I’ve done so because now that price savings are slowly disappearing this new methodology will help you dig even deeper and broader for new and even better savings.
Here’s what it is all about
Activity-Based Costing (ABC) was developed in manufacturing in the 1970s. It was introduced by cost accountants that were seeking to identify the cause-and-effect relationship of their organization’s products and services to more objectively and accurately assign cost to each of their operations. Prior to this point in time, most operating cost were assigned by accountants as broad percentage for direct and indirect cost.
Where products, services and technology costs are shared, such as we do in healthcare organizations, the ABC methodology requires some sort a weight factor to allocate cost accurately. This weight factor is based on what is called a COST DRIVER or activity that directly relates to your products, services or technologies actual cost. For example, the number of custom packs that you use in any given year would be assigned based on the number of case mix adjusted procedures (cost driver) you utilize. In this way you now have identified a cause-and-effect relationship between your custom packs and case mix adjusted procedures that can be precisely calculated.
Here’s how it can help you
We have found by employing the ABC methodology to measure utilization performance for our clients, once we have assigned a weight factor (or cost driver) to all of our client’s natural classifications (IV sets, Oxisensors, elevator contracts, dressing, trays, pacemakers, orthopedic implants, etc.), we can then quickly and easily identify any and all of our client’s utilization misalignments. This means in real terms a saving in the range of 7% to 15% based our client’s total supply chain spend annually.
There are no shortcuts
You might say after reading this blog article, “Bob you are giving me a headache with all these calculations, isn’t there a simpler way to get the same results?” I’m sorry to disappoint you but there isn’t an easy way to make these huge utilization savings happen. Believe me when I tell you that I’m always looking for an easier way to save money, but sometimes there are no SHORTCUTS to making savings happen.
Where are your next savings coming from?
I would like to restate the fact that your easy price savings are slowly disappearing therefore, new and better savings strategies, tactics and techniques must be employed for you to keep your savings machine humming. Activity-Based Utilization Costing is one of the proven best practices that can assist you in improving on any savings strategy that you are now pursuing to save money.
Lastly, don’t be overwhelmed by the intricacies of ABC methods that I just talked about because if I can learn, master and then apply these ABC techniques of this new science of savings — YOU CAN TOO!
Confronting the Tough Stuff
Every supply chain professional is confronted every day with tough decisions, inflexible people, immovable objects, and sticky situations, especially now that we are in a recession. How do you cope in this environment?
The short answer is that you need to become more skilled at dealing with difficult people, irrational situations and the politics of your workplace. There is an art and science in doing so. Here are five basics that work every time:
- Have Patience – Thomas Paine, in his pamphlet “Common Sense” tells us that all things and truths become clearer with time. That’s why you need to have patience when confronted with a tough situation. I personally wait at least 24 hours before making any tough decisions because the emotions of the moment have now passed and I have a clear head to make the right decision. Don’t make rushed decisions if you can avoid it!
- Listen Artfully -We all know the techniques of “Listen Artfully”, but how many times have you really used them? I have found that if you can keep people talking and keep yourself listening attentively you can find out everything or anything you want to know about any situation. It always pays dividends to listen!
- Be Respectful - Even when you totally disagree with an individual’s point of view, be respectful, civil and polite. In doing so, you might just learn their reason(s) for why they have a different perspective on the subject at hand. Then you have all the facts you need to make your own decision!
- Ask Why – The most important question you can ask anyone, when confronted with an opposing opinion, is why they feel that way. They will then need to defend their position. Often they will talk themselves out of this opinion, when they hear their own answer. That’s why the “why question” opens up a whole new way of thinking for even the toughest opponent.
- Don’t Cave In -The easy route to take when confronted with tough people, decisions or situations is to “cave in”, but this won’t solve your problems. It will just complicate them. Once your colleagues, employees or management realize that you change your mind easily they will never ease up on the pressure to change your mind on any subject. But if they know that you are hard as a rock and are an unmovable object, they will soon tire of trying to change your mind. This doesn’t mean that you should be inflexible or stubborn, but always be mindful that your opinions count too! Be firm and consistent!
The Reverent Robert H. Schuller has said that “Tough times never last, but tough people do”. That’s why you must master these five skills that are needed to deal with tough people, tough decisions and tough situations. If you do, I can ensure you that it will make your job and your life a whole lot easier, more productive and fun again.
