Supply Chain Services Professional's Role in Achieving the Institute of Medicine's Six Aims for Improvement

In 2001 the Institute of Medicine (IOM) published

Crossing the Quality Chasm: A New Health System for the 21st Century

. With this report, the IOM called upon the healthcare system to focus on Six Aims for Improvement: care that is safe, timely, effective, efficient, equitable, and patient-focused. These Aims serve as the foundation for the AHRMM initiative on improving quality in healthcare supply chain management.

This document strives to follow the American Hospital Association (AHA) footsteps and the Health for Life initiative. AHRMM has developed this resource directed at supply chain professionals to make the business case for quality while using the Six Aims for Improvement as drivers for departmental operations.

Safe

Safety is the fundamental cornerstone of the healthcare system. If care is not provided in a safe manner in a safe environment, the chances of a positive outcome are lessened significantly. As noted in the Institute of Medicine’s publication, Crossing the Quality Chasm “Patients should not be harmed by the care that is intended to help them, nor should harm come to those who work in healthcare.”

While the goal is to provide safe healthcare at all times, it is clearly recognized that humans provide care and that errors can and do occur. Thus, the goal must be to prevent harm from reaching patients and those involved in providing care to those patients. To do so, requires everyone to be involved in identifying opportunities where patient care can be made safer. It also requires that everyone be continuously involved in learning from medical errors and “near misses.”

Supply Chain professionals play a major role in the safety of the patients, their families, their caregivers, and those whose work supports the patient care mission.  Supply chain staff are required to perform the prescribed duties and implement the proper protocols to assure clean, safe, and secure storage locations for supplies and material.  Supply Chain professionals provide the following programs to assist in the safety of patients.

1. Manage recalls, alerts, and service bulletins for equipment, supplies, and purchased services in an expeditious manner and assure that recalled products are removed from potential use in accordance with best practices.
2. Ensure appropriate storage of supplies and equipment to meet regulatory requirements and safe access and handling for staff.
3. Ensure that proper temperature and humidity controls are employed in storage facilities to assure product life.
4. Ensure appropriate documentation for in-house sterilization is maintained and adequate controls exist per regulatory requirements.
5. Ensure that proper safety precautions are employed in the distribution process (fork lifts, back braces, etc.).
6. Employ Value Analysis processes and product management to ensure that those affected by product decisions are represented in the product selection and decision-making activities.
7. Ensure product conversions are coordinated and staff receive clear communications and education when needed.
8. Ensure that all products acquired meet regulatory fitness for use criteria.
9. Manage dated product to ensure removal of expired/obsolete products.
10. Develop and maintain vendor access programs/credentialing policies and procedures to assure that those who enter into patient care areas comply with the same requirements held of those employed in the healthcare organization.
11. Support data standards.
12. Report bad product that is shipped in error or product that has unclear labeling.

Timely

Delays have become a frequently accepted norm within healthcare today. Delays may be attributed to long waits for appointments, long delays in waiting rooms, or in transporting patients. Delays can also mean problems in readily accessing patient test results or inability to provide treatments in a timely manner.  Regardless, all of those involved in healthcare should be focusing on ensuring that patient care processes flow smoothly.

Supply Chain Professional’s Role: Assist with the timeliness of care.

1. Provide the appropriate quantities of required goods to locations in a timely manner to ensure the continuation of patient care and other work processes.
2. Support an effective asset management system to assure that appropriate quantities of patient care technologies (infusion devices, physiologic monitoring devices, anti-thrombic pumps, etc.) are available to clinicians.
3. Proactively communicate information regarding alerts, product recalls, service bulletins, and known events.
4. Timely notification of stock-outs and product substitutions (throughout supply chain).

Effective

Crossing the Quality Chasm defines effectiveness as “care that is based on the use of systematically acquired evidence to determine whether an intervention, produces better outcomes than alternatives – including the alternative of doing nothing”. This premise is the foundation upon which “evidence-based medicine” rests.

As noted in the IOM report, evidence-based medicine is “the integration of best research evidence with clinical expertise and patient values”. This definition represents the melding of three critical factors: (1) best research evidence: a broad base of evidence that is derived from laboratory experiments, clinical trials, epidemiological and outcomes research; (2) clinical expertise – refers to the ability of the clinician to utilize clinical skills and experience to rapidly evaluate each patient’s unique health state to make a diagnosis and to recommend interventions based upon knowledge of the respective risks and benefits; and (3) patient values that refers to each patient’s unique preferences, concerns, and expectations that are part of each clinical encounter.

One of the most significant improvement needs concerning effectiveness of care is in the areas of palliative and end-of-life care. Nowhere do the AHA quality goals converge more poignantly to confirm the need for providers and patients to work together to make care better and to help people manage their own health and healthcare; asking 'what care is right”?

Supply Chain Professional’s Role: To provide services to facilitate effective healthcare delivery in the proper environment. Processes and protocols should demonstrate sound science and efficacy data to justify employment of a particular technology for a prescribed area as well as to determine if its employment could perhaps in fact be overused.

1. Evaluate the features and functions of supplies, technologies, and label claims to ensure the right product for the right application.
2. Follow service delivery best practices to ensure that appropriate quantities of goods are readily available for routine and emergency patient care and support services activities.  Appropriate quantities of supplies should exist to provide quality routine and emergent care.
3. Garner executive-decision support by making the business case for adequate resources for training and education for staff at all levels to ensure requisite knowledge and behavioral competencies.
4. Follow consulting, professional organization’s competency requirements, standardized procedures, benchmarks, and best practices.
5. Select evidence-based products.
6. Comply with PDSA modes: Use of PDSA, QM, PI, LEAN and Six Sigma tools and techniques to assess and to redesign support service processes.
7. Employ concepts of lifecycle and value analysis in product/purchase services decision-making.

Efficient

Fragmented healthcare delivery promotes wasted time, efforts, materials, medications, money, and trust. The Efficiency Aim describes the divide between good healthcare and the healthcare that people may actually receive. The term “efficiency” is often mistaken for cutting corners. This is not the focus of the IOM report. The report notes that there are two primary methods to increase the efficiency of the healthcare system: (1) reduce waste at all levels, and (2) reduce administrative or production costs.

Reducing waste may require a basic redesign to match the work to the worker; i.e.; developing competency requirements for each position. Reduction in administrative costs can also occur through the elimination of duplicative paper work, redundant testing, and multiple re-entries of various types of practitioner orders.

Supply Chain Professionals have been required to be more efficient in providing a cost-effective and safe environment for patient, visitors and staff and manage programs to promote efficiencies.

1. Ensure adequate resources for training and education for staff at all levels to ensure requisite knowledge and behavioral competencies. Well trained staff are more productive and engaged.
2. Conduct reviews to ensure that product utilization is within internal or external benchmarks to minimize waste within the health system.
3. Employ value analysis techniques and processes as the platform for clinical product decision-making and to promote standardization.
4. Integrate appropriate technologies to provide cost efficiencies and improve productivity in the replenishment cycle, including sterile reprocessing.   
5. Schedule staff to better meet the needs of the patients, caregivers, and the healthcare facility.
6. Monitor productivity of daily operations to ensure the right mix of staff and technology throughout the facility. 
7. Employ data standards to ensure efficiencies in the supply chain and enhance traceability of supplies, ease of ordering, data analytics for cost control, and revenue cycles.
8. Develop and maintain optimizing distribution channels and systems.
9. Develop, document, and communicate standard policies and procedures to promote end-user and Supply Chain professional’s ease of navigation through business processes, methods, and procedures.
10. Reduce variability of technologies, products, and processes to promote quality, cost-effectiveness, and safety.
11. Acknowledge that “one standard' will not always meet patient, caregiver, or physician requirements.
12. Support data standards.

Equitable

Simply stated by the IOM, the “purpose of the health system is to continually reduce the burden of illness, injury, and disability, and to improve the health and functioning of the people of the United States.” The focus of this Aim is that these benefits of the healthcare system should be available to all.

Equity occurs at two levels: (1) population – where disparities in the provision of healthcare services are to be reduced and eliminated for all subgroups, whether it be on the basis of race, ethnicity, or gender, and (2) individual – where each individual is treated on the basis of their needs in regard to availability of care and quality of services rather than on the basis of personal characteristics that are unrelated to their illness.

Supply Chain Professional’s Role is to assist the organization in their goals to ensure the Equity of care to all patients in the facility.

1. Assure appropriate representatives/stakeholders are actively engaged in product selection/review process.
2. Provide product to patient regardless of socio-economic standing.
3. Develop and actively support procurement and contracting practices which ensure the inclusion of minority, women, and veteran-owned firms, vendors, and suppliers.
4. Assure transparency in decision-making and transactions.
5. Promote community support through appropriate disbursement/donation of assets which are no longer of use to the healthcare organization.
6. Treat all patients, staff, suppliers, and others with dignity and respect.

Patient-Centered

This specific Aim focuses “on the patient’s experience of illness and healthcare and on the systems that work or fail to work to meet individual patients’ needs.” 

In work done by the Picker Institute and utilized in the 1996 AHA Eye on Patients report, several characteristics of patient-centered care have been identified: (1) respect for patients’ values, preference, and expressed needs; (2) coordination and integration of care; (3) information, communication, and education; (4) physical comfort; (5) emotional support; (6) involvement of family and friends; and (7) access.

While patients vary in their desire to be involved in their healthcare, all too often, patients feel excluded from discussions and decisions that affect them and the healthcare that they receive. As a consequence, patients may find their healthcare to be not only impersonal, but they are often left confused and unsure as to what they need to do in regard to participation in their care.

While Supply Chain professionals rarely engage directly with patients, their work processes affect the continuum of care afforded by caregivers, clinicians, and physicians.

Supply Chain professional’s patient-centered goals are to:

1. Foster clinician and stakeholder involvement in product and purchased services decision-making to ensure, when appropriate, that patient’s and internal customer’s needs are taken into consideration.
2. Use professional tools and resources in developing product standards, and the selection of supplies and services. Develop and support product standards, selection, and educational opportunities.
3. Demonstrate respect for patient’s and customer’s preferences and respect individual needs when possible (cultural, ethnic, etc.).
4. Integrate evidence-based decision-making in supply and equipment selections.
5. Develop evidence-based supply selection processes based on appropriate utilization of products.
6. Employ active listening skills as keys to making the patient, caregiver, visitor, family member, or associate feel supported and heard. 
7. Keep confidentiality of patient information (HIPAA – not printing or revealing patient or protected business information without encryption or appropriate authorization).