As director of supply chain management and purchasing for Kettering Health Network, Trisha Gillum is responsible for sourcing everything from toilet paper to orthopedic implants across 8 hospitals and 175 physician practices. In every case, she and her team act as consultants that address the network’s many different challenges.
“A particular change might increase spend on supplies, but if it reduces false positives on contaminated blood cultures, for example, it improves quality and the patient care experience,” Gillum says. “As we assess organizational needs against what vendors offer to address them, we constantly strive for the right balance of cost, quality, and outcomes with a focus on the patient.”
One of her tactics in achieving the right balance is decreasing variability across Kettering’s clinically integrated network. By standardizing what is kept in inventory, she is able to contribute to results that are more consistent, of higher quality, and at lower costs.
“Many customers we speak to are trying to crack the standardization code,” says Rick Hammerly, Medline’s division vice president of sales. “By serving all care settings, we provide full transparency to supply chain teams about pricing and process to drive improved outcomes and savings.”
Gillum’s most important strategies in reaching those goals are leveraging data and transparency, and building relationships with executives, physicians, and clinicians. Once she and her team have identified the appropriate data, which is culled from databases provided by Kettering’s financial decision support department, Gillum and her team use the information to explain the reasons for making changes to all stakeholders. The team identifies a physician champion who can follow up with peer-to-peer conversations to help build clinical support while the supply chain team educates executives on reasons for altering the status quo.
The most useful data, Gillum says, often focuses on best practices or the research that drives them. That may raise questions, such as, “Why spend five times more than is necessary to reach a particular goal?”
Transparency contributes to making changes by letting the data speak for itself. In one instance, four cardiac stents with a $500 variation in price were categorized as green, yellow, or red to represent cost—red indicating most expensive—and overall value. Monthly reports published their frequency of use, who used them, and when the applications were clinically appropriate.
“We raised awareness by specifying which product was better for specific patients and outcomes,” Gillum says. “We didn’t take away choice but helped highlight the best uses based on value and appropriate clinical practice, and no physician wanted to be seen as having the most red ratings.”
The monthly reports resulted in such a dramatic change—physicians stopped using the red-rated stent—that the vendor renegotiated its price in order to reposition it with a green rating.
“We didn’t take away choice but helped highlight the best uses based on value and appropriate clinical practice, and no physician wanted to be seen as having the most red ratings.”
The supply chain team manages a list of up to one hundred different projects at any given time. The team is split into smaller specialized groups, such as analytics, systems, and sourcing. This enables each to act as primary points of contact for different service lines and to build key relationships within specialties. It also creates narrower bandwidth on which each specialized group can focus.
The project queue itself is prioritized by what Gillum calls pain gain assessments often made in relation to “white elephants”—products or services that have a high degree of passion and emotion around them. This might be displayed, for example, as a physician group that threatens not to perform a particular type of procedure at Kettering if a specific highly charged change is made.
“We can take a year to work on a very challenging project that will save $500,000, but that also generates lots of push-back requiring tremendous manpower to respond to, carries high implementation cost, and forces us to spend excessive political capital,” she explains. “Or, we can tackle five $100,000 projects that will be easier to implement. It all boils down to creating the most overall value.”
Because of her background and experience, Gillum is well positioned for tackling all the challenges faced by a modern supply chain leader. She has worked extensively in healthcare finance and decision support, which gives her insight into Kettering’s business side. But she also worked in the operating room environment where she gained firsthand knowledge of clinical and operational procedures. This combination of expertise enables her to speak effectively whether she is presenting a business case to CFOs and other executives or explaining the medical reasons for making a change to clinical teams.
“If I’m speaking with a financial group, I can help them understand the clinical concerns doctors may have regarding a proposal we’re considering,” she says. “Otherwise, they might think the physicians are just saying ‘no’ for no good reason.”
That was the case when Kettering was examining the possibility of prohibiting sales representatives from the operating room during orthopedic surgeries. In that case, Gillum pointed out that the representatives actually provide value by ensuring that surgical implants are ready for use and being able to provide immediate answers if questions arise about the devices.
Gillum’s standardization efforts also extend to Kettering’s pharmacy practice. She has helped develop network-wide product committees that evaluate and compare the clinical impact of various medicines. She also helped launch the Medication Assistance Program. The program matches specific patients and their treatment needs to drug manufacturers’ programs that provide financial assistance or free products. After six years, the program has generated $10 million in savings.
Gillum and her team are part of an ongoing evolution in healthcare supply chain management. She describes the traditional approach as buying products, moving them from point A to point B, and showing the resulting costs. In addition, supply chains must now assess data from multiple sources, understand how products are being used, and provide solutions to address a variety of needs and challenges. Those include offsetting reductions in Medicare and Medicaid reimbursements, supporting services delivered via telemedicine and outpatient care, as well as increased focus on overall patient well-being.
“We need a holistic understanding of how products are being used in specific cases to ensure the best financial and clinical value,” Gillum says. “We accomplish that by being transparent and answering questions, listening to our partners, and building relationships so that we work collaboratively. We never want to dictate changes that make their jobs more difficult.”