For Chris Torres and her team at Main Line Health, supply chain management and clinical resource management are a package deal
Chris Torres
The supply chain executive as a utilization and waste management consultant? “Yes,” says Chris Torres, system vice president, supply chain and biomedical engineering for Main Line Health, Radnor, Pennsylvania.
“Some folks focus on cost,” says Torres, who was named 2018 Contracting Professional of the Year by the Journal of Healthcare Contracting, sister publication to Repertoire. “In my mind, it’s not the price [of supplies and equipment] that’s most important. It’s how we use it and how we can not waste it.”
To tackle those issues, the supply chain executive and his or her team have to work hand in hand with clinicians, with trust, openness and respect, she says. That is every supply chain executive’s duty. Some – like Torres – had a head start.
Clinical resource management
Founded in 1985, Main Line Health (MLH, the System) is a not-for-profit health system serving portions of Philadelphia and its western suburbs. At its core are four of the region’s respected acute care hospitals – Lankenau Medical Center, Bryn Mawr Hospital, Paoli Hospital and Riddle Hospital. MLH also includes Bryn Mawr Rehab Hospital, Mirmont Treatment Center for drug and alcohol recovery, and MLH HomeCare & Hospice, a home health service. Additionally, MLH consists of Main Line HealthCare (MLHC), one of the region’s largest multispecialty physician practices; the Lankenau Institute for Medical Research, a non-profit biomedical research organization; and five outpatient health centers.
As the system vice president of supply chain management and biomedical engineering, Torres oversees more than 250 employees in biomedical engineering, contracting, inventory control and logistics. The supply chain management team is responsible for approximately $300 million in spend. The program encompasses an in-house biomedical equipment management program, strategic sourcing, supply chain management technology and data analytics, clinical resource management aligned with clinician engagement, and systemized logistics management.
For the past two years, Torres and her team have been redesigning Main Line Health’s value analysis/technology assessment program. “The Clinical Resource Management program (CRM) is an important foundation for our performance excellence work,” she says. The program is a systemized approach to reviewing new products, services and technology, and is guided by the Institute of Medicine’s STEEEP principles, where STEEEP is an acronym for six aims of healthcare – Safe, Timely, Effective, Efficient, Equitable, Patient-centered.
CRM provides Main Line Health with tools and data to address the standardization of care and optimize patient outcomes, says Torres. “A key to success is our clinician engagement process. We have open communication with our clinicians, we are transparent with our cost data, and we share the responsibility of the ‘total value of care.’
“We are embarking upon the difficult journey of ‘bending the Medicare cost curve,’” she continues. The team is looking at variations in care, outcomes, and a more holistic approach to delivering high-quality care to patients. “Our hope is that this work will result in a sustainable model, which reduces variation in care, focuses on utilization and waste, and shows reduction in the total cost of care.”
Using STEEEP principles, for example, Main Line Health is trying to answer questions such as, For a certain patient population, do we need order sets that require an X-ray q8 hours when evidence-based medicine demonstrates that q24 hours is a safe and effective practice? “In the supply arena, we will work with our clinicians to determine if we really need 15 shoulder anchors, when perhaps four would deliver the same results.”
Just several months into the CRM program, Torres lists these accomplishments:
- Increased physician engagement, evidenced by their participation in work groups and in vendor negotiation meetings.
- Increased awareness of everyone’s accountability for managing the supply chain. (“We are getting ideas directly from front-line staff as they relate to waste and utilization management opportunities,” she says.)
- Identification of standardization/utilization management opportunities, such as review and standardization of custom surgical packs and expansion of Main Line Health’s reprocessing program.
- Implementation of a much more stringent vendor management program related to access to surgical suites.
- Issuance of multiple RFPs in the physician-preference arena, targeting vendor consolidation as well as price reductions.
Utilization consultants
There’s no doubt that her clinical background has helped Torres build the clinical resource management program. (She became certified as a surgical technician while still in college.) But every supply chain executive has the tools to become utilization consultants for their health systems, she says.
“The first place to start is with relationships built on trust and respect. Providing ‘actionable data’ to your clinicians is key.
“You don’t have to be the expert in the clinical arena,” she continues. “As a supply chain leader, you have access to a plethora of connections in the end user space. Leverage those contacts to assist in understanding the landscape of use.”
Supply chain executives should capitalize on the expertise of their VAC/TAC team members, she says. “Aligning with your CNO and CMO is a great place to start. They lead the teams that use the products, services or technologies, and they can be champions for your projects.
“If your data is accurate and if it provides a path to action, your clinicians will follow, as they are scientists and use rational thinking skills in problem-solving.”
Grooming tomorrow’s leaders
Over the past five to seven years, Torres has focused on building a team of “stars,” who are empowered to think outside the box, make decisions, feel confident that she will always have their back, and celebrate their successes.
“Supply chain management is hard work, if you do it correctly,” she says. “It’s not about chasing price. It’s about understanding the life cycle of the products, services and technologies we use; the total cost of ownership; measurable outcomes; engaging partners; and doing the right thing for patients.”
Selecting people with that frame of mind and heart is one of the supply chain executive’s most important functions, she says.
Supply chain management is by no means unique to healthcare, but healthcare does present some unique demands. “The big question [when considering bringing on new people] is, ‘What are the traits needed in a healthcare supply chain professional?’”
Given the urgency of healthcare, where the stakes can be life or death, “you need people with heart as well as common sense,” says Torres. “I can teach tasks, such as how to stock a unit or place an order. But does my contract manager know the importance of what they do every day? We talk about Lean Six Sigma, but ‘heart’ doesn’t fall in those guidelines.”
Clinical resource management
What clinical resource management is
Clinical resource management is a conscious, consistent and expedient decision-making process, explains Chris Torres, system vice president, supply chain and biomedical engineering, Main Line Health, Radnor, Pennsylvania. It:
- Uses interdisciplinary teams across the continuum of care.
- Has executive engagement and support.
- Uses STEEEP principles (Safe, Timely, Effective, Efficient, Equitable, Patient-centered).
- Uses DMAIC principles, a process improvement strategy whose acronym stands for Define, Measure, Analyze, Improve, Control.
- Uses a “system lens” for all discussions.
- Focuses on utilization, standardization and waste management.
- Ensures that training, education and communication on new products, services and technology are completed prior to introduction into the care continuum. (Focus is maintained on patient safety; enhanced staff education and inservicing.)
What clinical resource management is not
Clinical resource management is not:
- A wish list. Rather, products, services and technologies are evaluated based on their total value to care, not just because they are the latest and greatest.
- Simply a product review committee. CRM forces the team to look beyond product cost, to the outcomes associated with the product, service or technology.
- A path to find the cheapest product. Price is the last factor considered.
- A means to delay product approval. Rather, it is a process to make informed