Conversation, collaboration works with sportsmanlike conduct.
By R. Dana Barlow
If healthcare supply chain executives and leaders were asked to identify the two most challenging conversations that they experience on a daily basis they likely would place themselves between two bookends – contract negotiations with suppliers and service companies on one side and product and service discussions with clinicians (e.g., nurses, physicians and surgeons, etc.) on the other.
Bridging the gap between the two can have its positives and negatives, expectations and nuances. It can leave supply chain feeling like Crayola’s Silly Putty.
Working with external suppliers and service companies, supply chain strives to be the hero of its own story, representing the product and service needs and demands of its internal customers based on their clinical preferences and quality issues while trying to appease the fiscal constraints of its organizational employers.
Working with internal clinical customers, supply chain strives for credibility and respect, representing the cost pressures inflicted by its organizational employers while trying to explicitly understand as well as advocate for the product and service needs and demands of nurses, physicians and surgeons.
Supply chain nurtures the delicate balance between the provider organization on one hand and the clinical community on the other as it weaves between the art and science of conversations and negotiations with suppliers.
Supply chain experts generally agree that successful business relationships and transactions occur when they are fortified with clinical input and intelligence before sitting at the negotiation table with supplier and service company executives.
They also acknowledge that those clinical conversations straddle the line between art and science with clear recommendations on what to say, how to say it and what to avoid saying.
What supply chain should never say to a clinician
If there’s a common denominator for ticking off nurses, physicians and surgeons, supply chain experts agree on this: Ignore them, followed closely by talking down to them.
Joe Colonna, chief supply chain and project management officer, Piedmont Health, warns against tacitly excluding them from the product selection process, by “assuming that they don’t care about cost or imply anything that questions their clinical expertise,” he indicated. Colonna further lists two more red flags: “Your [insert product or procedure here] is costing too much money.” “Why do you have to have this?”
Don’t even think about dissing a clinician or a supplier, according to Mark Dozier, CPA, associate vice president, supply chain services, strategic sourcing and engagement, HonorHealth. “Never use unprofessional language when discussing a product request or the behavior of a specific supplier,” he told The Journal of Healthcare Contracting.
Dozier also dismissed the notion of supply chain acting like a boss with “You should clinically be able to use the product.”
Tom Lubotsky, vice president and chief supply chain officer, Allina Health, pooh-poohs the idea of playing the cost card right from the start.
“Don’t go with ‘I need you to consider this product because it is so far less expensive,’” he said. “Don’t lead with that. You’re going to shut off the conversation. Instead, you should lead with ‘I’d like for you to consider this because it sounds like it might offer the same or similar clinical benefit at a lower cost.”
What clinicians hate to hear from supply chain
Aside from budgetary and economic complaints, clinicians really don’t like to hear about limits on product and supplier choices, particularly if an agreed-upon formulary isn’t in place, according to Allina’s Lubotsky. “‘I want to be innovative. I want us to be innovative. I want us to be at the bleeding edge of providing the best of care, so don’t tell me what I can’t use,’” he added.
Piedmont’s Colonna points to accessibility with three statements that lack any explanation:
- “Your device is on backorder or is in some other way unavailable.”
- “You can no longer use your preferred vendor/product [no reasons given].”
- “Your new product request has been denied [no reason given].”
Passive-aggressive behavioral modification doesn’t work either, he added: “Your peers can change so why can’t you?”
HonorHealth’s Dozier also cites the backorder revelation, adding insult to injury by applying it to the clinician’s next case.
Further, clinicians don’t appreciate hearing that “the supplier rep who services you recently had a blatant violation of hospital policy and has been suspended from our campuses for the next 30 days” and “no additional suppliers can be added to this modality at this time,” he said.
Dozier also notes that clinicians tend to frown “when they are shown data that their procedures are not profitable for the healthcare organization.”
What clinicians prefer to hear from supply chain
Short of “you can have everything you want,” Dozier offers two distinct responses clinicians want to hear from supply chain: “Your new product request has been promptly considered and approved,” and the more succinct, “Yes.”
Colonna and Lubotsky center around collaboration and relationship management.
Colonna lists four statements that clinicians want to hear from supply chain that invite cooperation:
- “Can you help us to better understand your request and are you open to other options?”
- “Can we discuss both the clinical and financial aspects of the products you use?”
- “Would you join us in the value analysis process?”
- “What information and data would help you be more comfortable with our request for a product change?”
Lubotsky highlights the give-and-take of mutual compromise and concession.
“They would prefer to hear we are open to considering all suppliers that bring innovation and improvement in our care,” he told JHC. “We’re willing to do so, but I need your help in understanding what percent of our spend can accommodate innovation. We might pick two vendors that may represent 80% of the market share or spend in that category. That leaves 20% to allow innovation and other players in the door that they can continue to work with.
“What they prefer to hear is us saying is we are open to inviting all suppliers that you are interested in using. But then I need your help in figuring out how do we offer that choice,” he added.
What clinicians should never say to supply chain
Supply chain may say the darndest things to clinicians that irk them to no end, but then clinicians can reciprocate with questionable replies and retorts, too, that can be abrasive and petulant. And that can happen before they pull rank and approach the C-suite as a last resort.
Colonna and Dozier both hint at geographical leverage and the proverbial threat to relocate.
Dozier shares the nebulous: “Either give me what I want by approving my new product request, or I’m taking my patients and volume elsewhere.”
Colonna emphasizes proximity: “I want to use what I want to use, and if you don’t let me have it, I am going across the street.”
Then Colonna migrates to the dismissive with two more examples: “You only care about the money.” “I am not interested in hearing from you.”
Dozier moves to the intimate and intricate: “I want to move to this new vendor because the rep I depend on is now employed by them.” “I don’t care if I use the cheaper product at the ASC; I’m not going to use it at the hospital.”
Lubotsky winces when hearing, “I have to use this” or “I have to use that” without any background evidence because this really doesn’t invite supply chain’s expertise to help with any decision. “Show evidence on what you call best and let’s look at it critically,” he advised. “Part of it is the style or manner on how physicians approach us. It is always better if we talk about what are the clinical criteria [supporting] why you need it? What is the evidence behind it?
“We prefer to hear, ‘I’d like you to consider this product because I believe this has applications to a select set of patients and would like to have that be considered as part of the portfolio of offerings for our clinical patients,’” he added.
What supply chain hates to hear from clinicians
One of the challenges supply chain faces when working with clinicians is their employment status. Nurses tend to be employed staff; physicians and surgeons can be employed staff, depending on the provider organization, or they may simply have privileges to practice at the facility. The former grants the hospital more authority and control over decisions than the latter, which may require handling with kid gloves.
Colonna lists four potential statements that call for further discussion about procedures and processes:
- “The device you made me use is causing patient harm.”
- “The information you provided is old or incorrect.”
- “I already made this change, so why are you still asking? Do you actually know what is going on in the hospital?”
- “I feel like this change is being forced on me without my concerns be addressed.”
A blatant rejection of cooperation turns off Dozier: “I’m not willing to participate in a trial of your recommended contracted product.”
Lubotsky acknowledges that physicians and surgeons are suspicious that “we may seem to be interested in spending money on innovative products,” he indicated. “I’d rather they say, ‘I know you guys care about innovation and I found this product area of focus here that I like and I need some help in exploring it further. Can we look at this together?’”
Still, Lubotsky admits one familiar comment can be really upsetting to supply chain: “‘My patients are different. What I do is different.’ There may be clear instances of complex morbidity that require a different approach and therapeutic regimen to take care of a patient. I get that. But unequivocally saying, ‘my patients are different so I can’t use these products’ does not foster engagement with Supply Chain.”
Lubotsky also recognizes when residents come in and prefer to use products and technology they trained on in medical school, but the organization may have standardized to a set of branded product already or it may not have any of that on hand and isn’t likely going to invest in it. “It’s kind of an acceptable reality,” he added.
What supply chain prefers to hear from clinicians
Collaboration and cooperation toward the common goal of providing quality care for patients while keeping the facility’s doors open should be shared goals and responsibilities of administrators and clinicians alike.
Supply chain experts concur that their team must demonstrate an openness and willingness to understand clinical desires to provide the best, if not optimal, care with the appropriate products, services and technology available. Meanwhile, clinicians need to recognize and understand the motivations and reasons around fiscal constraints and restraint to act as economic stewards.
Lubotsky would like to hear something along the lines of “‘I know that things are tough in terms of being careful about managing our costs. I have a product or a service that I really would like to use. I need your help to examine it. Let’s evaluate it together and see if this is something that we could work towards bringing on board,’” he said. “I just think that’s a much better approach in terms of cooperation and the sensitivity and understanding around the financial hardships.”
Colonna give five clinician statements that make supply chain smile and offer value:
- “I am open to change if it makes clinical and financial sense for the patient and the organization.”
- “I may need help in getting comfortable with these new devices so can we discuss what I will need to help me change?”
- “Here are my concerns. If we can address them, I may be able to make this change.”
- “What can I do to support this initiative?”
- “Thank you. I feel included and heard in this process.”
Dozier adds two more:
- “I’m open to trialing a product that is recommended by the value analysis process or awarded a contract by your GPO aggregation model.”
- “What the hospital has on product formulary is fine with me and will meet my needs.”
Lessons learned
Clinicians and supply chain working together with shared goals and successful outcomes can be turbulent and unnerving, but ultimately necessary for the organization and the healthcare system to continue operating.
Much of this is rooted in simply listening, according to supply chain experts.
“I think among the most important [lesson] was to listen to the concerns and ideas,” Colonna noted. “There is more than one way to achieve the outcome you desire. Instead of coming to a clinician with a savings goal and a predetermined strategy or solution, just come with the goal and work out the strategy with the impacted clinicians. Then agree to move forward, together, with a commitment to the success of the strategy and to achieving the goal.”
Lubotsky concurs. “The key is always to listen to the purpose around why physicians want to do what they want to do,” he said. “Their style or manner may not be what you like, but at the end of the day, they’re doing this because they care about their patients. Get a deeper understanding about the reasons why they want to use or buy a certain instrument or device. You must listen to the purpose and the why and then help them create the business point, the business position around doing just that, but it may not always be attractive because it could be just too costly. The lesson here is don’t get contentious. Don’t say we can’t afford it. Listen to their purpose and the why and then go from there.”
Dozier shares four additional relevant tips.
“In-person conversations can sometimes be helpful as opposed to email,” he recommended. “Never ever share data with a clinician unless you are absolutely sure it is correct. If you find out later that the data wasn’t correct, the clinician will never forget it. It’s important and beneficial to get clinicians involved early in the process of a product decision, evaluation, conversion, etc. And it’s better to have clinicians trial a new product first to see if the technology walks the talk before approving it and adding it to contract.”