JHC July 2024

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Hackensack Meridian: Cultivating a Strong Nursing Workforce

Editor’s Note: In the following interview, Regina Foley, Executive Vice President, Chief Nurse Executive and Chief Clinical Transformation and Integration Officer discussed the IDN’s strong nursing culture, importance of safety for both caregivers and patients, and recent initiatives related to those topics.

Hackensack Meridian Health’s nurse vacancy rate is much lower than the national average (6.5% vs. 16%, according to a Becker’s report). What do you attribute to the successful retention of your nursing workforce?

Hackensack Meridian has built a strong nursing culture and we have a reputation as a safe place to work, a place where nurses can work autonomously and spend their entire career.

Our hospitals have been Magnet designated for nearly 30 years, and we are one of the most recognized health systems in the country for nursing excellence with eight Magnet designations; less than 10 percent of U.S. hospitals have earned this recognition. Research consistently shows that Magnet designation leads to increased RN retention and lower nurse burnout, increased RN satisfaction, decreased vacancy and turnover

rates, as well as improved patient care, safety and satisfaction. So, we have actively and intentionally created a Magnet culture focused on nursing leadership, professional development, full scope of license, evidence-based practice, and interprofessional collaboration.

We continuously invest in our team and their competencies to ensure our nurses are empowered and that we have an environment that supports the highest quality of patient care. We proudly offer educational reimbursements, including tuition for nurses who want to advance their careers. Our nurses are also reimbursed for national certification and for participating in professional development activities, including our clinical ladder program. We spend a lot of time and attention in developing our nurse leaders and giving our team opportunities to expand their skills.

Our strong relationship with higher education is another intentional step we have taken. We want our nursing students to have an exceptional experience in our clinical sites and to choose our health system as they begin their careers. We also incentivize our team members to help with recruiting as well. Employee referrals are now our third-largest source of hires.

And finally, we’re investing in technology and focused on innovative ways to reduce the administrative burden that many clinicians face. One way we are doing this is by partnering with Epic to explore opportunities where we can target efficiency, wellness and burnout.

How does Hackensack strive to make the environment a safe place to work?

We are so proud to have just recently earned the most “A” grades in New Jersey from the LeapFrog Group, which is a national hospital ratings program focused exclusively on preventable medical errors, infections and injuries. The top rankings we consistently achieve from LeapFrog and U.S. News & World Report is a testament to our overarching priority of ensuring a safe and high-quality environment for our patients and team members.

culture, where every team member is treated justly and consistently when reporting errors or missteps. We recognize that protecting team members and making advances in patient safety depends on our collective ability to learn from mistakes – whether human, technical or system-induced errors. Our team feels supported and encouraged to identify, report and address issues or concerns. Hackensack Meridian is nationally recognized for our patient safety and outcomes because of our safety environment and the exceptional care our team provides to our patients each day.

What are some areas of nurse safety that Hackensack has made a priority to address or implement measures? How does this lead to improved patient safety?

By creating and nurturing a fair and just culture consistently throughout the health system, we have built trust within our organization and we have created an environment where everyone feels comfortable and is encouraged to address safety and quality issues.

As a high-reliability organization, Hackensack Meridian Health has worked to embed our safety culture and universal skills in our work environment and everyday lives. We are laser-focused on driving a culture where everyone feels comfortable and is encouraged to address safety and quality issues as we work toward a shared goal of zero preventable harm.

As part of that commitment, we have built trust within our organization through the implementation of a just

Our commitment to providing a safe and healthy workplace environment for our patients and team members is paramount.

We live by our One Team for Safety adage, which speaks to the obligation we all have to look out for each other. That starts with a fair and just culture. By creating and nurturing a fair and just culture consistently throughout the health system, we have built trust within our organization and we have created an environment where everyone feels

comfortable and is encouraged to address safety and quality issues. Our team knows we want them to speak up for safety, and that they have our full support when they do. We protect our team members and make advances in patient safety because we collectively learn from our mistakes and keep getting better.

Several years ago, we advanced an initiative involving the redesign of ID badges for patient-facing team members in our acute-care hospitals. These ID badges display the first name and last initial in place of the full name. We implemented this across the system after a successful pilot at three of our hospitals, which showed no reported impact on communication with patients or families, an increased feeling of safety among team members, and overwhelming support to expand the pilot.

We also recognize that hand hygiene is essential to our infection prevention and control measures, and critical to our culture of safety. While we had always consistently monitored the hand hygiene of our team members, we implemented a new electronic hand hygiene system last year that allows us to more efficiently and effectively support patient and team member safety.

Support for the emotional wellbeing of our team is just as important as protecting them from physical harm. The nursing practice at Hackensack Meridian is built around Watson’s Theory of Human Caring, which reflects our deeply rooted commitment to providing holistic family and patient-centered care, and our shared belief that essential to human caring is fully embracing self-care. Research shows that the Theory of Human Caring improves patient care, and reduces staff burn out. We are proud that many of our

Sustainability runs in our veins.

Our commitment to sustainability is ingrained in everything we do. From using less plastic in our packaging to being the only supplier to offer a full line of IV solution and irrigation containers not made with DEHP or PVC, our focus is safety for the patient, clinician and the environment.

To learn more about how we can help support your health system’s sustainability and patient safety goals, please contact your local B. Braun representative.

nursing teams were among the first in the nation to have been honored with Lotus Recognition from the Watson Care Science Institute – including the first in the country to ever be awarded, which went to Hackensack University Medical Center. Our practice and nursing strategic plan demonstrate a relentless commitment to fostering a culture of genuine self-care and healing.

Providing our nursing team with the knowledge and tools needed to provide extraordinary clinical care is another area of importance – one critical to patient safety and team member wellbeing. A recent example of this is our partnership with the Morgan Stanley Alliance for Children's Mental Health and The Society for the Prevention of Teen Suicide to launch enhanced training to help our team better understand and manage behavioral health, particularly adolescent psychiatric challenges and at-risk pediatric patients. We launched this training last year and have a goal of training all nurses across our health system by 2025. The training covers all areas of behavioral health, from identification to treatment, and ensures our nurses have the knowledge and resources needed to deliver a wider range of behavioral health disease identification and treatment strategies.

How does Hackensack work to develop nursing leaders within the system?

As we continue to look for ways to strengthen the current and future nursing workforce, an enhanced framework was developed to support the ongoing professional development and growth of our nursing team. Through the integration of our three schools of nursing

(Hackensack Meridian Health School of Nursing and Wellness at Georgian Court; JFK Muhlenberg and Snyder School of Nursing; Middlesex College Nursing Program) and the new Hackensack Meridian Health Sheila Cancro Institute for Nursing Leadership and Practice Excellence, a host of programs and initiatives have been advanced. Examples include:

` NSPIRE , a new apprentice program designed to support newly-graduated, pre-NCLEX nurses in their transition to practice. The program offers a paid practice immersion curriculum before transitioning to Hackensack Meridian’s paid nurse residency program. NSPIRE nurses complete clinical immersions, shadow and are exposed to the clinical environments in which they work.

mentorship for nurse residency program graduates.

` In 2023, we also launched the new Lecture Workshop Series for nurse leader professional development. Topics covered included nursing finance and budgeting, nurse leader resilience and work/life balance, nurse onboarding, peer interviewing, team building and trust/conflict resolution.

We also support the development of nurse leaders through:

` National Certification – Nursing Policy – annual payment to help our nurses pursue national certification.

` Tuition Reimbursement

` Nursing Scholarships

Providing our nursing team with the knowledge and tools needed to provide extraordinary clinical care is another area of importance – one critical to patient safety and team member well-being.

` The New Grad Nurse Residency Program develops professionalism and independence among recently graduated nursing students and reinforces Hackensack Meridian’s commitment to educate and retain our high-quality nursing staff. Nurses within this program provide delivery of nursing practices using the outcome-based practice model by demonstrating competency in clinical judgment, technical skills and an appropriate knowledge base.

` Developed in 2023, the Beyond the Residency Program offers continued

` RN-Clinical Advancement Program – clinical ladder/advancement and compensation program

` New Doctoral Research Council to support a culture of continuous improvement and inspire nurses to get involved in research.

` Specialty Academies i.e. Operating Room

` Ensuring our leaders are coaches by providing tools and training to help them create a positive employee experience and workplace culture.

` Hackensack Meridian Health was certified as a Great Place to Work® in Jan. 2024 for the eighth time.

Stability through change: How automation makes life easier for lab professionals amid t work force shor tage

As healthcare organizations across the nation know, clinical labs continue to feel the strain of meeting rising demand with a stagnant workforce. Test volumes have rapidly swelled, and test menus have grown, yet the workforce of qualified lab professionals has not grown to match. The reasons behind this stagnation are clear: an aging workforce, dearth of new entrants to the field, lack of growth and retention opportunities, disparities in salary compared with other healthcare professionals, rising test volumes due to an aging population, growth of esoteric tests and additional volume fueled by the pandemic

Laboratorians are being tasked to do more, take on more responsibilities and work longer hours As it stands, the current situation has shown signs of improvement, but greater change is needed Regardless of any specific solution, the importance of lab professionals must be given the attention it deser ves. Af ter all, people are the driving force behind patient care. The human element is what makes lab testing what it is

The Association for Diagnostics & Laborator y Medicine (ADLM) recently published a white paper2 recommending amendments to the Clinical Laborator y Improvement Amendments (CLIA) policy to help overcome lab staffing shortages. These include advocating for the value of lab medicine, diverse and equitable recruitment efforts, reclassif ying lab tests based on per formance complexity and developing educational programs to provide alternate entr y points into lab medicine careers. Dramatic change like the proposed one takes time to germinate and bear fruit, so healthcare organizations must assess what they can do to mitigate the work force shortage with existing solutions and technologies to help lab professionals per form their work efficiently while avoiding overwork and burnout

Automation is frequently seen as a solution, or at least a critical component in the strategy for navigating the labor shortage. Since its introduction, automation has transformed the landscape of the clinical lab, helping reduce turnaround times, decreasing manual specimen handling and helping eliminate human error Across departments, today’s lab instruments are capable of automating routine testing and per forming a wide range of functions, including quality control (QC), maintenance and calibration verification But, as with any industr y, while automation has the potential to boost efficiencies, it also can boost inefficiencies depending on its implementation and the users

In addition, some clinical lab workers may have mixed feelings about automation, given the fear that automation could lead to work force reductions. Ideally, automation is a tool that enables greater productivity by redirecting workers from tedious manual processes to more interesting, value-added work. For clinical labs, this means replacing manual, repetitive tasks with critical work that benefits patient care.

Chris Wilson, Content Manager, Laborator y Products and Ser vices, Cardinal Health

41%

According to the 2023 Survey on Wage & Morale Issues Among Medical Laboratory Professionals, 1 41% of respondents indicated their laboratories were moderately understaffed, with another 26% recorded as significantly understaffed.

52%

A majority of respondents (52%) described themselves as overworked relative to their position

In the right setting, automated equipment is a boon to efficiency, safety and working conditions, but it cannot be forgotten that the human factor is vital. The knowledge and ability to solve complex challenges cannot be replaced.

In the right setting, automated equipment is a boon to efficiency, safety and working conditions, but it cannot be forgotten that the human factor is vital. The knowledge and ability to solve complex challenges cannot be replaced.

In the right setting, automated equipment is a boon to efficiency, safety and working conditions, but it cannot be forgotten that the human factor is vital. The knowledge and ability to solve complex challenges cannot be replaced.

Effective communication and collaboration between supply chain, hospital administrators, executives, and lab professionals must be facilitated to address concerns and ensure that automation complements rather than replaces human expertise. So, how can we be sure automation in the lab is making things easier for people without replacing the human element? Organizational decision-makers must consider where and how much automation is needed and if it will enhance productivity while positively affecting lab staff.

Effective communication and collaboration between supply chain, hospital administrators, executives, and lab professionals must be facilitated to address concerns and ensure that automation complements rather than replaces human expertise. So, how can we be sure automation in the lab is making things easier for people without replacing the human element? Organizational decision-makers must consider where and how much automation is needed and if it will enhance productivity while positively affecting lab staff.

Effective communication and collaboration between supply chain, hospital administrators, executives, and lab professionals must be facilitated to address concerns and ensure that automation complements rather than replaces human expertise. So, how can we be sure automation in the lab is making things easier for people without replacing the human element? Organizational decision-makers must consider where and how much automation is needed and if it will enhance productivity while positively affecting lab staff.

Over the past decades, different lab departments have experienced varying levels of automation

Over the past decades, different lab departments have experienced varying levels of automation

Over the past decades, different lab departments have experienced varying levels of automation

Histology automation

Hematology automation

Histology automation

Histology automation

While the histological workflow has seen less change than in other areas of the lab, various steps can be automated, including tissue processing, slide staining, coverslipping and labeling.

While the histological workflow has seen less change than in other areas of the lab, various steps can be automated, including tissue processing, slide staining, coverslipping and labeling.

While the histological workflow has seen less change than in other areas of the lab, various steps can be automated, including tissue processing, slide staining, coverslipping and labeling.

Blood bank automation

Blood bank automation

Blood bank automation

Automating routine testing functions like liquid pipetting, reagent handling, incubation, centrifugation, reaction grading and interpretation, and data management gives medical laboratory scientists (MLS) and medical laboratory technicians (MLT) more time to work on processes like antibody identification, eluates, full crossmatching and discrepancies.

Automating routine testing functions like liquid pipetting, reagent handling, incubation, centrifugation, reaction grading and interpretation, and data management gives medical laboratory scientists (MLS) and medical laboratory technicians (MLT) more time to work on processes like antibody identification, eluates, full crossmatching and discrepancies.

Automating routine testing functions like liquid pipetting, reagent handling, incubation, centrifugation, reaction grading and interpretation, and data management gives medical laboratory scientists (MLS) and medical laboratory technicians (MLT) more time to work on processes like antibody identification, eluates, full crossmatching and discrepancies.

Clinical chemistry automation

Clinical chemistry automation

Clinical chemistry automation

Clinical chemistry has seen the highest percentage of automation as far as lab departments go. Nearly every process can be automated, minimizing turnaround times and increasing throughput.

Clinical chemistry has seen the highest percentage of automation as far as lab departments go. Nearly every process can be automated, minimizing turnaround times and increasing throughput.

Clinical chemistry has seen the highest percentage of automation as far as lab departments go. Nearly every process can be automated, minimizing turnaround times and increasing throughput.

Hematology automation

Hematology automation

Automated hematology analyzers can eliminate the majority of commonly performed manual steps for tests like complete blood counts and differentials, speeding throughput and reducing errors.

Automated hematology analyzers can eliminate the majority of commonly performed manual steps for tests like complete blood counts and differentials, speeding throughput and reducing errors.

Automated hematology analyzers can eliminate the majority of commonly performed manual steps for tests like complete blood counts and differentials, speeding throughput and reducing errors.

Microbiology automation

Microbiology automation

Microbiology automation

Because of the numerous microbiological specimen collection types, automation has been achieved at a lower rate than in lab departments like clinical chemistry and hematology. However, technological advancements have led to many labs implementing automated microbiology systems that offer abilities that include standardized and accurate inoculation and streaking and high-throughput processing with minimized interruptions.

Because of the numerous microbiological specimen collection types, automation has been achieved at a lower rate than in lab departments like clinical chemistry and hematology. However, technological advancements have led to many labs implementing automated microbiology systems that offer abilities that include standardized and accurate inoculation and streaking and high-throughput processing with minimized interruptions.

Because of the numerous microbiological specimen collection types, automation has been achieved at a lower rate than in lab departments like clinical chemistry and hematology. However, technological advancements have led to many labs implementing automated microbiology systems that offer abilities that include standardized and accurate inoculation and streaking and high-throughput processing with minimized interruptions.

A clinical lab-focused distributor like Cardinal Health can make automation decisions easier for labs in a variety of ways. Understanding customers’ goals is at the heart of our values, and we apply this customer-centric approach through our team of experienced diagnostic specialists who recommend automated solutions that help optimize each lab’s performance. We also help labs gain additional efficiencies and cost savings through standardization, the management of instrument manufacturer relationships and our customized leasing options.

A clinical lab-focused distributor like Cardinal Health can make automation decisions easier for labs in a variety of ways. Understanding customers’ goals is at the heart of our values, and we apply this customer-centric approach through our team of experienced diagnostic specialists who recommend automated solutions that help optimize each lab’s performance. We also help labs gain additional efficiencies and cost savings through standardization, the management of instrument manufacturer relationships and our customized leasing options.

A clinical lab-focused distributor like Cardinal Health can make automation decisions easier for labs in a variety of ways. Understanding customers’ goals is at the heart of our values, and we apply this customer-centric approach through our team of experienced diagnostic specialists who recommend automated solutions that help optimize each lab’s performance. We also help labs gain additional efficiencies and cost savings through standardization, the management of instrument manufacturer relationships and our customized leasing options.

Cardinal Health has an extensive lab capital equipment portfolio that features competitive pricing and financing options. As your distributor, we can incorporate analyzers for multiple lab departments into a single contract and source capital equipment through the same channel as all your other lab products, helping maintain efficiencies with product procurement, laboratory data analytics, inventory levels and competitive pricing.

Cardinal Health has an extensive lab capital equipment portfolio that features competitive pricing and financing options. As your distributor, we can incorporate analyzers for multiple lab departments into a single contract and source capital equipment through the same channel as all your other lab products, helping maintain efficiencies with product procurement, laboratory data analytics, inventory levels and competitive pricing.

Cardinal Health has an extensive lab capital equipment portfolio that features competitive pricing and financing options. As your distributor, we can incorporate analyzers for multiple lab departments into a single contract and source capital equipment through the same channel as all your other lab products, helping maintain efficiencies with product procurement, laboratory data analytics, inventory levels and competitive pricing.

As automation continues to develop, the relationship between healthcare providers, distributors and supply chains is more important than ever. Whatever step you are in your automation journey, Cardinal Health can offer solutions that fit your needs and help your lab elevate healthcare diagnostics.

As automation continues to develop, the relationship between healthcare providers, distributors and supply chains is more important than ever. Whatever step you are in your automation journey, Cardinal Health can offer solutions that fit your needs and help your lab elevate healthcare diagnostics.

As automation continues to develop, the relationship between healthcare providers, distributors and supply chains is more important than ever. Whatever step you are in your automation journey, Cardinal Health can offer solutions that fit your needs and help your lab elevate healthcare diagnostics.

References: 1. Mitchell A. 2023 Wage and morale survey of medical laboratory professionals. Lighthouse Lab Services. https://www. lighthouselabservices.com/2023-wage-and-morale-survey-of-medical-laboratory-professionals/. Published July 18, 2023. Accessed November 8, 2023. 2. Deaton-Mohney E, Ehrmeyer S, Farnsworth C, Kunzler T, Strathmann F, Thomas M. AACC Whitepaper on overcoming lab staffing shortages. Association for Diagnostics & Laboratory Medicine. https://www.aacc.org/advocacy-and-outreach/ adlm-policy-reports/2023/aacc-whitepaper-on-overcoming-lab-staffing-shortages. Published July 14, 2023.

References: 1. Mitchell A. 2023 Wage and morale survey of medical laboratory professionals. Lighthouse Lab Services. https://www. lighthouselabservices.com/2023-wage-and-morale-survey-of-medical-laboratory-professionals/. Published July 18, 2023. Accessed November 8, 2023. 2. Deaton-Mohney E, Ehrmeyer S, Farnsworth C, Kunzler T, Strathmann F, Thomas M. AACC Whitepaper on overcoming lab staffing shortages. Association for Diagnostics & Laboratory Medicine. https://www.aacc.org/advocacy-and-outreach/ adlm-policy-reports/2023/aacc-whitepaper-on-overcoming-lab-staffing-shortages. Published July 14, 2023. © 2024 Cardinal Health. All Rights Reserved. CARDINAL HEALTH and the Cardinal Health LOGO are trademarks of Cardinal Health and may be registered in the US and/or in other countries. All other trademarks are the property of their respective owners. Patent cardinalhealth.com/patents. Lit. No. 2LAB24-2823678 (03/2024)

References: 1. Mitchell A. 2023 Wage and morale survey of medical laboratory professionals. Lighthouse Lab Services. https://www. lighthouselabservices.com/2023-wage-and-morale-survey-of-medical-laboratory-professionals/. Published July 18, 2023. Accessed November 8, 2023. 2. Deaton-Mohney E, Ehrmeyer S, Farnsworth C, Kunzler T, Strathmann F, Thomas M. AACC Whitepaper on overcoming lab staffing shortages. Association for Diagnostics & Laboratory Medicine. https://www.aacc.org/advocacy-and-outreach/ adlm-policy-reports/2023/aacc-whitepaper-on-overcoming-lab-staffing-shortages. Published July 14, 2023.

© 2024 Cardinal Health. All Rights Reserved. CARDINAL HEALTH and the Cardinal Health LOGO are trademarks of Cardinal Health and may be registered in the US and/or in other countries. All other trademarks are the property of their respective owners. Patent cardinalhealth.com/patents. Lit. No. 2LAB24-2823678 (03/2024)

Elevating your lab’s performance with every delivery

By choosing the Cardinal Health™ Brand advantage, most facilities can save up to 10% when converting from National Brand products to Cardinal Health™ Brand Laboratory Products.1

With the volume of supplies and equipment it takes to keep a lab running, choosing products that help you save, standardize and support supply chain resiliency can be a big boost to laboratory performance.

Cardinal Health™ Brand Laboratory Products are designed to meet testing needs across every lab discipline and are backed by our unmatched nationwide distribution network.

Northwestern Memorial Healthcare: Data-Driven Decisions that Enhance Nurse and Patient Safety

Alisha Beringer, Director, Supply Chain Distribution & Logistics, Supply Chain, Northwestern Memorial Healthcare, believes Supply Chain plays a very integral part in nurse and patient safety.

“In Supply Chain, you make sure your clinical partners have the right products, in the right place, at the right time, all while reducing expired and recalled product risk,” she said. “It is Supply Chain’s job to manage the inventory in a way the

ensures there is sufficient product on the shelf that is not expired and in unusable conditions. Our clinical partners should be responsible for patient care, not supplies, so we want to do our part to ensure that is what they can focus on.

“However, at Northwestern Medicine, we believe safety isn’t just with the products on the shelves that we manage, but with all products that could be used on our patients from the other uncontrollable avenues, like vendor owned

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product,” Beringer continued. “In Supply Chain, we also take the responsibility for making sure we are doing our part to manage those as well.”

Reducing the burden

Manual processes and administrative burden were what Northwestern staff reported they were experiencing, both for Clinical and Supply Chain. Too much time was wasted on tasks surrounding product being used on the patient and there was no way to improve due to lack of visibility. Time was being wasted trying to physically identify and remove expired products with no confirmation of success, which can have a negative impact on patient safety.

“Additionally, we had no way to mitigate waste, we were managing inventory levels based on tribal knowledge and not utilization,” Beringer said. “We also had no checks and balances on the integrity of vendor managed product being brought in and used on our patients. We wanted to create an environment where managing the inventory provided more visibility and value-added work, made clinical supply documentation easier and more accurate, and created confidence in the products we were using on our patients.”

Northwestern wanted better expiration and recall management and to create never ever events. The standard practice was manual and relied on human intervention. This could result in patient safety risks if expired or recalled products were missed. “We decided to implement RFID technology in our surgical and procedural departments

for our physician preference items to create easy visibility on the location of expiring/recalled items and to create best practice workflows for mitigating proactively,” Beringer said.

In addition, clinical users are notified if they go to document and use an expired/recalled item during a case, providing additional stop gaps for risk.

On top of RFID, the Supply Chain team implemented their own Two-Bin Kanban system for commodity products. This provides a built-in stock rotation to help reduce the risk of expiration, as well as allowing them to create metrics to see how fast bins rotate so they can give attention to the ones that might be of higher risk.

and implants were not documented to a patient chart, which could result in issues if there were recalls and the IDN didn’t have the proper documentation to notify patients.

“We have seen significant results with both our RFID as well as our Bill Only initiative,” Beringer said. “Utilization of RFID has resulted in a 78% improvement in our overall rate of product expiration and a 50% improvement in our supply waste. We have real-time visibility into our inventory and where opportunities exist for improvement. We now can be proactive and not reactive in making sure we have the right products, in the right

“ We now track using RFID in a way that forces our vendors to comply with Joint Commission requirements for not only our product on the shelf, but the product walked in for a case to ensure good integrity for our patients.”

In addition to inventory visibility, Beringer said they wanted better vendor tissue compliance. “We now track using RFID in a way that forces our vendors to comply with Joint Commission requirements for not only our product on the shelf, but the product walked in for a case to ensure good integrity for our patients.”

Lastly, the Supply Chain team wanted better compliance with documented products of both products they manage onsite as well as products brought in by vendors. Therefore, along with RIFD, Beringer said they also implemented a Bill Only management tool. This allowed them to catch if supplies

place, at the right time, all while knowing we have significantly reduced the chance of products using expired or recalled products on our patients. Utilization of a Bill Only tool has resulted in over 96% improvement in missing documentation. This has ensured that what is being used on our patients is documented fully and accurately.”

These initiatives have created a stronger collaborative relationship between Supply Chain and Northwestern clinical partners, Beringer said. “We now use data to help drive decisions that not only impact safety, but also create financial benefits for the departments and the organization.”

Our healthcare experts, trusted by 8 of the 10 top healthcare systems in the U.S., know how essential it is to have proper waiting room furniture, professional-grade cleaning supplies, and breakroom products to meet your team’s needs. Our experts know your world of work, which is why we offer next-day delivery, direct-to-department to over 98% of the U.S.

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Addressing Labor Challenges Through Integrated Kitting Solutions

The COVID-19 pandemic brought substantial supply chain disruptions to the healthcare ecosystem and the ripple effects have continued through labor shortages. According to a workforce study conducted by NCSBN and the National Forum of State Nursing Workforce Centers, throughout the pandemic, approximately 100,000 nurses left the workforce. Also noted in the study, almost 900,000 nurses intend to leave the workforce by 2027, threatening the national health care system at large if solutions are not enacted.

Labor shortages are straining healthcare providers and negatively impacting nurse satisfaction and patient care. As a result of these shortages, clinicians are now having to perform non-standard job responsibilities, like managing, organizing and tracking down supplies. To reduce this burden for staff, it's critical for healthcare providers to work with a medical supply partner offering creative solutions so clinicians can perform their most important job responsibility: taking care of patients.

Regard, a provider-owned medical supply manufacturer, has expertise in mitigating against unprecedented disruptions and providing solutions. Regard addresses challenges stemming from healthcare’s workforce crisis, which includes creating efficiencies through integrated kitting solutions. These kits bundle all the essential items for a procedure under one stock

keeping unit (SKU) – limiting product variation, reducing non-clinical tasks and standardizing care for improved nurse satisfaction and patient outcomes.

Limiting Product Variation

When nurses are asked to use a variety of products for the same clinical task across multiple care units, they can have trouble adhering to procedural protocols. Everchanging products can cause errors and frustration, especially with standard tasks like blood draws, which should be consistent no matter where the nurse is working. Regard’s blood draw and blood collection kits, for example, bundle all the required and preferred items for blood collection in one SKU so nurses experience less obstacles and more consistency during their workday.

Reducing Non-Clinical Tasks

Time is precious in healthcare, and for patients with conditions such as cardiac arrest, every minute’s delay in resuscitation can lead to a drop in successful outcomes by 7-10%. That’s why it is critical that nurses have the right supplies at the right time. However, nurses often spend too much time restocking supplies. For example, when nurses can easily restock a code cart drawer with one Regard kit SKU vs 80 individual SKUs they’ll spend more time on important clinical duties instead of supply chain tasks, leading to

increased satisfaction and improved outcomes. In addition, the Regard code cart drawer kit offers electronic tools to easily track expiration dates for greater quality and regulatory compliance.

Standardizing Care

Standardizing supplies and having comfort items in patient admission kit leads to uniform and high-quality experiences for patients. With the same personal hygiene items bundled in kit, for instance, healthcare providers can ensure each patient’s care experience is consistent across facilities and care units. This means they’ll have more time to focus on making patients comfortable and enhancing patient experience instead of tracking down various supplies upon admission.

Regard doesn’t just provide kits. We have a team dedicated to adding value by enhancing supply chain processes and addressing healthcare providers’ most urgent challenges. By working closely with providers amid today’s difficult labor environment, Regard creates tailored and cost-effective solutions that enhance outcomes, boost efficiencies, and most importantly, allow clinicians to practice at the top of their license.

Are your nurses spending more time managing inventory than they are on clinical tasks? Learn more about Regard’s integrated kitting solutions at regardsupplies.com

Kitting Solutions for your Success

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Identifying Cybersecurity Warning Signs in Supply Chain

Determining an organization’s supply chain cybersecurity risk can be more overt than covert.

Media reports of increasing numbers of healthcare system breaches negate any lack of awareness.

Instead, Bruce Goff, senior director, Category Management, Mayo Clinic, Rochester, Minnesota, points to an organization’s failure to acknowledge cybersecurity issues within their own systems as particularly challenging. This can span the lack of an assigned security official or similar lack of structure cybersecurity risks as the vendor list grows; a lack of understanding about the healthcare environment and requirements of covered entities; any financial data that suggests a lack of investment in risk management; a lack of HITRUST certification and SOC 2 Type II compliance; and more obviously, experiencing recent cyber incidents.

Meanwhile, Jacob Groenewold, System Vice President and Chief Supply Chain Officer, Froedtert ThedaCare Health Inc., Milwaukee, identifies erratic or slow behavior of the systems running as well as information that may not look accurate or consistent as other alerts, for which Jack Koczela, director, Sourcing & Transformation, Supply Chain, echoes in agreement.

“When it comes to phishing and other scams, I look for simple signs such as unexpected email addresses, erroneous information, attachments and misspellings,” Koczela said. “For more advanced security issues, our IT security team helps us to identify industry standard security methods to secure systems and data. When vendors cannot quickly answer these security configuration questions, this raises red flags.”

At BJC HealthCare, St. Louis, Tom Harvieux, Chief Supply Chain Officer, remembers older equipment running on earlier software versions as raising alarms.

“We had an old X-ray machine in radiology and some lab equipment running on [an older Windows version], which didn’t allow us to secure those items,” he said. “We have a very robust IT security team, and they work to locate all those access points where people can get in. IT put a firewall around those computers on the network so that if someone

CYBERSECURITY IN HEALTHCARE SUPPLY CHAIN

got in through a vulnerability point, they would be isolated from our network.”

Harvieux further noted an example of how hackers penetrated one healthcare system’s network by accessing their HVAC system, which was identified as the weakest point.

Healthcare organizations must avoid an ostrich mentality, according to Amanda Chawla, MHA, FACHE, CMRP, senior vice president and Chief Supply Chain Officer, Stanford (CA) Medicine.

defenses around their systems through supply chain-IT security collaboration and detailed risk assessment processes and surveys, questions arise about whether anything can be done even earlier?

For example, what if the federal government or a regulatory agency like The Joint Commission (TJC) or payers established and developed universal best practices and data security standards for the industry to satisfy?

“ The federal government may be best at setting the floor, where TJC and the insurance carriers can have leverage on what is acceptable based upon price signals. There must be standards, including a regulatory floor.”

“Organizations that say they don’t have cyber incidents or admit that they don’t have a lead for cyber risks, or programs for monitoring and response should be a warning sign,” she said. “Everyone has cyber issues in modern times, so if your head is in the sand, you’re already at incredible risk. A first level of due diligence is to ask some simple questions about cyber controls or governance. If the organization has no response, or an unenthusiastic one, that’s a warning sign. If your supplier or partner is silent or indicates that they do not have cyber security risks or issues you need to lean in and ask more questions. What is their downtime plan? How do they communicate? Is there standard work? Ask lots of questions.”

Fortress of fortitude

As healthcare provider and supplier organizations scramble to erect digital

IDN supply chain and IT security experts express cautious optimism and realistic skepticism.

“A consistent framework is essential, so federal guidance is important,” Mayo Clinic’s Goff indicated. “But given the pace of change, a different regulatory framework would be needed to continually update what is low-, medium- or industry-leading effectiveness. The federal government may be best at setting the floor, where TJC and the insurance carriers can have leverage on what is acceptable based upon price signals. There must be standards, including a regulatory floor. I just question what level of government or other organizations can meaningfully keep up.”

Froedtert’s Groenewold stands behind ongoing physical and digital vigilance as a baseline.

“Continuous monitoring of external ‘attack’ threats is clearly a best practice,” he noted. “Use of available IT platforms that

automatically monitor and funnel these types of ‘distractions’ into defense mechanisms would certainly be a proactive way to fend off some of these threats. We at Froedtert Health have proactive measures in place to monitor our emails, and place anything that might be suspicious into a ‘hold’ file on a personal portal that then requires us to review and approve or delete. This mechanism works very well. I think TJC could look at how systems work to secure and prevent cyberattacks, and could certainly create some guidelines around this, but in the end, as was seen by the recent Change Healthcare, even some of the strongest companies can be vulnerable to a cyberattack, as strong as your defense is.”

Might the levying of financial penalties for non-compliance influence behaviors?

“Many of our contracts do include security measures as part of the agreement,” Froedtert’s Koczela reassured. “A vendor who fails to meet agreed-upon standards of security may be considered in breach of the contract.”

BJC’s Harvieux contends the industry already has standards and guidelines, such as HITRUST, SOC 2, ISO 27001. “Those are third parties that we look to see if our trading partners have a SOC2 report, ISO 27001 certification, etc., then we know that they’ve gone through rigorous IT security,” he said. “We also look to make sure they have a certificate of insurance for cybersecurity liability and that they’re doing strong encryption.

“We would do everything in our power not to do business with those who don’t meet those criteria,” Harvieux insisted. “The security risk is too high. It would likely be a hard no. We couldn’t do business with them.”

Stanford’s Chawla urges examination of the financial resources necessary.

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CYBERSECURITY IN HEALTHCARE SUPPLY CHAIN

“Best practices are a complicated topic because it is easy to list more steps to take for protection, but the best practice lists don’t address funding,” she said. “Unfunded mandates don’t work and can lead to worse outcomes. That said, some of the more straightforward choices are multi-factor authentication and encrypting data by default, since these measures directly solve some very practical problems and directly reduce risks.”

At Baptist Health South Florida, Coral Gables, Florida, George Godfrey, Chief Supply Chain Officer and corporate vice president, Financial Shared Services, mulls whether FDA approval or clearance for marketing of products could include cybersecurity stipulations based on the premise of potential patient harm or impact if a certain device were hacked. “Whether it’s the FDA or some other regulatory agency, there’s someone that says you’re not going to be able to sell or ship any products or services into this provider ecosystem without this certification or documentation,” he noted.

Godfrey further indicates that payers likely will care more once cyberattacks impact their business directly. Incidents against individual healthcare provider organizations may not trigger much of a response, he adds.

“The question becomes how do we fortify the industry to motivate people NOT to want to hack into individual hospitals or major systems or major infrastructure that supports this important resource of providing patient services?” Godfrey asked. “If hacking has a material effect on patient care, such as a hospital cannot operate or accept patients, then you certainly want to figure out how to avoid it at all costs.”

Reinforcing digital infrastructure Healthcare providers must think meaningfully about strategies and tactics to protect themselves from outside digital intrusions, whether that’s through internal expertise or external third-party service companies. But supply chain and IT security leaders extol the value of both exploring issues on a case-by-case basis.

“We should own our general cybersecurity strategy, but we do not have the expertise or scale to own all aspects,” he admitted. “We must partner with experts who understand things like enterprise cloud security.”

Much depends on health system maturity and resources so that hybrid modeling may be the optimal course of action,

“ There are ways to isolate various technologies and firewall them. It really depends on how critical the system is and what alternatives we have.”

“In either path, leadership must stay actively engaged to become fluent in the issues and ensure the work is being completed as agreed,” advised Mayo Clinic’s Goff. “Even where leadership may not have the expertise, they should still work closely with their contracting teams to create deliverables and timelines that hold the vendor accountable. If work is not getting completed as agreed, there is then a great starting point for comparison moving forward.

“Leadership needs to constantly assess what is core versus not core,” Goff continued. “But they must also ensure that as a team they have the ability to lead and manage things even if they are not core. Solidly worded contracts are oftentimes one of the best tools.”

Joe Dudas, Mayo Clinic’s division chair, Supply Chain Management Innovation and Planning, contends that security is a functional requirement: “There are ways to isolate various technologies and firewall them. It really depends on how critical the system is and what alternatives we have. Today, just about everything has a processor and some sort of software so this is not limited to typical IT systems.”

Froedtert’s Koczela places some of the onus on the provider.

according to BJC’s Harvieux. “Smaller hospitals may be best to outsource as resources and talent are limited. Larger health systems will do more in-house and outsource highly technical monitoring and security systems. Mid-sized facilities may lean more toward outsourcing. It all comes down to internal capabilities and level of security you’re aiming for,” he said.

Stanford’s Chawla favors a mix of internal and external resources.

“Internal experts are needed to own the business outcome, manage third parties and map cyber investments to business goals,” she said. “External experts are needed to aggregate global knowledge and skills on a scale that a single organization can’t typically bring to bear. For example, aggregating enough data to keep up to date on the latest phishing attacks is a global problem for service providers that aggregate cyber incident data on a global, multi-thousand customer scale. Individual organizations can’t replicate that, but they can and need to leverage those services. You need to assess where your organization is at and what is best for you in terms of expertise, resources, sensitivity and complexity of data and risk.”

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Tech-Enabled Transformation: A Supply Chain Success Story Solving the Digital Manufacturing Disconnect

To solve the digital manufacturing disconnect, Dukal has launched an EDI-driven supply chain solution that provides unprecedented order transparency, tracking, and customer collaboration.

As the healthcare industry continues to grapple with increasing challenges across the manufacturing and supply chain landscape, port congestion and freight transportation issues have continued to emerge as significant disruptors. The need to adjust supply chains in a matter of hours or days rather than weeks has become the new norm.

Recognizing the need for transformative industry change, Dukal launched a cross-functional effort to achieve combined business, IT, and planning benefits. This effort involved cross-functional and cross-geographical teams focused on agility, customer centricity, data interchanges, speed, and customer satisfaction.

The Dukal team implemented Dukal InSightTM, built on Microsoft’s Dynamics 365 Business Central and in partnership with Mallory Alexander International Logistics’ order management process, to quickly deploy real-time visibility of customers’ orders from purchase to delivery. The project took around 36 months to complete, and identified opportunities to provide customers:

` Real-time visibility with on-time and accurate delivery

` Inventory assignment at the factory level, eliminating the industry practice of arbitrary allocation

` Timely and collaborative communication to overcome disruptions before they impact business or patient health

1 www.ey.com/en_us/coo

The Challenge:

With only 25% of companies digitally networked, enterprises must move from linear to connected ecosystems of partners and suppliers – to create supply chains that are resilient and sustainable.1

The Solution:

Dukal has built connectivity and agility into its supply chain operations to deliver adaptability and industry-leading transparency and communication with integrated business planning, transport and warehouse logistics, product innovation, and customer collaboration at the center of the solution.

EDI: Empowering Transformation

Electronic Data Interchange (EDI) is a cornerstone of Dukal’s transformative strategy, facilitating seamless communication and collaboration throughout the

Dukal

supply chain. By leveraging EDI technology, Dukal empowers distributors and selfdistributing health systems with real-time visibility, enabling proactive decision-making and mitigating disruptions before they impact patient care or business health.

Advanced Product Assignment and

Collaborative Communication

Through streamlined processes and customer collaboration, product is assigned from the start of production to their dock – ensuring health systems have what they need when they need it.

Overcoming Disruptions with Proactive Solutions

Dukal’s proactive approach to supply chain management allows for the identification of potential disruptions to maximize customer efficiency and avoid costly delays and out of stock situations.

InSightTM is delivering impact in every process across the supply chain.

In the first six months, 40% have experienced a 5x or greater improvement in:

End-to-end supply chain visibility Lead time estimation Accessibility to order status on all open orders

Conclusion:

Certainty of product availability, of delivery estimates, of actual delivery

Ability to anticipate and correct disruptions

Dukal’s innovative use of EDI exemplifies the transformative potential of technology in healthcare supply chain management. By prioritizing transparency, collaboration, and proactive solutions, Dukal is redefining what it means to be a trusted partner in healthcare.

See what’s possible

Distributors and self-distributing health systems now have complete transparency of their Dukal products’ from purchase order to delivery.

Product Assigned at the Factory Level

Product Tracking at the Item Level

Compatible Excel Reporting

Automated Communication

Worldwide Tracking

Scan

Digitally Bracing Against an Electronic Environment of Turpitude

Searching for secret treasure maps, product formulas and blueprints, fiscal transactions, financial backgrounds and the like may seem like obvious targets for cyberhackers. So, what’s the appeal with healthcare provider organizations?

Simple. The bad guys want money quickly and easily, according to George Godfrey, Chief Supply Chain Officer and corporate vice president, Financial Shared Services, Baptist Health South Florida, Coral Gables, FL. “From a government standpoint, patient information can have a negative financial consequence such that if patient information is compromised, then it can cost a lot of money,” he said.

“I don’t think the automotive history of your car, if it’s leaking oil, can cost the car manufacturer money. If you own a 2020 Ford F-150 and someone breaks into Ford’s system and posts your maintenance records, does that have any financial consequence for Ford? Who wants to pay to prevent that?”

Instead, the target is much more personal, but on a collective basis.

The stakes have changed. It’s time to raise the bar.

In this post-pandemic world, uncertainty is the new normal. Being resilient and ever-ready have moved from aspirational to table stakes. And now — more than ever — you need a reliable partner to support you and your patients every step of the way. That’s why we’re redefining supply chain expectations.

In this post-pandemic world, uncertainty is the new normal. Being resilient and ever-ready have moved from aspirational to table stakes. And now — more than ever — you need a reliable partner to support you and your patients every step of the way. That’s why we’re redefining supply chain expectations.

In this post-pandemic world, uncertainty is the new normal. Being resilient and ever-ready have moved from aspirational to table stakes. And now — more than ever — you need a reliable partner to support you and your patients every step of the way. That’s why we’re redefining supply chain expectations.

From physician offices to surgery centers and patients’ homes, we tailor our breadth of offerings to create a unique roadmap that helps you build a resilient, high-performing supply chain.

From physician offices to surgery centers and patients’ homes, we tailor our breadth of offerings to create a unique roadmap that helps you build a resilient, high-performing supply chain.

From physician offices to surgery centers and patients’ homes, we tailor our breadth of offerings to create a unique roadmap that helps you build a resilient, high-performing supply chain.

Redefining partnerships

Redefining partnerships

Redefining partnerships

We’re relentless about building trusted partnerships that make supply chain excellence and better health possible.

We’re relentless about building trusted partnerships that make supply chain excellence and better health possible.

We’re relentless about building trusted partnerships that make supply chain excellence and better health possible.

Redefining patient-focused solutions

Redefining patient-focused solutions

Redefining patient-focused solutions

We build customized solutions to help you improve operational, financial and clinical outcomes — efficiently, effectively and on budget — so you can deliver better patient care.

We build customized solutions to help you improve operational, financial and clinical outcomes — efficiently, effectively and on budget — so you can deliver better patient care.

We build customized solutions to help you improve operational, financial and clinical outcomes — efficiently, effectively and on budget — so you can deliver better patient care.

Redefining world-class distribution

Redefining world-class distribution

Redefining world-class distribution

We’re ready for the future — today. From global distribution to logistics services, we help you improve operational efficiencies across hundreds of micro supply chains, so you’re ready to take on any challenge.

We’re ready for the future — today. From global distribution to logistics services, we help you improve operational efficiencies across hundreds of micro supply chains, so you’re ready to take on any challenge.

We’re ready for the future — today. From global distribution to logistics services, we help you improve operational efficiencies across hundreds of micro supply chains, so you’re ready to take on any challenge.

Raising Supply Chain Expectations, so you can deliver care – anywhere. mms.mckesson.com/HealthSystems

Raising Supply Chain Expectations, so you can deliver care – anywhere.

Supply Chain Expectations, so you can deliver care – anywhere.

CYBERSECURITY IN HEALTHCARE SUPPLY CHAIN

“What kind of information do people want to pay to prevent it from being exposed? Some of it could be credit … a lot of it involves privacy issues … like with your health. By that topic alone it sets it apart from other areas,” he continued.

Still, disrupting payment transactions or privacy issues within a single healthcare system likely won’t generate the financial gains sought by more sophisticated cyberhackers so they strive for larger targets teeming with sensitive information, according to Godfrey. Should supply chain transactions be disrupted his team maintains backup plans with suppliers that rely on product demand history.

He points to simple economics: “There’s been enough occurrences that have been rewarding to the bad guys that just motivates more bad behavior,” he said. “The more money you make the more resources you can hire, the smarter the resources you can use, then the more successful you’re going to be,” he added.

“Compliance in any form is a moving target,” said Bruce Goff, senior director, Category Management, and responsible for third-party risk management, Mayo Clinic, Rochester, MN. “Technology related to cybersecurity is doubly hard given the pace of change and the many bad actors making a living at hacking.”

Goff encourages IT security leaders to review the seven elements of an effective compliance program, which the Department of Justice has published for decades, including policies and procedures, governance, risk assessment, training and education, reporting mechanisms, monitoring and auditing and enforcement. “I just think it is a useful framework to discuss with leadership – or think about it from your outside board

member or investor’s perspective – on whether your cyber compliance program is effective,” he added.

Never-ending story

Despite wishes to the contrary, 100% complete cybersecurity is a pipe dream, experts acknowledge.

“One hundred percent cybersecurity has always been impossible,” deadpanned Amanda Chawla, MHA, FACHE, CMRP, senior vice president and Chief Supply Chain Officer, Stanford (CA) Medicine. “Threats change not daily but evolve by the minute. Complex operations and systems

Goff

To err is human

Even though humans intentionally may hack or code software “bots” to do it, humans also casually and mistakenly invite intrusion.

“My own opinion is that 100% defense against cybersecurity attacks is hard to achieve because in the end it relies on the person who accidentally clicks on the link in the email. It could happen to any of us … very scary,” admitted Jacob Groenewold, vice president and Chief Supply Chain Officer, Froedtert ThedaCare Health Inc.

“Everything touches the network, and everything is interconnected,” charged Tom Harvieux, Chief Supply Chain Officer, BJC HealthCare, St. Louis. “There’s so

encourages IT security leaders to review the seven elements of an effective compliance program, which the Department of Justice has published for decades, including policies and procedures, governance, risk assessment, training and education, reporting mechanisms, monitoring and auditing and enforcement.

always have some failure scenarios, and software development and technology disruption are continuously moving forward and increasing complexity in the surface that attackers thrive in. The pandemic changed details, but not the basic problems.”

Jack Koczela, director, Sourcing & Transformation, Supply Chain, Milwaukee-based Froedtert ThedaCare Health Inc., concurs. “We should always be striving for 100% security, but no system is completely secure,” he said. “Cybersecurity is an arms race that requires us to constantly adapt and improve our systems.”

much to secure and all the bad actors need to do is find one weak link. It’s like the analogy where you can design a great prison, but no one can design it well enough to overcome a human spending 24/7/365 sitting in it just thinking how to get out of it.”

Harvieux admits that “users are sloppy and a weak link” as “hackers have gotten very sophisticated about phishing with emails and texts that use company leader profiles to get the chain of command to act. AI is making this harder to detect.”

He centers on the inclusion of those banner warnings atop email texts in red

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CYBERSECURITY IN HEALTHCARE SUPPLY CHAIN

font and ALL CAPS against an attentiongetting colorful highlight that screams, “THIS EMAIL CAME FROM OUTSIDE YOUR ORGANIZATION …” “I have stuff internally within BJC that goes into junk mail because it’s that strict,” he added. “It’s just really rigorous.”

Harvieux cites AI as a useful tool for hackers, too. “They will take an email or a text from your CEO, send it to your CFO and then they will do a daisy chain where they will have it sent from your CFO to somebody else to ‘activate these Amazon cards’ or ‘sign in and do this.’ And it looks so legitimate,” he said.

BJC tries to solve this by employing two- or three-step verification procedures, particularly for high-dollar requests, that may involve a live telephone call or video message for confirmation.

“Because cybersecurity is such a high-risk, having a partnership with your IT is really becoming a central focus for supply chain,” Harvieux noted. “Cybersecurity requirements in contracting is very real because the risk can be astronomical – from financial to operational to reputational.”

But Stanford’s Chawla warns against concentrating more on cybersecurity as a technical issue and not enough on human operators.

“There are human errors that can lead to breaches despite having robust systems,” she noted. “Somewhere along the line across suppliers, providers and other partners there will be incidents – it is about how you manage through them and mitigate disruptions continuously improving, evolving and striving towards ‘zero incident’ – akin to the concept of ‘zero harm’ in healthcare. Useful percentage guarantees are hard to find, and it is better to focus on

understanding your business and which areas you want to prioritize for more layers of protection as well as more robust backup plans for inevitable incidents. Cyber incidents are 100% certain to happen, but catastrophes are not a certainty for any single organization.”

Changing human behavior may be just as challenging and time-consuming as updating technical capabilities, according to Mike Mucha, Chief Information Security Officer, Stanford Medicine.

“Right now, the more people that are working on it are now causing delays [for the hackers] … the work that we’re doing as a standalone provider versus what a manufacturer is doing,” he noted. “All of that work I think is positive even though it’s not coordinated or dictated by an agency or the government at this point. Hopefully, that journey is yielding results.”

Godfrey salutes his IT department. “They’ve been, at times when this topic was not popular, getting a lot of pressure.

“Useful percentage guarantees are hard to find, and it is better to focus on understanding your business and which areas you want to prioritize for more layers of protection as well as more robust backup plans for inevitable incidents. Cyber incidents are 100% certain to happen, but catastrophes are not a certainty for any single organization.”

“Human behavior, especially group behavior, takes concentrated effort over time to change,” Mucha noted. “So, it’s very difficult to get to 100% compliance without technical controls. Behavioral components should be presented in multimedia and repeated, and tested, until it starts to become the new normal. The ideal version is to make the easiest and most productive technical path also the most secure one. But that’s hard to accomplish.”

Soldier on

Regardless, experts maintain a positive attitude about ongoing digital battles.

Godfrey acknowledges progress has been made during the last several years and he foresees more clearly defined progress emerging within the next few years.

But they’ve done a good job of keeping the patient in mind but at the same time maintaining balance [with supply chain issues]. I have one of the best IT security guys that you can imagine – Anthony Longo, vice president and Chief Information Security Officer. We have a great team and an alliance with his team, his department and my department. The productive action and teamwork have been very important versus having internal debates.”

Harvieux echoes praise for his IT security team, led by Matt Modica, Chief Information Security Officer. “The environment is changing too quickly,” he said. “One hundred percent may not be achievable but we’re always aiming to close gaps. And to be harder to hack than the other guy.”

Do the Math

Does it make sense to supply your non-acute sites through self-distribution or a non-acute distributor? A veteran IDN supply chain leader shares his perspective.

David Hargraves has a well-rounded view of the U.S healthcare supply chain. He currently serves as CEO of Pharma Logistics, a leading pharmaceutical reverse distributor. Prior to that, he worked on the GPO side as Senior Vice President, Supply Chain Services at Premier.

Before either of those roles, he helped lead one of the nation’s most renowned supply chain teams at UPMC for nine years. Part of Hargraves’ legacy at UPMC was setting up the distribution center that is still in use today. UPMC has been self-distributed in some shape or form for over 20 years. By bringing products in bulk to the distribution center, the IDN hoped to create greater efficiencies logistically, lower costs with manufacturers and enhance a greater service level with the acute hospitals.

But what Hargraves took away from that experience is that while self-distribution made sense for the large acute facilities, that wasn’t always the case with the non-acute sites. The math didn’t always add up.

“I’ll say this, with one notable exception, no one that I’m aware of does full self-distribution, meaning every item at every level to every facility,” he said. “It’s not economically viable. With the size of the warehouse you’d need to stock every single SKU … it’s just not possible. All IDNs are hybrid to some degree.”

“I agree with David,” said Brad Clark, Vice President of Strategic Accounts, Henry Schein Medical. “At Henry Schein,

we have some IDNs that completely outsource their non-acute distribution to us while others leverage us across product categories including medical surgical supplies, equipment, laboratory, pharmaceuticals and/or vaccines. We are built to ship in low unit of measure, directly to the non-acute facilities while also supporting CSCs that are owned and operated by the IDNs. At the end of the day, it comes down to ensuring the right product is where it needs to be while having a distribution partner that provides an overall value to the IDN.”

Factors to your distribution strategy

Indeed, there is more than one way for an IDN to service its acute and nonacute facilities. The most common is a replenishment model, where the IDN brings supplies in bulk to a distribution center where they inventory, pick, and then bring it out to various locations. One of the benefits to this is it eliminates having the asset inventories at every hospital doing the same thing. There’s a benefit to freeing up space within the hospital walls to put it to more use for clinical care rather than storage of supplies.

IDNs may also choose to use cross-docking, where items come in via a common carrier like FedEx and UPS. Healthcare systems can choose to centralize that as well. The general benefit of cross-docking is a reduction of FTE because you don’t need receiving personnel at every hospital location. You can also track supplies better and look for trends to reduce some of the cost.

The question every IDN must ask itself with these models is, can you still service every location? What about the frequency needed? What about distance? How much do they order? Those factors will all be very different for non-acute sites.

As a general rule, if you have a distant location ordering a small quantity, almost no matter what the frequency,

David Hargraves

Sponsored Henry Schein

sending a lone truck or van out to that site is simply not economically viable.

Hargraves said that when he was at UPMC, there were small locations such as a 30-bed rural facility that were anhour-and-a half out from the distribution center. It made more sense to keep those with a larger national distributor who might already be operating in the area rather than self-distribute. “Fundamentally, the question supply chain leaders must ask is what’s the most efficient, lowest cost way to get the caregivers the products they need?”

Taking that idea one step further, non-acute facilities such as ambulatory surgery centers, imaging centers, cancer centers, physician offices, urgent care centers, etc., might be physically close to an IDN’s distribution center, but their average order sizes are very different

than the 300-, 500-, 800-bed urban hospitals. Think cases and cartons vs. pallets. Those non-acute locations also typically didn’t have much storage space to put excess inventory, and no supply chain professionals exclusively devoted to receiving the product. Broadly speaking, when Hargraves and his team ran analytics on the costs involved in supplying the non-acute facilities during his tenure at UPMC, they found it was more efficient and less expensive to have a non-acute distributor service the majority of those locations than it was to service them through the IDN’s central distribution center.

Similarly, just as Hargraves and his team discovered the efficiency of having a non-acute distributor service most locations rather than relying on the central distribution center at UPMC, Hargraves

Pros vs. Cons

Supply chain leaders should consider the following four factors in their distribution strategy when servicing non-acute sites.

No. 1: Volume. Running a distribution center is a business of scale. You need to have a volume that makes sense for the cost of the building, staff, and equipment inside. Can you properly stock the supplies needed by the nonacute sites and ship them at the right sizes?

No. 2: Standardization. Driving standardization lowers your cost. Is it easier to manage through a national distributor?

No. 3: Location and routes. The logistics of running those routes is a science. Where are you going to run? What size truck do you need? What time of the day are you going to run and deliver it?

No. 4: Cost. Pulling all your data together, what’s the cost to do it yourself vs. your cost to have a distributor do it?

is leading his team to transform the pharmaceutical reverse distribution industry. At Pharma Logistics, Hargraves has worked with his teams to materially expand available capacity, deliver substantial cost savings to customers, improve return credit visibility, and ensuring Pharma Logistics continues to maintain the highest compliance standards in the industry.

New care settings

Another factor to consider is that care is moving outside the four walls of the hospital. “In general, it’s a better service for the patient and it’s a lower cost for the health system,” he said. “You add those two things together – it’s better and cheaper – you’re not going to stop that.”

The question is, will distributors and IDN’s adapt? Is that a new service that an IDN self-distributes? Or is there blending and blurring of lines in new services offered by distributors? National distributors have more people, more locations, and are used to doing small order sizes, kitting and customization. “There are some distributors out there doing it already, and some leading IDNs are really breaking ground and moving towards that today,” Hargraves said. “But I do think it’s the future.”

Yes, a big IDN with a distribution center could service its non-acute sites. But for the vast majority of them because of order size, service level, stocking, and the cost to transport, using selfdistribution for those sites does not add up. “Your mileage may vary in any given location, but if you look broadly across the U.S., when you just get down to it, it’s more efficient, at a lower cost and higher service level to take care of those through a non-acute distributor.”

Prioritizing Non-Acute Care

Henry Schein Medical has the resources and expertise to align your entire network.

• Non-acute distribution model designed for price transparency and efficiency

• Customized and collaborative approach to growth and standardization delivering clinical, operational, and financial benefits

• Clear sight lines to drive visibility across the entire non-acute continuum

• Cost containment strategies and opportunities for savings across the network without compromising quality patient care

• And more

Learn more about Henry Schein ALIGN by contacting your Henry Schein Medical Business Development Executive or visiting henryschein.com/ALIGN

UC Davis Health: Supporting Dedicated Teams

As of April 2024, UC Davis Health had achieved a 94% nurse retention rate and a nurse turnover rate of 5.4%, the health system reported to The Journal of Healthcare Contracting. That’s well below the national average of 22.5% according to the 2023 NSI National Health Care Retention & RN Staffing Report

Health system leaders attribute this success to a relationship-based and professionally governed culture, new graduate onboarding and diverse professional development opportunities.

“Employee retention is important to workplace health in all fields, as it promotes the cohesion and cooperation of teams, increases efficiency and improves employee satisfaction,” said Christine Williams , chief nursing executive. “At UC Davis Health, our nursing leaders and administrators are consistently strategizing to support our dedicated team of nurses, who exemplify our nursing values of love, compassion, courage and integrity.”

` Since 2010, UC Davis Health has embraced a Relationship-Based Care model in its mission to improve lives and transform health care. Relationship-Based Care focuses on three key relationships: relationship with self, with colleagues and with patients and families. It prioritizes caring for oneself as it is crucial and necessary to effectively care for others.

As part of the Relationship-Based Care model, UC Davis Health offers three relationship-based workshops.

` To bring new nurses into the health system and ease them into their careers, UC Davis Health has created a structured one-year nurse residency program. It is accredited with distinction as a Practice Transition Program by the American Nurses Credentialing Center’s Commission on Accreditation in Practice Transition Programs. In 2016, UC Davis Health developed a novel Critical Care Fellowship Program (CCFP) to streamline the onboarding of new graduate nurses across critical care settings by developing a structured, comprehensive, and supportive orientation for new hires to work in an adult intensive care unit (ICU).

` As the region’s only academic medical center, UC Davis Health is committed to the professional growth of its nursing workforce. UC Davis Health has found success in supporting the professional development of nurses by offering a variety of programs including tuition reimbursement and flexible work schedules. There are also a variety of fee reduction programs available to nursing staff. Davis Health offers workshops for professional certification to acquire essential knowledge, skills and abilities for ongoing leadership and professional development.

Navigating Market Shifts

How hospitals succeed with clinically-led strategic sourcing and total cost management

Hospitals and health systems constantly balance the need to deliver quality care while running a successful business. As shifts in sites of care, payment models and patient choices drive macro changes, how do providers deliver exceptional care while maintaining financial performance?

According to HealthTrust Performance Group (HealthTrust), a leading healthcare performance improvement company, organizations should consider the following to successfully navigate these market shifts:

Empowering acute and non-acute care organizations with total cost management ASC innovation around surgical and anesthesia techniques, as well as recovery strategies, has been a major contributor to the decreasing number of procedures on the CMS “inpatient only” list. That’s good news for patients, but the impact on hospitals is significant.

In response, hospitals are reevaluating their care delivery strategies by consolidating activities, analyzing value streams to remove waste, and seeking economies of scale. Simultaneously, non-acute care organizations like physician offices and ASCs are engaging in similar work to improve efficiencies.

Harnessing physician input for shared decision-making Healthcare organizations that will succeed in today’s challenging environment are

those that engage physicians in shared decision-making and collaboration, particularly when focusing on growth areas that ASCs can’t capture.

“It’s important to have conversations with physician leaders to identify potential commodity savings so organizations can stand up businesses for new growth,” said Dr. Young, HealthTrust’s Chief Medical Officer. “With cardiology, for example, if you want to start a complex EP program or TAVR program but have a lot of variation in drug-eluting stents, those are essentially commodities with existing standardization opportunities.”

Optimizing healthcare value –HealthTrust’s impact across diverse care settings

Healthcare organizations recognize that GPO and contracting services alone aren’t

enough to manage financial performance. In response, HealthTrust has built capabilities around its core GPO, focusing on labor, purchased services, and clinical and operational efficiency improvements.

“Our members expect us to have a differentiated market value and to simplify everything as much as possible,” said Dr. Young. “That means an easy-to-use contract portfolio, operational guidance and strategies that promote efficiencies. They want transparency in the supply chain, analytics and the business, as well as supply chain resiliency and business continuity plans.”

HealthTrust offers the same robust contracting, clinical strategy services and seamless contract portfolio to acute care members and to non-acute physician practices and ASCs through HealthTrust’s AdvantageTrust group. HealthTrust has a unique viewpoint of the market through both acute and non-acute lenses, leading to a broad perspective and ability to identify areas members should prioritize.

HealthTrust is committed to helping all members understand policy, payment and regulatory factors, as well as market dynamics. Based on this knowledge, organizations can conduct scenario planning and identify the best ways to deal with today’s evolving business environment.

With the inevitable shift in care taking place, the need for strategic partnerships that deliver meaningful value are increasingly necessary. Learn more about how HealthTrust provides strategies for success at healthtrustpg.com

IS SHIFT IN CARE DOWNSHIFTING YOUR PERFORMANCE?

HealthTrust Performance Group drives value across all sites of care by combining the power of an aligned model with decades of senior level healthcare experience to accelerate savings and total performance optimization. MAKE THE SHIFT TO HEALTHTRUST.

Walmart Health Closing All 51 Locations

The retailer said it found it difficult to operate a profitable business due to a challenging reimbursement environment and rising costs

Walmart Health is closing all 51 primary care health centers across five states over a 45- to 90-day span since its announcement on April 30. It’s also shuttering its telehealth service Walmart Health Virtual Care.

Other retail-based commercial healthcare providers (CHPs) have seen difficulties too. Walgreens has closed many of its VillageMD clinics and Amazon has cut hundreds of roles in its healthcare division, including its primary care company One Medical. CVS Health spent billions of dollars on its clinics for seniors but fell short of its revenue projections in the first quarter and cut its earnings outlook for 2024.

Walmart said in a release it could not operate a profitable business due to a

challenging reimbursement environment and rising costs, including labor costs tied to a shortage of healthcare workers in the U.S. It’s closing clinic locations in Arkansas, Florida, Georgia, Illinois and Texas.

Walmart had recently announced expansion plans for Walmart Health

It was a surprising announcement because it came one month after Walmart announced it planned to open 22 new

locations in 2024 and even more locations in 2025. Walmart opened its first Walmart Health in Georgia in 2019. After Walmart disrupted the pharmaceutical industry with generic drugs as low as $4 at its pharmacies, the retailer planned to do the same in other areas of healthcare.

But the healthcare business was tough to crack for Walmart against big hospitals and health systems. All Walmart associates with Walmart Health are eligible to transfer to any other Walmart or Sam’s Club location. If after 90 days, they don’t transfer or leave, eligible associates will receive severance benefits.

Walmart Health’s provider partners will continue to serve existing patients while clinics are open. These providers will be paid for 90 days through their respective employers, after which eligible providers will receive transition payments.

Walmart said in a statement, “We are deeply grateful to these associates and providers for their caring service to patients in our communities and to the patients who trusted us with their care.”

Walmart continues to operate its pharmacies and vision centers.

Choosing Cabinetry that Brings Value

Cabinetry design can determine the value and benefit it brings to the clinical environment. Medical-grade cabinetry can have a significant impact on efficiency, safety and the healthcare experience. While lower cost alternatives may seem like a good option, there can be additional associated costs. Involving us earlier in the project can take the pressure off you and help ensure the cabinetry you choose provides lasting value while minimizing additional expenses.

See why lower cost isn’t always best at: midmark.com/choosemedical

Scan to learn more.

Learn how Methodist Le Bonheur Healthcare resolved six different product shortages for their health system in less than a year with Premier GPO support.

Premier’s best kept secret comes baked into the GPO at no additional cost. I have never had this type of support before.

Rusty Parker
Methodist Le Bonheur Healthcare

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