Us: Warts and All

Edition: May 2002 - Vol 10 Number 05
Article#: 1244
Author: Mark Thill

I enjoyed reading Lawton Burns' book, The Health Care Value Chain. (Be sure to read a review of it in next month's Repertoire.) I mean, there we are – suppliers, providers, GPOs – all subjects of a book by a University of Chicago grad and Wharton School professor! It's like being on TV. What makes it even better is that Repertoire is cited in the bibliography.

There was one problem: Burns spends much of the book showing how and why the health care supply chain is so messed up. And he doesn't miss a beat. It obviously didn't take him long to uncover all the conflicts, vendettas, mistrustfulness and inefficiencies of this most important of supply chains. (As I read it, I couldn't help but ask myself, Why is it that a supply chain that produces cars runs so much more smoothly than one that helps produce and preserve human life. I mean, doesn't that sound a little bass ackward?)

I told someone outside the business that I had just read a 450-word book about the health care supply chain. After we established what a supply chain is and why I would read such a book, she asked a friend and me, Why is it so messed up? Why don't people fix it? My friend and I were speechless. After a moment, both of us said, “We don't know, but it's been that way for as long as we can remember.”

If Burns's book falls into the hands of one of its intended target audiences – provider CEOs and physicians – one of two things could happen: First, they could read as much as they could, then throw their hands up in the air and dismiss as fruitless any thought of trying to make things work better. Or second, they could try to fix things. Maybe they could make a difference where the rest of us haven't been able to.

One of the only factors missing until this point has been the interest or involvement of health care executives. We all know that hospital and IDN CEOs have weighty things on their minds – mergers, divestitures, managed care, reimbursement, community relations, fundraising, etc. With concerns like these, is it any wonder that materials management and purchasing have been delegated out of their offices and minds?

And what about physicians? How many doctors do you know who can place a purchase order? And if you know some who do, how many actually take the time to figure out how it could be done better?

Let's think optimistically. Suppose, in deference to Burns's credentials as a former health care provider executive, CEOs do in fact take note of the tremendous opportunities for savings and efficiencies in the supply chain. Let's suppose that, through education, they come to understand why things are the way they are, and how they could exert their influence to change them.

Perhaps we'll see CEOs of IDNs demanding that their system either use a GPO faithfully or do its own contracting. Perhaps CEOs will begin dictating that their hospital or IDN move to stockless purchasing or activity-based-costing with their suppliers. Perhaps CEOs will make things happen in a way the rest of us haven't. After all, they are the customer. They should be driving this thing.