Designs on the Future
Edition: December 2012 - Vol 20 Number 12
“My past work experiences prepared me in some unique ways,” says Switzer. “My engineering work gave me the ability to look at all of the processes individually, and to make them come together as a functioning system. The last 23 years have all been in multi-hospital roles, where I have had opportunities to redesign and open new distribution facilities, design and build facilities from the ground up, [and] upgrade and install new computer systems.” And, he has learned some valuable lessons along the way, such as the following, he notes:
Today, Switzer has a number of responsibilities at NMHS, an IDN comprised of six hospitals, four nursing homes, a surgery center and 38 clinics, and a med/surg and pharmacy spend of $130 million. His oversight includes:
Challenges, today and tomorrow
Perhaps one of the most challenging and rewarding projects Switzer has worked on over the past year or two has been to design, build and bring into operation a facility to provide central sterile processing and case cart assembly services for the IDN. “[We] designed the building from scratch, using the three- zone concept: decontamination (dirty), prep/pack (clean) and sterile,” he explains. “There is actually a fourth zone in the concept, which is a common (support) area.
“This has been a very challenging project, as we have had to bring together multiple software vendors and develop interfaces to allow the seamless flow of information to trigger processes,” he continues. “This has resulted in eliminating manual processes wherever possible. However, it has not been without its challenges. The biggest challenge is ongoing, [as] we are still waiting on the FDA to approve a new type of robot to automate some of our manual processes.”
Looking ahead, Switzer has plans to build an automated, LEED-certified laundry, with a sterilization plant and a clean room for pack assembly. “We will get away from using disposable surgeon’s gowns, surgical towels, back table covers and mayo stand covers,” he says. “We have a laundry [facility] that was designed back in the 1980s, but we have outgrown it.” And, newer is better, he points out. “The new laundry [facility] will take advantage of many new technologies to save electricity, water and gas,” he says. “We are planning to build this plant to not only handle our laundry, but to be able to sell our services to other facilities outside of our system.”
Besides working on a new laundry facility, Switzer looks forward to continuing to expand the role of the central sterile processing department. “We are currently doing the sterilization for over half of our facilities,” he explains, noting that the plan is to bring all of the IDN’s facilities online. “We plan to sell this service to some of the smaller hospitals in our region, which may have 20- to 30-year-old sterilization equipment and can’t afford an upgrade,” he adds.
Working with suppliers
When choosing a supplier, Switzer and his team look for one that demonstrates the ability “to help – not hinder us and our group purchasing organization – in moving forward,” he says. “MedAssets has been key in helping us find these great relationships.
“Too many companies have one way of doing business, and you have to fit into their mold,” he continues. “The best companies for us are those that are nimble and flexible enough to embrace change and look into different ways of doing business. We have embraced LEAN and look for partners with a similar outlook.”
At the top of Switzer’s list of prime suppliers is Owens & Minor. “When we opened our logistics center, its business plummeted because we were getting many items direct,” he says. “We worked with [Owens & Minor] on many different concepts to make things better for both of us. First, we looked at how they made deliveries to all of our facilities, [and] decided to have all deliveries [sent] to our logistics center. We then could cross-dock these items and deliver them to our facilities on our trucks with our deliveries. This cut Owens & Minor’s cost, allowing them to pass on the savings.
“Another [more time-consuming] item we worked on was the ability to use pallets as a unit of measure,” Switzer continues. “We have several items of which we use large quantities, but not large enough to go direct. We worked with Owens & Minor to set up standards for these items so that when we order a pallet of an item, we always get the same number of cases on a pallet, [rather than] split several pallets. This may sound like a trivial item, but it makes a huge difference in the ability to receive and put away goods in a timely manner. Owens & Minor had to make system changes to allow them to do this, [rather than simply] go to multiple locations in their warehouse and spread [a delivery] among multiple pallets.”
On the horizon
Of the various changes supply chain executives anticipate in healthcare in years to come, Switzer believes one of the biggest will revolve around contracting. “No longer will we be looking at squeezing pennies out of every item we buy on an individual basis,” he predicts. “To be successful, we will have to insert ourselves into the entire chain of the money flow. We will have to work directly with insurers, vendors and manufacturers to negotiate prices we can all live with, while looking at where we can implement LEAN methods to cut our overhead.”
It will be imperative for supply chain executives to get involved, he adds. Otherwise, “we’ll end up on the outside, looking at direct contracts between the insurers and the manufacturers.”