Collaborating to achieve breakthroughs in supply chain savings and patient care quality

Collaboration is a key to success in most improvement efforts, and healthcare is no different. Through the sharing of information and best practices and learning from each other, we have found we can accelerate the rate of improvement for the members of our healthcare alliance. By working together to share clinical knowledge, improve productivity and reduce the cost of supplies, we have delivered billions of dollars in validated savings to our member hospitals. In the past three years alone, our member hospitals have validated more than $2.5 billion in savings through their participation in Premier.

Premier’s Collaborative Breakthrough Series (BTS) is just one of the programs Premier offers to its members. The series allows hospitals to quickly identify and implement improvements in clinical supply chain management that result in significant cost reductions. Since hospitals in the Premier alliance launched the BTS seven years ago, more than 230 teams have taken part, capturing cumulative savings of more than $170 million. Through these efforts, participating hospitals generate the savings to reinvest in their communities to improve healthcare.

The BTS provides a unique opportunity for participating organizations to rapidly improve supply chain management processes and capture significant cost savings in a compressed timeframe, usually nine months. Participants develop the skills and knowledge necessary to implement changes in their supply chain rapidly. Momentum builds as organizations gain access to valuable networking opportunities and participate in an interactive collaborative process, resulting in impressive gains.

The BTS is based on a methodology for collaborative improvement created by the Institute for Healthcare Improvement. It allows participants to identify and implement improvements in supply chain management that result in significant cost reductions. The teams set goals and report progress toward attaining those goals monthly. They share progress through monthly data sharing, e-mails and conference calls. Final successes are shared and celebrated in conjunction with Premier’s Annual Breakthroughs Conference and Exhibition.

BTS results
Results from the BTS have shown that, each year, the knowledge base expands and the cumulative savings continue to grow as the annual series progresses. In the 2007 BTS teams implemented changes that resulted in cumulative, validated savings of more than $19 million – $6.3 million more than their $12.7 million goal. Hospitals around the nation achieved an average of more than $1 million in savings, freeing resources to meet critical patient needs in communities they serve.

For example:

• St. Louis-based SSM Health Care uncovered a significant opportunity to improve the financial health of one of its hospitals. Making system-wide improvements that strengthened the link between clinical supply chain operations and their revenue cycle saved the hospital $1.3 million and enhanced the organization’s ability to serve its communities.
• St. Joseph Regional Health Center in Bryan, Texas identified $800,000 in savings in eight months by strengthening its clinical supply contracting process. By contributing to its bottom line, the initiative helped support its vital mission of providing the highest quality patient care, medical research and clinical education to the Brazos Valley community.
• Savannah, Ga.-based St. Joseph/Candler, a two-hospital system, reduced costs in its orthopedic and neurosurgery programs by $400,000 in just eight months. The system also accelerated improvement efforts and enhanced relationships with its physicians, all of which benefits the patients and communities it serves.
• By participating in the BTS, Mercy Iowa City of Iowa City, Iowa, engaged with its physicians and is expected to save more than $240,000 per year in cath lab supply expenses. The Mercy team reduced peripheral stent costs by 20 percent and is expected to save $24,000 annually with new contracts. Drug-eluting stent use has declined to an average of 1.44 units (below the national average). An initiative to renegotiate DES contracts is also expected to save about $80,000 annually.

Greg Kuntz, Cardiovascular Services manager at Mercy Iowa City, kept an open mind. “We thought we were doing quite well, but we are always willing to look for new savings opportunities,” said Kuntz. “Even when things seem to be going smoothly, you can always find areas for improvement.”

Since the BTS began, hospitals have identified opportunities for improved efficiencies in key clinical supply areas and have implemented changes to reduce costs while maintaining safe, high quality care. Some highlights:

• Hospitals have implemented data-driven processes for new technology evaluation so they can understand better the costs related to new orthopedic technology adoption and to identify savings opportunities related to physician preference items.
• A focus on achievable efficiencies in catheterization labs produced impressive results. Providing timely information to physicians about device usage and working with them to reduce unnecessary utilization, hospitals were able to capture immediate savings without sacrificing high-quality patient care.
• The collaborative process inherent in the Breakthrough Series fosters interaction and knowledge sharing among Premier alliance participants, which continues to provide enormous benefits to all participants long after the project ends. Participants learn to share data through conference calls and special e-mail discussion lists, and they continue to have access to each other so they can call on colleagues from around the country for advice on any challenge they may face at a local level.

Knowledge transfer learning sessions
Learning sessions are the major integrative events of the BTS. Through plenary and small group discussions, attendees have the opportunity to learn from faculty and colleagues, receive coaching from faculty members, gather new information on the subject matter and process improvement, and share information and develop improvement plans. Teams employ storyboards to summarize their work.

“The networking relationships created here are invaluable,” said Shelly Shultz, director of Materials Management, St. Joseph Regional Health Center in Bryan, Texas. “Going forward, we have relationships with peers across the country. That’s a tremendous asset for the future. I can pick up the phone at any time and get solid advice about a challenge I may be facing.”

Participating member teams have at least three members for each track in which they participate. Members represent different levels of leadership; team leader, clinical champion, and day-to-day team leader. A team leader might be a VP, CEO, or senior director and ensures resource allocation and spreads necessary work throughout the organization. A clinical champion is a well-respected clinician with a passion for the topic area and interest in quality improvement.

“Physician insights from the BTS physician consultants were especially valuable,” said Joe Loya, director of Purchasing at St. Joseph/Candler. “Their presentations reinforced what we are doing well, but also gave us some proven ideas to try.”

A day-to-day leader is typically a staff person from either materials management or the clinical department who focuses on the project, prepares and submits monthly reports and keeps the team moving forward.

Participating teams:

• Perform pre-work activities including team formation, documentation of overall aim (preferably linked to an organization’s strategic goals), measures selection, and baseline data collection on selected measures;
• Identify senior leaders to provide support and other resources to the team;
• Participate in opportunities for shared learning which include face-to-face meetings (three learning sessions), monthly teleconference calls, monthly reporting, an e-mail discussion list, and development of storyboards for the learning sessions; and,
• Use a rapid, small-scale approach to test changes before implementing them in the pilot population – involves plan-do-study-act (PDSA) cycles.

The aim statement guides the team’s work by clearly stating desired outcomes; for example, reduce supply expense for total joint arthroplasty by $1,000,000 by reducing the joint implant expense per case to 35 percent of the average DRG 209 payment and/or reducing the price of the implant by $1,000. This will be accomplished through both price and utilization.

“Bringing together tools and ideas in an open, creative environment that encourages mutual success is a big motivator,” said Vicki Butler, director of Surgical Services at St. Joseph’s/Candler of Savannah, Ga. “Also, the structure and timeline really helped the team stay on task. There is some positive pressure and friendly competition among collaborators to stick to the timeline.”

Since we launched the BTS in August 2001, we have been amazed at what we have learned. Not only have we produced significant savings and improvements in the healthcare supply chain, but Premier has become a leader in collaborative knowledge transfer. The process inherent in our BTS series fosters interaction and knowledge sharing among participants, which continues to provide enormous benefits long after the formal sessions have ended.