The last couple of years have brought significant challenges in procurement of routine medical supplies with ongoing backorders, allocations and product substitutions - how can the healthcare supply chain work to build resiliency and security with strategic initiatives? After years of the healthcare industry transitioning to single-use products, many healthcare supply chains are now evaluating and moving back to reusable products as a long term solution. For instance, reusable gowns can be a reliable option to replace disposable items with more robust and better quality products that users feel more comfortable wearing. Patti Hoch discusses the benefits of these reusable products with Hays Waldrop, Garry Skinner and Justin Poulin on this episode of Power Supply, highlighting a way to build supply chain security that also provides some significant cost savings AND reduces excess waste from healthcare operations. With a Win, Win, Win, you don't want to miss this episode!
“Inova Health went back to reusables and we used a company called La Forma Medical… and when covid started to die down you’re like this should be something that we keep going with because it's working, it’s way more secure than disposable product, and what we found was that our clinical staff loved the product. It feels more secure, so supply security could mean something else too. Secure for the clinician because they’re wearing something that doesn’t feel like a garbage bag, they feel like it’s really protecting them."
- Patti Hoch,
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Transcript of "One and Done? Building a Secure Supply Chain" on Power Supply Podcast
PATTI: ...hospital systems that set these types of sustainability goals for themselves that this area of apparel and reusables and reprocessed or re-sterilized for that matter is a really good way to achieve those sustainability goals you know
ANNOUNCER: Without supplies, there's no surgery. Without products, there's no patient care. Welcome to Power Supply: the healthcare supply chain podcast focused on helping you navigate the intricacies of logistics, purchasing, contracting, and supplier relationships. Each episode, we speak with healthcare executives, supply chain leaders, and innovative entrepreneurs from across the country as they share their stories, experience, and expertise on the industry we love. From the loading dock to strategic sourcing - from buyers to the C-Suite - and across the enterprise, we tackle the real life issues impacting the healthcare supply chain. Whether you're tuning in for conversation or inspiration, we're glad you're here. You're just in time to hear it from the source and stock up on insights, so sit back and plug in to Power Supply.
HOST: This week on power supply we speak with Patti Hoch, VP of supply chain and product development at Ready, Set, Surgical. We're gonna be talking [about], well, really a very common kind of theme: sustainability in healthcare, or, building a secure supply chain with Patty today, and there's so many nuances to this but for today's conversation we're gonna be talking about reusable versus single-use, reprocessing well, really, the case study we'll be talking about today is gonna be [about] gowns. So, I'm interested to see how we kind of go, what I would considered to be a little more swimming upstream. It seems like we've been going really heavy on single-use over the last couple of decades, so if people are looking to go back in the other direction, how do they do that successfully?
HOST: Well, come on in and listen to us today, because we do address a bunch of reusable resiliency, near shore… we're doing a ton of stuff - and we're gonna learn a her favorite concert she's ever attended, so come on and join us!
HOST: We'll be right back after a short break with Patti Hoch
HOST: I'm Hays Waldrop
HOST: This is Gary Skinner
HOST: and I'm Justin Poulin
ANNOUNCER: A production of 17 studios, you're listening to power supply
HOST: Joining us now is Patty Hoch, VP of supply chain and product development at ReadySet Surgical. And Patti, we got introduced through a mutual acquaintance, and we're really excited to have on the show today. Why don't you tell everybody a little bit of your background before we start talking about building a secure supply chain?
PATTI: Well first of all, thank you for having me! I'm really excited to be here, sharing some of my experience with you. I have been in supply chain for 30+ years. I started, actually, in the medical field - I was an EMT and I was in the U.S. Army, so they kind of picked healthcare for me, and I have stayed in it and enjoyed it for the last 30 years. I started in supply chain probably 25 years ago through an introduction in Six Sigma, and then I was in charge of logistics at Ohio State Wexner Medical Center, and in my latest endeavor, I was the senior director of strategic sourcing and value analysis and purchasing at Inova health system in Northern Virginia. Now I'm the Vice President of supply chain and product development at ReadySet Surgical and I have my own consulting company, Gap Logic. So, I'm happy to be here talking about sustainable supply chains.
HOST: Patti, let me just jump in here - unfortunately, all our listeners that are with us right this second cannot see what we see in the background of your of your office, there. Can you describe what's on that wall back there? Because I think it's pretty intriguing.
PATTI: That is a Grateful Dead banner from the Bertha album, so that is a just a tapestry I like to keep in the background for my zoom calls. It's usually a good conversation starter, and then I get to talk about the Grateful Dead a little bit at the beginning of each [call].
HOST: How many show did you get to see?
PATTI: I've been, probably, to over 80 shows in my life
HOSTS: Woah, that's amazing!
PATTI: So I would say music is my second passion after healthcare supply chain. Which, those two things don't sound like they go together but they work well inside my life.
HOST 2: 80 shows… holy cow, that's impressive! I'm glad I asked! So now we know a little bit more about you.
HOST 1: We gotta know your favorite song then at this point. She's gonna go, "I love them all so much!" But, you gota choose one.
PATTI: I'm gonna say Estimated Profit. It's a song no one knows!
HOST 1: OK, yeah, so I was just gonna say so for anybody who's not a Dead Head, we're gonna like little put a little seven-or-less second sample in the background so they know what song it is.
PATTI: Thanks for asking, I love talking about them.
HOST: Yeah, so let's talk about sustainability. Or, the way we kind of term this one is a "secure" supply chain. And when I think of the word secure, I'm thinking like something we're confident in, something, you know, that makes us just feel safe, and that's just not how anybody in supply chain feels right now. I think there's a lot of insecurity and instability, back orders… you know, here we are a year later.. I actually was just talking to Susie Collins the other day I got a chance to meet up with her in Phoenix, AZ while I was out there for a conference. And she said, "You know, it's so funny: I think it was just about a year ago that I did my interview with you all, and I was saying that hopefully in about 12 months the back orders will kinda be a thing of the past." and she was like "I'm still - Nothing's changed. I'm still dealing with the same amount of back orders as I always did." And so, I think we're all looking for stability and security and I know a lot of what we're gonna talk about is sustainability. But, sustainability has a lot of different meanings, too. And so let's anchor on that when we're talking about supply chain security for the context of today's conversation. You know, what are we talking about, Patti?
PATTI: So, I look at sustainability or supply chain security, rather, a couple of ways. And I was in that exact same situation at Inova Health. I was in charge of sourcing when COVID started and I immediately knew or could tell that this was going to be longer than just, you know, the virus. Which is to say, so many parts of the supply chain were breaking down so quickly, and no one really wants to accept the responsibility of owning safety stock, so you know, the manufacturer doesn't wanna manufacture anything more, the distributers certainly doesn't want to carry anything more… so it seems like if you want to have the right par levels for demand for your products for your patients, then you need to start to look at what are some other strategies you could have, because there was just no way you could rely on the manufacturers to be able to get you everything that you needed through the COVID period of time - specifically on gowns. I think that was the the first sort of pain point that everybody felt, was masks and gowns, and those were the things where we immediately were put on allocation. And that allocation still is on today, just like you're saying. This is not improved, everyone is still on allocation for disposable product.
HOST: Patti, I love how you bring up Supply chain security - that's a new word I haven't really heard used much, but I think it makes us think differently. Obviously, the direction is" what's happened in the last two years is making us think more strategically and diversify. One of the questions I've asked seen asked in in our arenas is: "Are we going back to the think tank on disposables, reusables, and opportunities there where you have a spend and [running into] 'We've always used the disposables this way'? Well no, let's look at a little bit of an investment on something we can resterilize and reuse. Are you seeing a trend to evaluate some of those bits and pieces, clinically? What's your thoughts, Patti?
PATTI: So, that is exactly what i did, actually! As soon as I realized that this is gonna be an ongoing problem. And you could see the quality of the disposable gowns that were coming in, that were filling that void. So our major suppliers had a quality product we were really happy, with but they put us on allocation. We had way more demand than we ever had before, so that has to backfill with something, and what it backfilled with was a whole bunch of new market entries of product that didn't go through the same rigor, that didn't have to really meet hardly any standards. Infection prevention people were doing their own testing on it, because you couldn't really get any kind of information about what level these gowns really adhere to, so we at Inova, went back to reusables. We used a company called La Forma medical, who manufacturers sporting apparel, which was an interesting play on that, but during COVID, sports were kind of cancelled too, right? So they have this great capacity to start manufacturing things and no one to manufacture for because they're making sporting goods. So I think there was a lot of quirky things happening during COVID that [made it so that] when COVID started to die down you're [thinking], "this should be something that we keep going with." [And that's] because it's working! It's way more secure than disposable product, and what we found was that our clinical staff loved the product because it feels more secure. You know, so supply security could mean something else, too: secure for the clinician, because they're wearing something that doesn't feel like a garbage bag, they feel like it's really protecting them, and I think that we sort of lost that [before]. I was around for when we moved from reusables to disposables the first time, you know, this isn't new - reusables were in the 70s - so now we're just right back to reusables, but with, I think, a different twist: there's the technology, fabrics, and a whole bunch of other things that have changed, and a way that you can make a really nice garment that meets all the criteria, you can just wash it, and you are always going to be able to wash it again no matter what happens as far as pandemics or whatever the next thing is that's coming down the pike. So I felt that the resuable solution was definitely the best solution to make sure I wasn't again, two years later, dealing with the same disposable gown allocation that I had before.
HOST: Yeah, we've talked a lot about single-use, the supply chain disruption, and everything that kind of tees up the conversation around reusable, but I'd say the biggest trend in the industry was going towards single use in so many areas and so, going back to reusable, and, I think, an increase on sustainable solutions, even from an environmental perspective, is a really good conversation, and something that we haven't really gone down. And I know that part of that conversation, we've had: we have had a number of podcasts on Nearshoring. So, how do we keep local supply lines. But to reduce the supply chain demand, using recyclable materials, whether those raw materials you know, can then go back in - because the raw materials is a big issue with the shortages, right? But then also just products that are reusable. So I kind of want to go and talk a little bit deeper about the benefits of going to reusable. And I also want to talk about where some struggles might be for organizations. If you're a healthcare organization, you're trying to transition back, and you've got this culture of a lot more single use, what are the hurdles to overcome to start making those kinds of supply chain choices again around purchasing?
PATTI: The benefits are many, but there are a couple of roadblocks that you're going tohave to work through. So I think the benefits are: the first thing was a quality product. You can have things that are made out of really light materials, but still have the effectiveness of AAMI Levels II, III, and IV. We were looking at surgical gown reusables. And the other piece of that is the cost. So, a lot of people think the reason that we went to disposables was that it is a much cheaper solution. Well when the disposable gowns were pennies, that may have been the case, but I don't see disposable gowns returning to those prices, and I think you've also seen, even the manufacturers that were the quality manufacturers that we had pre-COVID, have had to make adjustments to their gowns because of the Poly-spun shortages, and those sort of things. They've had to make their own material adjustments because of raw material shortages. I think that that's one of the things that was nerve wracking to me was that I wasn't even sure if the manufacturers that we relied on were going to be able to get the raw materials to keep going in the long term for our facility.
PATTI: We actually ended up saving money on the gowns, but it was, like I think you were saying, Gary, it is an upfront investment. So number one, it's an upfront investment to look at your usage, determine how many reusable gowns you're gonna need because you know you have them in these three parts.
PATTI: I'm trying to keep my answers to two minutes, but it's really difficult to do that well.
JUSTIN: Let me ask you a question around that since you're bringing up the upfront cost- well, Gary, you brought it up, we'll give you credit.
GARY: Thank you, Justin.
HAYES: I'm glad this isn't on video for everybody at home As my kids used to say, (they're little) "That hurt my heart."
HOST: Love you, brother.
HOST: How do they get over the upfront investment? I mean, everybody is starved for you know savings, and the idea of savings at this point is almost nil because inflation. We've already squeezed everything pretty much out of the line item savings that we possibly could have. Inflation, if anything, is bringing those costs back up. They've suffered revenue. Where do they get the funding to make that kind of an upfront investment to transition? Are they essentially handcuffed at this point?
PATTI: Well certainly there are companies that are willing to let you spread that upfront cost out over a period of time, but you, you are going to have to bite the bullet on the upfront cost. But the good news is, is that with specifically the company that we were using, we were getting 100 washes out of isolation gown and we're getting 75 washes out of a surgical gown, which made the break-even point [about] two years. But [I knew] I was going to have gowns - I had enough gowns with that number of washes that I was going to have for 7-8 years. So once I hit that break even point, I'm paying $0.30 a wash. So the washing is a savings at that point and as long as you're injecting for loss and tearing, and you know, maybe someone throws it away or whatever a certain amount every month, you can keep that program going at a significant cost savings. One of the bigger cost savings we had was the amount of red bag waste we took out. I mean, it was immediately noticeable that we were not throwing away thousands and thousands and thousands of gowns in a week, and our sustainability people were actually able to put a dollar figure to how much red bag waste we were able to take out of the supply chain with the reusable gowns.
HOST: You know, PattI, you mentioned a couple comments here, and we talked about obstacles and then options - it's like a mini SWAT analysis on every product that we look at within supply chain, and how we can really focus on the important things: patient centered mission, as usual, that's our focus, and always working on helping with the reduction and stuff so we can take care of staff, which takes care of our patients. One of the things that I gotta ask you that I'm thinking about, and I don't know if we've asked this question as we evolve into this, but: reprocessing. I don't know where that's at, has that increased? As there are opportunities now where we are taking it out of the red bag and we put it in the reprocessing bin for certain manufacturers that do this, are we elevating our reprocessing in some of our surgery areas, are we utilizing that more? Are you seeing that Patti, is that a direction or not?
PATTI: The devices that are able to be reprocessed, and what I'll call more product-focused reprocessing, I just don't think it's ever been adapted to the point where people thought it would be. And I think that anything that you're handing to the surgeon, there's always been some skepticism around if this of the same quality as the new product. And even though we've put some recertifications on it or we redo the guarantees from certain companies who are doing that, I just don't know that that has ever been adopted the way it could be, and I don't think that I've really seen anybody increasing their reprocessing in the surgical suite, but the reusable gowns, going back to reusable lab coats, and going back to apparel where we tried to make this profitable apparel, I think is really the place where you can make a big impact, because it's just heavy and it's so much of it. Every time I go in, I put a new disposable lab coat on. Every time I go out, I throw that disposable lab coat away. Coveralls: how many times are we throwing this disposable apparel market where we're throwing thousands of those things away every day? I think we still have a lot of work to do in the reprocessing device space. I do think that that is a much easier pot to replace some of your disposable apparel with reusable apparel.
HOST: But don't you think, Patti, a lot of the emphasis on ESG and being environmentally sound, and all those things, that this is going to move, and push that faster. I mean, what do you think? I mean, it seems to me it kind of goes right in line with all that, and it's reducing a lot of your redbag waste, as well.
PATTI: Yes, I agree that there are a lot of institutions now that are setting pretty aggressive sustainability goals, even, regardless of cost. So, you know, 'we're gonna take this much, Reduce our trash by this much, and we're gonna we're gonna recycle by this much' regardless of if that's more money. I think that hospital systems that set these types of sustainability goals for themselves, that this area of apparel and reusables and reprocessed or resterilized for that matter, is a really good way to achieve those sustainability goals. There are a lot of things hospitals just can't do, but this is something they can do to make themselves more sustainable.
HOST: Alright, so let's talk about some other opportunities. I know we laid out a use case with gowns specifically, but where else can we go? I mean, we really talked a lot about apparel: head, footwear, disposable coveralls, but you know, one of the things I think about is the infection prevention side of that too, so the reprocessing has to be really sound to be able to do that on all of this apparel to make it something that is reprocess-able, what material does it have to be made out of? What, if you were to bring this into your supply chain, you know infection prevention is gonna do that. I think about all the disposable scrubs and the vendor scrubs realm, and recently there's been a lot of pushback on that on LinkedIn, too. I've seen some posts and what not, But that's all disposable scrubs. So, how do you make something we processable that's gonna go into a surgical area?
PATTI: That's one of the really interesting things that I learned, because I didn't really, until COVID, I didn't really know very much about the textile industry at all, but I certainly got schooled pretty quickly. That was one of the great things about working with this La Forma medical, which was is [also] La Forma Sports. They do a lot of biking, rowing, and all of these sports that sort of have these waterproof kinds of materials. Sports that do things in the water or have lots of sweating and running- sorts of things which have the same components of the things that we're looking for to repel blood or repel body fluid. The fabric that we landed on was a fabric that was used to make a waterproof running jacket material that was able to essentially be liquid proof and also have a light weight to it that you would use for sport. That's where I think that some of these companies that are focusing on what I'll call "high performance medical apparel", I don't think we've ever really had that before. We had, 'OK, here is a really heavy, cotton, hot bag for you to put over yourself so that you can be protected'. No wonder we went to disposables! I think of a lot of the reusables that sort of sat on the market, not really used very much pre-COVID - no one wanted to buy that stuff. It's not comfortable. It's hot. It's super expensive. And we haven't really ever had anybody who's like thinking about this from 'OK, What type of garments do high performing athletes wear?' Nurses and doctors who are in these same sort of these really hard conditions are battling some of the same thing: fatigue of the weight of the garment, how hot it is, how long you have to wear it. And those sorts of things, there was never really much effort put into: Can we make something that is good for these types of people? The translation between sports and medical works really well because they're on their feet all day, too, and they're working really hard, too, doing physical labor, too.
HOST: Well, the relationships in orthopedics too, right? You know, in orthopedics, you see a lot of that sports medicine and everything else is played out there. A lot of the innovation has come from the sports industry in terms of surgical procedures and some of the strategies, because the idea is to get the athletes back out there. I can definitely see a lot of that overlap, though, between the two. They're interconnected industries.
HOST: It would be nice to have gowns with the Nike swish.
PATTI: Actually, the company we used does stuff for Adidas! When we put out the gown, one of the things that I was trying to get was clinical acceptance. I want these guys to really like it. So we did have the Inova logo on it.
Other pieces: how is this designed? One of the things we put on it was a pull-cord, so that it could be donned and doffed individually, because one of the pieces of feedback we had was: "if I have to tie it behind my back, I'm creating contamination or I have to have somebody else do it". So it's a two person donning and doffing process. Having an opportunity to just sort of re-look at this whole space and say "how can we innovate here"? It was really fascinating. The gown had a pull cord so you could just basically rip it off the same way you can rip off a disposable. That had a really high clinical acceptance and high clinical feedback on the weight, the fabric, and the features.
HOST: Alright Patti, this time went very quick. I wanna thank you so much for coming on the show. Anything you wanna add before we wrap up?
PATTI: No, I think this was great!
HOST: That was Patti Hoch, VP of Supply chain and product development at ReadySet Surgical and, Gary, we're talking about trying to find ways to use renewable raw materials, reusable vs single use, and I feel like that's kind of against the grain. You did bring up that one area on reprocessing single-use medical devices, which definitely seems like a great opportunity for sustainability. A lot of times in that industry, it's just because the manufacturer hasn't gone through the additional 510k process to make those devices reprocessable, but that doesn't mean that the quality of the product is necessarily a single-use quality. There are some companies out there that do the 510k processes after the fact, which is a great opportunity. We've got an upcoming episode where we will be talking about sustainability, but more on that environmental related to chemicals and reducing the use of chemicals and reducing chemical exposures that can be dangerous to the environment and that humans can have reactions to when they're working around [them]. There's so many different meanings to sustainability, but I like this thing of taking what we're learning in sports apparel and being able to apply that to garments and other goods worn in healthcare and still achieve the same level of effectiveness.
HOST: I think you're right, it's the options. It's for supply chain security, as we talked about in the very beginning, is the options, and I think that now with dollars and focusing on the stuff within supply chain, we've got to look at every opportunity. I'm just curious: where is reprocessing at? Have they expendad their 510k portfolio from the calf lab to the OR. I'm always curious on how much they would take and what they wanted to use. It's really an opportunity to look at, when we have shortages of raw materials, we have shortages of product, we're on a ton of allocation - where is that? I'm curious from some of our listeners to see what their thoughts are. Please share with us if you know of any direction on that.
HOST: Anyways, good talk with Patti. She went deep into scrubs, we learned a lot about scrubs. Good discussion for today on Power Supply.
Host: Great point, we love feedback, and if anyone wants to send us an email, send it to email@example.com. That's gonna do it for this week's show, but as a reminder, you can help support Power Supply by subscribing to us on Apple, Amazon, or Google Podcasts. You can also find us on Stitcher, iHeartRadio, and Spotify, or simply search for Power Supply on your favorite podcast app. You can also access bonus content for certain episodes, but you've got to download our smartphone app for iPhone or Android. And while you're there, we'd certainly appreciate a rating or review, because your feedback is important to the show. On behalf of Hayes, Gary, and myself: Thanks for listening to this week's episode of Power Supply."
Skinner, G., & Waldrop, H., & Poulin, J. (Hosts). (2022, Nov. 7). One and Done? Building a Secure Supply Chain. [Audio podcast episode]. In Power Supply. The Supply Chain Podcast. https://podcasts.apple.com/us/podcast/one-and-done-building-a-secure-supply-chain/id1560877506?i=1000585315577