Enhancing Patient Safety through Healthcare Supply Chain ...
Transcript of Enhancing Patient Safety through Healthcare Supply Chain ...
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Enhancing
Patient Safety
through
Healthcare Supply Chain
Excellence
By Mr. Narongrid Galaputh
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• “Crisis to Opportunity” The Journey of BDMS
• Healthcare Supply Chain, our version.
• More safety More Patients
Experience Sharing
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BDMS Overview
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Medical cooperation and awards for excellence
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National Healthcare Systems Co., Ltd
A.N.B. Laboratory Co., Ltd.
Medicpharma Co., Ltd.
Bangkok Helicopter Services Co., Ltd.
Sodexo
Greenline Synergy Co., Ltd.
Bangkok Premier Life Insurance Co., Ltd.
Save Drug Center
N Health Pathology Co., Ltd
Bio-molecular Laboratories Co., Ltd.
BDMS Non-Hospital Business
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Hub-and-Spoke Model
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Crisis to Opportunities
TOM YUM KUNG CRISIS in1997
Exchange Rate 1 USD = 25 Bht. 55 Bht.
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USA
Crisis to Opportunities
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9/11
11 September 2001
Crisis to Opportunities
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The Key Providers of Medical Tourism
Crisis to Opportunities
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Medical Travelers by point of Origin
Crisis to Opportunities
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Expansion Through M&A and Greenfield Projects
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Growth Strategy Through Network Expansion
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Thailand International Hub
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Thailand International Hub
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Thailand International Hub
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Thailand International Hub
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Thailand International Hub
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How could we grab that opportunity so well?
Crisis to Opportunities
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About N Health
• Founded in 2001 by BDMS
• Prominent as healthcare service solutions provider in Thailand and international
• 59 branches all over Thailand
• 1,509 Skilled & experienced professionals: physicians, pharmacists, nurses,
medical technologists, engineers, accountants, logistics specialists and
experienced top management team
• Largest pool of 38 pathologists, 300 medical technologists, and 150
biomedical engineers
• Quality guarantee by international standards: ISO 9001:2008
ISO15189:2007 ISO17025:2005
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34.0 163.1 178.4 223.1 242.7
324.1 430.6
630.4 779.6
896.4
1,194.9
1,536.9
2,076.7
2,397.9
3,323.3
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015F
• National Healthcare Systems
Co. Ltd was founded 2001
• Laboratory service • Procurement service
• Central Sterile Processing unit
Single database
Central Supply Chain
Management unit (Full scale)
• Procurement
• Inventory • Logistics
• Rebranded from NHS to N Health • Engineering service
N Health Revenue Growth & Shared Services Development
Million THB
• Linen Management • CMS Lab
• Hemodialysis Service • TeleMedicine
• Medical Supply Distributor • N Health Asia Pte Ltd.
• Medical Equipment Distributor
• N Health (Cambodia) Co., Ltd.
2015F
• N Health (Myanmar) Co., Ltd. • N Health (Laos) Co., Ltd.
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Minimize total cost of ownership
Reduce Non-clinical Activity for all Medical Staff
Minimize Inventory Value
Maximize Patient Care
Product Availability
Healthcare Supply Chain Management Goal
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Physical
Flow Information
Flow
Financial
Flow
Information
Flow
Financial
Flow
Physical
Flow
Manufacturer Distributor ?? Hospital Patient
Forward Integration
Backward Integration
“SCM is to increase velocity within the chain”
Healthcare Supply Chain Management
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Drug
Supply
Food
Patient
Staff
Professionals
Medical equipment
And many other
Patient record
HIS
LIS
PR/PO
Financial data
Research
HR data
And many other
Funding
Budgeting
AP/AR
Registrations
Banking
Collection
Payment
And many other
Physical Flow
Information Flow
Financial
Flow
Healthcare Supply Chain Management
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Manufacturer Healthcare facilities Logistics provider
BDMS’s Healthcare Supply Chain Management
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Systems, Applications and Products in Data Processing
SAP ERP is enterprise resource planning software. SAP ERP incorporates the key business functions of an organization. Business Processes included in SAP ERP include Operations (Sales & Distribution, Materials Management, Production Planning, Logistics Execution, and Quality Management) Financials (Financial Accounting, Management Accounting, Financial Supply Chain Management) and Human Capital Management (Payroll, e-Recruiting)
What is
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Procure to pay (purchase to pay or P2P)
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Order-to-Collection
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Plan-to-Produce
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Customer Order Order to N-Health Operation
Warehouse
Pick product
Sorting Process Transport Delivery to customer
Day 0 ( Cut off 03:00 PM)
Day 1
Prepare Picking list
Send receipt to F & A
Warehouse & Distribution Processes
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Traceable delivery of specimens, blood products,
document, pharmacy, medical supplies, medical
equipment within the hospital
Mobile Transporter Service
Mobile Transporters - Serving 4 large scale hospitals: BMC, SVH,
SNH and SiPH
- Over 300 departments,
- 24 x 7 (150,000 jobs per month)
- 100% traceability
- 90% on-time services
- OPD Stat Pharmacy delivery
New design of delivery system for
hospital logistics that increase transport
efficiency with track and trace feature.
The new system which is web-based
and leverage the hospital Wi-Fi network
to quickly send jobs to the transporters
equipped with an hand-held PDA.
Internal Distribution: Logistics Service
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Call in request • Manage schedule
• Issue PDA
• Return PDA
-Enter requests
-Check Progress
- Cancel Job
• Scan location barcode
• Scan specimens
• Scan location barcode
• Job Complete
• Update job • Update job
Workflow Diagram
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16D
15D
14D
11D
10D
9D
6D
Kidney
Orthopedic
Med
Specimen
control room
Medical
supply
Pharmacy
room Mail/Document
Office
supply Blood bank
Laboratory
TRC
Supplier
DC Supplier
Sterile
Pharmacy
Store Supplier
Store Supplier
Replenishment
OPD1 trip/origin/day
IPD 2 trips/origin/day
Transfer stock
2 trip/origin/week
MTD
7,015 trips/month
?
?
?
?
External
Internal
2 trips/origin/week
70 origins
607 trips/month
Traditional Hospital Logistics
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16D
15D
14D
11D
10D
9D
6D
Kidney
Orthopedic
Med
Specimen
control room
Medical
supply
Mail/Document
Hub (sorting)
Office
supply
Blood bank
Laboratory
TRC
Sterile
MTD
Distribute
IPD On-Call
OPD Milk run
Fixed schedule
Collecting Arrival (before)
7:00 10:00
10:00 14:00
14:00 17:00
Urgent : On-call
Every
10 min.
Pharmacy
room On-call
Fixed schedule
Cluster 4 origins/man
Fixed schedule
Fixed schedule
On-call
1,754
trips/month Supplier
DC Supplier
Pharmacy
Store Supplier
Store Supplier
Internal Hospital Logistics
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Ward enters Request
Transporter Logs On
Transporter
Receives Job from system
Ward calls Call Center
Call Center creates request
Ward inquires on job status
Transporter travels
to and scans source location barcode
Transporter travels
to and scans Destination
Next Job or Back to Hub
Ward
Call center
N Health Mobile Transporter System
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Anywhere Anytime N Health Telemedicine Solution
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N Sterile
Total Solution of Sterile Services
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Sterile Processing Services
Services :
• Sterile Processing Total Solution Services
Values to Customer
• Decontaminate /packing/ sterilize
• Turnkey services
• Instrument Specialized
• Logistic and Supply chain management
Pricing
Pay per use by “Size”.
Green Linen
Services :
• Green linen is OR and CSSD “sterile linen” included Linen management.
Values to Customer
• Faster : 24 hrs. of TAT
• Better : Quality control meet HA/JCI
• Lower cost : Pay Per Use (PPU) , reduce total cost
Pricing
Pay per use by “Kg.“
Sterile Instrument Services
Services :
• Wide range of sterilize medical instrument for rental.
• Special Instrument Set (Heart/Neurology set)
Values to Customer
• No capital investment in medical instrument
• No maintenance & inventory cost
Pricing
Pay per use by “Set”.
Total Solution of Sterile Services
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Key scope of services: • Turn key services all instrument and
department • Pick up dirty and delivery clean instrument • Entire process of decontamination, packing,
sterilizing and distribution of the various medical instruments and devices and Linen
• Every cycle through Physical, Chemical and Biological monitoring.
• N Sterile Web base and Barcode
Objective: To provide Sterile Processing (CSSD) services
Key Delivers:
• People : Supervised operation and infection control by direct experienced nurses and professional team
• Process : Sterile processing services meet JCI, HA and ISO quality standards and High quality all of CSSD.
• Technology : Barcode, web base
• Turn key services (Pickup-Sterile-packing-
delivery-report)
• Reduce total cost = 9% from staff cost, investment , maintenance and med supply.
• Know about actual costs and apply them to the decision.
Total Solution
Quality and Standardization
Lowest Total Cost
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Co
Costs of fastening element
Visible
15%
Invisible
85%
Linen Supply
Laundry Logistic & Handing
Linen Management Costs & Operations
Linen Loss
Sourcing (Time order/design/spec)
Laundry Processing / Vendor
Quality Control
Stock
Infection / Environment
Staff
Customer needs
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Value Added Services :
• Linen Processing • Stock control and utilization • Collection of soiled linen and delivery of clean linen • Maintenance and Quality control
“Linen Internal Management”
Total Solution: • Pay per Use included linen, laundry, internal management • Monitor demand & usage • Design (comfort, safety) • Buying & replacement linen • Optimization PAR of linen
“Linen Supply”
Ensure quality by Healthcare Laundry processing to cleanliness, delivery on time and not damaged/loss.
Laundry services as: • Normal linen • Bio linen (Infection) • Special: gown, curtain, sofa
“Linen Processing”
Services Solution Service Level Agreement
Pay Per Use by Kg.
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Requirement Assessment Management
Procurement Maintenance Utilization End of Use Warehouse
• Financial Feasibility
for New Medical
Equipment Study
• Technology Assessment
and Pre-purchase
Consultation
• Strategic Sourcing ECRI
• Preventive Maintenance (PM)
• Calibration
• Correction Maintenance
• Computerized Maintenance
Management system , CMMS
• Performance Report
• Education and Training User
• Equipment
Database Register
• OEM Contract
Management
• Equipment Pool
Service
• Indoor Air
Quality Inspection
• Medical Equipment
Utilization Program
• Life Cycle
Management
• Alerts, Hazards
and Recall Management
• Parts Management
Quality Assurance with Consultant HA / JCI
• Acceptance Test
• Disposal
Assessment
Biomedical Equipment Services Value Chain
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• Skilled and experienced Biomedical Engineer
• 89 testers certified by *TPA and *KMUTT
• Preventive Maintenance and Calibration Procedure
compliance with *ECRI
• Professional report compliance with ISO9001
• Reference site for both private and government
hospital
Remark :
*ECRI = Emergency Care Research Institute
*TPA = Technology Promotion Association
*KMUTT = King Mongkut's University of Technology Thonburi
Example of testers :
Preventive Maintenance and Calibration Service
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Feature: • On line request or call services
• Verify Medical Equipment to be prompt
services by engineer before using each time
• Labeling : indicate pass checking and expiry
date 7 days after verifying
• Monthly regular report and monitoring
• Alert, Hazard, Recall
Benefits: • Track and trace
• Patient Safety
• Reduce Nurses admin task and able to focus
on patient activities
• Cost savings : prolong use life and reduce
repair cost
• Better allocation of resources
• BDMS Pool to prevent shortage
Equipment Pool Service
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Item Description
1 SYRINGE PUMP
2 FEEDDING PUMP (KANGAROO)
3 SUCTION REGURATOR
4 AIR MATTRESS PUMP (ALPHA-BED)
5 CHEST WALL SUCTION
6 PNEUMATIC PUMP (SCD / Venaflow)
7 BP DIGITAL
8 HEAT NEMBULIZER
9 CRYO CUFF
10 FLOW METER
11 OXIGEN REGULATOR
12 BIPAP
13 SUCTION MOBILE
14 TRACTION BAR
15 BOLLOW BAR
16 MONKEYBAR
17 OXIGEN TENT
18 UTRASONIC NEMBULIZER
19 HYPER-HYPOTHERMIA
20 OXIGEN BOX
21 ELECTRIC BAG
22 BED EXIT ALARM
23 INFUSION PUMP
24 VENTILATOR
Equipment Pool Inventory
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Reference Standard :: FEDERAL STANDARD 209E and ASHRAE
• Ensure Patient Safety in OR, ICU, Cleanroom –
Infectious Control etc.
• Regular Inspection 1-2 times per year
• Professional Report
Benefits
No. Test Type Standard
1
Airborne Particle Count
Class Limits* 10,000 (Count / ft3)
0.5 m 10,000
5.0 m 70
2 Room Temperature (C)* 17 - 27
3 Relative Humidity (%RH)* 30 - 60
4 Room Pressurization (Pa) + 2.5 or -2.5
5 Minimum Total Air Changes 20 Per Hour
6 HEPA Filter Leak Test < 0.01 %
penetration
Test Parameter
Indoor Air Quality Inspection
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Feature:
• Daily Check List and report
• Preventive maintenance
and Calibration
• Medical Gas Safety and
Alarm inspector
• Spare part Management
Benefits:
• Patient Safety
• Risk Management
• Compliance with
• JCI Standard
Our services
1. Liquid Oxygen Tank
2. Oxygen Reserve
3. N2O Manifold
4. Vacuum Pump System
5. Medical Air Compressor System
6. Liquid Oxygen Alarm System
7. Master Alarm
8. Zone Alarm
9. Zone Valve
10. Medical Gas Outlet
11. Distribution Piping System
Medical Gas and Vacuum System Services (MGVSs)
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MTD (August, 2012)
Target 2012 (5% increased)
Diff Target YTD
PET / CT 58% 53% 5% 61%
Cyclotron 9% 11% -2% 12%
Novalis 24% 17% 6% 22%
SPECT 18% 26% -8% 16%
Brachy Therapy System 4% 6% -2% 6%
LINAC 118% 95% 23% 103%
Digital Mammogram 57% 43% 14% 47%
Ultrasound 28% 23% 5% 25%
WSH 39% 34% 5% 36%
Fig 2: Percentage Utilization of this month vs Target
Measure,
Compare,
and Improve
Sample Report
Fig 1: Comparison of MRI utilization vs target
Asset Utilization
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BETTER
• Web-based CMMS
• Largest pool of
experienced Bio-med
engineers in Thailand
• Benchmarked with
International standard
- ECRI
LOWER COST
• Asset Utilization
• Technology
Assessment
• Contract
Management
•Economy of Scale
FASTER
• Timely repair service
• Uptime Guarantee
more than 95%
• Emergency 24/7
Services
Customer Value Proposition “Patient Safety”
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Productivity Efficiency Staff Engagement
FTE workload per month
1 FTE
Note: work load per FTE
Work load definition • Lab: No. of Lab Test • CSSD: No. of CSSD Set • BME: No. of Equipment • Linen: No. of Kg.
Retention rate (Target 90%)
Financial
Inventory Days: target 25 days
32.7 days
Key Equipment Availability (% Uptime): target 95%
98.9%
Total Staff Expenses to Core Revenues:
24.6%
Receivable Turnover Days: target 58 days
Bad & Doubtful Debts to Core Revenues: target 0.2%
-0.12%
Total 97 No. of occurrence
Business Efficiency Goal (KPI) As of June 2015
Quality
47.3 56.0 61.0 59.1 47.4
Feb Mar Apr May Jun
Average SLA
(Core Service)
achievement target 90%
86.0%
Variance from budget -0.7%
Note (Core Services: Lab, BME,
Sterile, Hemo)
Corporate Services and linen need
to verify data – To be reported next
month
3,433
35
1,738
1,329
3,276
38
1,847
1,339
- 500 1,000 1,500 2,000 2,500 3,000 3,500
Linen
BME
CSSD
Lab
Jun May
98.4%
99.0%
98.8%
95% 96% 97% 98% 99% 100%
Apr
May
Jun
2
8
25
15
31
16
0 10 20 30 40
Level 5
Level 4
Level 3
Level 2
Level 1
Level 0
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Minimize total cost of ownership
Reduce Non-clinical Activity for all Medical Staff
Minimize Inventory Value
Maximize Patient Care
Product Availability
Healthcare Supply Chain Management Goal
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THANK YOU