A Global Strategy for Advancing Supply Chain Transformation in Health Systems

A Global Strategy for Advancing Supply Chain Transformation in Health Systems

Anne W. Snowdon Anne W. Snowdon, PhD World Health Innovation Network

Charles Alessi, MD

Patient Safety in Health Care

One of the greatest challenges facing global health systems is patient safety‌ Error and adverse events are increasing; medication safety, surgical safety, home care safety, infection (CPSI, 2016) (Spine surgeon, Foregn Body in Surgical Sites, Dialysis patients, Chemotherapy error 990 patients)

Medical Error is now the 3rd leading cause of death in North America.

…23,000 Canadians experience death that is preventable (2014) 2016 – 251,454

deaths USA

(Makary & Daniel – estimate calculated from 4 studies, 44-98,000 deaths identified IOM, 1999)

Baker, 2004

Challenges for Clinical Teams

“Clinicians become used to missing information (1:4 pts), equipment is missing or defective (1:3 pts), “cut corners” to get the work done.

“Accept poor reliability as the norm, and stop reporting problems” “Reporting is voluntary – fear of being blamed, receive no feedback, view reporting as unlikely to lead to change” (Baker, 2014)

Adverse Event Reporting Manual reports (“issues�) = 1400/yr Digital system = 3400/year (60100/week) External notifications = 3500/yr (140/day) System Action required = 2300/year (200/month)* (Syringe recall)

The Challenge of Device Recalls

In the case of the metal-on-metal joint implants it took 4–5 years before evidence was accumulated and reported. We are left with more than 500 000 patients with metal-onmetal prostheses in the USA and more than 40 000 in the UK who are at elevated risk of device failure, which will inevitably result in the burden of further surgical treatment as well as billions of dollars in costs to taxpayers (Lancet, 2015)

13.5% Adverse Events, nearly double the rate in hospitals (7.5%)

What is Common to all these Safety Challenges?

•

Not well documented, essentially “invisible” to the system

•

Life changing for patients and families, yet preventable

•

Learning is Retrospective, not ≈ prospective

•

Common to every country

•

Limited or no improvement in 10 years

Reframing the challenge of patient safety and care quality as a system infrastructure opportunity

“Adverse events and medical error are an outcome of a lack of well-developed supply chain infrastructure that would make it nearly impossible for errors to happen�

Where is Supply Chain well developed?: Grocery: tracks and traces every food item Airlines: trace every passenger Retail: track every retail item

Retail Pharmacy • Track, trace and recall every product to individual consumer in one hour or less • Can move product anywhere in Canada it is needed on short notice • “Sentinel Surveillance” system - Walkerton

Future State: Transformative Supply Chain System for Healthcare Systems

Value for Patients

* Safe, effective care that is accessible when and where it is needed to achieve quality of life, health and wellness. • Informed of products, ability to report adverse events.

Ireland Case, Recall Challenge

Value for Clinicians and Provider Teams • Tracking across the continuum of care, identify root causes of adverse events • Reduced workload burden automated adverse event reports and recall notification • Product identification and patient outcomes tracking • Early warning systems and alerts for proactive, prevention of error (MRI example)

Value for Healthcare Organizations • E-commerce and Inventory savings $$$ • Automated safety reporting • Accurate data on value to support procurement Expired Product

Value for Industry Visibility to assess product performance Insights into Population segment of patients Product innovation – next generation of product innovation

Product Use during Care Processes – trends in adverse events, or error Recall to individuals, Liability

Global Strategy a. Establish a global network collaboration b. Mobilize knowledge of strategic supply chain best practices to inform Canadian, American, Australian and European (UK, Netherlands) health systems c. Create knowledge mobilization tools and resources d. Strengthen leadership capacity in health system supply chain e. Position Canada as a global leader in health sector supply chain innovation to reduce medical error and achieve safer health outcomes for patients and reduce costs

Rationale a. Medical Error is a global supply chain challenge – solution to which will come from knowledge mobilization engaging multi-stakeholders and multiple regions of the world. b. Knowledge of supply chain is highly developed in industry, empirical knowledge is well developed in Business schools, yet this knowledge has had minimal impact on health systems to date.

c. Requires multi-sector, multi-discipline global knowledge mobilization, informed by research evidence.

Stakeholders Engaged in Network Global Networks

Business Schools Canada (5) USA (>20) Netherlands (1) UK (3) Australia (1)

GS1 Global: 114 countries HIMMS: 60,000 members, CIHI: Commonwealth Fund, Cdn Blood Serv., Infoway

SCI-Net Knowledge Mobilization Health Systems USA (6) Canada (7) UK (NHS) Netherlands (1) Australia (2)

Industry Manufacturers • Pharma • Devices Distributors IT Solutions Associations - CMA

Knowledge Mobilization Strategy 1. Supply Chain Maturity Assessment Tools (HIMMS, CIHI) 2. “Supply Chain University” Online learning platform (knowledge synthesis) 3. Design Competition (industry-health system engagement) 4. Business Case Competition (Business School leads) 5. Annual Networking Event – embedded in existing global network events, HIMMS, GS1

Key Outcomes • Advance global traceability of product use, and patient outcomes to reduce error, inform safety, and reduce costs • Embed supply chain transformation in existing global networks to advance collaboration across global jurisdictions • Establishes Global supply chain maturity scale – disseminated globally • Solutions disseminated and Scaled, mobilizing industry expertise (Design contests) • Curriculum and Leadership capacity building focused on health system supply chain expertise and transformation • Overcome Medical Error as the third leading cause of death

Thank you. snowdon@uwindsor.ca

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