Sameer Kumar, Ph.D. Professor of Operations and Supply Chain Management

Qwest Endowed Chair in Global Communications and

Technology Management

Opus College of Business

University of St. Thomas, Minneapolis

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Managing the Healthcare

Supply Chain

Trends Issues Applications

A Systems Perspective

Systemic Intervention for Public Health

“Because of the complexity of many public health issues,

where numerous interacting variables need to be accounted

for; multiple agencies and groups bring different values and

concerns to bear, it is not uncommon for people to call for a

systems approach.

This should not be surprising, as the whole concept of

public health is founded on the insight that health and

illness have causes or conditions that go beyond the

biology and behavior of the individual human being.”

Gerald Midgley, PhD, (2006), “Systemic Intervention for Public Health,”

American Journal of Public Health, Vol. 96, No. 3, pp. 33-39. 2

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Presentation Outline

Research Approach / Interests

System and its Structure

Health Care Supply Chain Problem Definition

Health Care Supply Chain

Healthcare Initiatives (and Associated Issues) – Federal and

State / Local Levels

Health Care Questions / Applications

System Dynamics Modeling Illustration

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Research Approach

Systems Thinking

Interconnections (Collaboration), Synthesis (Integration) &

Behavior (Performance)

Analytical and Computer Competence, Mathematics,

Statistics, Risk Management, Reliability Engineering,

System Modeling and Optimization, System Simulation, . .

. System Dynamics, Problem Formulation

Interdisciplinary Leaning

Global Implications

Complexity of the Issues 4

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Research Interests in Healthcare Systems

Health decision and prevention systems

Healthcare supply chain informatics

Healthcare system design

Health communication

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System and its Structure

Assemblage of sub-systems

(components, modules, etc.), agents

(people, technology, equipment,

other resources) and mechanisms

designed to perform a set of tasks to

satisfy specified functional

requirements and constraints.

(e.g., healthcare supply chain)

Unity („consistent whole‟, „complex whole‟, „wholeness‟, „synergy‟, etc.).

Parts („elements‟, „constituents‟, „components‟, etc.).

Relationship („interrelationship‟, interactions‟, „structure‟, and „organization‟).

Unity

Relationship

Part

Environment

System Dynamics

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Healthcare Supply Chain

Manufacturers

Medical

Equipment

Manufacturers

Pharmaceuticals

Companies

DistributorsG

Medical Equipment

- Prosthetic Devices

- Artificial Body Parts

- Wheel Chairs

- CT Scanners

- Laboratory Equipment

Pharmaceuticals

Healthcare

Providers

Healthcare Professionals - Doctors, Nurses,

Respiratory Therapists, Dietitians,

Medical Technologists,...

Healthcare Facilities - Hospitals

- Proprietary Clinics - Nursing Homes

- Hospices - Urgent Care

- Same-day-surgery Centers

G

Patients

Public and Private Payer

Systerms

G & S

Insurance

Companies$

$$

e-Commerce (using Internet/Intranet/Extranet)

$ $ $

Medicare

Medicaid

Employers

Government Regulatory

AgenciesEnforce Health Care Regulations On Manufacturers / Distributors / Health Care Providers

US Congress

Food & Drug Administration

National Institute of Health ...

Legend:

G – Goods

S – Services

I – Information and Directives

$ - Payments / Reimbursements

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Healthcare Supply Chain:

General Problem

Design a healthcare supply chain that effectively

responds to needs during a health related activity in a

specific patient scenario by optimizing allocation of

resources under constraints of health care professionals

size and capability, health provider environment, nature

of disease (ailment), and insurance coverage.

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Healthcare Initiatives and Issues

Federal / State / Local Levels

Global Healthcare Supply Chain Opportunities (Logistics related issues)

HIV / AIDS Prevention & Control

Bird Flu Pandemic Prevention & Control

Essentials (food, water, medicine) delivery for disaster events (drought, tsunami, earthquake)

Disease Free Crop Production and Distribution

Medical Tourism

Humanitarian Supply Chains

Global Medical Diplomacy

Cargo Container Security (biological/nuclear/chemical weapons)

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Policy Initiatives and Issues

Federal / State / Local Levels

National (US) and Community Health initiatives

Elder Care delivery systems

Affordable public housing

Child Care delivery systems

Prescription Drug delivery supply chain through Medicare / Medicaid

Health Management Organizations Supply Chain Management

Technology Impact

Cyber-infrastructure for Healthcare Enterprises

Role of e-management in Healthcare Enterprises

Expert Systems / Decision Support Systems in Healthcare Delivery

RFID in Healthcare Supply Chain

Electronic Health Records

Classification and Coding of Clinician Diagnostics Systems

Integration issues for ERP Systems in Healthcare Enterprises

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Healthcare Questions Examined

? How severe is the impact of potential Avian flu pandemic disruptions on

global supply chains and what are the continuity strategies for mitigation?

? How can the role of nurses can be expanded for long-term care during and

post hospitalization?

? What effects medical tourism has had both on the U.S. and the global

healthcare supply chains including managerial and cost implications that

various surgical procedures will have on the global healthcare system?

? How to improve the insufficient health communication efforts to inform

uninsured or under insured medical tourists about the benefits and risks?

? How medical diplomacy can be used to curb extremism?

? What should a modern day hospital design look like? 12

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Healthcare Questions Examined

? How can RFID technology improve efficiency and mitigate medical errors in

hospitals?

? How can increased emphasis on preventive measures reduce national

healthcare expenditures?

? How can we improve the functionality and uses of the Electronic Medical

Record?

? What can be done to facilitate early diagnosis of childhood strokes and how

to reduce variability of diagnosis and treatment?

? Can we quantify the difference between the current process flow model for a

typical patient workup for chest pain and development of a new process flow

model that incorporates DMAIC Six Sigma and EBM in a best practices

model for diagnosis and treatment?

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Health Care Systems Applications

The Role of Leveraging Nurses for Long-Term Care During and Post

Hospitalization. (Journal of Home Health Care Management and Practice, 2011)

Decision Support Tool To Streamline Patient Diagnosis For Chest Pain Utilizing

Six Sigma DMAIC and Evidence Based Medicine. (Quality Management in Health

Care, 2010)

Supply Chain Disruption By Avian Flu Pandemic For U.S. Companies – A Case

Study. (Transportation Journal, 2010)

A modified Delphi methodology to conduct an FMEA: a patient-centric effort in a

clinical medical laboratory. (Quality Management in Health Care, 2011)

Revenue and Cost Economics of Partnering with Health and Wellness Services.

(Journal of Revenue and Pricing Management, 2011)

Service delivery of care in children who have had strokes: review of the initial

diagnosis and ongoing treatments. (Journal of Pediatric Neurology, 2009)

Medical errors elimination in U.S. hospitals. (International Journal of Health Care

Quality Assurance, 2008)

Technical efficiency measurement of specialty hospitals versus community

hospitals. (Journal of Revenue and Pricing Management, 2008) 14

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Health Care Systems Applications

Electronic health records economic justification and technical implementation.

(Health Informatics, 2010)

Rx for smart hospital purchasing decisions to influence product packaging.

(International Journal of Physical Distribution and Logistics Management, 2008)

Product recalls and counterfeit drugs control measures and mitigation in

pharmaceutical supply chain. (International Journal of Productivity and

Performance Management, 2009)

E-healthcare. (IIE Solutions, 2001)

RFID in healthcare supply chain. (International Journal of Health Care Quality

Assurance, 2009)

Medical diplomacy supply chain to curb extremism. (Journal of Health

Communication, 2009)

Managing risks in a relief supply chain in the wake of an adverse event. (OR

Insight, 2011)

Modeling Patient Flow Operation of a U.S. Urban County Hospital. (Technology

and Health Care, 2011) 15

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Health Care Systems Applications

The Hospital Cost Structure in the U.S.: What‟s behind the Costs? (International

Journal of Health Care Quality Assurance, 2011)

Stage Implementation of RFID in Hospitals. (Technology and Health Care,

2010)

Specialty hospitals emulating as focused factories – models for improved

efficiency. (International Journal of Health Care Quality Assurance, 2010)

An Ounce of Prevention: Revenue and Cost Economics of Partnering with

Health and Wellness Services. (Journal of Revenue and Pricing Management,

2011)

Examining Quality and Efficiency of the U.S. Healthcare System. (International

Journal of Health Care Quality Assurance, 2011)

Modeling hospital surgical delivery process design using system simulation:

Optimizing patient flow and bed capacity. (Technology and Health Care, 2011)

HIPAA impact on U.S. healthcare systems. (International Journal of Health

Care Quality Assurance, 2009)

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Health Care Systems Applications

Examining Potential Avian Flu Pandemic Disruptions on Global Business

Operations and Strategies for Corporate Preparedness – A DMAIC Case Study.

(International Journal of Health Care Quality Assurance, 2011)

Globalization of Health Care Delivery in the U.S. Through Medical Tourism.

(Journal of Health Communication, 2012)

RFID in Healthcare: A Six Sigma DMAIC and Simulation Case Study.

(International Journal of Health Care Quality Assurance, 2012)

Six Sigma Tools in the Health Care Supply Chain: A U.S. Retail Pharmaceutical

Service Application. (Technology and Health Care, 2011)

Exploring the Impact of Management of Chronic Illnesses through Prevention

on the U.S. Healthcare Delivery System – a System Dynamics approach.

(Information Knowledge Systems Management, 2011)

Development of a hospital based menu driven clinician coding tool to implement

quality reimbursement process. (Technology and Health Care, 2011)

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System Dynamics Modeling Illustration

• Supply Chain Disruption by Avian Flu Pandemic paper