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For other articles and previous issues click here. April 4, 2005 Demanding
Supplies Supply management is routine, often dull … but vitally important to a smooth operation. Here’s some insight on how some facilities handle the chore. Who really cares about supply management? The honest answer is probably only the person in charge of stock—that is, until someone needs an item and it is not available. Who cares then? Everyone. The radiologist, the technologist, the patient, the stock person, and materials management all care because now they are involved. Quantities, dollars, stock, storage, waste, and pilfering add up to supply management. Radiology departments have a primary obligation to patients to maintain the supplies needed for their exams. There’s also an obligation to the facility to be prudent in ordering and using supplies. Balancing Supply and Demand Judy Capko, a practice management consultant and owner of Capko & Company, a medical practice management and market research company, says, “Supply management is a quiet problem.” Capko and her company find solutions to this quiet problem for medical practices and departments that cannot find it internally. Capko, who once worked in a radiology department, suggests questions needing answers are often as easy as: How much are we using? Is there waste? Is the volume up? Is there misappropriation or personal use? Paper supplies can easily disappear through conscious or unconscious pocketing or simply throwing away items. Capko’s philosophy is: “Each time something is thrown away, that equals dollars spent and not used.” Another costly supply management mistake is storing too many materials or supplies that will never be used. To answer supply management questions, Capko evaluates the office or department and its staff. During her “day in the life of the office,” one of the first things she looks for is written procedure, or a how-to-do-things outline. Many places do not write down what is expected, which often results in waste. A look is given to where resources are used and whether they are used well. The manner of purchasing—Internet and intranet ordering, contracts with vendors, and regional supply centers—can also affect the bottom line. Finding a cost-effective solution can start with using an Excel spreadsheet to assist in documentation. “Stubbornness and an unwillingness to look at new technology will impede your ability to manage the costs of supplies and labor,” Capko says. Inventory control was done manually in the past and in some instances is still used. A flag system marks dates purchased, delivery times, volume used, frequency used, and reorder levels. Capko notes that vendors can also track usage, but an in-house system offers more cost control and better comparison capabilities. Price Check Frequently Steve Trudeau manages Commonwealth X-Ray, a Sellersburg, Ind.-based supplier servicing all areas of radiology in Indiana and Kentucky. The company works through contractual agreements and as a local handler of supplies. Commonwealth provides equipment and repairs, film, processors, chemicals, and computed radiography and digital radiography equipment and repair, all the way to the smallest item, such as a lead marker. Trudeau will even teach a technologist quality assurance techniques and answer the most mundane questions—albeit important to the one questioning. Need an accessory? Trudeau will find the best price and type for the job. His group even finds buyers for old equipment. “With changes in technology, the role of the independent dealer has changed,” Trudeau says. “Our focus has changed from film and chemicals to digital and PACS. Our service personnel receive training to meet the professional standards and qualifications associated with diagnosing and repairing equipment. Gone are the days of on-the-job training.” But smaller, independent dealers still trade on personal service. “It is our responsibility to communicate with the customer and solve day-to-day problems,” Trudeau says. Supply management can be as close as your independent dealer, where local availability and quick response may provide an edge over larger dealers. The proximity of the company and affability of the employees contribute to a successful business with many repeat clients. When you run low, forget to order, or have a dreaded film bin exposure (for those still using film) and you can still get same-day service from a company, that instills confidence. Facility Size The radiology department sends the orders to Burton for processing. SIRH is a 60-bed hospital and radiology is just big enough to accommodate the smaller number of patients: one examination room, a darkroom, and an office. Supply space is especially limited due to the small space and only what can be easily stored is ordered. Burton encourages the technologist to place a single order, including all that can be stored at one time. He says, “The fewer times you order, the more you save.” Each purchase order is handled by approximately six different employees, and each time the order is handled adds another cost. A larger hospital, Floyd Memorial Hospital & Health Services, also in New Albany, has a different system. The radiology department utilizes a number of people to keep abreast of the department’s stock and supply needs. Each person focuses on a different piece of the pie. A technologist keeps track of day-to-day needs for the examination rooms, such as needles, syringes, tape, barium, oxygen supplies, suction, and bandages—anything that might be required to complete an exam. An assistant environmental services employee keeps the linens in order. The assistant also keeps the blankets warmed and the wheelchairs handy. Bill Jackson, RT(R), quality control coordinator, oversees all these operations at Floyd Memorial. Jackson orders the rest for the medical side of the department. Everything has to come from somewhere, and while the small items come from an in-house materials management department, Jackson orders many items from the Internet, and materials management handles the purchase order numbers to be sent by facsimile to the companies. Contrast is a big part of the expense for radiology and the patient. It is also of utmost priority to keep it in supply. At Floyd Memorial, the intravenous contrast stock is kept under a lockup system in a department that is staffed 24 hours a day, seven days a week. The department serves a 220-bed hospital and an active emergency center. Limit When Orders Are Made Support service coordinator Leigh Ann Rudy manages the office staff and office supply management for Floyd Memorial’s radiology department. Rudy keeps a minimum amount of supplies sitting around. “I run it tight,” Rudy says. “I don’t order more than I need. That’s money in our pocket and not the office supply company’s.” The hospital has a program set up with a Voluntary Hospitals Association vendor and Rudy orders online. Deliveries are two days per week—no matter what—to help contain costs. Before, the orders were placed and delivered when ordered and at a premium price. Rudy’s costs are approximately $1,000 to $1,500 per month. The hospital at the University of Virginia (UVa) is a larger facility than the others mentioned in this article and depends on daily supply management in the interventional department. The number of exams dictates the daily orders and who orders the numerous and varied supplies. Anita Bell, RT(R), RCIS, FAVIR, is the angio-interventional radiology manager at UVa and handles supply management for interventional radiology. Bell assigns each technologist a specific supply area and a physician to determine supply needs. There is a delicate balance in an interventional department, and cost is not the bottom line—performance of the product is an important part of the equation. Bell’s staff has software available for scheduling, tracking, and ordering, but once the technologist is skilled at the process, Bell says, “they run the supply tighter.” One provider or many is a question for which Bell has an answer. “Don’t get in bed with one company,” she cautions. Mostly the admonition is a reminder from Bell to stay available to learn about other products. Captivity to one company can thwart learning about newer innovations. Jerry Cirino is president and CEO of SourceOne, which provides one-stop shopping for every need conceivable: paper, envelopes, film, chemicals, and more. If an imaging center uses it, SourceOne has it. Cirino says, “Wherever imaging is done is where we are.” If an imaging group needs something, SourceOne will get it and soon. Cirino ensures that orders received by 11 am are out by 2 pm and there is a 99% fill rate—virtually no backorders. Forty-three distribution centers across the country enable them to stay on top of orders and deliver in a timely manner. Where you are depends on the actual delivery date. Utilizing Suppliers Levels for imaging materials tend to be predictable and can usually be tracked and orders accomplished in an appropriate method. SourceOne will customize programs at the level the hospital wants. Orders are typically set at points for reorder but are still procedure-driven. Numbers can shift at various times because seasonality can affect procedure frequency, such as holidays and summer. Cirino says, “We can accommodate the hospital to keep only the amount of stock necessary.” Supply management is an arrangement between suppliers, manufacturers, and imaging customers. Cirino says he is adamant about providing customers what is wanted and not imposing his ideas and forcing the customer into an unwanted purchase. “We play a vital role in bringing the innovations of manufacturers to the healthcare providers, and we are proud to impact the delivery of healthcare to the patients,” Cirino says. Radiology supply management is no small task. It takes time and technology to accomplish. Seamless, errorless days are accomplished by teams—not an individual. The first step is to examine what needs are not being addressed and how to match them to the solution options available. — Janet Needham, RT(R), is a veteran radiographer and regular contributor to Radiology Today. She lives in New Albany, Ind. |
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