What are leading health systems doing to protect today’s caregivers? And what role does the supply chain have?
Editor’s note: The Journal of Healthcare Contracting would like to thank AliMed for sponsoring the topic of patient and nurse safety.
When it comes to the safety of nurses and the patients they care for in hospitals and health systems, there are no silos. Everything is tied together, which means today’s providers need a holistic approach across all departments and staff, including the supply chain, said Emily Champlin, associate director, Regulatory Advocacy at ANA.
For instance, staffing is directly related to workplace violence, one of the top focus areas for the ANA. Less staff on the floor means less backup and less eyes watching for certain behaviors from patients and visitors. Fewer staff also increases the likelihood of burnout and fatigue.
“There’s a lot of injury in patient handling, needle sticks, and workplace violence that happens if you have inadequate staffing levels,” Champlin said. “It’s all tied back to having a holistic perspective of nurse safety in the workplace.”
The Journal of Healthcare Contracting reached out to national organizations, health system nursing leaders, and leading supply chain executives, to get their insights on a critical topic for today’s healthcare providers. The following are their stories.
Banner Health’s multi-year journey
Banner Health’s Denise Robson believes it’s imperative for medical products, services, and technology to be vetted and managed from a safety perspective to prevent staff and patient injuries. Supply Chain plays a very important role in this process, from new product and technology introduction to product substitutions, standardizations, and utilization initiatives.
“Supply Chain can assist in reviewing options based on needed clinical attributes thereby finding the right product when there are several items available from different vendors. This can remove any preferential biases,” said Robson, Clinical Supply Program senior director, Supply Chain Services Clinical Alignment Team, for the Southwest-based IDN. “Having clinicians who work in supply chain is key as they bridge the gap between supply chain and the clinical teams by providing unbiased review and keep safety, quality, and economic performance as the priorities,” she said.
During the pandemic when Banner had a critical shortage of fetal scalp electrodes, the IDN’s Clinical Team in Supply Chain was key in notifying and pulling together the right subject matter experts to determine next steps, Robson said. “We collaborated with clinicians from our labor and delivery teams across the system and came up with an interim plan to ensure we could utilize our current stock of products safely and without disruption to PT care.”
Banner is currently launching a multi-year journey on becoming a high reliability organization (HRO) to meet its safety and quality and efficiency goals. This work includes several new system-wide initiatives that encompasses cultural changes, education in HRO principles, continuous improvement, teamwork and communication, accountability, transparency, reliability, and psychological safety. “This work will bring Banner closer to our mission of Making Healthcare Easier, So Life Can Be Better,” Robson said.
Hackensack Meridian ensuring safety in every setting
New Jersey-based Hackensack Meridian has built a strong nursing culture with a reputation as a safe place to work, “a place where nurses can work autonomously and spend their entire career,” said Regina Foley, executive vice president, Chief Nurse Executive and Chief Clinical Transformation and Integration Officer.
The healthcare supply chain impacts nurses in significant ways, said Foley. “We know that supply chain workflow can be cumbersome and time consuming for our nurses. We continue to explore ways to enhance the efficiency and safety of this process, including the use of handheld barcode or radio frequency identification (RFID) scanning tools in place of traditional supply chain management.”
More generally, Hackensack Meridian has been focused on utilizing artificial intelligence, informatics and robotics to help transform some of these processes and tools. They have several pilots in place already – AI-driven chatbots to enhance the patient experience and AI solutions to help detect chronic disease earlier on. Algorithms are already being deployed across many clinical departments to speed up some of the more mundane processes for clinicians, Foley said. “These not only save our nurses time and increase job satisfaction, but also help to elevate the quality of care provided to our patients.”
“As we shift into different care settings, such as our Hospital at Home program, we will have different supply chain needs – from medication management to diagnostics,” she continued. “I view that as an opportunity for the Supply Chain to work with us to help ensure the safety of our nurses and our patients in every healthcare setting.”
SSM Health’s improved outcomes
Brad Forth, vice president, Sourcing & Vendor Management, at SSM Health, said Supply Chain plays a critical role in nurse and patient safety throughout the lifecycle of their work. To start, Supply Chain engages with the care givers to develop product and service solutions necessary to support the delivery of exceptional and safe health care services. “Through this work we collaboratively reduce unnecessary variation…both in care delivery and product utilization,” Forth said.
This consistency in practice and supply allows for optimized workflows, effective education, generation of actionable data, and other key contributors to the delivery of safe care and improved outcomes. The Supply Chain operations support nurse and patient safety by ensuring the availability of these supplies, Forth said. “Timely and efficient delivery of these resources prevents shortages, reduces the risk of errors, and promotes continuity of care, ultimately enhancing the overall safety and well-being of both nurses and patients in the communities that we are blessed to serve.”
Forth said SSM Health’s Supply Chain team is continually engaging with nursing leadership throughout the system on various initiatives in support of improved outcomes and safety for both care givers and patients, including:
- Standardized IV Start Kits:
“We transitioned from 19 IV start kits to two for the system (one for short term, one for long term). Through this effort, we worked closely with our caregivers to ensure the products included in the kits would support our efforts in reducing CLABSI (central line bloodstream infections) and dressing integrity.”
- Hazardous Drug Spill Kits:
Kit revision designed around needs and gaps identified by the nursing and USP team. These revisions allowed for the proper designation of components to keep end users safe, adequately clean drug spills, meet storage requirements, and fulfill guidelines of the regulatory governing bodies.
- Patient Care (Pediatrics):
Not all of SSM Health’s engagement, and developed solutions, are done as a full system, Forth said. “Given the specific needs in geographies, patient populations, and service lines we do also get very specific. We regularly collaborate with our clinical teams at Cardinal Glennon to create formularies for product categories specific to pediatrics. Most suppliers focus on the adult population, which may leave gaps in supplies for pediatric populations. Working collaboratively with our suppliers to address and solve for these gaps allows us to create a formulary for all patient populations we serve while retaining alignment to our system strategy in a particular space.”
ANA advocacy and initiatives
Workplace violence as a safety issue for healthcare workers has only increased post pandemic, Champlin said. ANA member surveys report more evidence of not just physical but verbal violence, which adds up to the enormous amount of burnout in the industry.
“People have noticed a dramatic increase,” Champlin said. “It’s growing into a powder keg.”
According to the American Nurses Foundation’s workplace survey of over 11,800 nurses in 2022:
- Almost one-third (29%) of nurse respondents have experienced one or more incidents of physical violence at work.
- 60% of nurse respondents have experienced one or more incidents of violence, bullying, at work. 55% of this is from patients and 49% from patients’ families.
According to ANA data, out of all nurses who experience workplace violence, as many as 80% of their cases go unreported. ANA’s top recommendation for better visibility of this issue within hospitals and health systems is a workplace violence prevention committee made up of diverse perspectives from across the organization. “That way, everyone problem-solves to create a prevention program using different perspectives,” Champlin said.
At the national level, ANA formed the National Workplace Violence Prevention Committee late last year. The committee consists of leaders across the healthcare continuum and private security. ANA is planning to release a toolkit that helps the individual nurse figure out how to keep themselves safe and how to scale things up in their systems.
“We also have a lot of advocacy on workplace violence and safety in general,” said Champlin.
ANA’s End Nurse Abuse webpage has resources for individuals and organizations, including education and research. ANA’s updated Position Statement on Workplace Violence will be released later this year and both the current version and new version include step-by-step instructions for both the individual nurse and leadership or systems.
The top legislative item related to the issue is the Workplace Violence Prevention for Healthcare and Social Service Workers Act, which puts a timeline on OSHA’s work to release prevention standards for workplace violence in healthcare. OSHA’s standards have been long-awaited by industry stakeholders, Champlin said. “They began their rulemaking process in May 2023, but we still haven’t seen a proposed rule. So, we sent a sign-on letter from nursing organizations across the country this April urging quick action from the agency because nurses cannot continue to wait.”