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Supply Chains in Perilous Places
Bryan C. Baylis CSCP
Nepal
$141
Corporate Social Responsibility at Merck Richard T. Clark Fellowship
“A global program designed to leverage the skills and talents of Merck employees to help build and support the efforts of humanitarian organizations to address the health
needs of the underserved.”
The Objective • Improve the quality of available Healthcare in Western
Nepal • Install durable supply chains for life saving medicines
and surgical supplies within the Bayalpata Hospital
The Team
The Three Amigos - Philip, Bryan and Nardi
Bayalpata Hospital
• Founded in 2005
• Public / Private
Partnership
• 100% Free Healthcare
• Local Advocate for the
Community:
• Domestic Violence
• Maternal Health
• We left the comforts of our corporate environment…
The Challenges
• For the comforts of Nepal…
The Challenges
Philadelphia, Pa Doha, Qatar 14hrs
Doha, Qatar Kathmandu, Nepal 5hrs
Kathmandu Dhangadhi 1.5hrs
Dhangadhi Achham 11hrs via Jeep
The Challenges - Location
The Challenges - Water
The Challenges - Electricity
The Challenges - Food
The Challenges - Hospital Priorities •Priorities focused on short term treatment of patients
•Lower priority for long term procurement, supply chain and
general management of the hospital
Bayalpata - Filling a Basic Human Need • Maternal and Child Health
• Communicable Disease Treatment
• Emergency for Trauma
• Active Community Health Program
• 300 Patients Per Day
External Supply Chain - Initial State • Few personnel understood supply chain for pharmaceutical products
(who, where, how much, at what price)
• Lack of clarity on competitiveness of pharma pricing
• Doubts about reputation and quality of pharma companies providing medicine
• No real procurement strategy
• Benchmarked supply and procurement practices at peer hospitals throughout Nepal
• Met with government representatives to document public supply flows (HIV and TB Medications)
• Learned Nepali private supply systems and documented current private supply chain
– Manufacturer super stockist stockist hospital
• Detailed out a comprehensive procurement strategy, which included controls to safeguard quality and cost
External Supply Chain – Our Accomplishments
Nepali Drug Manufacturers - Due Diligence
• Identified top tier Nepali manufacturers and inspected their facilities
Identified Drivers of Medicine Spend
Procurement Strategy Execution
Pareto
Quotes
Decision
Internal Supply Chain
Medical and Pharmaceutical Stores Incoming goods
Emergency Outpatient Inpatient Operating Theater
Health posts Police,
external
Distribution to customers
Internal Supply Chain
1. End to End Flow
2. Physical Upgrades
3. Inventory IT System
• Selection
• Implementation
4. Standard Operating Procedures
Major Areas of Focus:
Internal Supply Chain – Initial State
• Multiple Dysfunction • Supplies dropped off by public buss, unprotected from elements
Internal Supply Chain – Our Accomplishments
• Physical Upgrades of Store Room, In-patient Department, Emergency Department, Out-patient Department and Operating Area
Old name New name
Mersilk 2 piece per unit Suture, Silk, (2-0), no needle, cutting (NW 5036)
Promethagin hcl 25 mg injection Promethazine hcl 12.5 mg/ml injection, 2 ml vial
• Provided item numbers for ordering • Provided standard names for medicines and medical consumables
Formulary Development • Outdated list with many misspellings and undecipherable names • Duplicate items • No order numbers
• Scope:
– Select appropriate inventory management software for all medical and non-medical consumables utilized within the hospital
• Starting point:
– MS Access dBase (homegrown) was in use, but was not consistently used and therefore out-of-date
– Mapped out requirements
– Identified and evaluated two off-the-shelf software solutions
Inventory Management – IT Solution
Internal Process Flow
Inventory Management Hand-over to Finance Receive PO’s Purchase Goods Deliver Items to
internal Customers
End to End Process Bayalpata Procurement
Hand-over to Finance
T r a i ne d R e so u r c e s
Review and adjust replenishment levels
Check Inventory (Cycle Count)
Adjust Inventory, when needed
Receive Customer Orders
Pick Customer Orders
Administer Inventory Transactions in SiE and
on the Stock Cards
Generate Replenishment
Purchase Orders
Adjust suggested quantities , based on
usage knowledge
Place Purchase Orders
Receive Purchase Orders
Count, and match Receipts with PO
Note when quantities don’t match
Administer Inventory Transactions in SiE and
on the Stock Cards
When Purchase Order is complete, close the
PO, and print the Delivery Sheet
Compile full PO paperwork (Delivery
Sheet, Supplier Packlist, and Invoice)
Sy st e m a nd Da t a Co nt r o l ( St o c k i t E a sy )
Inventory Management - Benefits
To improve control of our Inventory, know what we have in inventory at all times:
• Do we have the essential drugs in house, and where are they?
• Who are the Manufactures and Suppliers?
• Quantities in house, open orders
• Expiry date control
To understand what we use within each department
Provides visibility to open supplier orders
To assist with managing our finances and overall product costs
Sets us up for growth
** Manual Backup Stock Cards **
Training
Criticality of Quality Communication
Standard Processes
• Standard Operating Procedures (SOPs) were introduced to the hospital One-on-one mentoring of hospital staff – Standardize all processes to ensure Bayalpata Hospital is running at
optimal efficiency
– Assists in training new hires
– Cross-functional training
– Log books ensure tasks are being completed on time and by the appropriately trained employee
• Hiring the right employees for the right positions • Ensuring employees are trained correctly and are provided with the
tools to continuously learn • Recognizing the need to reassign employees to more or less
challenging positions depending on their abilities and performance (Critical in such a remote environment)
Management Consulting
Sustaining Change
Success Measured!
• Stockouts reduced from 80 to approximately 3 occurrences per month
How We Accomplished Our Goals
• Built strong relationships based on trust
• One-on-one mentoring of hospital staff
• Cultural sensitivity • Flexibility • Creativity • Sense of humor • Open to new experiences • Prepared to go out of your
comfort zone physically and mentally
• Keeping it Simple
Video
Supply Chains in Perilous Places
Questions?