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Bridging Generational Gaps in Healthcare Teams · Taking The Supply Chain Pulse

• 0:10
  Speaker 1: Hello again everybody.
• 0:11
  Speaker 1: This is Fred Krantz from St Onge coming to you with another episode of Taking the Supply Chain Pulse, where we talk to leaders and luminaries in the healthcare supply chain field.
• 0:22
  Speaker 1: And today we're going to be talking to one of St Onge's own, albert Nkansa, who is a senior healthcare engineer for St Onge, one of my work colleagues and a really interesting man.
• 0:33
  Speaker 1: The reason I wanted to have Albert on is Albert works a lot of projects, a lot of varied types of projects, and he is in at the sort of grassroots level of what's going on in the organization.
• 0:46
  Speaker 1: I want to get his observation and have him maybe tell us why things like assessments are good ideas for organizations.
• 0:54
  Speaker 1: So if you're out there listening in and thinking you might want to do an assessment, maybe Albert can shed some light on that.
• 1:01
  Speaker 1: Albert, thanks for joining us today.
• 1:04
  Speaker 2: Thank you, Fred, for having me.
• 1:05
  Speaker 2: I will say I'm very proud of you.
• 1:07
  Speaker 2: Great pronunciation of the last name.
• 1:10
  Speaker 2: Not everyone gets it and I think actually as long as I've known you, every single time you've got it first, firsthand.
• 1:17
  Speaker 2: So I got to commend you on it.
• 1:19
  Speaker 1: Well, you know, they say, even a blind pig finds an acorn once in a while.
• 1:23
  Speaker 1: Thank you, Albert.
• 1:26
  Speaker 1: So, Albert, tell us a little bit about yourself, your background and how you got to St Onge.
• 1:32
  Speaker 2: Absolutely, absolutely.
• 1:33
  Speaker 2: So it's funny, we're out of college.
• 1:37
  Speaker 2: So I went to Texas Tech University out in West Texas and so out of college I actually wanted to be a lawyer.
• 1:45
  Speaker 2: But before I wanted to be a lawyer I said you know, well, let me make some money first.
• 1:48
  Speaker 2: And I got a job out in industrial manufacturing and I realized I didn't necessarily want to go to law school.
• 1:55
  Speaker 2: I actually realized how much I liked supply chain but I didn't like industrial manufacturing.
• 2:02
  Speaker 2: Like I knew way too much about bucket elevators than I ever wanted to know.
• 2:06
  Speaker 2: I was driving down the highway one day I saw a full conveyor belt material handling conveyor belt out on the road and I was telling my wife exactly what that is and she was like why do you know all this?
• 2:20
  Speaker 2: And I say I don't know and I don't want to know all this.
• 2:23
  Speaker 2: So from there I really I knew I wanted to change industries and and my family is in healthcare, my dad's in pharmacy, my mom's in as a historically a cath lab nurse.
• 2:36
  Speaker 2: So and I knew I liked supply chain.
• 2:39
  Speaker 2: So I was able to kind of get in on the ground level and supply chain working in the cath lab and so I became a cath lab materials manager, working in HCA hospitals, starting off at Kingwood Medical Center out there in northeast Houston, and that really opened my eyes to the hospital supply chain, which is very different than the other industries, very different than distribution and manufacturing and kind of that aspect of it it's different, but it's also still similar in that you know parts, items and supplies still need to make sure it gets to its final destination and I think the from you know not just these big sprockets and big gears that I was dealing with previously, but the importance of even something as small as an introducer making its way inside the room Right.
• 3:27
  Speaker 2: And so from there we got a opportunity to go to a large facility out in North Houston Conroe Regional Medical Center or not industrial as an intervention or internal coordinator and working with preference cards, picking cases, kind of getting at the grassroots level, then became a materials manager in the OR as well as back in the cath lab and the IR.
• 3:55
  Speaker 2: So from there then I started working at Staples.
• 3:58
  Speaker 2: I was in Staples for a little bit as a as a health care consultant there and working with some of the office supplies needed in clinics and in hospitals and things of that nature, and then before coming over to St Ange with some of that experience helping us out on the health care side.
• 4:16
  Speaker 1: Hey, you said that and I just found myself looking around for my easy button.
• 4:23
  Speaker 2: Listen, I had a bag of them to give you about about six years ago, you know many, many people might not remember that those, uh, those commercials.
• 4:34
  Speaker 1: Well, what did you learn working in uh?
• 4:37
  Speaker 1: Tell me about each of your jobs in uh, in the cath lab and in and what did you learn that helped you further along later from those roles?
• 4:49
  Speaker 2: Yeah, I mean, I think that when I was working in both the cath lab and the OR, you know, again, my mom is she was a cath lab nurse, so I knew at least what the cath lab does.
• 4:58
  Speaker 2: I feel like a lot of people, before they get into the cath lab, don't even have never even heard of the cath lab.
• 5:02
  Speaker 2: So I at least knew, you know, some of the, the interventional procedures that were going on in the cath lab and things of that nature.
• 5:08
  Speaker 2: I think the unique aspect of cath lab and ir is just the amount of supplies that are kept within the room and the, the necessity to be able to make sure that you have enough inventory.
• 5:21
  Speaker 2: Uh, at a moment's notice, right.
• 5:23
  Speaker 2: So I know, I know in the OR it's a lot of open or holds.
• 5:26
  Speaker 2: In the cath lab everything's a hold.
• 5:27
  Speaker 2: So everything's a hold, everything is.
• 5:30
  Speaker 2: I could use it, I could use that catheter, I could need that stent.
• 5:33
  Speaker 2: Everything needs to be within.
• 5:35
  Speaker 2: You know a quick notice, because at any moment you know whether it's the doctor needing this, the scrub tech needing this, the patient needing this because of the size, things of that nature.
• 5:43
  Speaker 2: It's the doctor needing this, scrub tech needing this, the patient eating this because of the size, things of that nature.
• 5:47
  Speaker 2: So because of that, the inventory that's within the cath lab and the ir rooms themselves is so much more pertinent because you need to have it and or which is?
• 5:54
  Speaker 2: It's a different, it's a, um, uh, you know, same beast, different animal or however they, however they say it, but, like in the or, it's's just the need for making sure that all the suppliers are within the larger supply room and then the cases are picked appropriately just became that big amount of steps.
• 6:13
  Speaker 2: So really just learning you know the various ways and the various things of how each of them work in the perioperative space I think was very interesting.
• 6:22
  Speaker 2: I think a lot of people, especially in support services, become, you know, either an expert in cath lab or an expert in IR or an expert in OR.
• 6:29
  Speaker 2: So I got the opportunity and the joy to kind of spread my wings a little bit and learn much about all three spaces while also still being in supply chain.
• 6:37
  Speaker 2: So you learn about the entire workings of the whole hospital, because you know I was working under the overall supply chain umbrella.
• 6:42
  Speaker 2: Yeah, you know, I always working under the overall supply chain umbrella.
• 6:44
  Speaker 1: Yeah, you know I'm, I always thought that one of my biggest um advantages and it wasn't, you know, it wasn't intentional I started out at when I came back from the military.
• 6:54
  Speaker 1: I started out as a nursing assistant at Baptist hospital Miami.
• 6:57
  Speaker 1: So I worked?
• 6:58
  Speaker 1: I were.
• 6:59
  Speaker 1: I was one of two male nursing assistants at a 350 bed hospital, so you can imagine how popular I was every time a patient needed to be lifted or moved or something.
• 7:08
  Speaker 1: But as a result of that I knew how things worked.
• 7:12
  Speaker 1: I knew every supply that was used and care on the nursing units, what it was, how it was used and, much more importantly, where it was stored, so that if we ran out of something in Davis Pavilion the cardiac pavilion I knew where it was stored on 3 North and I could go up and get some stuff from that and take care of the issue.
• 7:33
  Speaker 1: And by the time I got in management, my experience of having done the job for three years while I was at the University of Miami and seven years altogether in my military service really helped out.
• 7:48
  Speaker 1: Did you find that, once you started in consulting, your knowledge of having done the job really gave you an edge on what you were doing?
• 7:57
  Speaker 2: Oh, absolutely.
• 7:58
  Speaker 2: I think it also makes a lot of the people that we work with it makes them comfortable.
• 8:03
  Speaker 2: The fact that I'm talking about the intricacies of case card picking because I've done it right.
• 8:09
  Speaker 2: I'm not just saying it off of hearsay or saying it because you know, I heard somebody else talk to it, or I am saying that I know that when I was picking cases, picking supplies, going through having to pick lists and making not only just doing it because of what they were the location is, but knowing, okay, this is the flow of the supply room, this is how I got to pick it.
• 8:29
  Speaker 2: These are.
• 8:29
  Speaker 2: I got five dental cases.
• 8:31
  Speaker 2: Let me go put them all five cases on a push cart because I know that there are, like, like intricacies of that aspect, of that nature.
• 8:37
  Speaker 2: Right, those are things that I can talk to the uh, the people we're working with and they know that.
• 8:44
  Speaker 2: Okay, he at the very least used to be in my shoes, right, he at least knows some of the things that I'm dealing with when it comes to working through bill onlys, when it comes to consignment agreements, you know, and I think that does give you know, provide some comfortability on the other side, but on our side.
• 9:02
  Speaker 2: I think it gives that extra layer of analysis.
• 9:05
  Speaker 2: Right, we're not just looking at numbers, we're not just looking at you know what, how the feel is.
• 9:13
  Speaker 2: We're saying, okay, well, based off of what we know and how workings happen, because of our experience, not just in healthcare but our experience around we are, we're just giving that extra layer, that additional layer that I think a lot of other places that don't have the experience can give.
• 9:29
  Speaker 1: Yeah, it's interesting Before we start talking about the kind of projects that you work on and getting your input from that.
• 9:38
  Speaker 1: There are a couple other things I noticed when I was looking at your profile on LinkedIn.
• 9:43
  Speaker 1: Number one is you subscribe to the Value-based care newsletter.
• 9:46
  Speaker 1: Can you tell us what value-based care is and what's your interest in it?
• 9:51
  Speaker 2: Yeah.
• 9:52
  Speaker 2: So to me, I think value-based care is very important.
• 9:55
  Speaker 2: Now, mind you, I work for a for-profit hospital, so multiple for-profit hospitals, so for me, financial value is always going to be a big piece of it.
• 10:04
  Speaker 2: It's always going to be an aspect to where you're trying to make sure you get the best bang for your buck and you important is because I think they do a really good job and, in my opinion, how I feel about it is that of showing what the value is in not just the actual clinical healthcare aspect, but also the inner workings of support services, the inner workings of the hospital at large right.
• 10:42
  Speaker 2: We all play a part in patient care, and that's, to me, providing that overall value making sure that you know, even as a supply chain tech, the work that you're doing is just as important to make sure that Bob Johnson's stent is placed appropriately, and so that, to me, is the biggest piece of that value there.
• 11:06
  Speaker 1: Interesting.
• 11:07
  Speaker 1: The other thing that I wanted to ask about is a couple years ago we attended a session at Arum together.
• 11:16
  Speaker 1: That turned out to be one of the most interesting sessions I've ever attended.
• 11:20
  Speaker 1: I was talking with Mike Schiller, who is the guy who is the director that leads ARM yesterday, and he said that that session that we attended was the largest individual, non-general audience session that was attended.
• 11:35
  Speaker 1: They had 155 people there and that was the young professionals session, and in that group we learned, among other things, that there are like five generations in any workplace at any time, starting from either I qualify, believe it or not as a pre-boomer, because I was supposed to have been born in January of 1946, but I was born in November 1945.
• 12:00
  Speaker 1: So boomers are 46 and after.
• 12:03
  Speaker 1: But there's that there's the boomers, there's the Gen X, you know, there's, there's, there's five generations, all of whom have different outlooks on life, different viewpoints, different, different needs and concerns.
• 12:17
  Speaker 1: My question is about that is, what do you see is the similarities and differences of those generations in the workplace and when you're in a project, for example?
• 12:28
  Speaker 1: How do you identify, you, know who you're dealing with and adapt your presentation style to them?
• 12:37
  Speaker 2: So good question.
• 12:37
  Speaker 2: First of all, fred, I don't know what you're talking about.
• 12:39
  Speaker 2: You're a millennial.
• 12:41
  Speaker 2: Second of all, I do think you know, like you mentioned, all generations attack things differently.
• 12:48
  Speaker 2: We've all had different experiences, as different you know, different generations.
• 12:51
  Speaker 2: I think millennials are considered like the 9-11 generations.
• 12:55
  Speaker 2: That's the first huge world event that impacted our lives, world event that impacted our lives, and so, because of this, we all kind of go through things differently.
• 13:04
  Speaker 2: We have different mindsets as we go through.
• 13:04
  Speaker 2: I think one of the important things to do, and I think one of the things that I did, you know, before my role here and while I was working in healthcare, was understand and talk to people from different generations.
• 13:16
  Speaker 2: I'm a big fan of, I'm really big into diversity, right, and not just diversity in.
• 13:22
  Speaker 2: You know, I think a lot of times we think of diversity, we think of of race, but also race, gender, age, like you need to have a really good understanding of you know and be able to talk to and work with people that are a lot older than you and and as I am getting older, people that are a lot younger than you as well, and as I am getting older, people that are a lot younger than you as well.
• 13:42
  Speaker 2: So it's so with that, you know, I think, because that I have that experience as far as working with people of all ages, you know, I use that as my advantage.
• 13:49
  Speaker 2: I mean, I think one of the things that older generations, like Gen X and boomers, the ability to I think it's very their whole thing is they're very big on working harder.
• 14:00
  Speaker 2: Right, we are going to do whatever it takes to make sure that this job is done, and whether it takes two hours to get it done, five hours to get it done, eight hours to get it done, it will get done and we'll make sure of it to where the younger generation.
• 14:11
  Speaker 2: What I've learned is is that it's all about what's the best way to get it done, you know, swiftly and smartly, and done and efficiently.
• 14:18
  Speaker 2: Right, it's, it's a.
• 14:19
  Speaker 2: You know, fred, you and I are both into sports, right, and so basketball, for example.
• 14:23
  Speaker 2: Now it's all about efficiency, right, let's take the three point shot, because three is greater than two, and if I take three, two point, three point shots and make two of them, that's more points than taking, or that's the same amount of points than taking three, two point shots and making all of them.
• 14:36
  Speaker 2: So, and I think that same trend in sports is also the same trend generation, like every, all the analysts and engineers that I work with now is really into what is the you know, best way we can do this?
• 14:53
  Speaker 2: What is the swiftest way we can do this?
• 14:55
  Speaker 2: What's the most efficient way we can do this?
• 14:57
  Speaker 2: To where, as I work with some of the, the, the, some of our, our end users and clients, it's you know, what can we do to make sure that this is done?
• 15:05
  Speaker 2: And I'm talking to a guy that's been in the industry for 30 years.
• 15:08
  Speaker 2: You know I'm not going to come in there and and and talk to him about.
• 15:12
  Speaker 2: Well, this is the number.
• 15:13
  Speaker 2: Say, I'm going to come in here and talk about all right, because of a, we're going to make sure that b is done so c can happen, right, and that, and that's just how you adapt and you get to know people.
• 15:22
  Speaker 2: You really get to learn what the true needs are, how they're shooting it, and once you get to really know them at a human level, I think it's actually quite easy to adapt presentations, adapt talking points, because you get to know them as people.
• 15:37
  Speaker 1: Yeah, that's great.
• 15:38
  Speaker 1: I'm tempted to go into the story, though, about the.
• 15:42
  Speaker 1: What generation was the young woman that didn't want the boss to find out where she was because she wanted to go to the doctor's office without having anyone bother her?
• 15:53
  Speaker 1: Which generation was that.
• 15:55
  Speaker 2: I'm pretty sure she was Gen Z.
• 15:56
  Speaker 2: That was uh during that presentation.
• 16:02
  Speaker 2: Yeah, I was, I was.
• 16:03
  Speaker 2: I was trying a little bit to help her out of like, yeah, you know work-life balance, and she said, no, I just want to uh be able to do whatever I want, not tell anybody.
• 16:13
  Speaker 1: And I was like, well, I can't you know, and if you looked at that room, everybody that was in uh, my, my, my, uh generation, and maybe a, a couple younger, were shaking their heads all the time that woman was talking.
• 16:27
  Speaker 1: Anyway, so, albert, what kind of projects do you find yourself typically working on?
• 16:34
  Speaker 1: So?
• 16:35
  Speaker 2: yeah, so over at St Onge, of course, on the health care side and our our prong, our little section of health care, is really into supply chain Right, and so that is doing supply chain assessments, doing still processing assessments, really looking at the support services and ways we can provide a review, what ways we can assess the departments at each facility, you, what ways we can assess the departments at each facility.
• 17:03
  Speaker 2: We've done full system assessments when it comes to standardizing processes and work patterns across the system and also we really work a lot in new building design.
• 17:12
  Speaker 2: So new construction and so with that, a lot of some of the projects, especially in the last few years, we've really undertaken is a lot of the sterile processing new construction design.
• 17:22
  Speaker 2: So we are going in looking at new builds, whether that's consolidated services centers, whether that's straight up supply chain offsites or sterile processing offsites.
• 17:32
  Speaker 2: We've recently got a little bit into pharmacy, but those are a lot of the projects that I'm working on is really just assisting support services and whether it's assessments, new construction and assisting with those designs, but really kind of coming in as that quote-unquote subject matter expert to be able to improve some of the processes over at different hospital systems and hospital facilities.
• 17:55
  Speaker 1: Well, you know, I was going to ask you.
• 17:57
  Speaker 1: I'm going to ask a question I already had here, but you brought something up when you talked about new construction.
• 18:02
  Speaker 1: So, you're talking about new construction and say we have a central sterile processing area, right?
• 18:10
  Speaker 1: Do the architects just say well, the hospital has 500 patients, they do 16,000 procedures.
• 18:18
  Speaker 1: They do 16,000 procedures.
• 18:20
  Speaker 1: That means they need 17,820 square feet of space for central processing and then leave you to figure out what's going to go where.
• 18:31
  Speaker 1: Or is there more detail before you get there?
• 18:37
  Speaker 2: How honest can we be on this podcast?
• 18:38
  Speaker 1: No, I think it's important because I'll tell you why.
• 18:40
  Speaker 1: Because, as a person that's gone through a couple of these, at Baptist, you know, I was a department director.
• 18:48
  Speaker 1: I didn't know anything.
• 18:49
  Speaker 1: I thought that you know these guys knew what they were doing and I wasn't involved.
• 18:53
  Speaker 1: So I'm just wondering and I would like to have known something.
• 18:56
  Speaker 1: So pretend you're talking to me as a young director that didn't know anything.
• 19:02
  Speaker 1: What do you find out, Do?
• 19:08
  Speaker 2: you have to solve the problem for them or do they give you some guidance?
• 19:10
  Speaker 2: So I personally hope that when it comes to a new hospital or a cell processing center, especially cell processing, that these architects, when they're coming in, they are including engineering groups like St Onge or just engineering groups in general that are able to help them in certain support services they may not have the knowledge to, because one of my just and I joke about it at work all the time but one of the things that really frustrates me in some of these architecture meetings is when I hear the words well, that's industry standard.
• 19:39
  Speaker 2: I cannot stand it.
• 19:41
  Speaker 2: I can't stand that, because most of the time how I've come to know industry standard is that it's we kind of just I don't know, we saw it somewhere else and we kind of just made it up.
• 19:51
  Speaker 2: That's how I hear it.
• 19:52
  Speaker 2: When I hear industry standard, I hear, okay, well, you just kind of put a number around that you think is somewhat accurate and we just don't do that right, all of our.
• 20:00
  Speaker 2: When we're designing a sterile processing center and I'm focusing on sterile processing just because I think that's probably the biggest gap in architects developing a new space and what they actually know and when we're doing sterile processing department.
• 20:15
  Speaker 2: We are using data.
• 20:17
  Speaker 2: We're using, you know, actual data from the work that's already been done.
• 20:22
  Speaker 2: We're using growth measures to see what the work is projected to be done and we're placing it in.
• 20:26
  Speaker 2: We're projecting how much backlog is going to be in the state of processing.
• 20:29
  Speaker 2: We're projecting all this and then we're using our inherent knowledge of all right well, this aspect are going to have to staff.
• 20:34
  Speaker 2: Is staffing going to be?
• 20:36
  Speaker 2: What's staffing going to look like?
• 20:37
  Speaker 2: What are the process flows going to look like through here, really going through each of those steps instead of just saying, well, industry standard says you have this many beds and this many ORs, so therefore you need this much space instead of processing, because it simply doesn't work that way.
• 20:49
  Speaker 2: And I mean even as we look into the supply chain, warehouse or new hospital builds, when we're looking at on-unit supply rooms and things of that nature.
• 20:59
  Speaker 2: It's so common for on-unit supply rooms to say, oh well, we're just doing 100 square foot of supply rooms throughout the hospital with no rhyme or reason, just out of no, you have, it's a hospital with 500 beds, so you need X amount of square footage and that's just not how it works.
• 21:17
  Speaker 2: You know how many SKUs are going to be in this, on this unit?
• 21:18
  Speaker 2: What type of unit is it?
• 21:19
  Speaker 2: Is it an ICU?
• 21:20
  Speaker 2: Is it you know what type of patients are going to be in this place, right?
• 21:24
  Speaker 2: What can we expect in these rooms?
• 21:26
  Speaker 2: And if we are going to standardize the rooms, all right, that's fine, but let's put some data behind it.
• 21:31
  Speaker 2: Let's actually say what each of these rooms should look like.
• 21:34
  Speaker 2: And so, yeah, I mean long story short to answer your question.
• 21:38
  Speaker 2: I do think that a lot of the times, architects kind of come in with this thought of OK, we have an industry standard, we have a best, you know, our best guess of what the room should be, but I do think that's where we provide value of our.
• 21:51
  Speaker 2: Well, let's actually think about this at an engineering and an experience level.
• 21:59
  Speaker 1: Yeah, have you ever had situations where you go in I'm thinking in places like clean utility rooms and, you know, care unit storage sites where it's already done and there's the empty spot?
• 22:10
  Speaker 1: And now you got to figure out, because I know we have, for those of you out there, information.
• 22:17
  Speaker 1: We have weekly staff meetings where we discuss projects and stuff and I'm always interested in how detailed our young folks can get about types of containers, types of storage, what's going to go in them?
• 22:28
  Speaker 1: I mean, you have to go in and make magic happen in a space that you have no control over sometimes.
• 22:33
  Speaker 2: Is that?
• 22:33
  Speaker 1: true.
• 22:35
  Speaker 2: So a lot of the times, it is A lot of the times we are kind of told this is the space, so this is the space, and figure it out right.
• 22:42
  Speaker 2: We do occasionally have what's called our peer reviews, whether it's a warehouse or a supply room or an SPD, where they say we've already done this, but please give us your expertise on if anything should change, if equipment should be included, if equipment should be increased, decreased, et cetera.
• 23:02
  Speaker 2: Right, and so if we're able to do a peer review at an appropriate time in schematic design or even in detailed design, we get an opportunity to at the very least give our concerns about the layout that's already been there.
• 23:18
  Speaker 2: But, to your point, there are other times where it's we've already designed this, so can you make this work?
• 23:23
  Speaker 2: And those are those are the most difficult.
• 23:28
  Speaker 2: Unfortunately, I wasn't on this project.
• 23:29
  Speaker 2: I want to say what it was, but we did have a recent project where that exactly happened.
• 23:34
  Speaker 2: We've already designed this, this is already the building, this is already ERP we're going to use, and these are the things that we've already.
• 23:41
  Speaker 2: These are the storage units we've already purchased.
• 23:43
  Speaker 2: So say, now can you make it work?
• 23:45
  Speaker 2: And it was.
• 23:46
  Speaker 2: It was extremely difficult and I think we did provide good service and it does.
• 23:52
  Speaker 2: I mean they were able to implement it and it works as it does work fairly well.
• 23:57
  Speaker 2: But it could have just been done a lot better if we I think we were at the beginning of it, but we'll, we'll try to make magic happen as best as we can I've been there, but without you know where there's the room, figure it out and uh, and you know this.
• 24:13
  Speaker 1: The neat thing is that we always figure it out.
• 24:16
  Speaker 1: You know what I mean.
• 24:17
  Speaker 1: It may not be optimal, but we always get it done.
• 24:21
  Speaker 1: So here's, here's.
• 24:22
  Speaker 1: You do a lot of assessment projects and you do a lot of all types of operations.
• 24:26
  Speaker 1: I would ask you how many of these assessments are proactive?
• 24:33
  Speaker 1: I want to make things better in the long run and plan my future assessments and how many are uh-oh?
• 24:39
  Speaker 1: Things aren't going well.
• 24:40
  Speaker 1: I got a crisis.
• 24:41
  Speaker 1: I need to do an assessment to see what I need to fix.
• 24:45
  Speaker 1: What would you say?
• 24:46
  Speaker 1: The mix is?
• 24:48
  Speaker 2: It's typically the latter.
• 24:49
  Speaker 2: I think what ends up happening is that, if you know it's typically what happens is that you're going through, you're looking at your department or your area, or even your hospital, and you're saying to yourself there is something off and I cannot pinpoint what exactly it is.
• 25:06
  Speaker 2: This department, whether it's in sterile processing this department continually has a high amount of bio burden, or we're continually having issues with staffing over here or if it's in supply chain, where it's man, all of our storage units are wildly outdated and we got to find a way to, to, to upgrade this.
• 25:25
  Speaker 2: But before we do that, we need to figure out what exactly we want to do.
• 25:28
  Speaker 2: Like, it's typically in this sense of oh, something's off, but we don't necessarily know our next steps.
• 25:35
  Speaker 2: Now I think from that you start thinking of OK, if we're going to make this update, we're going to have this assessment, we're going to make, we're going to invest real money into it, let's not just invest for the next year or two, let's invest for the next 10 plus, the next 15 plus, right?
• 25:49
  Speaker 2: And I think that's where it kind of combines.
• 25:51
  Speaker 2: The two of you start off with an uh-oh but then you say, okay, well, we're going to fix this, going forward and let's see how far we can, or let's make sure we plan this out for the future.
• 26:04
  Speaker 2: We did have another facility a few years back that we took.
• 26:06
  Speaker 2: When we first got in there, it was like I was transported to a hospital in the 80s, and so it was like we just had to get them up to date.
• 26:14
  Speaker 2: We had to get them up to date to where they are now, but then now, from here, we've been able to work with that facility for the last three plus years now, and so now they really are looking forward to okay.
• 26:25
  Speaker 2: Well, we were in the 80s, now we're in the 21st century, but how can we plan for the future?
• 26:30
  Speaker 2: And so now I think their mindsets are really running to.
• 26:32
  Speaker 2: We started off with a problem, but now let's plan to where we can eliminate problems overall.
• 26:38
  Speaker 1: See, I think an assessment is a baseline necessity and I think that if I were to give advice to anybody out there who's listening, that gets a job as a supply chain leader in any system in America or in the world.
• 26:53
  Speaker 1: You have goodwill when you first come in and the first thing I would tell my C-suite folks before they even hired me is if you hire me, I want to have a baseline of assessment of my entire operation so I can see what experts say we need to improve, and I don't think that happens that frequently.
• 27:17
  Speaker 1: But I would recommend that because, with IDNs changing their size and all regularly and reaching out into the community with new logistical demands and all that kind of stuff, and if you've got an IDN that's got, say, seven hospitals, you've got seven sterile processing functions that are antiquated and need to be fixed, because sterile processing never gets any attention unless the sterilizer blows up and then they have to do.
• 27:47
  Speaker 1: I'm serious and so I think assessments are very important, absolutely.
• 27:54
  Speaker 1: But where do you think healthcare supply chain needs to improve the most?
• 28:01
  Speaker 2: So, as far as when it comes to improving the most, I actually think you're kind of hitting it on being proactive.
• 28:07
  Speaker 2: You know, I do think that we are, as an industry, very reactionary.
• 28:12
  Speaker 2: I think a great example of this is recently with the hurricane that affected North Carolina.
• 28:19
  Speaker 2: You know, years ago when I was working in a health system I was working in the OR whenever the Puerto Rico hurricane hit and where we couldn't we couldn't get half of our supplies to save our lives Right.
• 28:35
  Speaker 2: There were so many things that were on back order, so many introducers on back order, some catheters on back order and that's why I always joke that that you never knew how much things were manufactured in Puerto Rico until a hurricane hit Puerto Rico and you couldn't get half of your items right.
• 28:48
  Speaker 2: And so I think that it was all reactionary For the most part.
• 28:54
  Speaker 2: We had manufactured so much stuff in Puerto Rico.
• 28:56
  Speaker 2: We were so used to, you know, funneling everything from there.
• 28:59
  Speaker 2: So instead, what we did is we were reactionary and we said, okay, well, you know, baxter has a location out in North Carolina, we have fluids out there, we'll be fine manufacturing all of these IV fluids out in North Carolina because we're in the mountains, natural disasters aren't going to happen to us up here, and then a natural disaster happens up there, and I think that that's, I think, a good example of where we are now sitting, in a situation where, instead of thinking to ourselves ahead of time of maybe we shouldn't put all our eggs in one centrally located basket, whether it's in Carolina or Puerto Rico or wherever we're now reacting Now we're thinking of, oh well, maybe, you know, after two natural, two huge disasters happen that completely throw the supply chain out of whack, you know, once again we're reacting to it as opposed to taking a proactive approach of thinking, well, what if this was to happen?
• 29:48
  Speaker 2: Right, instead of thinking before the hurricane in North Carolina, what if we said to ourselves, well, okay, I get it that it's in the mountains, that it shouldn't happen, but what if we thought ahead to it?
• 29:57
  Speaker 2: What if it did?
• 29:58
  Speaker 2: And I think, a lot of the times, as far as an industry, we're not always proactive, you know.
• 30:04
  Speaker 2: So there's, I think there's one, and the only other one that I also think is that in the health care supply chain, I believe that we are a little conservative when it comes to our innovation.
• 30:21
  Speaker 2: So, you know, at St Onge, of course we health care is only one of our departments we have distribution, we have manufacturing, we have logistics also in our engineering firm, and so because of this, I think we're exposed to just all that is out there, right, and so it is interesting sometimes to hear on the other side of the aisle just the type of, you know, technology and things that are being used excuse me, in distribution and in some of these other areas we're healthcare I mean for the most are being used, excuse me, in distribution and in some of these other areas where healthcare I mean for the most part, we're still very conservative in the ways that we kind of think about supplies and we and people are so very important in the healthcare scheme of it.
• 30:56
  Speaker 2: But I think we as, as an industry, can think about ways that we can make you know staffs, jobs and lives easier while working.
• 31:03
  Speaker 2: What are ways that we can improve you know the work cycle and we can use some of this technology and this innovation going forward.
• 31:09
  Speaker 2: I don't think we always have to, you know again, be reactionary to innovation.
• 31:14
  Speaker 2: Instead we can kind of think about ways we can move the needle forward.
• 31:18
  Speaker 1: That's interesting.
• 31:19
  Speaker 1: You know, when you talk about the Hurricane Maria and the recent hurricane stuff, we talk about transparency.
• 31:26
  Speaker 1: I just had Dr Gene Schneller on a couple episodes back.
• 31:30
  Speaker 1: He hasn't been posted yet but he says that you know, healthcare doesn't know enough about its operation.
• 31:37
  Speaker 1: When you ask somebody where do you get your IVs from, they won't say, oh, the mini bags are manufactured in Puerto Rico.
• 31:45
  Speaker 1: No, they'll say, oh, we get them from Baxter, we get them from Cardinal, and we have historically left the job of knowing stuff to our distributors.
• 31:59
  Speaker 1: We haven't taken responsibility for it ourselves.
• 32:02
  Speaker 1: And I think that speaks to what you were just talking about.
• 32:05
  Speaker 2: Yeah, no, absolutely.
• 32:12
  Speaker 2: So what do you see as the great challenges looming in the industry?
• 32:14
  Speaker 2: Well, I think I hit on a couple of them right there.
• 32:19
  Speaker 2: As far as, especially with the conservativeness of innovation, I do think one of the biggest challenges and so it's already hitting us is, of course, staffing right, and I think, a big, especially when it comes to support services.
• 32:30
  Speaker 2: I'm obviously speaking from a supply chain still processing, you know, lens and, I think, as costs nationwide and worldwide increase and, as you know, the need for income increases for people, I do think staffing is already being such a strain.
• 32:52
  Speaker 2: So, because staffing is already being such a strain, I think some hospital systems are looking into okay, well, how can we reduce staffing?
• 33:01
  Speaker 2: I don't think that's necessarily the right way to look at it.
• 33:03
  Speaker 2: I think the right way to look at it is a couple ways.
• 33:07
  Speaker 2: It's how can we make staffing more efficient?
• 33:09
  Speaker 2: So that is, how can we make it to where this FTE, this employee, can work more efficiently and make their jobs and lives easier?
• 33:18
  Speaker 2: So you can actually add more staff there and, through innovation, add more staff there.
• 33:27
  Speaker 2: And we, through innovation, through technology, um, but then also right are we?
• 33:29
  Speaker 2: Are we making ourselves competitive in the workplace, in the marketplace, right.
• 33:33
  Speaker 2: Supply chain, you know, when I was, when I was hiring, a lot of the people that I was hiring it was either I can come work for you over at carnal regional or I can go work at the Amazon warehouse down the street, right.
• 33:44
  Speaker 2: And so what are we doing as healthcare supply chain that incentivizes somebody not to work elsewhere?
• 33:53
  Speaker 2: Right, because I think that's really the difference.
• 33:55
  Speaker 2: I mean, I know, when it comes to an OR director looking for a nurse, they're competing against other hospitals, right.
• 34:02
  Speaker 2: If you're a nurse, you're a nurse.
• 34:04
  Speaker 2: You know you're going to work at a hospital or at a healthcare facility somewhere.
• 34:08
  Speaker 2: But when you're a supply chain tech, not only are you competing for supply chain techs across, you know, against other hospitals, you're also competing against the Amazons, the Walmarts, the Targets, the you know the Cardinals, right, and working at a warehouse of a distributor right down the street.
• 34:28
  Speaker 2: And so I think that is a big piece of what are we doing when it comes to healthcare supply chain to incentivize staff and sale processing, for that matter, to incentivize, you know, our staffs to come work here in ways that can be more efficient, that can make your life easier, that can allow you to have that work-life balance that you see that you may not be able to get elsewhere.
• 34:51
  Speaker 1: Yeah, I think that is a big deal, and I think of Amazon, and you're right, I mean, that's who we're competing with in supply chain, but they have brutal work conditions and they have almost unrealistic measurement demands on their people, so that they can't even take a bathroom break.
• 35:11
  Speaker 1: Why would people want to work there instead of in a much more relaxed, collaborative scenario such as a healthcare warehouse or a healthcare distribution center?
• 35:26
  Speaker 1: What is the draw of Amazon?
• 35:28
  Speaker 1: Is it just money?
• 35:30
  Speaker 1: Is it only money?
• 35:32
  Speaker 2: I do think it's primarily money.
• 35:34
  Speaker 2: I think it's also familiarity.
• 35:35
  Speaker 2: Everyone knows Amazon, it's very comfortable.
• 35:38
  Speaker 2: So, even though you have this draining schedule, everybody knows where you work it's you work at, everybody knows where you work.
• 35:47
  Speaker 2: You work at Amazon, you're, it has that brand, that's there.
• 35:50
  Speaker 2: But I mean, let's be real, a lot of it is money, and so what are?
• 35:53
  Speaker 2: And and we know that you can't always outbid the competition you can't always, you know, say, hey, I know Amazon is paying you.
• 36:03
  Speaker 2: You know, 20 plus dollars an hour, depending on your hospital system.
• 36:13
  Speaker 2: You can't always outbid that, and so there's always some soft ways that you can still put your name, I think, out there.
• 36:16
  Speaker 2: And so, if it's, you're not going to always be able to get the tax, that are kind of always going to the highest bidder, but I do think you can get the tax that see the value in, you know, not just chasing the highest, the highest dollar amount.
• 36:29
  Speaker 2: That being said, you know, if I'm choosing between a job that's going to pay me $25 an hour versus the job is going to pay me 15, that's a big gap, yeah Well you know, the outbidding strategy doesn't always work.
• 36:41
  Speaker 1: In Cleveland we outbid everybody and got a $230 million quarterback that can't play and we've turned the Texans into a playoff team.
• 36:50
  Speaker 1: So I mean there's got to be some qualitative stuff as well as quantitative as a Texans fan.
• 36:56
  Speaker 2: I love it.
• 36:57
  Speaker 2: I can't thank the Browns enough.
• 37:00
  Speaker 1: Albert, it has been so great having you on here.
• 37:03
  Speaker 1: One final thing I had to decide which of these two questions I'm going to ask and since you and I both know almost as much about basketball as each other, I'm not going to ask that question.
• 37:16
  Speaker 1: The surprise team in college football, in my opinion, this year has been SMU.
• 37:22
  Speaker 1: Now that payments are legal, everything they did in the eighties would have been okay, but uh, but um.
• 37:28
  Speaker 1: Smu is uh is rolling along with one loss and no losses in the ACC and my alma mater, the U, is.
• 37:37
  Speaker 1: Is uh got to beat Syracuse this week to play in the uh in the uh ACC championship game.
• 37:43
  Speaker 1: A do you think that you will do it?
• 37:45
  Speaker 1: And B who do you think will win?
• 37:48
  Speaker 2: I still.
• 37:49
  Speaker 2: You know I'm a big fan of Cam Ward.
• 37:51
  Speaker 2: I think Cam Ward is the best quarterback in football.
• 37:53
  Speaker 2: I think he'll be the first quarterback chosen in the draft in the NFL.
• 37:57
  Speaker 2: I think he's an incredible talent and when you have a quarterback like that, you can beat anybody.
• 38:03
  Speaker 2: They can play Oregon, I think, and win.
• 38:06
  Speaker 2: The problem that you have with Miami is your defense is a bit atrocious and I went to Texas Tech so I know bad defense when I see it.
• 38:13
  Speaker 2: So that's your biggest problem.
• 38:16
  Speaker 2: As long as you have Cameron Ward, you have the ability to beat anyone.
• 38:20
  Speaker 2: I think with SMU it's funny you said that you think SMU is the best story in football this year.
• 38:25
  Speaker 2: I think Indiana is I like what Indiana's done over there first-year head coach.
• 38:29
  Speaker 2: I think that with SMU my question still comes into are they good or is the ACC questionable?
• 38:37
  Speaker 2: Right Like this is an SMU team that you know.
• 38:41
  Speaker 2: I think they beat Duke in overtime.
• 38:42
  Speaker 2: They lost to BYU right Shout out to the Big 12.
• 38:47
  Speaker 2: They barely beat Nevada.
• 38:50
  Speaker 2: So I look at SMU and I'm like oh are they?
• 38:52
  Speaker 2: Just how good are they?
• 38:54
  Speaker 2: Right, it's a little easier when you're beating the Virginias and the Stanfords and the Florida States of the world.
• 38:59
  Speaker 2: Shout out Florida.
• 39:01
  Speaker 2: A little bit of a shot to Florida State.
• 39:03
  Speaker 2: But I'm curious in a game against Miami, they avoided Miami all year long.
• 39:12
  Speaker 2: Right, miami is going to be the best team they've played all year.
• 39:14
  Speaker 2: I don't know if they will have enough to be able to beat a team like the U, who I do think is the only team in the ACC that's worth anything.
• 39:23
  Speaker 1: Well, I don't know that they're worth that much when you have to beat everybody 45 to 43,.
• 39:29
  Speaker 1: You know that's a statement of its own.
• 39:32
  Speaker 1: Albert, it's been great having you here.
• 39:34
  Speaker 1: You're a great colleague, a good friend.
• 39:37
  Speaker 1: I think I am so happy to have gotten to know you since I've been at St Ange, and thanks for joining us today.
• 39:44
  Speaker 2: Oh no, no doubt, fred.
• 39:46
  Speaker 2: I really appreciate it.
• 39:47
  Speaker 2: It's always a great time talking to you.
• 39:48
  Speaker 2: You deserve.
• 39:50
  Speaker 2: I told you this yesterday, but I'm going to tell it to you again.
• 39:52
  Speaker 2: I think you're one of the the brightest people I know, and you know I.
• 39:57
  Speaker 2: You made it.
• 39:58
  Speaker 2: You made a joke as far as somebody wanting you to be their mentor and that you didn't deserve it, but let me tell you something.
• 40:05
  Speaker 2: I think that, fred, you are one of the brightest minds in healthcare supply chain in general and you deserve all the flowers coming your way.
• 40:16
  Speaker 1: Albert, I'm humbled, buddy.
• 40:18
  Speaker 1: Hey, thanks, dude.
• 40:20
  Speaker 1: Thanks for having me.
• 40:21
  Speaker 1: We'll have you on again sometime, Albert, oh absolutely Anytime.
• 40:25
  Speaker 1: Because you've got the eyeballs in the workplace and that's an important thing.
• 40:28
  Speaker 1: You can bring stories back from the front if you will, and I like that.
• 40:33
  Speaker 1: So thanks for joining us, albert.
• 40:34
  Speaker 1: Have a great holiday season and we'll talk to you soon.
• 40:39
  Speaker 2: Absolutely Talk to you again, Fred Thanks.
• 40:41
  Speaker 2: Take care Bye.