Chapter 11: Read and watch the video for the case Resource Planning at Cleveland Clinic on pages 507-508 of the textbook and provide your answers to the following questions (about 300-400 words total).

- Explain how the concepts of dependent demand and bills of resources are being used at the Cleveland Clinic. Using Heparin IV flushes as an example, how do these concepts support Cleveland Clinics Patient First focus?

- What might be risked if the supply chain organization is not fully aligned with the entire spectrum of managing dependent demand for a patient from pre-operative care to discharge?

Chapter 11: Resource Planning RESOURCE PLANNING CHAPTER 11507 VIDEO CASE Resource Planning at Cleveland Clinic Founded in 1921 by four physicians with a mission to provide better care for the sick, investigate patient problems, and further educate those who serve, Cleveland Clinic is one of the world's most respected healthcare organizations, offering patients access to its world-renowned healthcare specialists at multiple locations globally. At Cleveland Clinic, the focus is on putting "Patients First." This means a patient experience that includes safe care, high value care, high quality care, and patient satisfaction. The effort has not gone unnoticed. For 26 consecutive years, U.S. News and World Report has recognized Cleveland Clinic as \#1 in cardiology and heart surgery, with an additional 13 specialties ranked in the Top Ten. According to its website, to deliver on this "patient-centric" promise requires more than world-class clinical care-it requires "care that addresses every aspect of a patient's encounter with Cleveland Clinic, including the patient's physical comfort, as well as their educational, emotional, and spiritual needs." Cleveland Clinic was the first major academic medical center to make patient experience a strategic goal, appoint a Chief Experience Officer, and establish an Office of Patient Experience. 6 Each patient at the Clinic generates a demand for activities and supplies used in the hospital, which we term dependent demand. To support its patient centric approach, Cleveland Clinic's Supply Chain and Patient Support Services team has been on a journey of establishing a foundation of strategic sourcing that places emphasis on understanding this dependent demand and how to fulfill it to maximize patient outcomes. This journey is supported by an innova- from pre-operative through to patient discharge. As the nursing staff remove Heparin flushes from the supply carts, the on- The Cleveland Clinic performs a large number of complicated surgeries hand inventory is reduced or even depleted. If a floor has multiple patients on IV and procedures on a daily basis. Each of them has its own set of required and port catheters, the demand for the Heparin flush will increase. If the medical resources that are much too voluminous to mention here, but include floor has very few patients on IVs, the Hepanin flush usage is reduced. The future assorted material supplies, operating rooms, recovery rooms, nurses, estimates of patients requiring IVs is important in keeping enough Heparin in stock. doctors, and support personnel among others. The timing and quantity This process is repeated for hundreds of items that are required to needed of a given resource is aggregated across each patient's specific deliver daily therapies for a patient. Each of the supplies has its own pattern type of surgery or procedure and their associated schedules. Cleveland of usage. The Supply Chain organization has to understand all the dependent Clinic thus manages dependent demand by focusing on the specific needs demand patterns from the patient that drive the need for supplies at the of each patient and then working backward through each level of care internal supply locations and then to the external vendors and manufacturers. similar to the bill of resources depicted in Figure 11.21. Resource planning This "Patient-Centric Supply Chain" is responsive to the demand pull of a at Cleveland Clinic ensures that all services, supplies, and staff necessary nurse retrieving items required to administer a prescribed therapy. The goal for the proper care of a given patient at different stages of care are available of "patient first" drives the physical flow of items to come through the supply at the time needed. chain process, starting at the receiving dock (operations) and moving through A simplified example of this resource planning approach can be seen in the hospital's various supply locations to the supply carts, and eventually to the workflow for how the nursing staff handles flushing intravenous tubing lines the nurses and patients. (IVs) with medicine to keep them from becoming blocked. The daily demand Historically, point-of-care supply locations in hospitals were always manfor IV usage is driven by the aggregated number of surgeries and procedures aged by nurses. Surgical and procedural areas limited access to those areas scheduled each day. Following Cleveland Clinic's Clinical Care protocols for and a physical "Red Line" was often painted on the floor designating it as a patient care, a nurse is required to flush an IV line with the drug Heparin to "Staff Only" area. Supplies used behind the Red Line were always considered prevent the tubing from being blocked. To physically complete this protocol, too unique and complex to be managed by a logistics organization that was the nurse retrieves a pre-filled Heparin flush syringe from a supply cart, usually mostly focused on lower cost, high velocity common items such as bedpans, inside or close to the patient room. This action is performed multiple times a gloves, sponges, gauze, needles, syringes, bandages, and Heparin flushes. day for every patient on the nursing floor that has an intravenous line or port. The Supply Chain organization would previously service the needs of Surgical At some point in the day, the nurses need to replenish that drawer with the and Procedural areas by processing the departmental supply requests and pre-filled Heparin flush syringes. These supplies are stocked in a nearby supply delivering requested items to drop off locations, largely staying outside of the Iocation managed by the Supply Chain organization, which requires notification patient care work streams behind the red lines. But all that changed with the Chapter 11: Resource Planning