Physicians and Nurses Pivotal in Yale New Haven Health's Supply Chain

The health system employs physicians as supply chain medical directors and nurses as value analysis nurses.

Physicians and nurses play a formal role in supply chain at Yale New Haven Health.

At health systems and hospitals, supply chain departments play a gatekeeper role in the acquisition of medical devices and supplies, particularly for new products. Physicians and nurses can play formal or informal roles in this decision-making.

Lorraine Lee, MHA, is senior vice president of clinical operations at Yale New Haven Health, and she formalized the role of physicians and nurses in supply chain at the New Haven, Connecticut-based health system. "I have been responsible for supply chain for four years. When I got there, there was no infrastructure within supply chain to have doctors and nurses be part of the department. That's something we started right away," she says.

Physicians and nurses play key roles in the health system's supply chain department, Lee says. "I have a medical director and an associate medical director who are doctors and work for the supply chain department. I also employ nurses, many of whom have worked in operating rooms, critical care, and the emergency department. Those are usually the types of physicians and nurses we like to have involved in supply chain because they are used to devices and using medical supplies—they have worked in procedural areas or surgery."

The medical directors have backgrounds in emergency medicine and anesthesiology.

Lee says she looks for communication skills, authenticity, and transparency for doctors to fill the medical director roles. "They need to be someone who can be approachable by the physicians they have to deal with. They are often the ones who are trying to figure out whether a device or medical supply is the right one to have, so they have to ask questions and be approachable. They have to be able to talk with all levels of physician staff, from training physicians all the way up to chairmen of departments. They need to be able to understand where the requesting physician is coming from."

The eight nurses who work in the supply chain department as value analysis nurses all have extensive clinical experience, she says. "Most of my nurses have worked as nurses for 15 to 20 years at the bedside. So, they have seen it all. They know how to use medical supplies and devices. They understand procedures. The more we can hire nurses with that kind of background the better because a surgical nurse, an emergency department nurse, or a nurse who has worked in the diagnostic cath lab can understand supplies."

Doctors and nurses play formal role in supply chain decisions

The medical directors and value analysis nurses work collectively as a team, Lee says.

"They review our formulary of medical supplies. Due to supply chain backorders, they look at things that we cannot get in, which happens as many as hundreds of times a day. They find out what we can use instead, what is safe for the patients, and what is good for the caregivers to use. They do a lot of backorder management or outage management for supplies. They also review all new requests. So, if a new surgeon joins our health system and wants to use a new device or a new supply that we do not have on our formulary, they review the request. They review for safety profile, for how well it works in other places, and other information they can get about it."

After new requests have been reviewed, they are submitted to a physician forum—the Clinical Governance Committee—that meets monthly to decide whether requests for new devices and supplies are approved, she says.

"The Clinical Governance Committee is a group of physicians from across our health system in all of the specialties. They congregate once a month, and supply chain manages the agenda and recommendations for new things to be added to the formulary. We make presentations to this group of physicians for a vote. For new products, there are several considerations at this meeting. For example, is it a new and enhanced supply that will help our patients or is it just like the supply that we have and does not offer any advantage?"

Doctors and nurses generate benefits in supply chain roles

Having physicians and nurses working in formal supply chain roles establishes credibility for the department, Lee says. "The biggest win is that we consider ourselves to be a clinically integrated supply chain. The broader view is that supply chain is not making decisions about supplies and devices based on cost alone. We are bringing in the right devices or supplies for patient care. People believe in that because we have physicians and nurses helping to make the decisions."

Physicians and nurses have backgrounds that help them perform admirably in supply chain departments, she says. "Physicians and nurses are vastly experienced in reading medical literature and understanding the pros and cons of a new therapy or a new device. So, they are able to look at decisions with a medical eye and use evidence-based medicine in their review of products."

Physicians and nurses can also play a role in staff development, Lee says. "They can teach—they teach members of my staff who are not clinical. We have people who work in contracting or on the procurement staff who tend to not have a clinician background, and it is beneficial for them to learn from physicians and nurses."

Related: Physicians Can Play Formal, Informal Roles in Healthcare Supply Chain