OU Health's supply chain team has very low turnover.
Editor’s note: This article appears in the July-September 2023 edition of HealthLeaders magazine.
OU Health has achieved low turnover in the health system's supply chain team by hiring the right leaders as well as having clear roles and responsibilities, says Josh Bakelaar, MBA, vice president of supply chain.
Bakelaar has been vice president of supply chain at OU Health since May 2020. His prior experience includes serving as system director of strategic sourcing for UW Medicine.
HealthLeaders recently talked with Bakelaar about a range of issues, including the challenges of leading supply chain at OU Health, lessons learned during the coronavirus pandemic, and the role of physicians in the OU Health supply chain. The following transcript of that conversation has been lightly edited for clarity and brevity.
HealthLeaders: What are the primary challenges of serving as vice president of supply chain at OU Health?
Josh Bakelaar: I have been here about three years, and one of the biggest challenges is that our supply chain team had lots of opportunities for improvement. I have addressed three things. The first focus was governance. Our hospitals were functioning pretty independently in their decision making around supply chain. We had centralized services, but a lot of the decision making was happening at the site level as opposed to the system level. We addressed that so we could realize economies of scale and other benefits of being a health system.
Second, there was a lot of tribal knowledge around our processes. We didn't have a lot of documentation. So, there were many opportunities to close gaps around processes and efficiencies.
Third, there was a leadership and talent gap. Our hospitals were largely making independent decisions—they each had individual supply chain leaders. Plus, we had an off-site warehouse that had a different leader. There was not a singular guiding force across all of our supply chain teams strategically.
HL: How did you improve leadership across the supply chain?
Bakelaar: It was mainly redesigning the org chart. When we divested from HCA about five years ago, one of the things that was apparent to me coming in was that a lot of the central back-office functions just did not exist as part of OU Health. We did not have a complete supply chain. For example, we did not have inventory control. We only had a couple of contracting people and one value analysis person. There were limited informatics capabilities. We had to scale up and build out an end-to-end supply chain team.
Josh Bakelaar, MBA, vice president of supply chain at OU Health. Photo courtesy of OU Health.
HL: You became vice president of supply chain at OU Health during the beginning of the pandemic. What were the primary lessons you learned from leading the health system's supply chain during the pandemic?
Bakelaar: I started here in May 2020, a couple of months after the pandemic hit the United States, but it had not hit Oklahoma yet. What I learned was the importance of good supply chain leadership. We had to have a good governance structure in place around how decisions were made. You need to have clear roles and responsibilities. Sometimes, a disaster hits and there is scrambling to figure out who is going to do what. Having that ironed out ahead of time is valuable.
Remote working was an issue. Right now, there is a debate in this country about the feasibility of working remotely. When I started at OU Health and came in for my first day, there were only about three or four people in our supply chain office. Everyone else was working from home. I came into the office every day for many months, got to learn the operation but I also had to build a lot of relationships on Zoom and Teams.
Over the past three years, we have built our team in a largely hybrid and remote environment. Our purchasing team is classified as remote. Our informatics team is classified as remote—the director of that team lives in Florida. Our sourcing team is classified as hybrid—they work remote most of the time. With all of this remote work, we have thrived.
You have to have good documented processes for backorders and substitutions. Early on in the pandemic, personal protective equipment was not available but everything else was fine. Eventually, multiple suppliers started making PPE, and we had it coming out of our ears but we were running out of other supplies. So, going into the pandemic, it would have been better for us to have more documentation of the backorder and substitution processes.
HL: What have been the keys to success in having so many people working remotely?
Bakelaar: Leadership is critical. You need to have the right people in the right seats with the right mentality of how to manage people in the work environment. We round on our people regularly. For the people who report directly to me, we talk informally several times per day. We call each other on Teams. We put a lot of emphasis on having the camera on and being engaged as if you are working in person. We communicate informally but intentionally.
We make sure we are hearing from our teams—what's making them happy and what's not. We look for opportunities for improvement. Our turnover is really low.
HL: Why do you think you have low turnover in your staff?
Bakelaar: I have heard the phrase that people don't quit their jobs, they quit their bosses. I believe strongly in hiring the right leaders, getting them the right seats, and having clear roles and responsibilities. We also have done a tremendous amount of work around process discipline and process documentation. The expectation on our team is that we all get on the same page about what a process is, and we stick to it.
I have worked in supply chains where not everybody was on the same page, or there were different priorities. We have been intentional about removing things that are frustrating. We are accountable to creating a positive work environment.
HL: How does your group purchasing organization function?
Bakelaar: Vizient is our GPO, and there are several areas of benefits in working with them. First is cost savings. We have partnered with them and implemented cost savings over the past couple of years.
Vizient describes themselves as a performance improvement company, so they look beyond just the traditional GPO supply chain functions. They work on quality with their databases as well as patient safety. We are partnering with them to tackle catheter-associated urinary tract infection and central line-associated bloodstream infection reductions. We are tackling patient safety issues and clinical documentation improvement.
We use Vizient to help solve some of our governance challenges. They helped us get some governance models created around the supply chain function.
HL: How do you engage physicians in the supply chain?
Bakelaar: Physicians played a key role in the governance work that we did with Vizient. We set up some service line clinician-led groups. These service line groups meet monthly. Supply chain will facilitate the conversation, but, ultimately, we look to our physicians and clinicians to make data-informed decisions around the supplies we are going to contract for. At any given meeting, we might talk about some new products that are coming to market. Most meetings focus on looking at our portfolio of contracted products and making strategic decisions that maximize cost, quality, and outcomes for our patients.
HL: Your background includes experience in strategic sourcing and inventory control. How did this background help to prepare you to serve as a supply chain leader?
Bakelaar: I have come up through the ranks. I started in healthcare supply chain soon after high school. So, I have been doing this work for a long time. I have done many of the frontline jobs such as supply chain technician work, ordering, and receiving. I moved up through different management positions along the way. This experience has allowed me to lead with a lot of empathy when it comes to my team—I can put myself in their shoes.
When I round on the team and hear the frustrations that they have, it takes me back to when I was in their shoes doing that work. I make sure frustrations get fixed.
I have worked in supply chains where the senior leadership said "yes" to everything that came their way. That created pressures, and workload management issues would arise. What I try to do as a supply chain leader is to be mindful and protect my team along the way. If an executive asks me whether we can do something, I don't just say "yes." I say we can do it, but I may say that we will need more resources, or we may need to slow down another process. I am mindful to make sure that we are not over-promising and under-delivering. I am mindful to make sure we are not putting too much on our plate and stressing our folks.
Christopher Cheney is the senior clinical care editor at HealthLeaders.
One of the first challenges OU Health's vice president of supply chain addressed was to ensure decision making was occurring at the system level instead of the hospital level.
At OU Health, supply chain lessons learned during the coronavirus pandemic include the importance of good leadership and adapting to remote work.
The health system incorporates physicians in the supply chain by enlisting them to serve on service line clinician-led groups.