A ‘credentialing’ system at Leeds Teaching Hospital means the trust can now keep better tabs on sales reps and other people with access to wards, writes Nosmot Gbadamosi
“There is nothing that’s happening in Leeds that isn’t happening anywhere else”, surmises Tony Whitfield, finance director at Leeds Teaching Hospital.
His response follows HSJ’s questions about Lord Carter’s review, which cites the 650 medical sales representatives targeting the hospital, with 65 on site at any one time.
“Those sales forces not only have a big influence on choices made – they also have big costs that in the end we pay for,” the review said. It went further: The “proliferation of sales representatives selling in the NHS is a huge cost which neither the NHS nor its suppliers want or need if alternative models of doing business could be developed”.
Leeds is hardly the first trust to face problems in the way medical companies sell and market to its clinicians. Carter called the situation a huge challenge.
“In some ways,” Mr Whitfield reflects, “clinicians often had to look to reps to give them support in a way that they couldn’t look to management to do. However, I think it creates an unhealthy supplier-employee relationship”.
’For all the right and wrong reasons as a customer it’s nice to know what they are up to, where they are going and what are they seeing?’
While the number of reps competing on its site may not be exceptional, what is unique to Leeds is the reason such a number could be quantified. The hospital had installed a cloud based credentialing system as part of investment in its supply chain management.
The idea came from a best practice procurement visit to University Hospital of Massachusetts. Upon entering the site, they were asked to sign into its credentialing system. Credentialing allowed the hospital to control certain access points from people representing suppliers or potential suppliers. The Leeds group became instantly fascinated.
Cat and mouse
“We’d actually been to look at RFID technology in inventory; that was the purpose of the visit,” recalls Chris Slater, the trust’s head of supplies and procurement, “but whilst we were there, we picked up on the fact that there are these kiosks, when you went into the main hospital for medical device representatives to effectively log in at the start of their visit”.
“We started getting very interested in how that might work within our hospitals”, he adds. Leeds subsequently became the first UK trust to implement the system, in April 2014.
“Chris and many other supply and procurement leaders spend their lives trying to play a game of cat and mouse with reps who know that the key relationship is with the clinicians and not with Chris and we are saying that can’t be a healthy, sensible way to do business”, says Mr Whitfield.
“I’ve never been in an environment where representatives had freer access to the organisation as they do when they come into the NHS,” agrees Mr Slater, whose career began in the British coal industry and subsequently led to him being head of supply and contracts, at Selby Coalfield.
“For all the right and wrong reasons as a customer it’s nice to know what they are up to, where they are going and what are they seeing? If we are seeing an increase in activity from one particular supplier, it allows us to go back and understand or ask why is that happening?
“The first we used to know about it was the presentation of an invoice, for works, goods, and services carried out”.
The system now allows the trust to pick up early warning signs that “supplier A or supplier B are targeting Leeds in a particular area and this allow us to go out and talk to staff and clinicians”, he says.
’Chris and many other supply and procurement leaders spend their lives trying to play a game of cat and mouse with reps who know that the key relationship is with the clinicians’
Although not its original intention, the system has contributed in some way to patient safety.
“For us, the other thing that was happening in Leeds at the time,” notes Mr Whitfield “was [the] Jimmy Savile [scandal]”.
“One of the criticisms of hospitals was that it’s hard to know who’s on the premises and what they are doing at any one time. Again it’s all part of that kind of credentialing of people so that we can be more certain that they are there with legitimate purpose,” he explains.
Recommendations given by the inquiry into abuse carried out by Jimmy Savile at Leeds General Infirmary, Broadmoor Hospital and Stoke Mandeville Hospital was that organisations should try to “reduce opportunities for those without legitimate reasons from gaining access to wards and other clinical areas”.
“There’s a whole host of information that sits about the individual in the background to [the system]” explains Chris. “If they are going to a children’s ward, have they been through all the necessary checks and CRBs,” he adds, explaining “if they’re not approved to go on a children’s ward and that’s where they are going we would know about it”.
Mr Slater explains it’s also to track “and to make sure the individual coming through the door is the person they say they are and that they understand some of the protocols of Leeds Teaching Hospital”.
It works by both supplier and representative registering information on the type of access they need and relevant documentation; for example those going into theatre will have been through a theatre access course and have had all the right immunisations.
“The overall review is paying attention to the detail of how you run your organisation on a day to day basis”. While the start of the journey was trying to understand its supply chain, the end result is overall financial management.
“Where we have electronic rotas – are we optimising those? Have we put the right level of management support into those?” These are the sorts of questions Leeds is now asking itself, says Mr Slater.
“We’ve now got a situation where 380 wards, departments and theatres have a dedicated materials management system and person across the whole organisation”, says Mr Whitfield. “It doesn’t matter which hospital you are in within Leeds, you will be materially managed for what we would classify as stock item”.
’This has been an organic growth through minimum investment and probably through enthusiasm’
Next on its agenda is full monitoring of its inventory control through GS1 validation. The trust is working with the Department of Health in becoming one of its exemplar sites for GS1 and global location identification within the NHS.
Hunt announced an investment of £12m in “electronic procurement systems” at six trusts, which includes Derby, Salisbury, North Tees, Cornwall, and Plymouth. It is hoped the system will see every product given a barcode.
Since 1999, Leeds has already barcoded 3,000 of its consumables items throughout cardiology, radiology, orthopaedic and trauma. To date in 2015 it now has 6,000 stock keeping units.
What the trust aims to achieve is full tracking of inventory and patient interventions throughout its hospital wards – thereby integrating its patient administration system with its stock control system.
“This has been an organic growth through minimum investment and probably through enthusiasm,” says Mr Slater.
On the cheap
He believes the NHS is still lagging behind in understanding the importance and impact that supply chain and procurement can have on its bottom line.
Both are candid in admitting the investments made are unlikely to lead to colossal financial savings. “The backdrop is Leeds Teaching Hospital is one of the TDA trusts in a significant amount of financial distress,” admits Mr Whitfield, “it would be easy to say well if you were so successful why have you ended up with some of the problems that you have had?”.
“The GS1 project in its own right is unlikely to save money,” maintains Mr Whitfield. “We don’t expect it to. What we expect it to be able to do is to enable a whole pile of other things to then happen in a much more planned, appropriate way that will create the financial returns that you expect me as financial director to want.”
“We are not trying to get clinicians to work on the cheap,” insists Mr Whitfield, “but we are asking them to pay attention to the appropriateness of the cost of what they are using”.