When it comes to innovation in healthcare, it is all too easy to lose sight of the progress made and where we have come from. Back in 2014, the Department of Health and Social Care (DHSC) mandated that all NHS trusts in England must adopt GS1. This led to Scan4Safety and, subsequently, the launch of six demonstrator sites to prove its efficiency potential.
In February 2016, the Carter report on operational efficiency in the NHS pointed to a history of chronic underinvestment in inventory control, and the reality that very few trusts were able to demonstrate even basic levels of control or visibility of their stock. The potential for efficiency savings was estimated at £700m – £1bn, in large part based on a 9.5% reduction on the £6.5bn clinical and general supplies and services spend.
In 2018, in a bid to further drive improvements in operational efficiency, cost savings, and clinical outcomes within the NHS, Matt Hancock, Secretary of State for Health and Social Care, announced the availability of £487m in sustainability and transformation partnerships (STP) funding. As a result, many NHS trusts started working towards securing investment to fund STP programmes, including Scan4Safety.
How Scan4Safety Boosts Operational Efficiency
GS1 barcodes as Core Enablers of 5 R Principles
The aims of Scan4Safety are to increase clinical productivity, improve quality outcomes, and reduce risk by placing the five R principles at the centre of operational processes; namely ensuring:
- the right patient,
- is in the right place,
- at the right time,
- with the right process being used, and,
- with the right products.
To achieve these 5 R princples, three different GS1 barcode types form the ‘Core Enablers’ of:
1. Patient Identification – barcodes printed on patient wristbands.
2. Location Identification – whereby each physical location in the hospital, primarily clinical and stock holding areas, has a unique barcode label.
3. Catalogue Management – each individual product used across the trust has a unique barcode.
By using all three Core Enablers in synchrony across a wide range of clinical and non-clinical processes, the trust can build a rich picture of data that can be used to improve patient safety and optimise trust-wide efficiencies. For example, scanning products to patients provides a record of care provided, and scanning a patient to a ward pin-points where a patient is at any one time.
The role of the IMS
The Inventory Management System (IMS) is the missing piece of the jigsaw which stores all stock information and enables the virtual linkage between patient, place and product. As such, without an IMS, there would be no centralised system to compile all scanned data and enable proactive work to identify risks and optimise processes.
Its primary use cases include:
- Product Recall – with the aid of an IMS, it may take less than 30 minutes to find all patients who have interacted with a specific recalled product (this can take days or weeks if undertaken manually).
- Inventory Management – by enabling electronic traceability of products through the supply chain, the volume and location of stock is available in real-time, which in turn enables stock optimisation – e.g. PAR level optimisation or product standardisation.
- Purchase-to-pay – by having a single and centralised platform that interfaces with other systems, including product catalogue, finance and enterprise resource planning, an IMS offers continuity across the trust; this extends to other further use cases that can benefit from Scan4Safety traceability, such asMedical Records, Medical Equipment, Pharmacy, and Pathology Samples, to name but a few.
Beyond the use cases, the benefits of a Scan4Safety IMS include to:
- Release valuable working capital by reducing your overall inventory volume up to 25% through stock optimisation, consolidation, obsolescence and wastage reduction, standardisation, and real-time visibility
- Result in 3 – 5% saving in total operational cost savings
- Provide full clinical confidence in the ability to recall medical products
- Enable patient-level costing calculations
- Reduced clinical overhead to manage stock – thereby freeing up expertise at the front line of patient care
- Reduce the burden of leased assets on the trust’s balance sheet
- Reduce the considerable man-hours needed for stock-taking
- Unlock opportunities to adopt leading supply chain practices such as improved demand and cyclical planning
- Prevention of ‘never events’ and patient safety incidents – ensuring the right product is being used on the right patient (i.e. prevent using the wrong medical implant during surgery), and preventing the use of out of date consumables
- Traceability of implants at batch level – e.g. confidence in data for accurate product recalls
- Drive benefits across pharmacy, pathology, sterile services, foodstuffs and even laundry
Lessons learned in the implementation of IMS solutions
Since 2016, Akeso & Co have provided expert guidance to a number of NHS trusts in England and Wales implementing IMS/Scan4Safety solutions. During this time, we have gained considerable insight into the approach necessary to achieve a successful outcome, including as follows:
1. Take the time to understand solution requirements and align these with solution capabilities
Modern hospitals are highly complex operating environments; as such, it is essential to make sure the scope of the IMS is clear from the outset. There are many factors which must be understood in each service, department or function which the IMS will be utilised, including, but not limited to:
- Criticality of product availability
- Speed of product consumption
- Operating hours of the department
- Access for delivery
- Availability of space for stock
- Priorities and risks
- When, how, where will products be used
Each of these criteria should inform how you segment your supply as not all products will be handled in the same way, e.g. products that are high volume but low-value items (e.g. clinical examination gloves or aprons) may require a different strategy to low volume but high-value products (e.g. orthopaedic implants).
When it comes to selecting a system which meets your needs, remember, not all IMS systems are created equal; e.g. only some solutions provide patient-level costings – the ability to attribute costs of a particular case, be it an outpatient clinic appointment or a full surgical procedure, to a given patient – which is now a base requirement for many NHS trusts.
Many trusts avoid or neglect to complete this scoping stage thoroughly, leading to lack of buy-in and engagement as the project progresses. Thorough analysis at this stage will put your IMS on solid foundations.
2. Focus on the whole solution, not just the system
Remember, an IMS is far more than just an IT investment. A universal observation we have made all too often is that IMSs are seen as being a standalone technology solution – but don’t let the word ‘system’ detract from the need to consider how people and organisations, processes, physical and non-physical resources, and software and hardware will interact.
3. Importance of stakeholder involvement at all levels
During our work with NHS trusts, we have observed at first hand the value of sowing the seeds of change with clinical and non-clinical staff members to gain buy-in and engagement. This is not an overnight process. To gain the trust and ears of key staff members requires time to gain credibility and share ideas. It is also likely staff members have heard many such promises in the past which were never delivered on, perhaps due to budgetary constraints, or changes in management focus. This means that it will be all the more important to demonstrate that the intention to deliver a Scan4Safety IMS is real, budgeted, resourced, bought in to by senior trust members, and based on real success in other trusts. Arranging a site visit to a trust hospital which has already achieved the successful implementation of Scan4Safety can go a long way to showing intent and providing inspiration.
4. Governance is crucial
The importance of implementing a dedicated programme governance board from the outset cannot be overstated. The role of the programme board is to make clear decisions and act as a steering body throughout the project and beyond.
Effective project management, risk management, and training is vital to ensuring a smooth transition to the new solution. Planning must reflect the realities of modern hospital operations, e.g. there are large numbers of staff working in a range of different shift patterns.
5. Delivery of IMS solution is only the start
Following implementation, solution evolution is then key. Evolution is about looking for opportunities to bring the IMS into alignment with other transformation initiatives such as the model hospital, patient-level costing, and Getting It Right First Time (GIRFT).
With a robust and fit for purpose IMS, the maturity level of your supply chain will increase, as will the gains you realise and the incremental opportunities that can be unlocked when processes are integrated across functions.
Have expected benefits been realised in demonstrator sites?
Recurring non-pay benefits
Based on Akeso&Co’s analysis of the top six Scan4Safety solution providers as of February 2019, inventory management capability is offered as standard across all solutions, with the exception of one, and four of the six main providers have also extended their solution to offer patient-level costing capability.
This trend in the market reflects the need of NHS trusts to demonstrate value-for-money when implementing a solution of this nature, beyond the improvement in inventory management processes. Solution providers typically list the incremental benefits delivered by patient-level costing as:
- Increased product standardisation – enabled by analysis of usage by procedure and surgeon
- Renegotiation of tariff rates to reflect actual procedure costs – enabled by capturing full procedure costs and using this in negotiations with commissioners
- Release in clinical time spent manually capturing data – enabled through automated scanning process
- Reduced time to re-call product – enabled by automated reporting, by product, by patient
Recurring efficiency benefits
Another key benefit identified through Scan4Safety was the release of nursing time back to patient care, stated as the equivalent of 16 band five nurses per trust, or 2,400 across the NHS, in the most recent GS1 figures. Trusts that have implemented IMS have released band 5 nursing roles at a faster rate than those without IMS, but the overall national level is trending downwards. Clearly, the change in the number of nursing roles over this period cannot be solely attributed to the existence of an inventory management system, and many other factors such as vacancy rates, service consolidation and changes in the primary care model will be influencing these figures.
One-off non-pay benefits
Trusts with an IMS have seen their medical supplies spend grow by 3% from FY16/17 to FY17/18 on average, but managed to reduce their inventory by 1% in the same period. Conversely, trusts without IMS have seen a 2% growth in spend, but a 4% growth in inventory, worth £19m in financial terms. To achieve the £216m inventory reduction target, acute NHS trusts will need to reduce their overall inventory stock cover to around 21 days, which although ambitious, is certainly achievable in the medium to longer-term given the 17.8 days currently held for pharmaceuticals.
Final words
So far, Scan4Safety has had a moderately positive impact on the operational efficiency of trusts that have implemented Inventory Management Solutions. There is clearly a long way to go before the programme can be described as a complete success, and the level of compliance at the end of 2020 will ultimately be perceived as the most important measure for the DHSC. By learning from those NHS hospitals which have achieved the best results, we will be able to increase further the efficiency gains made. Experience from prior learning is essential to achieving success; let us show you how.
Akeso & Company (Akeso&Co) have worked with over 40 NHS trusts in England on inventory and supply chain initiatives; at all stages from determining strategy and business case development, to implementation, operations, and ongoing improvements.
For more information, please call Scott Healy on 020 3011 1381 or email scott.healy@akesoco.com.
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