Long, long ago I was a psychology major. It was a compromise (as many of my life decisions are) in that it gave me a flavor of biology, philosophy, statistics, english, religion, and my personal favorite – abnormal behavior – all packaged into one legitimate degree.
My senior year project involved sitting in on group therapy sessions on The 6th Floor, i.e. the psych ward, of a Charlotte hospital. (Remember, this was over 30 years ago, before the advent of SSRI's, SSNRI's, etc., and group therapy was a core treatment strategy.) I had many memorable experiences that semester. Some were good, like the time I snuck two women out of the hospital and took them to Baskin Robbins. Some were very bad, like when a first-time group member – a delightful, gregarious, middle-aged woman – killed herself that night.
My experience on The 6th Floor led me to a lifelong belief, one reinforced by my own shortcomings as well as my observation of others. It was the theme of my semester term paper: "The difference between a normal person and one with a clinically certified neurosis is not a solid line; it is merely a matter of degree." Anyway, there's your thought-to-ponder for the day.
Why this psychological reminiscing? Well, to transition to a story about the supply chain, of course!
Sitting at lunch last week at the IDN Summit meeting in Orlando, I overheard a conversation between two materials folks about what workshop to attend that afternoon: One remarked, "How to Manage Physician Preference Items is a waste of time; every time I try something either administration or the surgeons cut my legs off." The feelings of frustration and defeat were palpable. The comment conjured memories of a behavioral psychology concept (yes, this is my transition and yes, it's a stretch) known as "learned helplessness," a term coined by Dr. Martin Seligman in the late-1960s.
Dr. Seligman ran a research lab at Cornell University and spent much of his time experimenting with lab rats. In one particular and somewhat cruel study, he placed a lab rat in a specially constructed box, repeatedly rang a bell, and followed the sound with a mild electric shock. The rat quickly learned to anticipate the shock when he heard the bell. As you can imagine, the rat would become frantic at the sound, running around his box in a futile attempt to avoid the discomfort.
It took very few rounds of this "bell-plus-shock" routine before the rat's behavior changed. The bell still evoked agitation, but once he resigned himself that he had no control to stop the shock, the rat basically gave up and took it.
This observation led Dr. Seligman to his theory of learned helplessness, a phenomenon that he believed was observable in other species as well, including us humans. Makes sense – I don't know about you, but when I'm faced with a stressor and perceive that I lack any control to resolve or avoid it, I usually suck it up and go with the flow.
Going back to the supply chain managers at my lunch table last week, I suspect they had experienced their own version of the "bell-plus-shock" routine. Like many others in their position, they have been charged with taking control of supply costs in their hospitals but then are met by a barrage of stressors when they try to tackle the high dollar preference items. You work long hours to gather case specific cost data, you work with VA teams to verify clinical equivalency, you present results to the docs and admin, and you get... nowhere. A stressor scenario on steroids and no authority to do a damn thing about it! So you pick yourself up and confine your efforts to the commodity end of the supply spectrum.
I see two lessons here. The first is basically a repeat of my mantra: there are millions of dollars of savings to be realized in the supply chain if CEOs empower the supply chain executives and actively (and publicly) support them with the clinical community.
The second lesson is broader in scope: too many of us accept the existing operational characteristics of the supply chain – business relationships and their pre-defined "balances of power," pricing practices, transparency or lack thereof, software system limitations, timeworn workflow patterns, etc. – as immutable. They are entrenched, but they are not immutable.
We in the provider community need to realize this. Changing these characteristics and asserting control over them is our right, our obligation, and a critical piece of the savings equation. I'd like to discuss some specific cases-in-point in my next several blogs.
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