The profound change in the health sector
The hospital supply chain
Hospital centers (CH, CHU, CHS, etc.) have launched, through several waves (Hospital Plan 2007 then 2012), investment programs in order to optimize their management and reduce expenses while guaranteeing the safety and quality of care. administered to patients. Pharmaceutical logistics represents a significant part of the hospital budget and the savings were eagerly awaited.
In France but also in Europe, the healthcare sector is constantly transforming to adapt to a complex and changing environment. The hospital service environment has experienced multiple changes in recent years:
- growth in health spending,
- Aging of the population,
- integration of increasingly sophisticated and increasingly expensive technologies,
- shortage of nursing staff,…
Furthermore, in most countries, the operating budget granted by the state is increasingly controlled and reduced (in France new pricing for T2A activity, 2007 hospital plan).
In such a context, hospitals must optimize their management. It is therefore interesting to identify the most important cost items to estimate possible gains. A study conducted by LANDRY (2010) for hospitals in various countries (France, Netherlands, Quebec and USA) estimates that hospital logistics expenses represent 30 to 40% of annual hospital costs. Among these logistics costs, the pharmacy alone represents more than half of the expenses and therefore presents interesting earning potential.
We therefore naturally focus on pharmaceutical logistics and the improvements that are made there. We will study whether over the last decade a specialized “hospital” supply chain has been built or whether we are simply witnessing the start of the connected hospital or in other words Hospital 4.0.
Hospital 3.0 already a reality
In order to determine the methods that are applied to the management of the pharmaceutical chain, it is interesting to characterize the health sector as a center of service production and it may be profitable to establish an analogy with the industrial sector in which very much research has been done. Many also consider the hospital as a production center, certainly with important specificities, but sufficiently identical characteristics (the temporary deployment of rare resources to satisfy a critical and partially uncontrollable demand) to apply the techniques resulting from research. operational, techniques widely proven in an industrial environment.
Logistics issues have been extensively addressed in industrial management. However, proportionally few studies focus on these themes in a hospital environment. The legal aspects and constraints of the drug chain, as well as the importance of the human factor, can explain this relative lack of enthusiasm.
However, the comparison shows that the adaptation of industrial techniques to the specificities of the medical world is promising. The early adaptation of just-in-time concepts to supply chain management made it possible to considerably reduce logistics costs, better monitoring of relationships with suppliers and a significant reduction in stocks without altering the quality of care provided to patients. patients.
Likewise, classic inventory management models adapt to the optimization of the hospital pharmacy and make it possible to rationalize flows among them:
- Kanban management called full/empty management in hospital centers,
- pulled flows favored over pushed flows,
To guarantee the performance of the pharmacy supply chain (medication, Sterile or Implantable Medical Devices) within a hospital structure, it is necessary to implement management tools capable of helping managers make decisions at the both fast and efficient.
It is in fact a matter of managing the flow of products whose rupture is extremely problematic and whose consumption is highly variable. This antagonism accentuates the effect bullwhip caused on the one hand by the versatility of demand and on the other hand by the difficulty of implementing consensual management methods.
This problem opens up several avenues of research:
- The possibility of establishing more reliable forecasts of supply needs, anticipating variability factors (seasonality, climate, epidemic, etc.).
- The possibility of defining a real correlation between a history of replenishment needs (of the central pharmacy and care units) and the realities of patient consumption.
- Supply management modeling deployed on the hospital structure to guarantee robust and efficient operation of the entire logistics chain.
Outside of the production environment, these questions are typical of any consideration of an advanced planning solution or what we commonly call a… APS (Advanced Planning and Scheduling Software).
Proposed research direction:
The second aspect in which we wish to focus is that of the implementation of functional decision support tools for managers and capable of taking into account the multi-site and multi-decisional nature of a hospital structure. It is then a question of defining distributed management tools allowing collaborative management guaranteeing optimal overall operation. In industry we call this OM (Order Management). ie where, how, and in what quantity should we best dispose of medications? (Central Pharmacy, PUI Pharmacy for Internal Use, Care Unit, Operating Rooms, etc.)
Finally, the wildest dreams of our Health executives (apart from the Single Patient File, etc.) often concern the following themes:
The integration of seasonal epidemic events and unforeseen climate events,
- The proper use of acquired knowledge and aggregations of molecules (chemical and therapeutic equivalence of ATU drugs).
- The creation of broad consumption benchmarks by typology of the hospital center (DNA of the hospital, type of care service, geographic sector, etc.) in order to generate efficient control towers based on the expertise of our French hospitals.
The scope of study allows us to cite Big (or at least Smart) Data and AI?
New facilities are also appearing:
- Proximity to the consumer (patient) and therefore better knowledge of the need
- A field of study devoid of any pollution due to erratic consumption following the marketing deadline (promotion, black Friday, etc.)
- Reducing the transport problem (delivery round)
TMS does not yet have its place in the hospital environment, or at least not until we approach e-health…
Hospital 4.0 within sight
The reorganization of the logistics supply chain poses numerous technical problems specific to the world of health due to the nature of patient, staff and pharmaceutical product flows.
- The uncertainty of needs (no a priori knowledge of the demand for care and the care manufacturing processes remain specific to each patient and each UF),
- The multiplicity of actors (difficult coordination for decision-making by qualified people with different visions, objectives and interests: pharmacist, logistician, economic and financial manager, doctor and nurse),
- The volume of data to be processed, on average a PUI (Internal Use Pharmacy) manages 6,000 drug references, a CHU group can manage up to 40 PUIs and 700 Care Units,
- The constant presence of uncertainty over the duration of each activity (care, drug consumption) and uncertainty over the continuation of the activities to be carried out,
- Resistance to change (duty of support and training) and respect for the history of an organization which is specific to the company culture,
This apparent pseudo marginality actually shows very similar characteristics to the world of industry and commerce. It’s no longer about the patient but the customer. With the arrival of e-commerce and omnichannel, the world of retail has moved closer to health logistics. The world of AI, Big Data and IoT will naturally benefit the Healthcare Supply Chain.
Moreover, thanks to AI, therapies are already being optimized; a startup TheraPanacea is developing a soon-to-be-marketed tool making it possible to optimize the areas to be treated during radiotherapy while optimizing the dose of radiation.
Do you know, but in the name of AI the largest database which collects all social security reimbursements (20 billion benefits) is churned in all directions, to improve the quality of care reduce costs, and finally accelerate therapeutic trials (echoes of 5/10/2018).
Patient monitoring is one of the most sensitive areas, IoT can keep all its promises. During hospitalization, notifications can be sent to suggest changes in trends in the evolution of vital prognoses, and to act accordingly. The first applications of connected bracelets and textiles are appearing.
So long live Hospital 4.0.
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