The Hospital As a Supply Chain – And Asset Utilisation Should Be Key

Anyone watching the excellent new BBC series on the pressures facing NHS hospitals, featuring St Mary’s in West London, will have been engrossed by the incredibly difficult decisions the doctors have to make. Because of capacity limitations, they are often choosing which of two patients to operate on today, knowing that the one who is not chosen may well die because of the delay. Then their careful  calculations can then be thrown into chaos as an unexpected emergency arises.

I cannot imagine having to make that type of decision, day in, day out. But sometimes it is not just choosing between two patients,  it is being able to do any operation at all. We saw one cancer patient in the BBC programme whose operation was postponed on the day of surgery because the hospital’s intensive care unit (ICU) was full. But that was not just difficult medically; it also struck us that this was in effect a supply chain (or value chain) problem as well, and was also a huge waste of money.

This case created enormous frustration for the surgical team, who spent most of the day hanging around hoping a place in ICU would become available so they could go ahead with the operation. The productivity of the team was appalling that day, and the cost of the team’s time and the operating theatre must have run into many thousands of pounds. In other sections of the programme, we see top surgeons spending their time desperately negotiating to find beds for their patients, rather than using their huge expertise and experience to improve medical outcomes – which is what they are paid to do.

Often, this is because beds are blocked by patients who should really be at home or in care homes, but lack of provision in the social care sector leaves them stuck in hospital. That means there is no space to accommodate those patients who should be having their operations, leading to the surgeons' frustration and poor health outcomes of course.

If we look at this in supply chain terms, you can see how deeply inefficient this is. Going back to my formative days at Mars, the firm was a huge believer in making the most of expensive assets. Factories ran 24 hours a day, 7 days a week, and return on assets was perhaps the key performance measure of the business.

If we had told Mr Mars that the Mars Bar production line was going to shut down for a day because the warehouse was full and there was nowhere to put the production (which was needed by the end consumer), then the explosion from him would have been heard in the next county. Sweating the most expensive and valuable assets was key to the whole business approach.

Yet this is far from the situation in the NHS, if the BBC programme is typical. The most critical and expensive assets – surgeons, operating theatres, expensive equipment – are not being properly utilised because of capacity constraints and bottlenecks further along the supply (value) chain. A top surgeon should be operating all day, every day (within reason) – not spending his or her time as a bed-finder.

The cuts in the social care budget (as well as increasing demand and other factors) have certainly been an issue here and point to real lack of joined up supply chain or systems thinking. We know there are some very good supply chain folk in senior procurement and supply chain roles in NHS Trusts now, perhaps their expertise could be used more widely to take a truly holistic look at these problems of capacity, bottlenecks and blockages in the total system?

Voices (2)

  1. Bob Beveridge:

    This has been a major issue for several years and is getting worse. The figures for delayed transfer of care are published and the link is below. The worst affected area are Hampshire and Southampton, Oxford and Sheffield. This is a scandalous situation as you outlne; hundreds of thousands of operations are cancelled each day, the backlog increasing and morale in the medical community is rock bottom.

    https://www.england.nhs.uk/statistics/statistical-work-areas/delayed-transfers-of-care/

  2. Mark Lainchbury:

    Even Elon Musk or Henry Ford would be stumped.

    This is already a huge trans-atlantic area of study in itself.
    Try googling “Patient flow theory of constraints” but don’t mention it to Roy Lilley unless you have an escape plan ready 🙂

    The science is well understood, so it’s all down to, politics and (ownership of) budgets these days.

    FWIW… Management consultants claiming “expertise” are commanding daily pay rates of multi-£1,000’s but seem to be having little effect, from my experience.

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