Delivery Failures and Nursing Burden (Part 1): It’s Worse Than You Think

This is Part 1 of a series on nursing burdens. In the follow-up piece, 4sight Health’s David W. Johnson and Medspeed’s Jake Crampton talk about ways advanced logistics help suppliers embrace a higher per-unit cost to optimize efficiency and enhance unit quality. Read Part 2 here.

Breaking Bad

Last December, winter storm Elliott wreaked havoc with holiday travel. While other major airlines major airlines were back up and running within days, Southwest Airlines cancelled over half its flights between December 21st and 29th. Southwest’s cancellations stranded customers, angered employees and dented its reputation. Financially, Southwest estimates its operational meltdown has cost the airline more than a $1 billion.

What went wrong? Southwest’s point-to-point operating model has less resilience than the hub-and-spoke models that other major airlines employ. Unlike point-to-point models, hub-and-spoke models concentrate employees and equipment in their hub locations. This built-in redundancy speeds system-wide recovery. Southwest’s dated technology platform and its inability to reconfigure flight schedules and crews compounded its logistical challenges.

Supported by big data, predictive analytics and enhanced communications, complex systems create efficiencies and offer customer benefits that previous generations of managers could scarcely imagine.

Here’s the rub. Small failures often compound within complex systems. Even minor glitches can become tipping points that trigger operational calamity.

Healthcare, We Have a Problem

Healthcare is wrestling with major logistical and financial challenges related to clinical staffing. Providers are throwing money and bodies at the problem to ease the burden that the current system imposes on nurses and other frontline caregivers. Seemingly minor failures that happen consistently increase burden, deplete morale and erode trust among hardworking employees. This type of logistical failure is acute in healthcare.

Surprisingly, a nationwide survey conducted by the American Nurse Journal (the official publication of the American Nurses Association) found that courier errors are the source of significant operational disruption and related caregiver distress. Delivery failures are textbook examples of the detrimental impact that accumulating minor failures can have on operational efficiency and employee morale.

Trent Green, Legacy Health’s former Chief Operating Officer, noted that “healthcare supply chain operations are remarkably complex due to the multiple actors requiring lots of different inputs in numerous locations in real time.” Janice Walker, Baylor Scott & White Health’s Chief Nursing Executive, echoed Green in emphasizing the complexity of healthcare logistics, “It (delivery of medical supplies) intermingles supply chain, procurement and PAR (Periodic Automatic Replenishment) of regularly used items.”

With the scale, complexity and interconnectivity of actions woven into healthcare supply-chain logistics, errors happen with alarming frequency. Among the 353 responses to the American Nurse Journal survey, here are the most eyepopping findings.

• 87% of nurses surveyed said that medical courier deliveries, or lack thereof, have a negative impact on their work weekly.
• 71% indicate that a medical courier delay or error impedes their ability to provide effective patient care at least once a month; 19% said that errors and/or delays impede patient care five or more times per month.
• 65% had to collect another patient specimen or sample in the past year due to courier delay or error.
• 56% of nurses had to reschedule a patient procedure in the past year because of courier delays or errors.

“So, I think what happens is that courier errors can be one of the proverbial things that break the camel’s back. They’re additive to the mounting frustrations that our nurses are experiencing,” commented Legacy’s Green.

Additional survey findings related to courier errors addressed cumbersome rescheduling, nurses personally transporting items and re-collections of specimens from patients. Green added, “We have a system that impacts nurses’ ability to do their job, that creates safety risks for them and their patients… We realize, unfortunately, that our nurses are pros at day-to-day workarounds.”

Too many courier delays and errors create unnecessary stress, distract from vital patient care, while increasing waste and duplicating effort. The anecdotal refences captured by the survey reflect the chaotic impact of delivery failures. Here are a few telling comments.

Our facility had to cancel and reschedule several cataract surgeries because a specific courier had delays getting the lens implants to our facility in a timely manner.

We don’t have a courier service. We must take a nurse away from patient care to take STAT labs to the hospital or go to a local pharmacy to purchase medications we don’t carry. This significantly impacts our patient care.

Vaccines left on a loading dock over the weekend. Stock spoiled.

One surgery was pushed back and numerous redraws were required.

The worst was when a platelet transfusion was needed for my patient and was delayed which resulted in great loss.

Collectively, these anecdotal comments paint a disturbing picture of how courier failures make challenging work environments even more chaotic. Such failures needlessly compromise customer service and institutional well-being. The survey’s findings astonished Legacy’s Green, “What was surprising to me is that 71% of respondents said that courier delays or mistakes impact their ability to provide appropriate care.”

Both Legacy and BS&W employ intricate escalation processes when operational problems emerge. Perhaps that is why neither Green nor Walker thought the issues of delivery error and delay would be high on the list of problems that contribute to increasing nursing burden, although so many respondents did. Both leaders emphasized workload, turnover and constantly changing care teams as other key factors causing nurse burnout.

Where There’s Smoke, There’s Hope

Despite the lack of attention they receive, medical delivery failures impede the quadruple aim goals of better care outcomes, lower care costs, better patient experience and better caregiver experience. Their cumulative and compounding effect takes a bad situation and makes it worse.

“We’re trying to solve problems at their roots by eliminating waste and redundancy while improving both patient and employee safety and satisfaction,” remarked Legacy’s Green.

Lowest unit-cost solutions (i.e., payment per mile driven or number of stops) are inefficient and error-prone. They increase total costs and compromise quality. The best systems are those that prevent errors from occurring in the first place. They build trust, improve productivity and increase employee morale.

We know from decades of work on performance improvement that eliminating waste is the key to both lowering costs and improving quality. This logic applies to improving the reliability and cost-effectiveness of medical courier services.

We will turn our attention to how medical courier services can improve reliability and cost-effectiveness in Part 2 of this series.