By Dr. Yasel Costa and Dr. Teresa De la Cruz
The Covid crisis has rightly brought praise for the heroic efforts of doctors and nurses in healthcare organisations (HOs) around the world. But it has also revealed to politicians and the public just some of the logistical challenges that healthcare faces, even in normal times. By coincidence, the virus hit during the final period of the EU’s HELP project, which is intended to improve healthcare logistics efficiency, and therefore productivity, performance, and patient outcomes, through education, and in which ZLC has taken a leading role.
Healthcare is expensive, but most people probably think that most of the cost is in staff, or in headline-catching advances like MRI scanners or wonder drugs. But in fact, research shows that between 30% and 45% of healthcare costs are logistics-related, and also that these costs could in theory be reduced by half. (Interestingly, that seems to apply regardless of the form of ownership or source of funding of HOs).
However, in a world which is not over-supplied with trained logistics people, especially at the expert and managerial levels, such skills are in short supply in HOs. Manager-level courses such as MBAs often only cursorily treat with logistics, while even dedicated logistics training rarely covers ground specific to healthcare.
This matters because healthcare logistics is uniquely challenging, and not just because of its scale and breadth. The inputs to be sourced and managed range from pharmaceuticals to bedsheets, gowns and masks (PPE), scalpels and surgical equipment, and many other items. Often these have short shelf lives, or require temperature controlled storage, and full traceability at batch or item level may be essential. There are non-clinical functions, such as catering for both staff and patients, that require logistics support. And healthcare is not just a logistics of inert items. There is logistics around the flow and movement of patients and staff to, from and within health facilities (with as we are now well aware the need to reduce opportunities for cross-infection); there is the logistics around the movement of biological materials – bloods for transfusions, tissue samples for analysis, organs for transplants; and the logistics of storing, retrieving and moving records, X-ray films and the like.
There are further, over-reaching, challenges. Healthcare, being about individual human beings, does not lend itself well to economies of scale based around standard products and procedures. And partly for this reason, demand forecasting at any useful level of detail is peculiarly difficult.
But there are ways of tackling these issues – they are just not widely known or taught in the healthcare community. This is where HELP comes in.
HELP, or Healthcare logistics Education and Learning Pathway, is a three year project funded from the ERASMUS+ Programme, and co-ordinated from LAB University of Applied Sciences, Finland. The aim has been to develop educational programmes for healthcare logistics, appropriate to various educational levels. ZLC has led the work on the Masters level course.
The two-month course that has been successfully developed and delivered is a MOOC (Massive Open Online Course) which means it is uses innovative mixes of learning aids such as videos and chatrooms to enable students to learn at their own pace, and is scalable – it could in theory be attended by thousands of students in countries across the globe (worldwide availability is a long-term aim).
Extensive preparatory research was carried out with healthcare providers, educational institutions and other stakeholders into the current state of healthcare logistics, understanding of the subject, and education and training provision, across the partner countries. We also looked at the literature for current case study material (and, significantly, didn’t find much, which had implications for the development of course materials). From this was derived a Competence Framework summarising the task based competences needed at various levels (operator, expert, manager) and this was used as the basis for the final structure of study modules, course content and teaching methods.
The Masters course has been designed around two modules – an instructional module delivering the knowledge, competencies and skills required to develop, implement and manage healthcare logistics concepts, and project work developing the competencies and skills required for logistics development and problem solving – this was the area where the lack of published case work was felt, and some creative thinking was required!
Content includes understanding healthcare supply chain and logistics-derived problems; with an overview of healthcare supply chains, what makes healthcare supply chains different, and the challenges, such as those mentioned above, to efficient healthcare logistics.
Resisting the temptation to load the course with too many topics, all highly relevant, the course as delivered covers eight core competencies. A key insight has been the role (or lack of role) of data in healthcare logistics. Like most organisations, HOs have massive data sets, although they may not recognise it or know what to do with it. Given the inherent difficulties in for example forecasting (from minor variations across individual patient cases to unpredicted, if not unpredictable, events such as epidemic outbreaks) and the scale and complexity of transport, warehousing, issuing, tracking and so on, the use of advanced techniques to tease knowledge out from data is imperative. So a major part of the course is around forecasting techniques, analytics, and the potential for machine learning in healthcare supply chains.
The pilot course, originally scheduled to start in March, was like so much delayed by Covid, but was successfully launched in May with students of five nationalities, of heterogenous backgrounds but most already had a Masters degree, and around half were female. End of course feedback was overwhelmingly positive – students were satisfied, felt the content was relevant, and that they had acquired important insights and new skills and competencies. All would recommend it to their colleagues. Of course there were suggestions for improvements, especially in case materials, and these are being addressed for future iterations (enrolment for which is now open). What we had hoped would be an ‘in-person’ wrap-up meeting with students at the end of October will now happen on-line.
Beyond the provision of education, an aim of HELP has been to promote a ‘community’ of healthcare logistics professionals across Europe and globally. We are, for example, identifying ‘guest lecturers’ to talk about topics such as Six Sigma or Theory of Constraints in the healthcare logistics context, and we are also encouraging students and others to share Masters theses and similar work to help inform casework.
For more information on the project, contact the authors at [email protected] or [email protected].
