Alan Weintraub, Chief Procurement Officer/Director of Support Services
Enloe Medical Center, Chico, CA
The following interview was conducted by Robert W. Yokl, Managing Editor, Healthcare Value Analysis Magazine
Allan Weintraub is a 30-year supply chain veteran who is Chief Procurement officer and Director of Support Services for a multi-facility system serving a six-county region in Northern California. Allan is past president and board member of the California Association of Healthcare Purchasing and Materials Management.
(HVAM) How did you get into value analysis?
(AW) I think it was an evolution born out of my passion for decision-making models, but certainly influenced by the works of Miles, Deming and Yokl. I was interested in better ways to make capital and consumable technology decisions than old product standardization committees could offer. I saw technology purchases merely as an input that needed to be evaluated by its effect on quality and outcomes. I felt value analysis offered a more suitable method to consider technology purchase decisions. From there, it became about crafting a model for a program that fit within the organization's culture.
(HVAM) When you first started planning your value analysis program, what was your vision of how value analysis should operate at Enloe Medical Center? Was it a steep learning curve for you and your organization?
(AW) Those who were around at that time will likely tell you that I was passionately committed to certain characteristics that I felt the program must possess to be effective, evidence-based, collaborative decision-making, an emphasis on determining what technology is functionally necessary to achieve a desired quality outcome, a focus on cost of care, and the inclusion of both new technology requests and retrospective review of existing technologies; however, I wanted the program to have a certain degree of flexibility, that is, to withstand being moved to different settings (both physical and electronic). I didn’t want our program restricted to “only these individual decision-makers and only in this specific meeting.”
In addition, I wouldn't say the learning curve was steep, but the adoption curve sure was. Our program caused us to change the way we make decisions and that didn’t happen overnight, nor did it happen without some resistance.
(HVAM) A number of years ago, you hired a value analysis coordinator to manage your value analysis program. Back then it might have been a bit forward thinking, but today, hiring a value analysis coordinator is a “best practice” for hospitals and systems. Why do you think this is such an important position for your hospital, and why should other hospitals consider this position mission critical for their organization?
(AW) First off, let me just describe the position at our hospital. An outstanding value analysis coordinator is a supremely talented individual that is able to speak multiple languages, possess x-ray vision along with a microscopic attention to detail, able to build bridges while standing on them, and display the skills of a UN ambassador while being outspoken.
What I mean is that we are dealing with the second largest area of expense in a hospital. Numerous stakeholder groups have input in how the money is spent. Those stakeholders don’t all speak the same language, so I wanted someone with a clinical background who understood supply chain to translate between clinicians and non-clinicians, a clinical/financial liaison if you will, and focus on it every day to ensure that we maintain traction for our program. Someone who also gets up out of their seat and observes practice to understand what our clinicians are trying to accomplish…someone who sees the disconnects and wants to make a difference like I do.
How Do You Approach Gaining Your Senior Management and Department Heads' Buy-In to Value Analysis?
I was passionate about the characteristics of the program but open to what the organization’s culture would support. So, the short answer is that I sat down and talked to people – our senior leadership team, medical staff, key department leaders – and shared what I saw as the impetus for change. We talked about the inconsistent use of items, excessive variation, the lack of consensus and clinician input into decision-making, fragmented process, unfavorable financial impacts of existing technologies, and the disconnect to quality.
Once there was common ground on those items, I shared the characteristics I desired for the program and asked a lot of questions to determine what each leader would support in terms of commitment, structure, process, turnaround time, etc. Asking the questions I did allowed me to implement a program that fit within Enloe’s culture. From there, we kept at it until it was grafted into the fabric of how we do business.
(HVAM) Could you give me an example of one or two of your most recent successes?
(AW) Our IV securement device initiative stands out due to the collaboration between our anesthesiologists, nursing staff, OR staff, radiology, and our value analysis program. It is a great example of how focusing on functional need first helped to facilitate solutions. Our stakeholders in this initiative were focused on meeting the patient care need (functionally) rather than being married to any particular manufacturer. Our annual savings will exceed $43,000.
Another recent initiative focusing on reducing variation in both price and practice in orthopedics is expected to save our organization in excess of $500,000 over the next year.
(HVAM) Can you share with me some key leadership attributes that make your value analysis program successful?
(AW) Several things stand out. First, we hold quarterly meetings with our senior leadership team to discuss our value analysis program activities and initiatives and any concerns we have relative to our initiatives. I will tell you that the opportunity to collectively discuss these issues with our CEO, CFO, and VP’s and make decisions together is amazing and key to our success. Second, we have great working relationships with quality management and Infection Control which I believe is essential. Third, we use a standardized scoring system to objectively rate each request. Fourth, each of the early decisions that I made – a flexible, movable model, inclusion of new and existing technology review, and inclusion of Pharmacy—have all contributed to our success. Last, but certainly not least, we have an outstanding program coordinator, who is everything I described earlier and more.
(HVAM) How is your value analysis program incorporating new disciplines within value analysis, such as, utilization management and evidenced-based evaluation into your program?
(AW) Maybe here too, we were a bit ahead of the curve in that we’ve used a utilization benchmarking tool for several years now. Prior to using it, I felt we had a blind spot that its use helps resolve. We also consider studies and market data, when available and reliable, to drive evidence-based decision-making (often shying away from early adoption of new consumable and capital technologies).
(HVAM) What advice would you give a fellow supply chain leader if they were looking to take the plunge into a comprehensive value analysis program?
(AW) Ensure senior leadership support, hire the right coordinator, be careful to exercise relational (rather than positional) power, understand your culture, and don’t worry about whether your structure matches what you may see in a magazine article. Value analysis is a methodology – how you apply it depends on you and your organization.
(HVAM) How do you envision the impact of value analysis, moving forward in the age of the Affordable Care Act, dramatically effecting hospitals’ bottom lines?
(AW) The ACA is a very complex issue which many are struggling to understand. Since I don’t possess the crystal ball that gives me the answers, my approach is simple. I believe that our ability to control expenses and reduce cost of care may be the difference between those that make it and those that don’t. Unless, or until, I find a methodology more effective than value analysis, I’m sticking with value analysis.