Category Archives: Healthcare

Prices too High? Take a Leaf from the Green Cabbage!

Green Cabbage, formerly known as PAAS Advisors (which stood for Product Analysis and Strategy), is an interesting spend analytics offering as it is both a product and a service advisory practice. The platform provides unequalled insights into the indirect technology, contingent workforce, and clinical categories; deep invoice analytics down to the line item; market intelligence theses (MITs) on very specific indirect technology, contingent workforce, or clinical sub (sub) categories that are far deeper and fresher than any peers; and a third party negotiation (support) service (where they will negotiate at the Senior Executive/C-Suite level) to help you get the best contracts possible on key high-value contracts. That’s a lot to digest, but we’ll tackle each point in this write up.

Let’s break down the “practice and platform” part first, starting with their pricing model. Their pricing model is a variation of standard percentage of savings model — it’s a subscription model with a savings target and a guaranteed savings of at least 3X, which is better than just a straight cut of savings for you. If they don’t help you hit the savings target they promise, you will get a discount, or an extension to your subscription, but if you blow way, way, past the target (like many of their clients do), instead of paying more than 3X what you would have otherwise have paid through pre-negotiating a fixed fee for unlimited use of the platform, you pay the pre-negotiated subscription fee.

It’s important to understand their pricing model, as it drives the unique approach they take in their practice, which is designed to deliver savings to the clients that engage them for software and services as fast as possible. Most spend analysis companies start by attempting to load, cleanse, classify, and enrich all of an organization’s spend data before attempting to do any analysis or identify any savings opportunities. This can take weeks or months, which means its weeks or months before the first opportunity is identified. To allow them to start pursuing, and capturing, opportunities in just a few weeks, Green Cabbage starts by loading all of an organization’s contracts, starting with the Indirect Technology Human Capital, and Clinical Supply contracts, because the most immediate opportunities are where contracts are needed ASAP (because the organization allowed them to expire) or in the short term (as they are coming up for renewal), and in those categories where Green Cabbage are experts in finding cost reductions quickly.

From just the contracts, using their deep community intelligence provider benchmarks and market knowledge, they can identify the best opportunities to go after immediately in indirect technology, contingent workforce, and clinical supply categories. They can even negotiate on behalf of the client and often get savings better than their client would on their own due to their deep domain knowledge and years of experience analyzing and negotiating in these categories, usually with senior executives in the supplier organizations.

Once the contracts are loaded, only then will Green Cabbage begin to load and classify all of the organization’s spend data into their One Workspace Spend Analysis platform, which can be provided to them as flat file exports or loaded through an API. The organization can define their own categories and Green Cabbage will map the organizational spend to those categories. Once the spend has been loaded into One Workspace, the organization can build some basic spend reports to do some basic spend analysis on their own, export the clean categorized data to Excel files for local spend analysis, or use the customized workspaces with deep pre-built custom dashboards for Indirect Tech, Human Capital and Clinicals.

The Indirect Tech module is designed to help a buyer identify the current and upcoming projects based upon expired and expiring contracts that need to be renewed to support their organization. The main dashboard shows the buyer the YTD savings, the upcoming renewals by contract, the top suppliers by spend, key category metrics, and the primary actions that can be taken (such as upload a contract or request a MIT). From here, the buyer can click into the suppliers dashboard or straight to an indirect technology supplier dashboard that summarizes key metrics (last year of spend, lifetime spend, estimated spend this year, next key [contract] date, relationship length, agreement gaps, etc.), contracts, and visual timelines. From there, the buyer can click into a contract and see associated details or kick off a project.

In addition to the supplier dashboards, there are also spend analysis, renewal, project, and MIT dashboards. The spend analysis dashboard allows the buyer to create custom reports to slice the data by different dimensions. The renewals dashboard in the Indirect Tech Module summarizes the status of contracts coming up for renewal (queued, in review, out for sourcing, terminating, etc.) as well as the category breakdowns, spend by stage, and timeline summaries. The projects dashboard allows contract renewal projects to be created, assigned, and tracked while providing a summary view of all current projects. It also supports savings tracking by agreement. From a project, the buyer can click into the renewal details and access the current (draft) version of the contract for review, the reviewers, see any notes or documents they uploaded, and the activity log.

Finally, the MIT — Market Intelligence Thesis — dashboard allows the buyer to quickly access the completed MITs, month-over-month and year-over-year savings from projects based on the MITs, and key MIT metrics (in process, completed, estimated savings available, % discount from baseline, etc.). The Green Cabbage Market Intelligence Thesis is much more than just a benchmark, it’s a detailed sub-category analysis on a specific product or service of 1 to 2 pages done in near-real time by expert advisors that augments the benchmark data with deep vendor insights into the SKUs being purchased, market conditions, and negotiation strategy. The MIT is offered at three different levels:

  • lightweight: basic MIT as described above
  • comprehensive: lightweight MIT as well as a detailed analysis of standard/available terms & conditions
  • competitive: competitive MIT as well as a detailed analysis of top 3 competitors across similar SKUs and similar terms and conditions, with appropriate negotiation strategies and expected savings under different conditions

Unlike some providers which simply do this every quarter (Denali, SpendHQ, etc.) and provide this as a reporting service, or others that do fully automated real-time augmented benchmark production based on current data, trends, and standard practices based on the trends and current market conditions, Green Cabbage does a custom, semi-manual, MIT upon request within three (3) business days, and usually within one (1) business day, on every request to make sure the client always has the most up-to-date information appropriate to that client’s situation. They can do this because their platform automates the benchmark computations and their advisors are experts in the indirect technology and human capital categories and are analyzing and negotiating in the categories on a daily basis. As such, their analysts can turn around a custom analysis specific to a client’s situation in an hour or two.

However, as per our intro, Indirect Tech is not the only area they go deep. They also go deep in contingent workforce/staffing agency in their Human Capital module that more-or-less mirrors the Indirect Tech module with a main dashboard and dashboards on contingent workforce suppliers, human capital spend analysis, renewals, projects, and MITs. The main dashboard summarizes savings to date, percentage from baseline, forecasted spend (vs. actual for historical), top agency relationships, expiring contracts, and key metrics. The other dashboards are similar in purpose to Indirect Tech, but customized to Human Capital.

The main difference is in the MITs, where a contract owner / project owner can benchmark as many positions as they want in a sub-category or category for a given provider (should they be looking to renegotiate) or a small set of providers (should they be looking for true market intelligence or looking to negotiate with multiple providers and trying to figure out how to best split demand). The benchmarks are similar, wth all the benchmark data (which shows the low/medium/high averages, the service locations, the expected savings at each level) auto-generated. The only exception is the additional market/negotiation notes at the position level that is manually generated on top of the basic thesis information. Note that there is a limit to the number of positions if you want the guaranteed turnaround time, but if they have a few extra days, they have done detailed benchmarks of over 1,500 positions in the past, and with their deep insights, expertise, and negotiation skills obtained savings percentages typically only seen by providers who offer deep multi-level decision optimization across multiple national and regional contingent workforce providers. (We’re talking 30% range in some cases.)

(When you have deep benchmark data and powerful spend analytics, you can quickly divide contingent workforce needs among the providers best suited to offer those positions at a lower cost, use this data for fact-based volume-based negotiation, and shave off almost as many points as the best optimization engines without any mathematical modelling whatsoever, and not have to worry about if the split between the providers is one you are comfortable with.)

Other key features of the platform include:

  • Clinicals: which is their clinical supplies spend analysis module that is similar to their Human Capital Module (except the SKUs are clinical suppliers and not contingent workforce positions)
  • GC Legal: which maintains a standard set of Terms and Conditions clauses that specify exactly what different Ts and Cs means to the client (and helps the analysts do custom MITs and negotiation projects)
  • SKU Search: that allows the client to search for particular SKUs across their suppliers and contracts
  • Outside Data: that allows them to import additional data to augment their spend from third party products, with out-of-the-box integration options for a number of indirect tech (SalesForce, etc.) and contingent workforce (ServiceNow, etc.) providers
  • Invari: their invoices platform
  • End-to-End Security: all MITs, which are often based on organizational contracts, are done through the platform, where data is fully encrypted both in transit and at rest, and not through e-mail, FTP, or other unsafe data transmission methods employed by some other service/advisory firms

Let’s talk about Invari now. This is an analytics backed invoice management platform that allows an organization to upload, manage, and analyze invoices in real time. While it can support any category and supplier, it is designed to support their technology, human capital, and clinical supply categories and benchmarking in particular. When purchased, they request at least 3 months of invoices for all of your providers, and will accept up to 3 years of history if available in order to get enough invoices to allow them to train a custom model for every single provider so that, when an invoice is uploaded, it can be automatically parsed at least 95% of the time for immediate availability. Because models are customized per supplier per client, their system detects any issues and when the invoice cannot be parsed or key information cannot be found. When this happens, the invoice processing system kicks the invoice out to a manual processor who will fill in the missing information in under 3 hours and then update/retrain the model to prevent the same error from happening again.

In addition to allowing invoices to be immediately available for management and analytics in the future, these detailed models also allow the system to build up invoice profiles by supplier and the system can detect when an expected invoice is missing (because you always get a monthly invoice for a service by a certain date in the month), duplicated (because the spend profile is doubled in a month, etc.), or suspect (because it doesn’t fit the pattern).

The main dashboard provides an overview of key invoice KPIs (pending submission, awaiting approval, total count, unresolved, missing), an overview of missing invoices (so immediate action can be taken), a summary by providers, and a summary of top variances.

The approvals dashboard shows all of the invoices that need to be approved, along with variances from the best “prior” invoice, colour-coded on the green to red spectrum (so you can quickly see if there is a likely price issue even before drilling in to the invoice). On this screen, you can quickly pop-up the six-month history for more details on the variance and trends and pop-up the invoice summary window that summarizes billing arrangements (from the contract), line items, and sub-charges.

Fore more details on costs and variances, you can dive into the invoice analytics dashboard that provides a variance report across suppliers over the past X months (on a green – red spectrum that represents decreases to increases) that also clearly identifies new charges (in yellow) so you can see where regular billings start or change. From here, you can dig into a supplier and see the same breakdown by line item / SKU, and then, in that breakdown, you can drill into a particular line item / SKU and see the same breakdown across the sub-charges. For example, at the top level, you see all your providers. When you drill into Your-BroadBand-Provider, you see High Speed Service, Mesh Network Rental, Taxes and Fees. When you Drill into High Speed Service, you see monthly service fee, modem rental, and fixed IP lease. And, of course, you can also search across contracts for specific SKUs and set up alerts when new variances are detected off of new invoices.

At this time it’s worth pointing out that in Indirect Tech, Green Cabbage does true micro-SKU benchmarking, unpacks all of the different offerings in a SKU offered by a tech provider who might include multiple modules in a SKU or a broadband provider who will pack in rentals with subscription fees, and can tell when a provider changes a SKU description or composition. This allows it to do price benchmarking (or at least price range benchmarking) across individual products and services and provide more finer grain details and guidance than the majority of its peers, even in the specialized SaaS market.

And while Green Cabbage might not be a common name in S2P, or one getting a lot of buzz from the analysts, they are bigger than you think. Serving eight (8) of the top ten (10) private equity firms in the US and four (4) of the top private equity firms in Europe, global consultancies like KPMG and BCG, along with other big name Fortune 1000 clients, they have over 500 Billion of spend under management (which is sizeable when you consider that Coupa, that claims to have the most, only has about 4 Trillion in global business spend data), over 1.25 Billion data points, and over 13,000 benchmarkable suppliers in their categories of expertise. That’s very significant, very powerful, and allows them to identify large cost reduction opportunities and negotiate them for you at contract renewal time. (And if you don’t have the volume on your own for significant savings, they also have a group purchasing offering called Receptio that you can look into. Note that since this blog covers technology, we won’t be covering Receptio in this write-up.)

The main weakness right now is that the API is only for getting data in. They are working on extending it to get data out, but there is no timeline for that yet. This is critical for a number of reasons:

  1. their contract management is limited to file uploads and metadata and it would be very useful if they could push rates, benchmarks, and standard Ts and Cs to a contract management/governance platform to support creation, negotiation, and ongoing management of contracts outside of renewal projects
  2. spend export is limited to Excel / flat file dumps; while their tool is good, it’s not BiC for generic spend analysis, especially outside their core categories, and neither is their categorization knowledge beyond their core categories — depending on the spend, it’s not guaranteed to be accurate beyond level 2 or 3 (of a 4 to 6 level UNSPSC or equivalent hierarchy), so if the organization has some very specific or detailed indirect or direct categories it needs deep categorization for, this will have to be done in an external tool (where you can classify to a lower level, do more detailed analytics, and then push the refined data back) and you need Green Cabbage to be the single source of truth (because it allows you to do invoice management and deep invoice analysis and keep your spend data up to date)
  3. you can mark a category or contract as in Sourcing, but there is no connection to an external sourcing tool

We will note that they have indicated they are working on expanding the API for pushing/pulling data out, and that their first priority is to push appropriate data to a contract management platform to allow for contract creation, negotiation management, and governance (as all the platform supports around contracts is file-based uploads and meta-data). Hopefully they finish this by the end of the year and can start extending the API for export of all data in the first half of next year as an organization needs a single source of spend truth and there are lots of great DiY spend analysis tools (like Spendata) that could connect to the Green Cabbage platform for one-off category analysis where Green Cabbage doesn’t provide detailed benchmarks (or support easy/refined classification).

In other words, if you are in an industry that makes heavy use of indirect technology (SaaS, Cloud, etc.), the contingent workforce, and/or clinical supplies and you want a service-based spend analysis offering that can help you find deep savings based on real-time competitive benchmarks and on-demand category analysis, and even use their manpower to capture those opportunities for you, you really should check out Green Cabbage. There’s really no one like them in their categories of expertise.

Sanguine Strategic Sourcing

Today’s guest post is from Jennifer Ulrich, an Associate Director and Category Planning Subject Matter Expert at Source One Management Services as well as a contributing author of Wiley & Sons “Managing Indirect Spend: Enhancing Profitability”.

It’s not just vampires that find themselves looking for blood. Healthcare procurement professionals also depend on a consistent stream of the stuff, though they’d define stakeholders quite differently than Dracula. All purchasing is important work, but they can honestly say that their sourcing operations are a matter of life and death. Imagine learning that you couldn’t receive a transfusion because your medical center couldn’t locate a reliable supplier, or failed to plan for a disruption in its supply chain. It’s a terrifying thought.

Human blood ($150 – $180 a pint!) is one of countless commodities Source One’s consultants and I have helped our clients purchase more efficiently. For one organization in particular, it amounted to eight million dollars of total spend. You might think that sourcing a product out of a horror film would present especially grim or bizarre challenges, but the initiative proved straightforward. It essentially came down to a question of vendor consolidation, a question that’s always essential in procurement: Would our client benefit more from a single, or multi-source strategy?

Whether it’s blood or Butterfingers you’re buying, your answer to this question will largely shape your strategy. It’s important to consider the potential drawbacks and benefits of both approaches.

The recent rash of natural disasters have not only underlined the importance of well-supplied healthcare providers, but they’ve also reminded procurement teams around the globe how important it is to assess and mitigate risk across the supply chain. When you’re dealing with a commodity as valuable as blood, the smallest disruption can have deadly ramifications. In theory, a multi-source strategy reduces the risk of shortages by broadening the supply base. Medical organizations that draw blood from a number of suppliers are unlikely to be completely drained if one should come up short.

A multi-source solution also presents the potential benefit of supplier competition. Leveraging this could mean a more agreeable arrangement or sustainable strategy. Though your average individual might know of just one blood supplier (you know the one), the field is actually saturated with a number of emerging regional businesses. Granted a seat at the table, they can drive more competitive pricing while partnering with one another to collectively manage volume concerns.

Sourcing from more than one supplier does not, however, eliminate risk or produce value in every instance. In fact, an organization might find that the strain and uncertainty of managing multiple supplier relationships outweighs its benefit. Consistent communication is essential for maintaining an amicable, respectful, and fruitful relationship with any provider. It’s obviously far easier to ensure open lines of dialogue with a single vendor than with a large group. The right SRM expert can make any arrangement work, but it’s often preferable to consolidate your supplier base for more personalization and collaboration.

In this particular situation, our client found that one trusted supplier could most effectively meet their specifications. With our help, they learned that a close relationship with this provider presented considerable value incentives. In addition to a tiered discount structure, they offered risk management solutions in the form of comprehensive training programs. By educating end users on the proper procedures for transporting, handling, and administering blood they helped foster a sense of teamwork while greatly reducing the chance of lost or wasted product.

There’s no O negative approach when it comes to assessing the market. One company’s life-saving cure could send another into convulsions. That being said, whatever your industry, whatever size your supply base, the same set of principles apply for effectively maintaining relationships and encouraging compliance. The most successful procurement professionals perform a transfusion of sorts. They supplement the foundational techniques of good sourcing with a healthy dose of innovation to determine the appropriate treatment.

In a future post we’ll dissect single and multi-source strategies and discuss which situations favor which approach. Happy Halloween!

Thanks, Jennifer!

Top 12 Challenges Facing India in the Decades Ahead – 06 – Health Care

As per our post on poverty, health care is a substantial problem in India. Not only does India have the 9th lowest life expectancy among the 16 countries outside of sub-saharan Africa that are poorer than it is, but is also has the 10th lowest infant and under-5 mortality rates and the second worst proportion of children under 5 who are undernourished! Then, as per our last post on education and opportunity, at leaset 93% of the workforce has no health insurance in a country leaning heavily towards privatized health care.

And this is just the tip of the iceberg. Almost 40% of all deaths in India are still due to infections! (Source: Health and Health Care in India by UCL) The majority of the remainder are due to non-communicable conditions such as cardiovascular diseases, chronic respiratory disorders, and cancers. (Compared to the developed world which manages most chronic respiratory disorders and some of the cardiovascular diseases so well that the patients often die from other causes.) In comparison, the only type of death due to infections to break the top 10 in Canada is death due to influenza and pneumonia which strike down 1.6% of the population to grab the 9th spot. In other words, the number of deaths in India due to easily treatable infections is at least 20 times higher than it should be!

India currently spends about 1.2% of GDP on publicly funded healthcare, an amount considerably less than most other comparable countries. In comparison, health care spending clocks in at 5.1% of GDP in China and Russia and 9% in Brazil! (Total spending on health care, including all private spend, is about 4%, but the private spending is mainly by the rich.) Due to this limited funding, and the substantially insufficient funding allocated to the National Rural Health Mission (NRHM) (as outlined in our post on Poverty), 400 Million to 600 Million of the poorest Indians do not get access to the essential medicines they need. When you also consider that India is now the worlds 3rd largest producer of medicine by volume, the absurdity of the situation really comes into the spotlight.

And progress is slow. Even if the extension of the Government’s National Common Minimum Programme, announced by Prime Minister Manmohan Singh on the country’s 66th Independence Day achieves its goal and provides access to free public health care to over half of the population by 2017 (as opposed to the fifth who currently have access) via the country’s 160,000 sub-centers, 23,000 primary health care centers, 5,000 community health centers, 1,000 sub-district hospitals, and 600 district hospitals, that will still leave hundreds of millions of Indians without access to even the most basic of health care services. (Furthermore, the proposal that the Federal Government would directly fund 75% of the relatively limited cost of extending the generic medicines supply to the public health service doesn’t go far enough. At least one third of the population cannot afford to pay even 25% of the cost of generic medicine, which, as it is produced in India, represents relatively little cost to the Government.)

And even though 160,000 sub-centers might sound-impressive, the requirements for a sub-center is one Auxiliary Nurse Midwife (ANM) and one Male Health Worker. That’s it. Not even a full nurse. You only find those in Primary Health Centers, Community Health Centers, and Hospitals. In addition, the primary health centers (PHC) also tend to be minimally staffed. They are only required to have one medical officer (doctor) who is supported by an average of 14 paramedical and administrative staff, in total, and, at current numbers, support a population base of 50,000 people! Furthermore, a community health center, which has to serve approximately 200,000 people on average, typically only has four medical specialists (a surgeon, general physician, gynaecologist, and paediatrician). Plus, per capita, the number of physicians is quite low. Right now, India clocks in at roughly 6.5 per 10,000 people (and many of the doctors are in the hospitals), while Canada has 20.7 and the United States has 24.2. (Source, KFF) Also, while India has roughly 1,600 hospitals to serve 1,237 Million people, the United States has almost 6,000 to serve 314 Million people. In other words, there are 15 times as many people per hospital in India as there are in the United States. (770,000 citizens per hospital in India vs 52,000 per hospital in the United States)

Health Care is a huge problem and one that desperately needs to be solved. After all, if your population is not healthy, how can you expect to give it a good education if it’s worrying about being well enough to study? And if you cannot educate it, how can you ready it to take advantage of any opportunity that may give it the hope of lifting itself out of poverty, something which must be done to increase the tax base enough to build the required infrastructure to support the fierce competition of today’s global economy?

BravoSolution’s Business Center 2.0 – A Complete Category Solution for Transportation, MRO, Temporary Labour, GPO Category Management, and Retail: Part I

Two years ago, we reviewed BravoSolution’s Business Center Category Sourcing Solution that took e-Sourcing to a new level for nine common categories that provided the average Supply Management organization with a considerable sourcing challenge. In order to maximize savings in each of these categories, the organization needed to construct category-specific RFQs/RFBs for the category, collect extensive amounts of detailed data, build a tailored model, and/or analyze the impact of each possible sourcing decision. And if the RFXs were designed wrong, the data was incomplete, or the model missed key trade offs, the solutions were sub-optimal at best, and not even as good as the current supply management situation in the worst case.

That’s why BravoSolution built a solution that, capturing the years of experience and knowledge built-up by their global sourcing and solutions teams (who work out of offices in ten different countries on four different continents), that would allow a buyer to:

  • define an event of the supported type with the click of a mouse,
  • dynamically determine appropriate, and minimal, data requirements,
  • send the appropriate RFXs to the chosen suppliers with just a few clicks of the mouse,
  • push the data into the optimization engine,
  • add or remove (default and pre-defined) constraints with a few mouse clicks, and
  • select the award scenario and generate a contract template with a click of the mouse.

It was a great leap forward in e-Sourcing technology for the average buyer who was not an expert in e-Sourcing, and definitely not an expert in the chosen categories. But it had limits — specifically, out-of-the-box, it was limited to the categories that it supported or to categories for which repeatable methodologies could be identified and for which appropriate workflows could be implemented (as long as the buying organization was willing to work with the BravoSolution team to build a new category solution).

Knowing this, and knowing that certain industries had needs that were different than other industries, BravoSolution decided that what was needed was an equally simple solution that could be applied company wide (to all significant categories) for buyers in industries that needed extra support (either due to the complex nature of the problems, the time intensiveness of the categories, or the average level of e-Sourcing sophistication of the buyer in an industry where the average organization is arriving late to the advanced sourcing party). This is because BravoSolution realized that the reality of the situation is that if e-Sourcing is easy to use for some categories, but hard to use for other categories, the organization will continually favour the easy categories in their sourcing efforts, to the detriment of the organization’s cost savings or value generation goals. If a sourcing event is appropriately designed and effectively executed, and the organization has Procurement policies and systems in place to insure that the identified and negotiated savings are appropriately captured, most of the savings are going to be identified in the first event and the incremental return on subsequent events, especially in an economy where costs are going up and the supplier has more bargaining power, will be minimal. Meanwhile, more and more dollars will flow down the drain as savings-rich categories get continually ignored.

But if the sourcing team is presented with a solution where every souring event is as easy as every other sourcing event, intelligence is built in for all of the common categories, and existing data (such as supplier locations, contract transportation pricing, production constraints, etc.) can be re-used and propagated from one event to the next, then every category is going to be given equal consideration for the strategic sourcing treatment. And BravoSolution’s new and improved business center solution makes this a reality for the Transportation (3PL), MRO, Temporary Labour, GPO Category Management, and Retail industries.

In the remainder of this series, we will discuss BravoSolution’s new business center solution, built on collaborative sourcing capabilities (that were covered in these posts on Collaborative Sourcing, High Definition Sourcing, and Category Excellence) for MRO, GPO Category Management, and Retail. Stay tuned. (We’ll be back at the same KaT time on the same KaT channel.)

It used to be that Doctors made Life and Death Decisions. Now Supply Managers do too!

This recent CSR briefing over on the CPO Agenda on “when good procurement can be a life and death factor” is great food for thought as it points that not Supply Management is more then just sourcing and procuring, it’s also also sustaining and securing — in more ways than one!

Focussing on how the early 2000s saw several incidents where hospital patients inadvertently received excess doses of their drugs that resulted in fatalities, the article pointed out how a poor selection of IMDs (Interactive Medical Devices) that didn’t do anything to prevent common human errors was the reason that a premature baby died after receiving 10 times the required dose of diamorphine and a person lost their life after receiving a dose 24 times too high after a daily dose was miscalculated as hourly when it would have been trivial to code in a dosage check that asked a nurse or doctor are you sure before administering a dose outside of the range. After all, it’s easy to mistype a decimal point and then 13.5 ml becomes 135 ml, or click the hourly instead of daily button if you’re in a rush (and what health-care professional isn’t overworked these days)?

Now, you could say that the real problem was lack of training, as better training could have minimized the possibility of human error, but in each case sourcing was involved. In each case, a wide range of IMD devices were in service in each of the hospitals. And in each case, each time a procurement exercise took place, a different machine was chosen as the most cost effective. The factor that should have been last on the list was placed first and people died. Remembering that Supply Management’s ultimate goal is value (creation), not cost (reduction), and in this case, the value was procuring the best IMD for the hospital, not the cheapest one today, where the best IMD was one that was easy to use, programmed with easy range checks, reliable, fault tolerant, long lasting, and safe and reasonably priced with respect to these requirements. Considering the inherent value in human life (and the cost of the lawsuit or settlement that the hospital is going to have to pay as a result of a preventable death), if that means spending 20% more, so be it.

If instead of sourcing IMDs as one-off sourcing events when a need arose, Supply Management put security and sustainability first and foremost and redefined IMF sourcing as a multi-year master contract agreement, negotiated against projected demand over the next 3-5 years, lives might have been saved as there would likely not be more than two types of IMDs at any one time (the ones sourced during the last contract, and the ones being sourced during the current contract, where the contract length is defined to insure all of the old machines are replaced before a new contract is negotiated with the possibility of switching vendors) and the amount of training the health care staff would need would be minimal.

And the reality is that medical device sourcing is not the only area of Supply Management where lives are at stake. Supply Managers also source food and beverage categories, and melamine in the milk, diethylene glycol in the toothpaste, salmonella in the spinach, bovine spongiform encephalopathy in the beef (which can cause Creutzfeldt-Jakob disease), and botulism in the chili sauce can all result in death, and if not caught in time, can be as deadly as a plague or coronavirus (SARS).

And Food & Beverage is just one example. The chemical sector is another. What if the chemicals are hazardous and the storage units are poorly made and leak? Cyanogen chloride is colourless, and deadly, and used in the production of Chlorosulfonyl isocyanate which is used in medicine in the production of Beta-lactams, which form the foundation of antibiotics (including penicillin).

Another is heavy machinery. Carbon monoxide (CO) is regularly produced by internal combustion engines in enclosed spaces. If the exhaust system is not airtight and properly insulated, CO could leak into the factory and poison (or kill) your workers before they even know it’s there as it is an odourless colourless gas.

The point is, where physical products are concerned, almost anything you source could be a hazard to human health, and even life. (We still have problems with led in the paint and asbestos in the insulation when sourcing from overseas.) This doesn’t mean that you don’t have to worry about services — it just depends on what you’re sourcing and what products and materials the service providers have to use in the performance of their jobs. For example, Janitorial Services could be a problem if the company is contracted to provide the cleaning products and they consistently use cleaners with too high a borax concentration which is not properly cleaned up.

So, next time you source, get out that corporate social responsibility scorecard; make sure safety, security, and sustainability play a prominent role, and remember that, indirectly, you could be responsible for someone’s life.

Your job just changed, didn’t it?