Arrives able to run a tender and negotiate a rate, usually from an industry where a stockout delays a delivery rather than a patient.
Our own project · Meridian Hospital Group is a constructed operator; the instrument and its figures are real
Meridian Hospital Group · Group
Director of Procurement and Supply
Sees unit price with great precision and the cost of an absence almost never, which is the wrong way round.
Chapter 1 · Group
What they actually do
Owns contracts, suppliers, stock policy and what is held on site. Answers for everything the hospital consumes being there when it is needed, at a price that can be defended.
The two halves of that sentence pull against each other. Holding less stock improves the number this role is measured on; the cancelled list caused by the item that was not there lands on somebody else's.
- Answers for
- Everything the hospital consumes being there when it is needed, at a defensible price.
- Can actually move
- Contracts, suppliers, stock policy and what is held on site.
- Sees the cost of
- Unit price with great precision. The cost of an item not being there, which is a cancelled list or a delayed discharge, almost never.
Chapter 2 · From arriving to moving on
Growth in the role
Procurement trains hard on price and contract. The healthcare development is learning that availability is a clinical variable.
Which substitutions are clinically neutral and which are not. This is where inexperienced procurement does its damage.
Beginning to argue for stock on the basis of the theatre list it protects rather than the capital it ties up, which requires numbers nobody currently produces.
A natural route into operations, because the good ones have already learned to think in flow rather than in unit price.
Chapter 3 · And how it is usually settled
Where this role is in conflict
Conflicts here look like price arguments and are almost always availability arguments in disguise.
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With The patient
Over Substitution- Why it is structural
- A clinically equivalent product at a lower price is a genuine saving. A clinically different product at a lower price is a cost that arrives later, in a form nobody traces back here.
- How it is settled today
- By whether clinicians were involved before the contract was signed rather than after the delivery arrived.
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With Clinical Leads and Consultants
Over Standardising consumables- Why it is structural
- Variety is expensive and clinical preference is often based on real experience with a specific device.
- How it is settled today
- Well when the clinical case is heard and priced; badly when it is overruled by category strategy, which produces workarounds and hoarding.
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With The Head of Operations
Over Stock levels- Why it is structural
- Operations needs certainty to schedule; procurement is rewarded for holding less.
- How it is settled today
- By whoever has been burned most recently, which is a memory-based system rather than a designed one.
Chapter 4 · Actor one
How this reaches the patient
Reaches the patient as availability: the implant that was in stock, the drug that was not, the list that went ahead.
A saving made here can surface as a cancelled operation three months later, and because the two are recorded in different systems by different people, almost nobody in the organisation ever connects them.
Chapter 5 · Actor two
How this reaches the rest of the provider
Sets the buffer that absorbs supply variability, which is the same choice about where variability lands that runs through this entire study, made in a different currency.
Squeeze that buffer and the variability does not disappear. It reappears as a theatre list rearranged at short notice, which is absorbed by staff goodwill, which returns eighteen months later as turnover.
Every role, side by side
The full hierarchy, and where accountability and control come apart.
Back to people and hierarchy