Richard Bays MBA, RN, CPHQ
Ambulatory Surgical Centers
ASC’s operate in a different
environment than traditional                     Operate

hospitals. There is less physical
space for stock and cases can be
scheduled with short notice.
Financial constraints prevent a large
buffer stock from existing.
                                        Change
                                                 ASC        Orders




                                                 Optimize
Whip It !
            The Bullwhip Effect (or
            Whiplash Effect) is an
            observed phenomenon in
            forecast-driven distribution
            channels.
            Since the oscillating
            demand magnification
            upstream a supply chain
            reminds someone of a
            cracking whip it became
            famous as the Bullwhip
            Effect.
    Because customer demand is rarely perfectly stable, businesses must forecast
    demand to properly position inventory and other resources.
   Forecasts are based on statistics, and they are rarely perfectly accurate.
    Because forecast errors are a given, companies often carry an inventory buffer
    called “safety stock”.
   Moving up the supply chain from end-consumer to raw materials supplier,
    each supply chain participant has greater observed variation in demand and
    thus greater need for safety stock.
   In periods of rising demand, down-stream participants increase orders. In
    periods of falling demand, orders fall or stop to reduce inventory.
   The effect is that variations are amplified as one moves upstream in the supply
    chain (further from the customer).
Information Coordination: The Bullwhip Effect

                                             Consumer Sales at Retailer                                                                                                 Retailer's Orders to Wholesaler
              1000                                                                                                                         1000
                   900                                                                                                                            900
Consumer demand




                   800                                                                                                                            800




                                                                                                                             Retailer Order
                   700                                                                                                                            700
                   600                                                                                                                            600
                   500                                                                                                                            500
                   400                                                                                                                            400
                   300                                                                                                                            300
                   200                                                                                                                            200
                   100                                                                                                                            100
                     0                                                                                                                              0
                                             11
                                                  13
                                                       15
                                                            17
                                                                 19
                                                                      21
                                                                           23
                                                                                25
                                                                                     27
                                                                                          29
                                                                                               31
                                                                                                    33
                                                                                                         35
                                                                                                              37
                                                                                                                   39
                                                                                                                        41
                         1
                             3
                                 5
                                     7
                                         9




                                                                                                                                                                                                                             29
                                                                                                                                                                             11
                                                                                                                                                                                  13
                                                                                                                                                                                       15
                                                                                                                                                                                             17
                                                                                                                                                                                                  19
                                                                                                                                                                                                       21
                                                                                                                                                                                                             23
                                                                                                                                                                                                                  25
                                                                                                                                                                                                                       27


                                                                                                                                                                                                                                  31
                                                                                                                                                                                                                                       33
                                                                                                                                                                                                                                             35
                                                                                                                                                                                                                                                  37
                                                                                                                                                                                                                                                       39
                                                                                                                                                                                                                                                             41
                                                                                                                                                        1
                                                                                                                                                            3
                                                                                                                                                                5
                                                                                                                                                                    7
                                                                                                                                                                        9
                                 Wholesaler's Orders to Manufacturer                                                                                            Manufacturer's Orders with Supplier
            1000                                                                                                                            1000

                                                                                                                             Manufacturer Order
                   900
Wholesaler Order




                                                                                                                                                  900
                   800                                                                                                                            800
                   700                                                                                                                            700
                   600                                                                                                                            600
                   500                                                                                                                            500
                   400
                                                                                                                                                  400
                   300
                                                                                                                                                  300
                   200
                                                                                                                                                  200
                   100
                                                                                                                                                  100
                    0
                                                                                                                                                    0
                                                                 19
                                             11
                                                  13
                                                       15
                                                            17


                                                                      21
                                                                           23
                                                                                25
                                                                                     27
                                                                                          29
                                                                                               31
                                                                                                    33
                                                                                                         35
                                                                                                              37
                                                                                                                   39
                                                                                                                        41
                         1
                             3
                                 5
                                     7
                                         9




                                                                                                                                                                                  13
                                                                                                                                                                        10




                                                                                                                                                                                        16

                                                                                                                                                                                                  19

                                                                                                                                                                                                        22

                                                                                                                                                                                                                  25

                                                                                                                                                                                                                        28

                                                                                                                                                                                                                                  31

                                                                                                                                                                                                                                        34

                                                                                                                                                                                                                                                  37

                                                                                                                                                                                                                                                        40
                                                                                                                                                            4
                                                                                                                                                        1




                                                                                                                                                                    7




                                                                                                                                                                                                                                                                  5
Behavioral Causes


 Misuse of base-stock    Panic ordering after
  policies                 unmet demand     *
 Misperceptions of       Perceived risk of other
  feedback and time        players rationality
  delays
Operational Causes

 Dependent Demand Processing           Trade promotion and
      Forecast Errors                   forward buying
      Adjustment of parameters with
       each demand observation          Anticipation of shortages
 Lead Time Variability (forecast          Allocation rule of suppliers
  error during replenishment lead
                                           Shortage gaming
  time)
                                           Lean and JIT style management
 Lot-sizing/order synchronization
                                            of inventories and a chase
      Consolidation of demands
                                            production strategy
      Transaction motive
      Quantity discount
Sources of Performance-Cycle Variation
                                                                Total Performance Cycle



                                       5                10                      40
                       Customer
                       Delivery                     Time Range - Days                                Order
                                                                                                     Transmission
1/2             1                  3
          Time Range - Days                                                   1/2             1                3
                                                                                        Time Range - Days

                          Order
                          Transportation                                                              Order
                                                                                                      Processing
      2           4                    10
           Time Range - Days                                 Order
                                                             Selection              1          2              4
                                                                                          Time Range - Days
                               1                2                        20
                                            Time Range - Days
Supply Chain Quiz
   A box of cereal spends ?        A box of cereal spends 104
    days in the supply chain.          days in the supply chain.
   Total inventory in the            Distorted information causes
    pharmaceutical supply              total inventory in the
                                       pharmaceutical supply chain to
    chain exceeds ? days and ?         exceed 100 days with $11
    $ in savings to be realized.       billion in savings to be
   Poor coordination in the           realized.
    food industry supply chain        Poor coordination wasted $
    wasted ? dollars.                  30 billion annually in the food
                                       industry.
   Boeing wrote-off ? dollars
    in 1997 due to supply chain       $ 2.6 billion is how much
                                       Boeing wrote-off in 1997 due
    inefficiencies.                    to supply chain inefficiencies
   It costs, on average, ?           $80 was paid, on average, to
    dollars to process each            process each purchase order.
    purchase order.
Time is Money….

ASC’s attempt to eliminate all
work and time not bringing
value.

ASC’s look for suppliers who:

• Integrate Customer Service
• Respond to Production
• Supplier Integration - Limits
Supply Chain Performance Outcomes




                                    Cost

                    Safety                    Assets



                                                   Responsive
          Sustainability          Outcomes            ness



                    Customer
                   Satisfaction              Reliability

                                  Revenue
Urgent Need to Address Customer Needs
On average, suppliers lose the sale 41% of the time




     Consumer behavior when confronted with an option

                                      Delayed   Other
                                     purchase
                                                8%
       Did not buy product             14%                        Substituted
                                                                 another brand
             10%                                                     19%

                              Purchased at              Substituted same brand
                             another supplier               (different size)

                                  31%                           18%
Results of Poor ASC Supply Chains
Since ASC’s work on a streamlined
system without the traditional
buffers of hospital networks, the
consequences are felt more directly   Cancellation of Surgery

by the facility.
                                      Physician / Patient Dissatisfaction


Patient safety can be compromised     Increased cost for services
due to poor planning.
                                      Loss of future Business
Questions??

                             Thank You


Richard Bays MBA, RN, CPHQ      for
Rbaysconsulting@gmail.com


       832.316.2701
                               Your

Supply Chain Management - R Bays

  • 1.
  • 2.
    Ambulatory Surgical Centers ASC’soperate in a different environment than traditional Operate hospitals. There is less physical space for stock and cases can be scheduled with short notice. Financial constraints prevent a large buffer stock from existing. Change ASC Orders Optimize
  • 3.
    Whip It ! The Bullwhip Effect (or Whiplash Effect) is an observed phenomenon in forecast-driven distribution channels. Since the oscillating demand magnification upstream a supply chain reminds someone of a cracking whip it became famous as the Bullwhip Effect.
  • 4.
    Because customer demand is rarely perfectly stable, businesses must forecast demand to properly position inventory and other resources.  Forecasts are based on statistics, and they are rarely perfectly accurate. Because forecast errors are a given, companies often carry an inventory buffer called “safety stock”.  Moving up the supply chain from end-consumer to raw materials supplier, each supply chain participant has greater observed variation in demand and thus greater need for safety stock.  In periods of rising demand, down-stream participants increase orders. In periods of falling demand, orders fall or stop to reduce inventory.  The effect is that variations are amplified as one moves upstream in the supply chain (further from the customer).
  • 5.
    Information Coordination: TheBullwhip Effect Consumer Sales at Retailer Retailer's Orders to Wholesaler 1000 1000 900 900 Consumer demand 800 800 Retailer Order 700 700 600 600 500 500 400 400 300 300 200 200 100 100 0 0 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 1 3 5 7 9 29 11 13 15 17 19 21 23 25 27 31 33 35 37 39 41 1 3 5 7 9 Wholesaler's Orders to Manufacturer Manufacturer's Orders with Supplier 1000 1000 Manufacturer Order 900 Wholesaler Order 900 800 800 700 700 600 600 500 500 400 400 300 300 200 200 100 100 0 0 19 11 13 15 17 21 23 25 27 29 31 33 35 37 39 41 1 3 5 7 9 13 10 16 19 22 25 28 31 34 37 40 4 1 7 5
  • 6.
    Behavioral Causes  Misuseof base-stock  Panic ordering after policies unmet demand *  Misperceptions of  Perceived risk of other feedback and time players rationality delays
  • 7.
    Operational Causes  DependentDemand Processing  Trade promotion and  Forecast Errors forward buying  Adjustment of parameters with each demand observation  Anticipation of shortages  Lead Time Variability (forecast  Allocation rule of suppliers error during replenishment lead  Shortage gaming time)  Lean and JIT style management  Lot-sizing/order synchronization of inventories and a chase  Consolidation of demands production strategy  Transaction motive  Quantity discount
  • 8.
    Sources of Performance-CycleVariation Total Performance Cycle 5 10 40 Customer Delivery Time Range - Days Order Transmission 1/2 1 3 Time Range - Days 1/2 1 3 Time Range - Days Order Transportation Order Processing 2 4 10 Time Range - Days Order Selection 1 2 4 Time Range - Days 1 2 20 Time Range - Days
  • 9.
    Supply Chain Quiz  A box of cereal spends ?  A box of cereal spends 104 days in the supply chain. days in the supply chain.  Total inventory in the  Distorted information causes pharmaceutical supply total inventory in the pharmaceutical supply chain to chain exceeds ? days and ? exceed 100 days with $11 $ in savings to be realized. billion in savings to be  Poor coordination in the realized. food industry supply chain  Poor coordination wasted $ wasted ? dollars. 30 billion annually in the food industry.  Boeing wrote-off ? dollars in 1997 due to supply chain  $ 2.6 billion is how much Boeing wrote-off in 1997 due inefficiencies. to supply chain inefficiencies  It costs, on average, ?  $80 was paid, on average, to dollars to process each process each purchase order. purchase order.
  • 10.
    Time is Money…. ASC’sattempt to eliminate all work and time not bringing value. ASC’s look for suppliers who: • Integrate Customer Service • Respond to Production • Supplier Integration - Limits
  • 11.
    Supply Chain PerformanceOutcomes Cost Safety Assets Responsive Sustainability Outcomes ness Customer Satisfaction Reliability Revenue
  • 12.
    Urgent Need toAddress Customer Needs On average, suppliers lose the sale 41% of the time Consumer behavior when confronted with an option Delayed Other purchase 8% Did not buy product 14% Substituted another brand 10% 19% Purchased at Substituted same brand another supplier (different size) 31% 18%
  • 13.
    Results of PoorASC Supply Chains Since ASC’s work on a streamlined system without the traditional buffers of hospital networks, the consequences are felt more directly Cancellation of Surgery by the facility. Physician / Patient Dissatisfaction Patient safety can be compromised Increased cost for services due to poor planning. Loss of future Business
  • 15.
    Questions?? Thank You Richard Bays MBA, RN, CPHQ for [email protected] 832.316.2701 Your