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The purpose of this article is to shed light on hospital supply expenses, which form the second largest expense category after payroll and hold more promise for improving cost-efficiency compared to payroll. However, limited research has rigorously scrutinized this cost category, and it is rarely given specific consideration across cost-focused studies in health services publications. After reviewing previously cited estimates, we examine and independently validate supply expense data (collected by the American Hospital Association) for over 3,500 U.S. hospitals. We find supply expenses to make up 15% of total hospital expenses, on average, but as high as 30% or 40% in hospitals with a high case-mix index, such as surgery-intensive hospitals. Future research can use supply expense data to better understand hospital strategies that aim to manage costs, such as systemization, physician–hospital arrangements, and value-based purchasing.

The metaphor of 'orchestration' is applied to an emergent change whereby developing different versions of a resource to solve local problems with managing hospitalized patient care in the USA became conceived as a nationwide innovation. A pluralistic framework incorporates Abbott's conception of a system of professions, a cultural and political perspective on interaction and the notion of 'orchestration' which is distinguished from leadership and management. Small‐scale research in diverse settings shows how key stakeholders including academic medical researchers orchestrated the coalescence of disparate practices into a unified movement, although working in a relatively decentralized healthcare system featuring a complex mix of public, private and voluntary sectors. Sufficient confluence between diverse interests was nurtured for widespread acceptance of a new 'hospitalist' role coordinating inpatient treatment. It is suggested that the metaphor of orchestration may have wider potential as a heuristic for understanding emergent change that becomes more complex as it spreads.

This book explores the management of change to improve public service effectiveness. It breaks new ground in addressing why public service change is becoming increasingly complex to manage, how people cope with this new complexity, what implications arise for improving policy and practice, and which avenues for further research and theory-building look particularly promising.The contributors are all leading researchers from the USA, Canada and the UK. Together they provide a synthesis of state-of-the-art thinking on the complex change process in Anglo-American contexts, policy-making for publi

Cover -- Title Page -- Copyright Page -- Contents -- Acknowledgments -- About the Authors -- Remembering -- About the Companion Website -- List of Exhibits -- List of Acronyms -- Preface -- Chapter 1 The Healthcare Supply Chain Environment-Here's the Big Picture -- 1.1 The Healthcare Supply Chain: Evolving Recognition and Importance -- 1.2 Healthcare System Challenges and Strategies -- 1.3 Supply Chain as a System of Systems within Healthcare as a System -- 1.4 What Is (Healthcare) Supply Chain Management? -- 1.5 Supply Chain Processes and Functions -- 1.6 The Supply Chain Stakeholders -- 1.6.1 Primary Actors: Buying and Selling Organizations -- 1.6.2 Supporting Actors -- 1.6.3 Influencers -- 1.6.4 Fusion Organizations -- 1.7 FISCO Functions and Supply Chain Maturity -- 1.8 From Cost Center to Strategic Asset -- 1.8.1 Clinician Centrality and the Customer -- 1.8.2 Who Is the Customer? -- 1.8.3 Advancing Capabilities -- 1.8.4 Lessons from Other Industries -- 1.8.5 Clockspeed -- 1.9 Chapter Summary -- Notes -- Chapter 2 Building a Strategy for Healthcare Supply Chain Management-Creating the Vision -- 2.1 Introduction -- 2.2 Vision Statements -- 2.3 Mission Statements -- 2.4 Corporate Objectives -- 2.5 Business Process Strategies -- 2.6 Technology Framework Strategies -- 2.7 Distribution Network Strategy -- 2.8 Action Initiatives/Strategies -- 2.9 Chapter Summary -- Notes -- Chapter 3 Risk Management Strategies-Healthcare Is Risky, So Is Supply Chain Management -- 3.1 Introduction -- 3.2 The Nature of Supply Risk -- 3.3 Risk Categories -- 3.3.1 Strategy Risk -- 3.3.2 Market Risk -- 3.3.3 Demand Risk -- 3.3.4 Implementation Risk -- 3.3.5 Cost Risk -- 3.4 Response and Resilience to Risks -- 3.4.1 Mitigating Risks -- 3.4.2 Reducing Risk Through Technology -- 3.5 Chapter Summary -- Notes.

POLICY POINTS: a framework for governance and response to enable a globally independent supply chain; a flexible structure to accommodate the requirements of state and county health systems for receiving and distributing materials; and a national material "control tower" to improve transparency and real‐time access to material status and location. CONTEXT: Much of the discussion about the failure of the COVID‐19 supply chain has centered on personal protective equipment (PPE) and the degree of vulnerability of care. Prior research on supply chain risks have focused on mitigating the risk of disruptions of specific purchased materials within a bounded region or on the shifting status of cross‐border export restrictions. But COVID‐19 has impacted every purchase category, region, and border. This paper is responsive to the National Academies of Sciences, Engineering and Medicine recommendation to study and monitor disasters and to provide governments with course of action to satisfy legislative mandates. METHODS: Our analysis draws on our observations of the responses to COVID‐19 in regard to acquisition and contracting problem‐solving, our review of field discussions and interactions with experts, a critique of existing proposals for managing the strategic national stockpile in the United States a mapping of the responses to national contingency planning phases, and the identification of gaps in current national healthcare response policy frameworks and proposals. FINDINGS: Current proposals call for augmenting a system that has failed to deliver the needed response to COVID‐19. These proposals do not address the key attributes for pandemic plan renewal: flexibility, traceability and transparency, persistence and responsiveness, global independence, and equitable access. We offer a commons‐based framework for achieving the opportunities and risks which are responsive to a constellation of intelligence assets working in and across focal targets of global supply chain risk. CONCLUSIONS: The United States needs a ...