Leveraging Millennials and Technology to Weather the Perfect Storm

October 19, 2016 | Content Areas: Finance | Tags: Analytics, Change Management, Cost Management, CQO, Inventory Management | Formats: White Paper
Authors: Annette A. Wooters, FAHRMM, CMRP, MBA

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Annette A. Wooters, FAHRMM, CMRP, MBA
Far West Division Supply Chain COO
Las Vegas, NV


Increasing federal regulation compliance costs and declining reimbursements have compressed hospital profitability. This is leading hospitals to turn to Supply Chain to reduce direct costs for supplies, devices, drugs, and purchased services. Traditionally Supply Chain has aggressively pursued these cost reductions through price reduction tactics. These techniques, however, are yielding diminishing savings returns.  To develop larger savings opportunities, Supply Chain must expand the use of supply utilization analysis and alignment.  This requires effectively and collaboratively using real-time, granular usage data, acquired through electronic technology such as barcode and Radio-Frequency Identification (RFID). Simultaneously today’s workforce is shifting from Baby Boomers to Millennials, with Millennials having become the largest share of the American workforce (Fry, 2015).  Understanding and engaging their unique attitudes and capabilities, especially their technology orientation, and successfully integrating these with Boomer attributes, will enable Supply Chain to leverage the new workforce culture through the increased use of electronic technology to shift the cost savings paradigm to supply utilization alignment.  Through this synergy, Supply Chain can drive significant savings to help their facilities weather the perfect storm of declining revenues and increasing costs. 

Leveraging Millennials and Technology to Weather the Perfect Storm
Over the past seven years, hospitals have experienced the perfect storm of rising costs and declining revenues.  Compliance costs have increased due to governmental regulations while revenues have declined due to decreasing volumes coupled with the impact of evolving new technologies. The repeated use of price reduction tactics to minimize the financial gap is yielding ever diminishing success.  Current hospital replenishment and supply charge capture systems continue to have a substantial manual component managed by clinicians.  This results in spend analytics as the primary driver of value analysis for Supply Chain. These manual systems fail to effectively capture the granular, real-time data required for true supply utilization analysis and improvement.  Simultaneously, the American workforce is undergoing transformation as the Baby Boomer generation is supplanted by the Millennial generation.  While Boomers are traditionally seen as highly loyal, productive, and hardworking, Millennials are typically viewed as technologically adept, socially oriented and collaborative.  Engaging and retaining Millennials will require that healthcare facilities provide technologically efficient work tools, systems that yield constant and immediate feedback, and processes that encourage innovative and creative problem solving. This generational shift is driving the need to successfully blend the attributes and needs of both generations to leverage and focus their strengths.   Synergy will be created between the blended workforce and electronic technology used successfully for many years in the manufacturing and retail sectors.  This synergy will allow Supply Chain to capitalize on supply utilization opportunities to generate as much as 15% savings through greater operational efficiency, elimination of waste, and reduction of inventory (Yokl, 2013a).  

Healthcare Financial State
Substantial initial investment has been required to comply with the provisions of the Health Information Technology for Economic and Clinical Health Act (HITECH) and the Patient Protection and Affordable Care Act (PPACA). It is expected that over the long term, Electronic Health Records (EHR) required by HITECH will lead to improved clinical outcomes. Improved outcomes will result from improvements in the quality of care and lower costs due to greater efficiencies in facility operational and financial performance. Also, EHR will provide data for additional research that can be used to improve population health. Significant initial investment, however, is required for hardware, software, administrative infrastructure, and information system security. Additionally, there will be ongoing maintenance and security costs due to increased patient privacy violation risks requiring increased data security measures and monitoring (Menachemi & Collum, 2011). It will take a number of years for the benefits of EHR to positively impact hospital profitability due to the magnitude of these initial and sustaining costs. The enactment of the PPACA has forced additional investment due to the shift to new models of reimbursement such as value based purchasing (VBP) and accountable care organizations (ACOs). The entire cost structure of hospitals, as supported by organizational hierarchy, policies, procedures, work flows, and behaviors, is built upon the fee-for-service model of reimbursement. In the past, more procedures meant more profitability. The paradigm is shifting to a coordinated, standardized, high quality “episode of care” environment which will drive better clinical outcomes at a lower overall cost. This shift alters the processes and behaviors throughout the entire hospital structure, including interactions with physicians. Adding to the cultural stress is the inclusion of patient experience measures as a factor of reimbursement. This is a major philosophical change in healthcare that requires a completely different set of behaviors and thought processes from clinicians as well as administrators.

At the same time hospitals are investing heavily to meet the new reimbursement challenges, declining patient admissions and lower reimbursement rates have significantly reduced revenues. As a result of improved technology, better pharmaceuticals, and expanded case management, both admissions and length of stay have declined as care has shifted to ambulatory or home settings. A multitude of new rules have been instituted by the Centers for Medicare and Medicaid Services (CMS) under the PPACA. For example, the “two-midnight rule”, no longer recognizing admissions for patients with very short hospital stays, has accelerated the reimbursement decline, with occupancy rates dropping from 77% in 1980 to 60% by 2015 (Evans, 2015). Well illustrated by Grube, Kaufman, and York (2013) in their blog post, the following chart represents the cumulative change in Medicare inpatient discharges per FFS beneficiary from 2004-2010: [Download the PDF to view graph].

Additionally, Disproportionate Share Hospital (DSH) payments to hospitals that serve a disproportionate share of Medicaid and qualified low income patients began to be reduced in 2014 and will continue to decline through 2020. Also accelerating reimbursement declines is the CMS Hospital Value-Based Purchasing Program. Thirty percent of the program’s financial incentives are based on patient satisfaction scores as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. There have been disparities noted between facilities that achieve high clinical quality metrics yet low HCAHPS scores. Cocchi (2012) notes that some types of facilities, such as safety-net, teaching, extremely large hospitals, and some particular geographic regions, appear to generally trend low on all HCAHPS measures. Higher expenditures are required by these facilities to improve scores while experiencing increased reimbursement cuts as a result of these survey biases. CMS has also increased diagnosis-related group (DRG) payment reductions to fund incentive payments, potentially deteriorating reimbursement levels further for some facilities. Shoemaker (2011) observes that reasonably about half of all participating hospitals can expect to receive reduced Medicare reimbursement based on rising thresholds for earning incentives coupled with the myriad of penalties and funding shifts in the Hospital Value-Based Purchasing program. As a result of these negative impacts on reimbursement, hospitals will be forced to dive deeply into the factors driving cost, as well as low patient satisfaction scores, to develop sustainable processes and infrastructure improvements to meet the new reimbursement requirements.

To mitigate the impact of the financial compression on profitability caused by increased cost coupled with decreased reimbursement, traditionally hospitals have turned to Supply Chain to reduce direct costs for supplies, devices, drugs, and purchased services. These supplies and services are the second largest facility expense after labor (Lee, 2014). Historically, Supply Chain has focused on tactics such as price negotiations, standardization, group purchasing organization (GPO) contract compliance, and economies of scale to generate price savings. Large GPOs and purchasing cooperatives with committed volume structures have driven down prices on commodity-type medical supplies, as well as on physician preference items such as medical devices and implants. Research by Yokl (2013a) has found, however, that these tactics are now saving only in the range of 1% - 3% annually on total supply expense. Many hospitals have implemented cross functional value analysis (VA) teams to drive cost reductions. This typically is done through new product evaluation and approval, vetting of technology requirements, and data analysis to drive savings projects such as reprocessing of surgical or cardiac cath lab supplies. Some organizations have included physicians in their VA teams. Others have formed separate physician VA teams to review new or expensive physician-requested technology and supplies using an evidence-based medicine perspective. These teams evaluate clinical outcomes and total procedure costs to ensure improved outcomes are delivered cost effectively. Typically, however, these VA teams focus on projects, and do not encompass meaningful utilization analysis. While significant focus is placed on obtaining the lowest price for supplies, operationally the supplies are not tracked for appropriate use, overuse, waste, or product feature to required function match. Yokl (2013b) has observed that most VA teams do not have appropriate tools and data to evaluate utilization misalignments, so thereby default to spend analytics that may not truly reflect usage trends, patterns, and waste.

Current Healthcare Supply Chain Systems
Significant application of technology has been directed to the development of EHR and electronic integration of clinical systems to facilitate and enhance the coordination of patient care over the past seven years. Healthcare supply chain, however, has been slower to adopt electronic technologies such as barcode and RFID to improve efficiency and cost effectiveness through improved supply utilization management. Some healthcare systems have adopted electronic replenishment systems that have a barcode component. The use of these systems is typically limited in scope to specific Point-of-Use (POU) stockrooms managed by supply chain, leaving a significant portion of supply management in the hands of clinicians using manual systems. Additionally, the existing electronic systems are only as effective as clinicians’ use of them. Some electronic replenishment systems are constrained by low clinician compliance in scanning products and lack of accountability in linking compliance to an individual. According to research by Malhotra (2002), compliance implies motivation by either the desire of a reward or the avoidance of a punishment. Thus, based on the design of some electronic systems currently in use in healthcare supply chain, lack of accountability to a specific individual for the scanning behavior negates the effect of either reward or punishment in driving high levels of compliance with use of these systems. Overall these limited electronic systems do not give detailed usage data, resulting in the use of spend analytics for cost reduction activities.

The limited use of electronic replenishment systems leaves a significant portion of supply management to manual par orders, stickers, and tick sheets manually entered into software by user departments to trigger both supply replenishment and supply charge capture. These duties are usually assigned to clinical personnel who may execute these tasks with less attention, timeliness and consistency than patient care tasks. Frequently, clinicians attempt to compile the supply information, for both replenishment and supply charge capture, long after product use. This frequently leads to product misidentification, incorrect quantity charting, missed reorders and failure to enter supply charges. Typically waste and obsolescence are not reported accurately or at all via these manual processes, so utilization data is inaccurate and difficult to extract from spend data. Obsolescence is frequently only tracked as a dollar figure, thus the granular product data is lost. Additionally, these manual processes lead to the existence of silos between departments when ordering, stocking or consuming supplies. This leads to higher overall inventory levels and increased wastage from obsolescence as actual on hand inventories are unable to be viewed facility-wide. The data is not integrated across the hospital to facilitate rapid, accurate data capture and supply charging. This data is also not necessarily reflective of effective utilization since based on each department requisitioner’s perception of need. Additionally, due to lack of real-time integration across facilities in an integrated delivery network, imbalances in inventories are not as readily observable and inter-facility inventory transfers are infrequent or unaligned with actual requirements. Yokl (2013c) proposes that uncovering supply utilization misalignments requires specialized technology to uncover waste and inefficiencies within the supply streams, as well as to provide the charts, graphs, and benchmarks used to induce the behavioral changes required to eliminate the waste and inefficiencies. None of the current data generation systems supports these real-time requirements.

Limited electronic system usage coupled with the wide-spread use of manual supply replenishment systems inhibits effective supply chain knowledge management in facilitating supply utilization improvements. Spend data is typically the primary database used for analysis. Spend data, however, doesn’t take into account fitness for use, inappropriate use, or overuse of supplies. Currently, this type of information must be derived from collaboration between Supply Chain and clinical departments. Yuva (2002) has observed that the two most common methodologies of sharing collaborative information between supply chain management and other internal departments are email and informal discussions. The informality, lack of precision, historical nature, and difficulty in capturing these types of information exchanges make it a challenge to use this knowledge on a wider or more strategic scale (Yuva, 2002).

Supply Utilization Alignment and Analysis
Supply Chain needs to look at savings opportunities differently in order to provide the high dollar savings required by today’s healthcare financial landscape. Yokl (2013a) has estimated that 79% of all new supply expense savings will be achieved through utilization alignment, not price reduction or standardization. Supply overspend is rampant in healthcare because so much of the supply budget is actually controlled by clinicians who use the wrong product for a procedure or application, use more products than necessary, stockpile products in multiple locations, choose over-featured products, unintentionally waste products, or fail to rotate stock to prevent obsolescence. This overspend extends backwards in the supply chain to the vendor as well, in the form of damaged product, inefficiently packaged product, or upselling of higher cost or over-featured contracted product. Thus, using supply utilization analysis and alignment to focus on reducing consumption, eliminating waste, and matching product features with required functions, Supply Chain will be able to realize the 7%-15% savings opportunity available as estimated by Yokl (2013a).

In order to track, trend, and identify supply utilization misalignments, Supply Chain needs to implement new operationally oriented technology. This technology will be used to rapidly gather data on the use of supplies distinct from spend data, and to build databases from which useful information can be easily extracted and analyzed. The information generated will be used to implement actionable use-based savings plans. Barcode and RFID technology offer successful track records for the manufacturing and retail sectors in achieving substantial operational and utilization efficiencies. Barcode technology has been in use in the retail and manufacturing sectors since the early 1970’s, generating billions of dollars of savings through the reduction of labor costs due to faster processes, and improved inventory control resulting in less wastage, obsolescence, higher inventory turns, and lower carrying costs (Brown, 2001). While RFID technology was invented in 1948 and began to be used commercially in the 1980s, Wal-Mart first implemented RFID as an inventory supply and theft control process in the early 2000s. RFID technology has surpassed barcode technology in capability, building upon faster processes and improved inventory management by facilitating recall processes, reducing theft, and providing greater data collection capabilities (DataFlows Dimensions, 2011). Barcodes and RFID are now two of a number of technologies which include a variety of tasks that fall into the category of automatic identification and data capture (AIDC). These real-time tools provide improved data collection accuracy by eliminating human manual entry errors while collecting the data at much greater speed, thus improving productivity and lowering labor cost, as well as freeing staff to focus on other activities. Since data is available more rapidly by information scanned directly into databases at time of use, information can be obtained and analysis performed in real-time. This allows faster response to changing business demands and market conditions, facilitating more informed business decisions. Due to the precision with which barcodes and RFID permit inventory to be tracked, greater inventory control through item level quantities and locations can be maintained, allowing for lower overall inventory levels and thus lower overall costs. Lastly, costs for both barcode and RFID technology have fallen significantly over the past 40 years, with free barcode generators on the Internet and even free SMART phones applications with which to scan. With the variety of formats, low relative cost of implementation and use, simplicity of use, and ubiquitous presence, the improved data capture that is provided by bar code and RFID technologies can provide the foundation for development and evaluation of the organization’s supply chain knowledge and thus lead to significant supply utilization improvement. The rapidly growing Millennial component of today’s workforce, with their heavy dependence and insistence on technologically sophisticated work tools, can be leveraged to facilitate this shift to electronic data capture in healthcare supply chain.

While electronic technology can enable the real-time granular data capture needed to track and trend usage, as well as provide the databases needed to benchmark supply utilization misalignments, collaboration between Supply Chain, clinicians and vendors is needed to uncover inefficiencies, redesign products and systems, and operationalize savings opportunities. Collaboration, as defined by Sampson (2010), is built upon the human behaviors of sharing knowledge, learning, and building consensus. Supply Chain must establish a trustful relationship with clinicians in order to be seen as desiring the best patient outcome with the least waste rather than being seen as solely focused on cost savings. Supply Chain and clinicians must be authentic with each other, sharing truthful and accurate information regarding product uses, patient needs, clinical practices, and required product features to reveal the waste and utilization opportunities. Additionally, as proposed by Dale (2012), there must be a positive recognition or reward for good collaborative behavior to take place, the most effective of which appears to be the intrinsic recognition of demonstrated knowledge or expertise. Lastly, Dale (2012) indicates that the motivation for collaboration must be a commitment to the cause which engages the emotion or passion of the collaborators. This collaborative environment is growing in healthcare with the shift of the American workforce to the Millennial generation with their particular needs and attributes.

Millennials in the Workforce
The Millennial generation is commonly defined as those born between the years 1981 and 1997, consisting of adults aged 19 to 35. According to data presented by Fry (2015), the Census Bureau projected that in 2015 the Millennial generation would surpass the Baby Boomer generation, comprised of those born in 1946 to 1964, as America’s largest living generation. While the Baby Boomer workforce peaked in size in 1997, and Generation X, those born between 1965 and 1980, dominated the labor force for only three years peaking in 2012, the Millennial workforce has surpassed both prior groups with continued growth expected (Fry, 2015). Lynch (2008) has observed that by 2020 Millennials will be nearly half of the American workforce, as noted in the charts below:[Download the PDF to view graph].

Based on this expectation, it is crucial for today’s leaders to understand and adapt the workplace to the attitudes and needs of this generation in order to optimize their engagement in and contribution to the workplace.

As observed by Guenther (2010), the average age of most hospitals is 27 years, which indicates that the culture within most hospitals has developed around the values and expectations of the Baby Boom generation. While Baby Boomers are frequently regarded as highly productive, hardworking, team players who value continuous learning, they are not highly ranked as technology oriented and collaborative (Giang, 2013). While not technology-averse, they are not as comfortable or quick in adopting technology, and due to past experience have the patience to work linearly through work processes. Boomers tend to be more comfortable with a “command and control” management style, with annual feedback sufficiently motivational. Boomers bring experience and wisdom from decades of participating in relationships and projects (Koloc, 2013). They tend to view management as experts and less often challenge the status quo. Since Boomers are more comfortable with the existing work tools and processes, they will not be strong drivers of the needed shift to more technologically driven systems in order to support enhanced supply utilization alignment tactics.

Millennials, on the other hand, are highly collaborative, technology savvy to the point of dependence, desiring of constant and immediate feedback, wanting to positively impact the world, and insistent upon balance between their work and personal lives. They are the first generation to have been raised with computers, cell phones, and social media as an integral part of their daily lives. Gilbert (2011) states that in addition to being socially minded, Millennials desire to be creative and to use instantly available information to work on new and difficult problems which require creative solutions. Cultures that are based on retaining departmental silos and processes that are manual, non-integrated, and require long meetings and excessive paperwork will lead to frustration and disengagement for this generation.

Millennials are immersed in technology in every aspect of their lives daily. Text, Twitter, Snapchat, Instagram, streaming video, and Apple Pay are all part of their daily lexicon. They expect interactive technologies, and according to Wobbrock (2014), having become accustomed to an on-demand lifestyle, have less tolerance for poor online user experiences. Beese (2016) has determined that mobile technology has become the primary means of accessing social media. Thus, as Millennials bring these technology skills and expectations into the existing workplace culture, they are being confronted with systems and processes significantly behind the technological curve. This creates frustration leading to resentment and disengagement because Millennials believe these antiquated systems are inefficient, time-consuming, and labor intensive. This in turn may lead to noncompliance with existing processes and policies (Rikleen, 2014). With their demand for fast, efficient, mobile technologies and processes, Millennials are poised to drive the shift to technologies such as bar code scanning and RFID required to support supply utilization alignment.

Adoption of barcode and RFID to obtain real-time, granular usage data synchronizes with the technology expectations of Millennials. Beese (2016) indicates that 87% of Millennials claim they are never without their cell phones, thus making SMART phones a critical data collection tool. In addition to supply chain, future clinicians will be multi-skilled, having the clinical skills of nursing, but also tech expertise in the use of EHR and handheld devices (Putre, 2013). Providing Millennials with immediate access to information via their preferred method of access will satisfy their creative problem-solving desire while reducing their frustration with manual, inefficient systems and processes. Additional integration of these technologies between systems will reduce the number of data capture activities overall, further fueling Millennials’ desire for efficient work processes. By designing the systems to meet the technology expectations and current daily practices of Millennials, high levels of process compliance can be achieved. This will improve the validity and robustness of the data which will in turn lead to improved analysis and decision making. Decker (2016) concludes that since Millennials are comfortable with technology and the efficiencies it creates, they will help accelerate the adoptions of these tools. Therefore, Supply Chain leadership placing this electronic technology in the hands of Millennials will accelerate the transformation to the use of supply utilization alignment for cost savings.

The collaborative mindset of the Millennial generation has encouraged their heavy engagement in social media as well as enhanced their social conscience and activism. They were raised participating in team sports such as soccer and in organized activities such as lessons and camps as opposed to the Baby Boomers more individualistic and unstructured upbringing. This has honed Millennials’ collaborative skills and led them to crave collaboration over competition. Through the use of their social media networks, Millennials tap into diverse resources for research and information, and flow information and ideas out broadly in a real time basis, being leaders in crowdsourcing. The traditional, non-integrated departmental silo structure in most work cultures alienates Millennials as it is in opposition to their strengths. Key to engaging Millennials is creating a collaborative environment that allows the free flow of information, provides a team approach to improvement and problem solving, and connects their work activities to a social purpose to which they are attracted.

Millennials stand poised to break down interdepartmental silos through their overwhelming preference to collaborate coupled with their immersion in social media technology. In order to harness this collaborative nature, healthcare supply chain leaders need to embrace the new communication paradigm in the workplace. It will be critical to establish secure forums such as collaboration tools to serve as central hubs for sharing information, file sharing tools to facilitate rapid exchange of documents, and web conferencing tools to allow for virtual meetings. These tools will allow organizations to capitalize on data trends and operationalize decisions more quickly. Additionally, fostering the integration of the existing Baby Boomer culture with the ever-increasing Millennial workforce culture is essential to success. Establishing cross-generational teams, mentoring relationships, and open communication will be key in creating the workforce synergy necessary to realize the collaborative improvements. The transformation of the workplace to a collaborative, highly interconnected network will elevate the engagement of Millennials and will increase the speed with which supply utilization alignment is implemented throughout healthcare supply chain.

Koloc (2013) proposes that Millennials bring potential to the workplace. Their desire for continuous feedback coupled with their desire to progress rapidly makes them excellent candidates for mentoring. They do not view management as content experts as much as coaches or mentors. Due to their prodigious technological skills, they can search the Web quickly and efficiently for information, constantly learning due to the continuous stream of new or better apps available. This creates a scenario where, if implemented and managed well, collaboration between Boomers and Millennials can bring the best attributes of both generations together to create greater achievement and success than previously seen. Giang (2013) compares the strengths and weaknesses of Boomers and Millennials:[Download the PDF to view graph].

Realizing the synergy from uniting the greatest attributes of Baby Boomers and Millennials requires a focus on communication, coaching, and contextualizing. While Millennials want continuous feedback, they also need to be able to give feedback to their leaders and peers. This open line of communication will build the bridge between the generations for exchange of information. The Millennials will benefit from the past experiences, institutional knowledge, and wisdom of the Boomers, while the Boomers will benefit from the tech savvy and social media skills of the Millennials. The expectation must be for two-way teaching and learning. Tanner (2015) believes it is important that the feedback is balanced between what was done well and what needs improvement. The recognition of positive contributions will improve the trust in the relationship between the Boomers and Millennials, which will in turn improve the communication flow.

Millennials will respond more positively to coaching and mentoring than direct supervising. Coaching that focuses on outcomes helps Millennials understand their role in bigger picture, and helps them connect to purpose. A one-on-one mentorship program also facilitates communication and helps build relationships between the generations. Frequent coaching keeps Millennials engaged and on track with their work. Both Boomers and Millennials want to be treated respectfully, and will respond to effective coaching relationships.

Contextualizing means sharing the vision, goals, and underlying rationale for the work to establish a shared sense of purpose between the generations. This helps each group understand their roles in the process, and will play to the creativity and collaborative nature of the Millennials as well as to the desire of the Boomers to contribute and pass along their knowledge. This also allows the team structure to be flat, rather than hierarchical, allowing leadership to shift between the generations depending on the situation, meeting the need of flexibility for Millennials while being supported by the project management skills and experience of the Boomers. Their shared vision of the bigger picture keeps the team focused on the desired outcome. Thus, through setting the appropriate context for the generations, using a coaching/mentoring management style, and fostering open communication through continuous feedback, the strengths of the Baby Boomers and the Millennials can be united and focused on the challenges of healthcare facility profitability.

Healthcare supply chain stands at the intersection of three significant cultural changes – the shifting healthcare financial landscape, the generational changeover of the American workforce, and the needed transformation of supply chain tactics from spend analytics to supply utilization alignment. The drivers of hospital profitability compression will continue unabated while revenue relief moves slowly since based on the political process and election cycles. Supply Chain must successfully blend the unique attributes and needs of the Millennial generation with the existing traits and behaviors of the Boomer generation into a powerful team that is poised to use electronic technology to shift the cost savings paradigm to supply utilization alignment. By leveraging this multi-generational team and latest electronic capability, Supply Chain will be empowered to capitalize on the 7-15% estimated savings potential of this tactic.

Beyond providing higher levels of savings and greater levels of employee engagement, the fusion of Millennials and electronic technology through supply utilization alignment will facilitate societal contributions through both EHR and population health research. Usage data gathered on supplies and medical devices can be coupled with demographics, morbidities, and clinical outcomes to improve evidence-based medicine. This will create a feedback loop to inform supply decisions and further utilization improvements. Healthcare supply chain must be clinically integrated with physicians and clinicians in order for savings recommendations to be accepted and fully implemented. Tapping into Millennials’ desire to improve society in this manner will provide a connection to purpose that increases engagement as well as compliance with system use. This synergy also provides a bridge between supply chain and clinicians, creating a common purpose that will further build collaboration. By integrating the Millennial and Boomer cultures and then leveraging with AIDC electronic technology, Supply Chain can drive significant savings through a paradigm shift to supply utilization
alignment in order to help their facilities weather the perfect storm of declining revenues
and increasing costs.

Beese, J. (2016, January 4). 6 social media trends that will take over 2016. Retrieved April 10, 2016 from http://sproutsocial.com/insights/social-media-trends/
Brown, S. (2001, April). A history of the barcode. Retrieved February 13, 2016 from https://eh.net/encyclopedia/a-history-of-the-bar-code/
Cocchi, R. (2012, October 30). Patient satisfaction can affect your revenue. Retrieved March 18, 2016 from http://www.healthcarebusinesstech.com/patient-satisfaction/
Dale, S. (2012, July 12). The art of collaboration (collaborative behaviors). Retrieved April 3, 2016 from http://www.stephendale.com/2012/07/12/the-art-of-collaboration-collaborative-behaviours/
DataFlows Dimensions, Inc. (2011, February). An overview of RFID technology. Retrieved February 13, 2016 from http://www.dataflows.com/RFID_overview.shtml
Decker, L. (2016, January 7). Millennials and gen z will influence workplace tech trends in 2016. Retrieved March 29, 2016 from http://www.urbanbound.com/blog/millennials-and-gen-z-will-influence-workplace-tech-trends-in-2016
Evans, M. (2015, February 21). Hospitals face closures as ‘a new day in healthcare’ dawns. Retrieved February 13, 2016 from http://www.modernhealthcare.com/article/20150221/magazine/302219988
Fry, R. (2015, May 11). Millennials surpass gen xers as the largest generation in the U.S. labor force. Retrieved March 29, 2016 from http://www.pewresearch.org/fact-tank/2015/05/11/millennials-surpass-gen-xers-as-the-largest-generation-in-u-s-labor-force/
Giang, V. (2013, September 9). Here are the strengths and weaknesses of millennials, gen x, and boomers. Retrieved April 9, 2016 from http://www.businessinsider.com/how-millennials-gen-x-and-boomers-shape-the-workplace-2013-9
Gilbert, J. (2011, September/October). The millennials: A new generation of employees, a new set of engagement policies. Retrieved March 29, 2016 from http://iveybusinessjournal.com/publication/the-millennials-a-new-generation-of-employees-a-new-set-of-engagement-policies/
Grube, M., Kaufman, K., & York, R. (2013, March 8). Decline in utilization rates signals a change in the inpatient business model. Retrieved from http://healthaffairs.org/blog/2013/03/08/decline-in-utilization-rates-signals-a-change-in-the-inpatient-business-model/
Guenther, R. (2010, October 1). Global lessons in healthcare. Retrieved April 9, 2016 from http://www.healthcaredesignmagazine.com/article/global-lessons-healthcare
Koloc, N. (2013). Why baby boomers and millennials make great teams. Retrieved June 6, 2016 from http://99u.com/articles/14709/why-baby-boomers-and-millennials-make-great-teams
Lee, J. (2014 January 4). Outlook 2014: Supply chain pressure to spend less…price transparency…economies of scale. Retrieved February 13, 2016 from http://www.modernhealthcare.com/article/20140104/magazine/301049947
Lynch, A. (2008). ROI on generation Y employees. Bottom Line Conversations, LLC. Retrieved June 11, 2016 from https://www.knoxvillechamber.com/pdf/workforce/ROIonGenYWhitePaper.pdf
Malhotra, Y. (2002). Information ecology and knowledge management: Toward knowledge ecology for hyperturbulent organizational environments. Retrieved March 12, 2016 from www.yogeshmalhotra.com
Menachemi, N. & Collum, T.H. (2011, May 11). Benefits and drawbacks of electronic health record systems. Risk Management and Healthcare Policy. 2011;4:47-55.
Putre, L. (2013, September 1). The march of the millennials: Your hospital staff in 2025. Retrieved from http://www.hhnmag.com/articles/6397-the-march-of-the-milenials-your-hospital-staff-in-2025
Rikleen, L.S. (2014, February). Millennials and technology in today’s workplace. PD Quarterly, 1-5.
Sampson, M. (2010, May 4). Defining collaboration: Collaboration as “human behavior” (Sense 1). Retrieved March 29, 2016 from https://michaelsampson.net/2010/05/04/collaboration-sense1/
Shoemaker, P. (2011, August). What value-based purchasing means to your hospital. Healthcare Financial Management, 61-68.
Tanner, R. (2015). Can baby boomers and millennials just get along? Retrieved June 6, 2016 from https://managementisajourney.com/new-millennium-trends-can-baby-boomers-and-generation-y-just-get-along/
Wobbrock, J. (2014, September). How millennials require us to design the technologies of tomorrow. Retrieved March 29, 2016 from http://www.wired.com/insights/2014/09/millennials-design-technologies/
Yokl, R. (2013, February 14). Reduce, control and eliminate wasteful and unnecessary supply utilization practices. Retrieved March 19, 2016 from http://valueanalysismag.com/reduce-control-and-eliminate-wasteful-and-unnecessary-supply-utilization-practices/
Yokl, R. (2013, February 4). Why supply utilization management is significantly different than value analysis. Retrieved March 19, 2016 from http://valueanalysismag.com/why-supply-utilization-management-is-significantly-different-than-value-analysis/
Yokl, R. (2013, December 3). Supply utilization myths, misunderstandings, and mistakes. Retrieved March 19, 2016 from http://valueanalysismag.com/supply-utilization-myths-misunderstandings-and-mistakes/
Yuva, J. (2002, July). Knowledge management: The supply chain nerve center. Inside Supply Management, July 2002, Institute for Supply Management, 34-43.