Mission-First Medical Logistics and Supply Chain Readiness

How is military medicine shifting from institutional healthcare delivery towards operational readiness and warfighter support? What are the current priorities DHA is emphasizing? How can industry be a better partner? 

Join us on today's episode of the Fed to Fed podcast as we answer all these questions and more with today's featured guest, Scott Svabek. Drawing upon a military career as a medical logistician, Scott and Susan explore the growing importance of agile medical supply chains, lessons learned from Desert Storm and pandemic planning, and the critical need for logistics systems that support clinical outcomes.

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Transcript

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Welcome to the Fed to Fed podcast, where we dive into the dynamic world of government technology. In this podcast series, we'll be joined by current and former federal leaders and industry trailblazers at the forefront of innovation. Here, we speak openly and honestly about the challenges and opportunities facing the federal government and the Department of Defense and its partners in the modern age, driving innovation and the incredible capabilities of technology along the way. Whether you're a federal leader, a tech industry professional, or simply fascinated by IT modernization, just like us, this podcast is for you. And we're so happy to have you tuning in. Scott, thank you so much for joining us today. Good seeing you. Susan. I've always liked working with you over the years. It's been many years. It has been. And the best part is we so appreciate you always bringing your subject matter expertise to the table. And we're really looking forward to this discussion today. Thank you again. If anybody has ever seen me speak when I was in uniform, was pretty passionate about what I did in the mission sets. Right on you and you still are. And that's why those are the things that we're going to talk about today. So, Scott, what are you seeing over at Da? There's a new leadership taking the helm or has taken the helm. Tell us a little bit more of what you're seeing and what you're thinking about. So as leaving to a and I equated to a very new organization. If you're coming from a legacy organization that has a a firmly defined mission essential task list, Army calls it a metal. Everybody trains to the metal with new organizations. Sometimes the metal. The mission is central task list migrates to the to the to the personality or the priorities of the of the of the new leader. Case in point, General Carlson was very focused on on institutional medicine, very focused on institutional medicine. And Admiral VI, based on his background, is very focused on operational medicine. Both are 100% right. But the people in industry specifically have to adjust and pivot to those changing priorities. And sometimes the agency has long term contracts in place. Funding has already been, I would say, debated and allocated. And when priorities change, resources change, and then the agency has to respond to the changing priorities and then industry has to change. And oftentimes it takes time to to adjust the priorities, the processes and the mission set of both industry and the agency to to support those new those new priorities by the, by the new boss. And it's not bad. It's just the nature. The nature of business and industry is doing the best it can to to accommodate the new direction of the new director. Scott, can you tell us a little bit more about that new direction and things that industry should be thinking about to align with those priorities and initiatives? Sure. The new director is all about operational readiness, perfect at the time. We're with what we're doing in the Middle East, warfighter support, getting the service, the service members ready to fight, and the medical support entities ready to treat in very unique environment. It's different than training in the institutional side. So the director or with the services have to be able to convey the mission set to to get the forces ready into tools necessary to make sure they're ready. You can use metrics for readiness and then metrics for the capability of the provider. And not just a provider, the doctors and nurses, the all the supporting staff that deploy to include logistics and to be ready to support the fight. I came up through the world of you train. As you fight. It might be a little disconnected now, because some of the things that I have seen is the the people that deploy take the tools and techniques that they learned in garrison, ended a fight and adjust. They don't learn a new way of doing business in a new theater of operation. They modify their existing tactics, tools, and procedures to the environment that they're operating in. That's what I see as changing. Gotcha. What advice do you have for industry in terms of opportunities to come? Some gaps that you're seeing there some ways in which industry can help support the mission? I think first and foremost, if you're trying to sell a product, I would say that's risky because oftentimes because of the DHS is an agency now and looking at enterprise solutions, they're not going to want to, quote unquote, rip and replace, okay, with the operational side of the House. It has to work in the the environment where we fight and selling commercial product might work, but does it necessarily work in a low carbon, no common environment? Does it work in a low bandwidth? Does it work in excessive heat, dust, and humidity? Does that piece of equipment work on the ground, in the air, in transport? And do we have the people trained to maintain and sustain those pieces of equipment that are now being deployed? When I went to this is again, I'm older, but Desert Storm was a very a learning experience for me where I deployed from with the 101st, but many of my clinicians came from facilities that were expecting facility like equipment. So having them go through my sets that I maintained and taking out what they didn't know how to use or didn't want to use and replace it with new technology that they were comfortable with, helped when with the the development of four surgical teams, for example, back in the early 90s. And I think we we evolved to constantly do that. And so industry understand the Department of War and their mission set and where they want to go and stop skating to where the puck is and start skating to where you believe the puck is going to be, and be flexible to that, to a hockey term, a deflection. And if it's so rigid, it's very hard to to penetrate that. So if it's an application, it's a product. How it can enable and enhance the warfighter survivability in combat. That's kind of my advice trying to sell, you know, I mean I just seen the news. They're developing portable data centers, which I would have never thought of. But industry is this forward thinking that that data that people are accustomed to use in garrison are going to need that same sort of data fidelity and breadth and depth of availability in theater. So industry is adapting to making sure that data somehow available and reliable in those austere environments. Thank you for sharing that, Scott. You and I attended an event on the end of March all around supply chain. We had experts there from all different agencies FDA, VA, Da, DLA, DoD or Department of War. Now. Can you tell me a little bit more about the focus that people should be thinking about now regarding supply chain and what is happening and those gaps, those things that are missing and the thinking and planning? Yeah. First of all, it was a great event. And for a medical law guy like me from Army, it was like old home week for seeing some of my students and some and many of my peers, and they're all experts in the field. And the great insight. I coin a phrase we live for lessons learned and very seldom learner lesson. And and I think it's because the medical logistics from the past, we really didn't care about the process. Processes are important, but outcomes with more were more important. And what I mean by that is in our community, our major end item does very poorly waiting for parts or waiting for service. And that's the human where if you're a line logistics, your tank, your vehicle, your airframe can sit waiting for parts or sit waiting for services. So we our medical decision community across all services. Figure out. Figure out a way to solve the complex problem, even though the process wasn't didn't support the outcome. I think today, as we're so tied to technology and automated processes that we might lose that, that flexibility to operate more, focus on the outcome rather than the tools of the process. And I'm not casting dispersions on technology, but that patient doesn't care if it's if the electron is down or the request didn't go through electronically. We had hand carried notes from our aid station back to the supply point. You know, and everybody's talking about transmitting with different technology. But we have to work on the outcome and never lose factor debt, that piece of equipment, that pharmaceutical or the consumable is in response to a patient need or a casualty need. And I think that's that needs to be always first and foremost in our decision making. And then we we captured a lessons learned. We try to institute new policies and processes. But like most operators will tell you good plan only is through first contact and then everything changes. And you just had Kevin, those young logistics and senior decisions able to be able to think on their feet to to work around. I'll call them in the process to get to the right outcome. Thank you Scott. So there's been many discussions about the pandemic and the resiliency of our supply chain. Is there an aspect of medical logistics, pandemic or contingency planning? It should be part of the discussion. Yeah. My best. I mean, I might upset someone at my old form of 76, Juliet's, which are medical supply technicians. My best legit mental health person was a pharmacist, and he he taught me to to think in clinical terms rather than national stock numbers in a system, a system approach. And I think that paid well dividends for me in Desert Storm. And when it went as Iraq supporting the Coalition Provisional Authority. And when I say that real world example Desert Storm, my my division surgeon wanted to triple the number of these cylinder oxygen tanks for the ground ambulances and ambulances, and I had pallets of them with regulators because I believe that's what we needed. Come to find out is they were those 3 or 400 oxygen tanks were non mission capable because as a low decision, no one really explained to me that there's a yoke adapter that connects the regulator to the tank. And if you don't order the yoke adapters, those pieces of equipment are inoperable. So now I think of a systems a system approach, not just an IV, but it's an IV bag. It's the the needle, the catheter, the the starter kit and all the other consumables required to initiate the IV. So I focus on treatment protocols rather than individual widgets. And people are talking category management. And I think category management is a good idea to the extent, but it has to be translated into treatment categories. So when you're look when your clinician is engaged, he's not knowing the stock number. He has a gunshot wound in a lower leg. He has a chest wound. He's got a burn. And he's like the tools need to be necessary to translate the clinical language into items that are stored in stock to be packaged and delivered. And for the pandemic, I was back for not for Covid pandemic. I was the DoD medical director for Medical logistics policy director for OSD. I got brought into the H1n1 pandemic planning there. It was all about camouflage, antivirals, PPE and developing stock for that. But then it got into treatment because I'm not a clinician. Most of the clinicians indicated that the the greatest risk of death is from pneumonia as a result of contracting H1n1. So sitting down with the clinicians, it's what treatment protocols did we need to treat from the different antibiotics that were available, and not just the medication to antibiotics, but it's but it's also the needles and the syringes and everything that went into making sure that you could distribute or deliver the clinical treatment timely. And it isn't just one treatment. So working with my clinicians, how many days of antibiotics with this patient need. So I worked with them to calculate my contingency stock for antibiotics based on how many days of treatment for a particular patient based on the guidance that the clinicians drove. And then then I backwards plan into a we couldn't stop at all. So we managed we had vendor managed inventory. And then the other thing that we worked very closely with the services at that time with Health Affairs, is prepositioning those antibiotics in a, in a number that could be consumed, but not wasted, because the facilities where it was located consumed those same antibiotics. So not every hospital or clinic in the front of the defense at that time had the same access to those antibiotics. Those they were pre-positioned were the the most use would be and we developed a rotate. We didn't do a 100% stock of what we needed for the pandemic. We just increased our current stock by about 30%. So they could so they could rotate the stock with minimal ways to the to the drugs expiring. And in the end, which was important because I had I did this, it created a Palm Line program of objective to fund it because I had to defend those dollars with the with the budget people. And this allowed leadership to to defend cost versus readiness. I could have asked for them. I could have asked for the world. I need 100% of everything, which was a very expensive endeavor. But defending that, I don't. I can't ask for everything. But at what level is are there leaders with the health leaders willing to go to the budget people and said, we can accept this level of risk for this much, for this much money? And they did that and they funded it, which was very successful. I don't totally they used some of those same types of lessons, learning tools that we had back in early 2000 for what happened in and with the Covid in 2020 because logistics plan. But you also have to plan to defend your plan with the guys that fight for the money. And that's where I think the partnership between resource management and logistics needs to be strengthened. I'm not a clinician. I'm not making those clinical decisions. I'm hearing the message from the clinicians to the to the resource managers to make the clinicians with the logistics in the resource manager to fight as a single team and defend it. Thank you for sharing that that that's amazing perspective. So Scott, you talked a little bit about technology. AI is becoming an important part of medical logistics and clinical practice. Can you give an example on how AI could connect the supply chain with clinical practices within the Department of Work? I sat back when I was still in uniform. I said there should be a way to where I use the adage a good logistics is someone who is an unknown logistics, meaning they work very hard to anticipate what will be needed, because what you don't want to hear in an Or is the clinician yelling for the decision, where's my ex? Where's my why? So I sit there and think, from what the technology that we're using today is there capability for we can run scenarios of injuries. When I was doing simulations, the only thing that we had to to use for planning purposes was blood by type and short tons of supply. Now with technology, you can actually get into individual treatment. So you have the ICD tens. You can run scenarios with different ICD tens from pointer injury and making the assumption that technology is working, that the electronic health record is deployed and is the treatment is being collected, the patient record is being moved. So if he's being moved from a level one to a level two to an attic theater evacuation, by the time to gets to a level three, the logistics people should have a well understanding of what's needed to treat that patient and not wait to be diagnosed, then reorder and then shipped to delay treatment. I think the connection between the patient record and the logistics files is critical. So when that patient lands, that treatment package, almost like a surgical pack is waiting for the for the patient when they arrive, if the technology allows that to occur, but you have enough information from converting it to treatment from to an extent to map it to what type of antibiotic, what type of IV, what type of suture different, you know, burn pads, whatever the logistical need is, should be there waiting for the patient when it lands rather than being requested for it should be pushed to with the technology if that, if, if it's available. And we should be working hard in connecting that clinical practice with the logistics. And then the second nature is if you don't have that particular product, is there a suitable substitute that you don't have to search? But AI could scan your inventory. Yes, that a 400 suture won't work, but a three or suture would work. Type type of methodology utilizing AI. I love that, Scott. So let's go back to your original conversation or a discussion around operational medicine. Is that being done now? How does the Defense Health Agency and or industry address that and make that happen? So and I think I think December of 2024, Jonas PM Jonas issued an RFP for operational logistics to date, which I think is, you know, this is April 21st. Nothing really happened. So I don't really know what's what's going on. And my fear is that the the supply systems in technology that we used when I was younger was the same in theater, was the same that we used in garrison, might translate the might be different. And and that's a concern for me if the theater logistics people are not talking to the institutional logistics people to make sure that you're not learning a different. I'll show my age trying to learn how to use Harvard graphics. And while you're deployed with PowerPoint, the closer you get it to the same, the more comfortable people aren't using it, especially when they're losing sleep incoming, constantly having to move because the technology and the electronic footprint that's being that could potentially expose the the casualty locations or the treatment locations, you know, and and so what's happening in operational medicine almost seems like it's occurring quietly and not openly. And I think having constant engagement with industry of what they're thinking would pay off huge dividends downstream, because there's a lot of companies, a lot of industry partners that have unbelievable solutions, but they don't know what to bring it to because they don't. They're not following because all they have is from 2024. And they know that the the institutional side is really focused on logical. Is it the same? Is it not the same, the functions needing to be different? Anything that applies to medical maintenance? One of my greatest boss is she was the deputy assistant secretary for four, South Texas deputy assistant secretary for health for Health protection. And Alan Embry. Bring us far forward, as you can, the clinical practice to where it makes where it can be to generate the best outcomes and then pivot. And I worked hard with her on standardization, but we changed it. We tried to change the term because clinicians don't like the word standardization. So some of my senior mentors in the community, what we wanted to do in the supply chain is not standardize but reduce unwanted variation in it. And what I mean by that is sometimes things need to be different, but it's those known changes that are captured and identified. What spins the supply chain out of control is when you have hundreds of unknown variation that you can't respond to. So standardization in my world is just reducing the unwanted variation. And when you get when you capture that variation, analyze it, research it, and accept it as part of the new new process in operational medicine. So Scott and closing, what are your suggestions to move this forward? First suggestion is more engagement in industry. If you want to be a strategic partner, treat industry as a strategic partner and not just as a cost element or or a contractor. A large percentage of the workforce in Department of War is supported by contractors. Health is huge. Housekeepers, food service, all the administration, a lot of logistics, many of the clinical services nurses, allied health clinicians support the support the warfighter in their own way, treat them as a partner and then be transparent. Okay, we don't have all the answers, but we by working together, we could solve a lot of the problems. I did want to touch on one other aspect and ready to face on the call, the conference that we attended. In my experience, we do a lot of discussion about defense, the Defense Production Act, which I understand that POTUS has invoked for today for for this some of these efforts in this operation, manufacturing is one thing. I think that we need to think a little bit harder on. I don't know what the term is. I'll just call it a defense distribution Act because limited resources are available. It isn't necessarily the first person to place a dealer should be getting the order. And in the Department of War, we are part of the global supply chain. Okay. We we we are subject to the same risk and fragility of the supply chain. And we know we have to be cognizant of the fact we just don't come in and take. So we have to work. And I mean, by the Defense Distribution Act is you might have it on order, you might be first in line to receive it. But based on the analytics, are you are you the number one priority for that particular product or goods or service? We do it in comp. We do it in combat. They call it command controlled items. When I was in the army, certain things were command directed to be released or not to be released based on the phase of the operation. And I think if we look at that in the distribution, we won't have the hoarding of the first in scooping everything up. And the people that need to most are scrambling to get it. So I think that's that's an important logistical and operational discussion. Needs occurred not just within Department of War, but within FEMA norms for because medical medical supplies are limited and very subject to Conus influence, because some of those things we just don't manufacture and the raw material doesn't exist in the United States. Thank you. Scott. Scott, any time that I have the opportunity to meet with you one on one, or when you're with other groups of people, you're always so passionate and focused on the mission, and you're always so kind to share solutions, challenges, but solutions and things that you know that have worked in the past. And I can't thank you enough always for your time, and also for the way in which you care so much about the work that you've done and the work that you've led and the things that you can continue to to drive. So, Scott, thank you so much for your time today and as always, for everything that you've done for this community. Susan, you people really respect you and what you what you do for the community. And I think we've known each other for 15 years. And today is like your first day. We met day one about looking after the looking after the veteran and looking after the military member and their family member. And everybody loves a lot to you as well. Thank you Scott. Well, thank you for your time. I can't wait for the next discussion. I can't wait either. It's been fun. This concludes today's episode of the Fed to Fed podcast. If you enjoyed this episode, please don't forget to subscribe, rate and leave a review. Your feedback helps us continue bringing you thought provoking sessions with the brightest minds in government, technology. Stay tuned for our next episode, where we will continue to explore opportunities to harness the power of technology and explore what's next in developing a more innovative and efficient government. Until then, this is the Fed to Fed podcast by GovTech Connects. Thank you for joining us.