(July 2020) – KAHRMM Peers,

Does it normally take this long to get back to normal? For that matter, what is NORMAL? If you would take a couple moments to indulge with me, I have a couple more questions for you.

• How wealthy would you be if I could wave a magic wand and give you a $10 for every time someone has said the words "normal" or "unprecedented" in the last four months?
• Would you be able to make an additional car payment, or even possibly enjoy looking out your window to see a brand new and fully paid-off car in your driveway?

Thinking through this and if our pursuit is really toward a "so-called" return to normalcy, then I would suggest that we really have to ask ourselves, "What is normal?" and "Will we recognize it when it returns?"

To explore this, let's take a little trip down memory lane and reflect on the definitions of "normal." To start this little trip, let me just re-affirm "normally" normal means:

• The usual, average, or typical state or condition; when it is used as a noun. and/or
• Conforming to a standard; usual, typical, or expected state when used as an adjective.

In general and according to a quick BING search, "normal" refers to a lack of significant deviation from the average. The word normal is used in a more narrow sense in mathematics, where a normal distribution describes a population whose characteristics centers around the average or the norm. When looking at a specific behavior, such as the frequency of success, a researcher may use a bell curve to plot all reactions, and a normal reaction would be within one standard deviation, or the most average 68.3 percent. However, this mathematical model only holds for one particular trait at a time, and we are literally juggling hundreds and thousands of external factors in any given day, which makes our pursuit of normal even more interesting.

To recap and start our journey for the next couple of minutes, when we remove all of the external influences and succinctly strip everything away but the work itself, normal is really just average and typical. Which leads me to my question for you:

"Are you content with," and/or "Do you really just want to be average and typical in your life?"

"In your career ... with your family ... your memories ... and for sake of our conversation today, within your role and the performance of your health care organization?"

I am sure I can speak for you on this, and we will all shout an unresolute "Absolutely not!"

So, is normal really enough though? Let's ponder this together.

• If we settled for normal in school, would we have secured our most favorite and favorable memories?
• If we settled for normal in our first employment opportunities, would we be where we are now?
• If we settled for normal when we entered supply chain roles, would we be where we are now?
• If we settled for normal when everyone around is facing challenges, would we be tempted to just throw our hands up and say there is no hope?
• If we settled for normal would we ever consider new or improved alternatives?
• If we settled for normal would we forfeit the chance to learn new techniques, best practices, or improvements from others who have elevated or enhanced their outcomes?
• If we settled for normal when we faced adversity, would we have been able to rise from it and benefit from the experiences and lessons gleaned?

As we progress and mature, we quickly learn and come to see that the pursuit of normal can often become an anchor or even a complete and frustrating limitation for us. In fact, every level of our lives creates the possible opportunity of a "better us." As we get better, the "new and improved" situation or person that we become allows us to migrate into the next step and challenge with more confidence, knowledge, wisdom, strength and empowerment. Hence, the journey we are all on in healthcare and supply chain has no plateaus. And as with everything in life, this journey we are on is only filled with peaks and valleys. Often the outcomes (or the limitations) we experience are directly in proportion to our focus in either the peak or the valley we are facing at the time. Sometimes, the necessary path for the needed improvements beyond normalcy are already in place for us. We have to be diligently mindful that we need and must end up at positions and scenarios that are purposefully better than normal.

Within this pursuit, it is critically important to always remember that no matter how successful we may be, we should never stop learning, growing and improving. We should be un-reticently mindful that we continually challenge ourselves to avoid complacency in these challenging times. To achieve normal and to be even better, we should make certain we are never satisfied or settle for simply being good enough, nor should we allow ourselves to forgo our strengths, experiences, performance, and/or challenges that might allow for any health care organization to simply settle for just being average or typical. The truth is, our peers, HCO associates, community and the patients we serve are counting on us to be diligent. Furthermore, our mutual successes, as well as their future experiences, do in part rely on us to perform with results that are better than average; and as such, better than normal.

As we all face the uncertainties within the future of health care, a few new questions have impacted us all. Uncertainties like:

• What is my allocation?
• I am unable to find product? My supplier is on national backorder.
• The order is not coming for 120-180 days. No current national supply available. Furthermore, raw materials are being routed to other product lines.
• The pricing is 10 or even 20 times higher than what I have ever paid. I historically refused 10-20 percent increases.
• Missed delivery deadlines, route changes and non-forecasted and/or uncommunicated shortages. And no normal communications on when things may stabilize.
• New products, new suppliers and new business practices. I do not know or have familiarity with any of them, etc.

How many of these would you have expected just five short months ago? Would you have expected any or all of these? Now walking down the path of ancient history of just six months to a year ago, let's dig into our normal and truly consider normalcies in the health care challenges we were embracing.

• Sustainability? Over 85 percent of the hospitals in Kansas were losing money!
• Cash on hand? 40 percent had less than 25 days cash on hand, while only 10 percent of Kansas hospitals had greater than 100 days cash on hand.
• Staffing? Consistent registered nurses shortages, lab tech shortages, physical and occupational therapist shortages and continued shortage projections for physicians, specialists and mid-level practitioners.
• Retirements and experienced loses, burnout, leadership and potential culture changes.
• Support service shortages and retention loses in areas like IT, materials, EVS, food services, etc.
• Elevated EMR and IT costs.
• Increases in charity care.
• Declining patient volumes and shifts from inpatient to outpatient.
• Declining reimbursements and commercial insurance reimbursements.
• Financial and infrastructure/capital replacement hardships.

Hmmm! Is this the normalcy we are now longing for? Clearly, we all recognize it isn't. And to that point, what can we do, and what can we be preparing to do?

First, I would suggest we all remember change starts with each of us as individuals, and this is most certainly in thoughts, actions, aspirations and deeds. Secondly, I am sure we would all agree, that at different times in our lives, we have all embraced scenarios and situations where we simply cannot keep doing the same thing without ever adapting to the changing world around us. Have we not? To that end, adapting to the change may be: as subtle as renewing our commitments and diligence in current processes or challenges; as earth-shattering as committing to improve the situation or conversation with a friend or HCO peer daily; or being committed to expand our teamwork with other like-minded professionals.

Life (and survival for that matter) demands change. We all intuitively know there will always be new and different needs and unforeseen or unexpected challenges that require us to stop, ponder and to question or adapt from the status quo, right? And through this process, we must remain leaders that strive for improvement and for the necessary adaptability and change that allow us to succeed and improve our scenarios. Without question, today is one of those times in health care!

Remember, the successes and situations that got all of us here, will not be the same, nor will they individually ever be enough to totally elevate us beyond normal. However, as we work together inside and outside of our facilities, we significantly improve our odds of elevating beyond normal. Oversimplifying it, the "pursuit of normalcy" can sometimes be nothing but a compromise and sacrifice of your potential and your expanded opportunities! To that end, we must work together to strive for solutions above and greater than normal while knowing along the way, we can reflect every level of our life challenges will create a different you. Hopefully, we all elevate to better, wiser and more improved versions of each of us. Hence, my challenge to all of us in supply chain: lets leverage that in a pursuit to elevate ourselves beyond normal, and take this new opportunity as a challenge to rectify problem processes of the past and improve the future on the things we can and are consciously led to do.

Teams, I have this team challenge for you as friends, family, fellow supply chain leaders and champions at our individual health care organizations, lets be abnormal! Yes, above normal!

Above normal will require us to work smarter and more efficiently together within our common pursuits beyond normal. We have to be above normal in order to succeed and help our health care organizations remain sustainable and flourish!

In closing, whether personally, professionally or organizationally, I encourage each of us to continue to strive to improve, innovate and abnormally make great even greater! Respectfully submitted by your Abnormal friend, (And submitted with my best wishes of an above normal summer of memories, fun, family and experiences for you!
--Randy Lott