Tuesday, September 25, 2012

Change Management at Its Best: Kim Lane's Work at the CDC

In "Smarter Medicine," Michael Copeland explains the high-stakes changes that the Center for Disease Control (CDC) made in its supply chain management when it came to deploying vaccination to children in all U.S. states and territories. With just six vaccines in 1994, the Vaccinations for Children (VFC) operation seemed simple enough when it first began. By 2000, however CDC National Immunization Program manager Kim Lane saw that the current supply chain, with its increasing amount of stakeholders and variety in vaccinations, wasn’t scaling well. She predicted that the chain wouldn’t be able to withstand any disruption—from something as minor as one refrigerator malfunction to something with broader impact, like an anthrax scare.

In 2003, the program was still plagued with several inefficiencies, chief of which is the variability of its implementation. VFC allowed each of the 64 different state and city health agencies with which it worked its own operational decision-making, meaning that some agencies deployed vaccination via third party distributors, while others asked doctor reps to pick up the vaccines themselves. Per Prof Z’s first and second lectures, variability is poison to a supply chain—it allows for too many inefficiencies and deficiencies. Standardizing practices was key in streamlining the VFC supply chain.

I applaud the method that Lane and her colleagues, Lamont and Gimson, used in identifying the best solutions to their challenges. Their grit, their ability to highlight what was working well in VCF instead of being distracted by the inefficient programs, reminded me of a book I read this summer: Switch, by Chip and Dan Heath. The Heath brothers argue that to create large-scale change, leaders should look for the “bright spots.” In this case, what parts of the supply chain are working well? Taking a cue from some of the more successful programs among the 64 agencies, they identified centralized distribution as key. Outsourcing this function to McKeeson freed up the healthcare workers, and even CDC, to focus on what they do best: not inventory management, but healthcare.

 Of the many wise decisions that Lane and her team made, below are the two that I think had the broadest impact on the program’s success:

  •      They incorporated stakeholder feedback when restructuring the supply chain. Lamont held several town hall meetings that lent him the perspective of healthcare specialists who are actually doing the work of vaccinating children. Had he not done this, the new practice, he would’ve implemented a component of the supply chain, the call center, that would’ve eventually proved as inefficient as the old system. Furthermore, the call center would’ve weakened in the supply chain in that two of its major groups of stakeholders, the doctors who order the vaccines, and the program managers who distribute them, would’ve had less contact with each other.
  •      They implemented private sector best practices in operations, yes, but they tailored it to a public sector setting. While they looked to companies like Walmart and Amazon for more efficient operations settings, they understood that government, with its requirement to build consensus among stakeholders, simply can’t manage such a huge change as swiftly as most private organizations. Also, Lane’s team only used the salient factors of ops research—while many supply chains call for implementing a Just in Time system, they recognized that their project calls for reserves of vaccines, should there be another shortage.
As a former educator, this article most piqued my attention because of the critical
services that VCF provided to a vulnerable population. Having served in a low-income area, I’m well aware that not all children have access to preventative medicine. Running VCF efficiently allows them to serve that many more kids.

            Still, the article raises a few questions: how can the CDC implement this more robust supply chain in one of its broader goals—its commitment to global immunization? The network would be more complex. I imagine that this would require the CDC to work with at least one distribution center from each of the 60 countries with which it works on this initiative.

Another question: what other government agencies would benefit from revamping their supply chain entirely?  


Copeland, Michael. "Smarter Medicine." Smarter Medicine. Strategy Business, 26 Aug. 2008. Web. 23 Sept. 2012. <http://m.strategy-business.com/article/08307?gko=90e2e>.

"CDC's Commitment to Global Immunization." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 28 Nov. 2011. Web. 24 Sept. 2012. <http://www.cdc.gov/vaccines/programs/global/default.htm>.
Heath, Chip, and Dan Heath. Switch: How to Change Things When Change Is Hard. Waterville, Me.: Thorndike, 2011. Print.

Michalka, Elizabeth, and Victoria Bouloubsis. "What Will You Change: Taking on the Role of Vaccine Distribution." Feature Story. Duke Fuqua School of Business, 20 Apr. 2010. Web. 24 Sept. 2012. <http://www.fuqua.duke.edu/news_events/feature_stories/vaccines/>.

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