Piece Movement

Supply-chain economics in action

by Virginia Lindauer Simmon

charlieCharlie Miceli, vice president of both supply-chain services and information services at Fletcher Allen Health Care in Burlington, has saved millions for the institution.

Before Charlie Miceli came to Vermont in 2008 to join Fletcher Allen Health Care, he had built his career on being “a fixer: taking places that weren’t running well and increasing quality from the supply-chain side,” he says. “As a consultant, I had walked into 50, 60 hospitals over time. When I came up here to Fletcher Allen, this was the first place that I walked into that was good.

“I saw the opportunity to take us from good to great,” he continues, citing Jim Collins’ book Good to Great. “I said, ‘Oh my gosh! This could be my crowning achievement because it had everything lined up where I could work with staff and get that going.’”

Miceli is not shy about recounting his (and Fletcher Allen’s) achievements, but he has a way of doing so that comes across with humility. After a few minutes with him, two things become clear: He is the kind of ambassador every organization needs, and his energy has no apparent limits.

It’s a good thing, because he has what could be considered two full-time jobs, plus an avocation that crosses boundaries. As vice president of supply-chain services with offices at the hospital, and vice president of information services with offices at 1 Burlington Square, Miceli has about 350 people who report to him. His avocation is music — he plays guitar, currently in three bands — which he merges into his professional life in multiple ways. “I try to make as much as possible of every moment,” he says.

“Charlie is a man of causes; he’s driven by them,” says Churchill Hindes, chief operating officer of OneCare Vermont, and a Fletcher Allen vice president. “There is what I would call his ‘day job causes’ in terms of his core job description, where he excels. He shows up, he’s energized, and he has the great ideas, but he doesn’t have to be on stage. And then there’s the band. When he was a much younger man, Charlie played with Muddy Waters in Chicago.”

Hindes’ assistant, McKenna Lee, is the singer in Miceli’s band, McKenna Lee and the Microfixers. Except for one member, saxophonist Chris Peterman, the band (www.microfixers.com) is composed of hospital employees.

In 2012, the Microfixers were invited to play in Wisconsin before 5,000 people at the users group meeting of EPIC, an electronic health records company. That same week, Miceli flew down to Florida to accept an award for Fletcher Allen as Number 1 supply-chain operation in the country. Back in Vermont that weekend, the band helped raise $5,000 for Haiti.

As a result of the EPIC appearance, they were asked by the CEO of Masimo, a manufacturer of monitoring technologies, to play in Los Angeles for the inaugural Patient Safety Summit, in partnership with the Clinton Global Initiative, in 2013.

“We went out there last January, 2013. It was probably one of the best conferences I’ve ever gone to,” says Miceli. “President Clinton came and talked; the top tech companies had made pledges to make their equipment talk to each other and share patient information. I had an epiphany: Wow! We can use our music to push this cause. And, number two, we can make sure we buy computer systems, software, and hardware so these computers will have the ability to send information to electronic health records or to each other.”

Miceli also champions local causes, such as a pie-throwing contest to raise money for the Children’s Christmas Project. In 2011, he promised to get a Mohawk haircut if $5,000 was raised, and in 2012, he made the same promise if returns topped $7,000. “I got my Mohawks,” he says. Last month, the Microfixers played at Higher Ground to support the annual Big Change Roundup for the Children’s Hospital.

“Charlie is a true champion,” says Lewis First, M.D., chief of pediatrics at Vermont Children’s Hospital. “He gets it in his head to do something — doesn’t ask for the help, just says, ‘We’re going to do this,’ and people show up; they rally.

“This is what Charlie does: He goes where his passion lies. Music is his passion; family is his passion; work is his passion; and helping Vermont Children’s Hospital has become his passion.”

Miceli is much loved at Fletcher Allen. He whisks through the corridors, cheerfully greeted by staffers and instantly recognizable in his colorful bow tie — “I have 25 of them, all hand-tied. I buy them on eBay at $5 apiece.”

His roots are in Oswego, N.Y., where his father worked for Niagara Mohawk power company. After earning a bachelor of arts in psychology from the University of Notre Dame in 1977, he says, “my avocation became my vocation for a little bit.”

He played in bands in South Bend, Ind.; Chicago; and Milwaukee, Wisc., for a year before returning to Notre Dame for a graduate degree in hospital administration. He adds, with a laugh, that he didn’t finish his master’s degree. “I got half a master’s. I got my other half in music.”

He played music for a while, then was hired by W. Braun Co. in Chicago, which did cosmetic design for closures, caps, and bottles. “We designed the Softsoap bottle back in the early ’80s.” It was there that he met Mari Wiiken, an industrial designer, whom he married in 1982.

He left Braun in 1983 for Northwestern Memorial Hospital, where he worked for seven years, “becoming facile in procurement and information systems,” he says, “and proceeded to go to re-engineering of procurement operations at Loyola University Medical Center, and in 1993, to the University of Chicago Hospitals and Health Systems.”

In 1996, he was hired as the first leader of procurement for Partners Health Care System, the parent corporation of Massachusetts General and Brigham and Women’s hospitals in the Boston area. He left briefly in ’99 to work for a startup that, he says, “burned out in 90 days,” and was picked up by a former boss who had gone to Becton Dickinson, a manufacturer of needles and syringes. He returned to Partners in 2002 as director of resource management.

“I was also a key contributor to the dramatic financial and cultural turnaround at Newton Wellesley hospital, which had joined Partners in 1999, had a couple of negative things happen clinically, and lost a million dollars a month for 54 months in a row.

“And this is kind of cool,” he continues. “The guy second in command of Mass General, a psychiatrist, came in as president; then one of my partners, Pat Jordan, an Airborne Ranger who ran radiology operations at Mass General, came in as COO. We said we had to change the company to survive.

“In about two and a half years, it became one of the top performers in the system, not only financially, but also in patient satisfaction, quality of care, and operational performance. I was able to work with these guys for six years and get my tuition.”

In 2008, Miceli replied to an email announcing a position for a vice president of supply chain at Fletcher Allen. “I knew where that was,” he says. “My brother lives up here.” He was hired and started in September of 2008, traveling between Andover, Mass., and Burlington for a year until his son graduated from high school.

Having a chance to start with a healthy operation and “the best group of leaders I’ve worked with, probably in my career,” was exciting for Miceli.

He created a strategic plan and worked up some “Tenets of Success,” which included integrating supply-chain operations, cost management, and meaningful informatics — using data from inside and from other academic medical centers to set targets for continuing to reduce and manage costs.

“We aligned ourselves with a group called ECRI [Emergency Care Research Institute], a not-for-profit, independent, third-party decision-support service staffed by physicians, physicists, analysts, and they help us insure that we’re procuring the highest quality products at the right price.”

These efforts have been responsible for greater than three to four million dollars in unit cost savings on an annualized basis, he says. “But if you don’t have the people ...”

He mentions Ann Young, manager of central sterile reprocessing (CSR) at the hospital. Central sterile reprocessing tracks, cleans, sterilizes, prepares, processes, stores, and issues for patient care every piece of equipment and supplies used by the surgery operations at Fletcher Allen and Fanny Allen. She runs the CSR area with Marine-like precision.

“Both of her boys are Marines, and she’s about 4 feet tall,” says Miceli. “There’s a picture of her son standing in the desert with his assault rifle in Arizona on special duty, and her other son was on a presidential detail. So she met President Clinton.”

“Eight years ago, we went from 7,000 to 14,000 square feet, and we’ve already outgrown it,” says Young as she leads a tour. “We check what’s used, and then it’s replaced from our Williston warehouse.”

Surgical equipment and supplies are gathered and bundled in bags closed with zip ties. Each bundle contains everything needed for a particular surgery — for example repairing a hip fracture or doing a knee arthroscopy. Each features tape, labels, or paper strips that change color during the sterilization process to confirm sterility. This redundancy in process is evident everywhere, and ensures high reliability, says Miceli.

A direct lift from the sterile storage area to the 22 operating rooms carries needed equipment and supplies, and another lift brings used pieces down to be reprocessed. A bank of stainless steel installations that look like dish washers clean equipment after it’s been inspected. Two giant washers clean the wheeled carts that carry the equipment.

“There are 96 carts: for peds, adult, and neo natal. We used to do them on our hands and knees,” says Young.

Incredibly, Miceli still has time for his family and for working out at Champlain Valley Cross-Fit, a strength and conditioning program his brother introduced him to.

He and Mari, now a case manager at the hospital, live in Burlington, have raised two children. “She’s way smarter than me,” he says, adding, with typical Miceli humor, “I over-married, so I did pretty good.” •