Perioperative supply management requires collaborative, strategic, data-driven decisions
Two major challenges facing Perioperative leaders today are labor and supplies. These two areas also happen to be the largest and second-largest expense category at most hospitals, making the challenges even more pronounced. What actions can leaders put in place to ensure that clinical staff are used most effectively? How can we enable clinicians to focus on patient care, while also addressing supply chain costs and waste resulting from inefficient supply management?
This was the focus of a discussion during a luncheon Owens & Minor hosted for over 300 participants representing a range of titles from OR Manager to Director of Surgical Services to Nurse Manager at the 2022 OR Manager Conference in Denver. In our work with OR teams across the U.S., we hear first-hand about the importance of efficiency in care delivery, and factors that detract from it, most notably overreliance on clinicians for supply-related tasks. We shared these insights with participants through an engaging panel discussion, and in turn, asked them to voice their specific issues and brainstorm potential solutions.
Three key learnings emerged from the forum.
1. The role of Perioperative clinicians in supply chain should be strategic, not tactical
A recent McKinsey & Company survey of U.S. health system executives and supply chain executives found that clinical engagement is a critical element of a high-performing supply chain, how can clinicians delegate more of their time to supply-related tasks when they are already understaffed and overworked?
The answer isn’t more clinician time spent on supply tasks, but rather more effective use of their time. Attendees agreed that clinician involvement in supply chain should be strategic (decision-making), not tactical (day-to-day) supply management.
Today, most clinicians spend too much time picking, counting, and putting away supplies. The consensus among participants was that supply management is a task better suited to materials management so clinicians can focus on patient care.
Another outcome is that OR clinicians can have a meaningful impact on clinical and financial outcomes through participation in their hospital’s value analysis teams, offering expertise on product selection based on real-world experience of using products during surgical procedures.
Once a product is delivered, clinicians ensure that new or replacement items are included on physicians’ preference cards and in kits prepared for surgical cases. By making upfront decisions, the right items are available at the right time for the right patient, minimizing the need for clinicians to hunt down missing supplies or restock unused items.
"Attendees agreed that clinician involvement in supply chain should be strategic (decision-making), not tactical (day-to-day) supply management."
2. Collaboration among OR clinicians, materials management, and industry partners is critical
In today’s environment of continued supply chain disruptions, participants voiced the need for greater collaboration and communication among stakeholders where they can each bring their individualized expertise to the table to make the best decisions for the healthcare organization and its patients.
We saw this at a large academic facility in the Western U.S. during a consulting engagement. We found they did an excellent job getting all the necessary parties to the table when addressing product shortages. The multidisciplinary team included clinicians, materials management, industry partners, and supplier representatives who came together to review what items were on backorder, when they would be released, and what comparable substitutes were available.
Physician preference cards also rose to the forefront as one of these challenges. Preference cards drive the OR supply chain processes. Therefore, keeping them clean and up to date helps to eliminate rework and can provide consistency in case pick management. Those in the audience acknowledged that it is a major task to proactively make card changes, so it often gets put on the back burner in exchange for competing priorities.
The other challenge is lacking the data to determine how big the problem of inaccurate physician preference cards is. In many cases, it is not until we go onsite to perform an assessment, gather the data and compare the items picked for a case based on the physician’s preference card to those that wind up in the put-away or expired bins that the data even exists to quantify how big the problem of waste is. Having the data is incredibly important when discussing changes with surgeons and clinical staff and can help streamline changes for efficiency.
One audience member shared her story of collaborating with Owens & Minor on a surgical kit initiative. Her health system had built a multi-license surgery center, and they were challenged with storing supplies in a very small space. The solution was for Owens & Minor to build ready-to-use custom surgery kits (or “totes”) containing all the necessary consumable supplies for pre-operative, intra-operative, and post-anesthesia care unit (PACU) care, based on the procedure and physician preference, and deliver them right to the facility. The concept is still in place today though modified over the years to address changing product needs.
The attendee commented on the collaboration, stating, “We worked with Sheri on this, and it has been the most awesome thing. Opening for these cases takes seconds and we can now better track our costs for soft goods.”
With a service such as this, the OR team receives customized supplies, and accurate and timely data on their product consumption trends, including items used in cases and those that are returned.
With this knowledge, leaders can make data-driven decisions related to preference card changes, remove unnecessary items and improve the management of associated processes reducing the number of supplies that are opened, unused, and wasted. Materials management can also use the data to increase the number of on-contract supplies in the kits for less variability and greater savings.
"Having the data is incredibly important when discussing changes with surgeons and clinical staff and can help streamline changes for efficiency."
3. Process and supply standardization drives efficiency and cost savings
If you can reduce the variability in any process, it becomes more efficient and effective and goes a long way in controlling costs. During the forum, we discussed the benefits of reducing variability in the perioperative supply chain – both in products and processes.
One participant voiced the problems his hospital faced when a surgeon requested the procurement of new supplies not used by other surgeons. That surgeon resigned within one-to-two years, leaving unused items to expire on the shelf. The health system introduced a standardization committee comprised of OR team members, supply chain, and finance. Before a surgeon can procure a new item, the committee must review it from a value perspective (e.g., what is the benefit, who will use it, what is the cost, etc.).
“The surgeons are now hesitant to order something we don’t want whereas before they ordered whatever they wanted,” said the participant. “We have been working to standardize products across all surgeons so they are all using the same items.”
Another shared the story of how her health system approached supply and instrument standardization. Understanding how common items are used across their network of facilities, standardization would allow OR teams to “borrow” items from one another. In other words, it would enable the health system to maximize its supply and instrument inventory by directing items to where they are needed.
One challenge with standardization in today’s environment is the risk that chosen items are unavailable when needed. The participant explained her organization’s way to address this issue. She said all key stakeholders to the health system’s supply chain, clinicians, purchasing, allocation management, and quality management meet weekly to discuss what items are on backorder, what is needed, and what comparable items can be substituted.
While technology solutions and services can provide the data needed to drive effective standardization, such as insights into product consumption and waste, stakeholders must leverage their expertise when applying these insights to real-world scenarios.
OR clinicians have knowledge of patients, supply chain knows the organization’s contracts and has visibility into items procured across departments and facilities; and as a distributor and manufacturer partner, we have a unique view into the industry in terms of manufacturers, their product portfolios, and solutions to drive greater efficiency and cost savings.
"In the end standardization of products and processes comes down to the human element."
The bottom line
Effective and efficient Perioperative services are critical to the well-being of a hospital’s patient community and its bottom line, but OR teams are understaffed and overwhelmed. Supply management is a huge burden on OR clinicians, particularly given today’s labor and supply chain challenges. We need to find ways to free them up from day-to-day supply tasks so they can focus on strategic decisions that improve clinical and financial outcomes.
Materials management teams and industry partners can leverage their knowledge and resources to manage supplies in a more efficient and cost-effective manner. However, a collaborative approach where each party brings its expertise to the table, playing the role they best play, can help proactively work toward addressing today’s challenges and build a sustainable foundation for the future.