CS playing mixed role in purchasing process

While most sterile processing managers still juggle multiple tasks and wear numerous hats, it seems that many are seeing their departmental purchasing responsibilities slip from their grasp--at least to some degree.

The apparent trend has been perpetuated by several factors, most notably facilities' ongoing push for greater compliance with group purchasing contracts, and the desire to have sterile processing staff direct their full attention to decontamination and sterilization processes.

"We are noticing a dramatic change when it comes to CS purchasing. Today, many [CS] departments are primarily managing just the processing function," said Nancy Chobin, executive director for the Certification Board for Sterile Processing Professionals and Distribution Inc., Flemington, NJ. "I believe much of that has to do with the increasing sophistication of instrumentation that requires the competency of properly trained professionals. Taking on too many functions just isn't feasible."

Even so, the move away from the purchasing function is drawing mixed reviews. On one hand, CS managers are grateful that they can dedicate more time to instrument processing, but at the same time, many told Healthcare Purchasing News they were frustrated that they had such little say in the products purchased for their departments.

Contract dominance

With dwindling reimbursement rates and bottomed out budgets becoming common fixtures in healthcare, it's understandable that facilities are looking for ways to maximize their buying power.

As part of that push, it also becomes clear why vendor standardization and group purchasing contracts are playing such a vital role in product selection. The problem, noted one frustrated CS manager, is when administrative and materials management staff dictate to individual departments the products that must be used, and base their decision on cost rather than quality.

"By now, we all appreciate the need for controlling costs and work hard to contribute in whatever way possible. The problem, though, is that quality is often suffering for the sake of saving a few dollars on an item," she said. "We know what constitutes a quality detergent better than anyone else, for example, but we are stuck with products that someone else chooses just because they're cheaper. Even more frustrating is we are very rarely allowed to make a change."

That's not to say that every CS manager's hands are tied, however. Although the majority of organizations strive to boost GPO compliance across their facilities, that doesn't necessarily mean exceptions can't be made. By and large, sources agreed that they can bring in products off-contract as long as they can justify the need for the switch.

At Indianapolis-based St. Vincent Hospital, for example, presenting data to purchasing that reveals a product is superior in quality is often all that's required.

"Our first duty is to look at the contract. Usually, we comply and are happy with the results of those items, but if we even feel that a particular product is not appropriate or effective, we don't typically have a problem as long as we have data to support that claim," noted CPD manager Ron Runyon.

HCA Woman's Hospital of Texas in Houston understands that higher priced, off-contract items may actually save the facility over the long haul. When the CS department determined that a contracted impervious gown failed to keep technicians dry, the manager addressed the problem with the facility's clinical resource manager. Upon reviewing the product, the department was allowed to purchase a gown from another vendor.

"Although the gowns cost more initially, they worked so well that we were able to wear them more than once, which made them more cost-effective," explained sterile processing manager Joyce Dickerson.

Going outside the GPO is sometimes the best bet, both in terms of cost and quality. CS managers noted that there are instances where better prices can be negotiated through a different vendor--and for products that the department finds work better than contracted items.

"Cost is certainly a factor, but it comes after quality and service in terms of priority," said Richard Schule, surgical processing manager of the Cleveland Clinic. "lf a product is [inferior], then that could impact overall quality. Fortunately, our motto here is 'quality first.'"

Owning the process

Despite the growing number of CS departments that have relinquished their purchasing roles, some CS managers have been fortunate enough to maintain at least some buying independence.

Don Gordon, network director of sterile supply and OR material management at Jacobi Medical Center and North Bronx Hospital, Bronx, NY, said he has complete control over items used within the department. "Although materials management does the actual purchasing, we have a lot of flexibility when it comes to our own products," he said, acknowledging that GPO contracts do still play a part in product selection.

And Gordon isn't alone. At Anderson Hospital in Maryville, IL, each departmental director is in charge of its own product purchasing. In fact, it's not even unheard of for directors to order products and come to contractual agreements with vendor representatives themselves, according to the facility's sterile processing manager, Lisa Huber.

"I place orders through materials management, but it comes right out of my budget. Although there are preferences in terms of our GPO, if we ever have a problem with quality, we usually have alternatives," she said. "I have more say at the department level here than at other hospitals I've worked, which is nice."

For those wishing for more product selection and purchasing clout, sources contend there are ways to get it. Most agree that fostering better relationships with the operating room can work wonders. Alter all, if more than one department can agree on product and vendor preferences, they may have a better chrome of getting those at the administrative and purchasing level to convert.

That's especially true for capital equipment vendors, noted Runyon. "If two or more locations want to buy the same equipment, the chances of getting it are better."

New product policies

Even the must GPO-driven facilities will be faced with requests from departments interested in new non-contracted products. After all, CS professionals and other healthcare disciplines are frequently asked by vendors to try new products, and many are exposed to new formulas and technology via advertisements and conference exhibits, and understandably want to try them firsthand.

Many organizations recognize that product evolution is an ongoing process, and that technological and formulary advancements play an important role of quality healthcare. At the same time, organizations are also faced with the reality that purchasing every cutting-edge product is just not feasible due to space and budgetary constraints.

In light of such considerations, many hospitals are relying on multidisciplinary product evaluation committees to identify the overall value of an item or vendor. The committees, which may include representatives from surgery, infection control, nursing, purchasing, materials management, CS and other departments, typically meet monthly or as needed.

At the Cleveland Clinic, for example, a so called OR Product Cost Committee that consists of a physician chair, OR director, sterile processing manager, representatives from purchasing, finance, facility maintenance and others, meets to discuss a particular product. According to Schule, a form is completed that covers key areas, such as cost, whether the item has been cleared by the FDA, and whether the product is new or replacing another item already in place. A representative from the department interested in the product then has the opportunity to go before the committee to justify the need.

"We don't want to just keep adding new products. What we look for are products that can improve quality and [customer service]," he said, adding that the committee also evaluates less expensive products that departments have determined to be equally effective as pricier ones.

Of course, there's more to product and vendor selection than just the item alone. Today, organizations are placing a greater emphasis on education and inservices to ensure they are getting the most of the product, be it a detergent or wrap, or a piece of capital equipment.

In fact, vendors that approach CS with a new product from an educational perspective may come out ahead in the end, even if the facility does not buy the item initially. "Education is critical to what we do. If [vendor reps] provide an inservice that is helpful to the department and aren't just trying to force a product, there's a good chance they will be remembered down the road," said Huber. "If good education is provided, that adds to the value."

Increasing visibility

Regardless of a hospital's purchasing policies, sources agreed that CS managers can increase the chance of having their product and vendor opinions heard if they make themselves more visible.

Terrance Jackson, sterile processing manager for West Virginia University Hospital Medical Center, Morgantown, WV, knows the value of visibility firsthand. Because of his knowledge, he is frequently brought in as a consultant with infection control and also consults with the OR on products related to decontamination and sterilization.

"That team approach is very important," he said. "We each can bring a valuable perspective to the table, and that is understood here."

Getting that level of respect requires CS managers to step beyond the confines of their department and become better acquainted with other departments, including administrators, according to Sybil Williams, president of the International Association of Healthcare Central Service Materiel Management. As sterile processing manager of Houston-based Lyndon B. Johnson General Hospital, Williams has done just that, becoming an active participant in the facility's product evaluation committee.

"We need to be involved in the [product selection] for our own departments, as well as others so we ask the important questions, 'Can we clean this?' and 'Can this be sterilized?'" she said.

"If we don't leave the basement, we won't be included in these important decisions."

How frequently do CS managers have contact with staff from their facility's purchasing department?

* 56%--All the time

* 19%--1-2 times per week

* 2%--Almost never

Source: International Association of Healthcare Central Service Materiel Management online survey

COPYRIGHT 2004 Healthcare Purchasing News
COPYRIGHT 2004 Gale Group