Smart Surgical Product Evaluation & Purchasing for ASCs

Proper Preparation and a Positive Committee Lead to Better Product Evaluations at ASCs

Smart Surgical Product Evaluation & Purchasing for ASCs
Proper Preparation and a Positive Committee Lead to Better Product Evaluations at ASCs

By Michelle Beaver

Ambulatory surgery center (ASC) staff members evaluate products all the time whether they realize it or not, but a formal process is superior to happenstance trials. Unfortunately, it can be challenging to set up formal evaluations without the resources of a hospital or a large surgery center.

That’s why a majority of ASCs lack proper product evaluations, says Armand Paladino, account executive for non-acute care services at VHA, Inc., a provider alliance for more than 2,400 not-for-profit healthcare organizations.

“You would probably find that a surgical hospital is more prepared to have (evaluation) resources,” Paladino says. “At a small ASC you’ve got many people wearing many hats and they just don’t have the time, for one thing, and they might not have the proper experience to run an evaluation. It’s not to say that they’re not qualified or capable. Ambulatory surgery centers typically have some of the most seasoned professionals from a healthcare perspective… It’s just that (evaluation) takes more time and resources.”

Size of staff isn’t an end-all be-all, according to Libby Chinnes, RN, BSN, CIC, an independent infection control consultant with IC Solutions, LLC, based in Mt. Pleasant, S.C. “I think it’s just getting different disciplines together in a committee,” Chinnes says. “It may only be four or five people or 20, but it’s getting the right people to say, ‘let’s look at this criteria.’”

Chinnes recommends that team members judge products in terms of clinical use, cost and satisfaction.

“If it’s the Cadillac in terms of cost, then we’ll probably look at more reasonable products,” Chinnes says. “But if it’s really the best product clinically and there’s nothing else around, we might pay that cost for it. But let’s say we use it and patients aren’t satisfied or the surgeons hate it, we may re-inservice to make sure they know how to use it properly.”

Leader at the Helm

An effective leader can make or break the evaluation process. Oftentimes, infection control professionals and perioperative nurses are most apt for this role.¹ Another candidate is a materials manager or a director of purchasing. The post can, however, be filled by anyone with good leadership and organization skills. A pair or trio can also split the responsibilities.

Where the challenge comes in is with a facility that is either partially owned or majority owned by an organization or a hospital, instead of by physicians, according to Paladino.

“If it’s predominantly physician-owned, there is much more incentive to look at standardization and evaluation, and to look for best price,” he says. “The physicians have a vested interest obviously in driving costs out of the system and in many cases they are much more involved in the evaluation process. But if it is a practice or a surgery center that is less owned by a physician group then there is less incentive.”

A helpful material for the leader, Chinnes says, is an evaluation chapter in the 2007 edition of the Association of periOperative Registered Nurses (AORN) Standard Recommended Practices and Guidelines, which gives advice about forming a product selection committee, and how it should operate.

Choosing the Team

An ideal team includes a combination of end-users, materials managers, value analysis professionals and clinicians, says Cathy Denning, RN, MSN, senior director of surgical contract services at Novation, a contracting services company.

No matter who is on the committee, anyone should be able to bring a new product to the members, according to Chinnes.

“It may be one of the anesthesiologists in a surgery center, or one of the surgical techs, and it may be that they saw the latest and greatest at a trade show and they thought, ‘this will really make our job easier’ … but then it’s the committee’s purpose under the lead of materials management to look at, ‘is this product safe?’”

An important safety component is infection control. An infection control practitioner is an ideal committee member, but if an ASC is not privy to one, the entire committee needs to adopt an infection control mentality. Every new product should go through committee. It’s amazing how many products make it to the floor without anyone knowing how they got there, Chinnes says.

An important committee qualifier is enthusiasm. “Choose people who are interested,” Chinnes advises. “If you choose someone who says, ‘I’m on 52 other committees and I could care less about being on this one,’ then they’re not going to be much help.

“It’s like any other committee,” she adds. “If you get people who are interested, then you’re not going to get a disgruntled group unless you’re consistently picking inconvenient times or letting your meetings go two hours when they shouldn’t be but one or less.” The payoffs are significant.

“After a while they do see how products can make a difference — good or bad — for patient outcomes and they do feel responsible for what they pick,” she adds.

Evaluation Preparation

Preparation is key, according to Paladino. “Don’t just jump into an evaluation because (a product is cheaper),” he says. “All ASCs are looking to drive costs down wherever they can, but in many cases if you’re looking at best prices, it may mean that you use more of that product or that there are added costs associated to that cheaper product, or that it adds to the time in a procedure. That’s not always the best solution. You really need to look at the big picture as far as costs, operating time and your physicians being happy.”

Someone either on or off the committee needs to be responsible for narrowing the amount and type of products that will be evaluated. It’s good to evaluate three products or fewer at one time, so that people do not get confused or overwhelmed.

“I think you need to narrow the window and a lot of times that can be as simple as by price, or (manufacturer reputation),” Paladino says. “That may be someone from inventory materials management, or the director of nursing. Those two need to work hand-in-hand to really narrow that window, especially if you’re involving physicians. They don’t want to see 10 different manufactured products.”

It’s also a good idea to read product literature beforehand, and to screen products to make certain they are good enough to try. “I would certainly want to make sure that a product was cleared by the FDA to go to market if it was commercially available,” Denning says.

Length of Evaluation

The length of an evaluation should depend on the product. “If it’s clinical in nature you need to look at a two-week evaluation, with the flexibility of adding time if there’s some questions or concerns during those two weeks,” Paladino says.

The time span should depend on several factors, says Denning. “My opinion is that based on the equipment or product being evaluated, enough time must be allowed for the product to be used properly, and for the end users to determine if there is a benefit to the new product that eclipses the product currently in use,” she says. “If not, then price and other factors such as warranty, life cycle cost, etc., usually become primary decision drivers, all other things being equal.”

If the products are used extensively and rely to a large degree on personal preferences — products such as gloves or suture — they should be evaluated for two to four weeks, Paladino advises.

If the change is simply a switch from one manufacturer to another and the products in question are not very different from each other, the evaluation can be simple. An example would be an informal meeting outside the operating room.

Chinnes agrees that the evaluation time frame should depend on the product and its importance. No matter what, however, the evaluation shouldn’t last too long. If a product overstays its welcome, people get too used to it and may have trouble switching back to the old product, or to another trial. When a new product is being evaluated, it’s important to remove all its old counterparts from the facility, Chinnes says.

“Nurses — and I’m one of them so I can say this — tend to squirrel things away in case we can’t get them later,” she says. “So we may have the old product away or have it in drawers in patients room or utility rooms.”

Staff members sometimes shift between the old product and the new one, and that can result in skewed evaluations, Chinnes says.

Tallying the Feedback

After a participant tries a product, it’s important to collect their feedback soon afterward.

“You want the information to be fresh and the outcome to be fresh,” Paladino says. “You would want a response as soon as possible. I’ve seen evaluations where there’s no good process and where the ASC isn’t familiar with the process of evaluation. Basically the evaluation took place in the OR with the doc.”

Such shoddy evaluations go something like this, Paladino says:

“’Do you like this suture?” “’No, it’s no good, I don’t like it.” “And so they come back to me with, ‘He didn’t like it.’ Well, what didn’t he like about it?” Paladino asks. “What were the problems?

Did he have the right product for what he was trying to do?” It can be difficult for physicians to find the time to record their opinions, so Paladino suggests that a nursing staff member or a scrub technician ask the physicians three or four non-extensive questions, and then record his or her evaluation.

Organization is vital, Chinnes believes. “If you’re doing a trial for a month, you usually get the feedback from everyone when they fill out their evaluation forms and we compile it all at once,” she says. Only one product should be evaluated at a time, and replies should be gathered soon after so that people do not get confused.

Product Representatives

Product suppliers can be great allies during evaluations, and in this arena, small and medium ASCs need all the help they can get, Paladino says. “Evaluations are always hard in a surgery center,” he says. “I get involved with them from a group purchasing perspective as well in that I help coordinate those evaluations with our ASC members because I don’t think they necessarily have the expertise to run an effective evaluation.

“They don’t understand the criteria you’re looking for and what type of outcomes they should expect,” he adds. “I think if you don’t have someone who has that experience it’s very hard to run an effective evaluation. You should look to your suppliers.”

It’s advisable to include a manufacturer representative because he or she will understand the evaluation procedure and the proper application of the product. If the staff is comfortable with the representative, he or she can even be present in the meeting. The representative, however, should not pressure the staff in any way to make a purchase.

“Depending on the type of product we’re looking at — especially a very highly technical product like an instrumentation that’s fairly new — the manufacturer typically has a very clinical, technical individual who is responsible for helping to perform those evaluations or demonstrate the proper technique,” Paladino says.

Indeed, help from vendors is important not just during the evaluation process, but well beyond. Certain products are fantastic at first, but when questions or problems surface, some manufacturers are nowhere to be found.

For instance, Chinnes dealt with a soap that worked great for a while, until it started dripping on the floor when not in use. This is a prime time for a vendor to replace the product, recommend a different model, or offer tips on how to fix it. Some vendors will take these steps and others won’t. Therefore, the evaluation of a product should also include an evaluation of the manufacturer.

Guidance is important, but a product should be so user-friendly that instruction is minimal. At BrainLAB (which provides software for minimally invasive therapies and cancer treatment), for instance, product developers strive to make products, such as the Kolibri ENT Navigation, as easy to use as possible.

The Kolibri ENT Navigation system was designed specifically for the ASC market and guides the surgeon through procedures by providing online information on instrument position. The system incorporates a real-time endoscope video, touchless monitor and surgical instrument tracking.

“Relative to the market, BrainLAB’s system is extremely inituitve and user-friendly,” says Chris Kemp, a national BrainLAB representative.

Inc. “Assuming it’s a new account, there are a few ways in which a rep can assist. The degree of the rep’s assistance is dependent on how familiar the facility or staff are with image-guided technology. If it is a new account, then the reps assistance is critical in the set-up of the equipment, preparation of the instruments, prepping the patient in the OR and overall workflow.”

This can include a hands-on in service about the purpose of the technology. Overall, the learning curve is short, Kemp says, which is important for busy surgery centers.

Indeed, ease of use is vital and guided the design of Datascope Corp’s Spectrum OR, which is an anesthesiology monitoring device that features display visibility, quick-access menus and one-touch function keys. Excellent customer service throughout the evaluation process and beyond is also imperative, says Nicole Kroplewski, coordinator in Datascope's patient monitoring division.

"In discussions with customers … there is consensus around one requirement: that we provide value after the sale and throughout the life of the product," Kroplewski says. "Many hospitals have expressed disappointment in the level of clinical support and responsiveness provided by some of our larger competitors. Datascope’s focus is on listening to our customers, resolving their issues and training their clinical staff on our products.

"When customers choose a product, it's the sum total of innovative product design, value-effective cost of ownership, product reliability and performance, and the manufacturer's passion for quality and customer service, that defines their choice," she adds.

Stake in the Business

If upbeat, proactive people are chosen for an evaluation team, they will most likely feel satisfaction in the process and the involvement may even improve their loyalty to the business.

“I think that when people understand all aspects of a situation, clinical, financial or overall value and impact, most support a solution that is a win-win for all parties,” Denning says. “I don’t think this is any different with healthcare product evaluations, purchase and adoption.” The team members often end up feeling empowered, Paladino says.

“If they are involved in a process, obviously they have a vested interest and they’ve been viewed by their organization as a person who can make a contribution. It creates an allegiance of an employee,” Paladino says. “Some people view evaluations negatively though. ‘Why do I have to get involved with this, just give me what I want.’ That’s why it’s critical to identify people who will be a positive role player in the process. We don’t need negative comments feedback from the start related to just the evaluation process. You need to weed those people out.”

For ASC owners and operators who are new to the evaluation process, it is helpful to scour the Internet for tips. There is plenty of good information there, Paladino says, and manufacturers can also supply tips.

“You definitely need to prepare and identify what outcomes you’re looking for and what information you want to gather to make a strong decision,” he says. “The worst evaluation in the world is to just bring in a product and say, ‘Hey, try this.’ You need to know why you’re considering making a change and understand the issues with your current product, and look to see if the new products you’re evaluating rectify those issues.”

And in the end, staff members, patients and owners should be all the better for it.

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