Communication within a hospital is difficult at best. Is the message getting to the right people? Is everyone interpreting the message the same way, and are the best decisions being made? Even more important, is feedback or direction given once communication cascades down or up?
We recently worked with a member to establish a value analysis program in its stand-alone hospital. Developing a bilateral communications plan to ensure communications flows in both directions was a critical component.
The effort began by establishing a surgical value analysis steering committee to decide how to communicate important and costly value analysis decisions. The steering committee included C-suite, vice presidents and providers (physicians and end-users). Hospital leadership wanted a communication plan where providers and leadership could bring forward issues, ideas and new products and procedures for discussion and decision. The team wanted to avoid the types of communication breakdowns it had previously experienced when making new product decisions in silos without value analysis and bilateral communication. Here are two of their examples.
Leadership and supply chain not included in purchasing decision
The hospital purchased more than $1 million dollars of reusable surgical patient positioners but did not communicate the decision to leadership beyond the surgical area. As infection prevention staff were rounding on units, they discovered the new reusable positioners. They voiced concern about how the products were to be cleaned, where they were stored, and who approved the purchase.
The infection prevention staff brought these concerns to the huddle manager who quickly escalated the issue to the operating room director, chief nursing officer, vice presidents and c-suite. In response, the c-suite requested that the vice presidents, chief nursing officer, operating room director and infection prevention manager discuss the approved purchase, review the products and provide the infection prevention staff with cleaning and storage processes and procedures.
In this example, the process and lack of communication meant that the supply chain did not receive a cost analysis prior to the purchase and only a pricing agreement was in place with the vendor. The purchased items were not compared to competitors and did not go out for request for proposal. Limited research was examined. Even if the positioning products were not the best value, the money was already spent.
CEO makes purchasing decision in isolation
The hospital CEO mandated that all breast cancer surgeons use a more costly biodegradable 3D tissue marker, replacing the metal tissue markers they had been using. The CEO made the decision because his wife had recently undergone breast cancer surgery where the biodegradable tissue marker was used. He had been told that this product provided better visualization of tissue margins to spare healthy surrounding tissue. The CEO made the decision based on his personal experience with no cost analysis, literature research, or evaluation of competing products.
This was one of the first items the newly formed surgical value analysis committee tackled. Once the committee put the newly established value analysis and bilateral communication processes into place, it revealed important information leading to a modified decision.
The group found that the cost of the 3D marker was about $1,000 each compared to $6 each for the metal tissue markers. Medicare reimbursement totaled approximately $2,000 per case for the most widely performed procedure involving the tissue markers. When surgeons were told about Medicare’s $2,000 reimbursement, they initially thought the reimbursement was just for the implant, not the entire cost of the procedure. They learned that the 3D marker would use approximately 50 percent of the entire procedure reimbursement compared to 0.3% for the metal tissue marker.
The group reviewed literature to evaluate clinical outcomes. They asked the radiation oncologist to present his clinical outcome findings on the patients who had had the 3D marker implanted. They found that there was a slightly better demarcation with the 3D marker, but not enough to warrant its use on every patient. The surgeons agreed to limit use of the 3D marker to certain complex cases.
How bilateral communication improves overall value
Bilateral communication gives leadership the opportunity to share an idea for clinical thought and consideration. In the 3D marker example, instead of the CEO issuing a mandate, the initiative should have gone to the surgery value analysis committee as a new product request. The request would be treated as any other new product request, where the overall value would be determined through review of evidence, cost effectiveness, quality outcomes, reimbursement and other factors.
In this case, once the product was reviewed for overall value, the surgery value analysis committee made an educated decision. The team developed clinical guidelines for appropriate use of the 3D marker. The decision and guidelines were communicated to the c-suite, vice presidents and applicable surgeons, as well as to operating room leadership and staff. Finally, the surgery value analysis committee communicated to supply chain professionals so that they could put correct sourcing, contracting and logistics in place.
In both the patient positioner and 3D marker examples, no value analysis program existed when the purchasing decisions were made. There also was no communication plan to keep all stakeholders informed about important product decisions. The best practice is to have a vehicle to communicate noteworthy events in real-time across c-suite and end users.
Vizient Advisory Solutions can help organizations stage clinical initiative areas on a prioritized basis through its proprietary strategic planning methodology. Feel free to contact us for more information on this topic and clinical supply integration.
About the authors:
Ashley Zielny is a registered nurse with more than 20 years of experience. She has worked in ICU, intermediate care unit, respiratory and radiology departments. For the last six years, she has been working in supply chain as the clinical quality value analysis (CQVA) med surg consultant. In her role with CQVA Ashley has contributed to the $56 million dollar savings over the last two and a half years at a large acute care health system. Ashley has also participated in the development of an educational program for other health care workers related to CQVA processes. Ashley received her Bachelor of Science in Nursing from the University of Central Oklahoma and her Master’s in Nursing from Aspen University.
With more than 30 years of experience in the health care industry, Donna Colby is a consulting director for clinical advisory solutions at Vizient. Working both as a registered nurse and as a clinical director within supply chain, she partners with members to develop and establish clinical supply integration between clinical delivery areas, physicians and supply chain. She works with members to create overarching governance structures, including physicians, which provide a platform for leadership to make decisions based on quality, evidence and total financial value