Standardization can improve physician engagement while cutting costs & optimizing outcomes
On its face, product standardization in healthcare can offer an array of benefits: It can minimize waste, boost cost savings and optimize patient outcomes. But standardization initiatives—considered an integral component of clinical value analysis—can also improve physician engagement.
HealthTrust often guides members through product and service standardization by identifying key opportunities, providing supporting clinical data and offering expertise during what can sometimes be an exhaustive process.
“Clinical value analysis is not new to the world of healthcare, but it is interesting to learn of the different ways it’s conducted within facilities and the processes used,” says Angie Mitchell, RN, AVP of Clinical Services at HealthTrust. While often not easy to initiate, Mitchell shares, “There’s work to develop that sound process and put a structure in place. With diligence and perseverance, value analysis becomes routine for everyone, and the benefits are tremendous.”
A benefit of engagement
Benefits depend on the department being assessed, says Jennel Lengle, RN, MSN, CCRN, NE-BC, AVP of Clinical Operations at HealthTrust. “Among them are limiting the size and scope of your supply list, limiting the storage capacity needed, less training required for caregivers, and keeping consistent processes throughout,” she says.
“From a cost perspective, you can leverage the size and scale of an organization by standardizing it to certain products,” Lengle explains. “It allows HealthTrust to negotiate better prices and health systems to control costs by buying in bulk and appropriately utilizing those products.”
Remarkably, physician engagement is both a catalyst and a result of well-executed standardization initiatives, Lengle and Mitchell explain. Giving physicians a clear role in standardization efforts empowers them, leading to greater buy-in during and after the process. “All stakeholders want to know what’s in it for them, in terms of their ability to deliver quality patient care,” Mitchell says. “Everyone likes having a voice. It is important to fully understand the perspective and experience of each end user and avoid making assumptions.”
Health systems can help ensure engagement, Lengle suggests, by “involving physicians from the beginning and allowing them to help determine areas of focus and prioritizing the scope.”
Two HealthTrust members, Beaumont Health in Michigan and Steward Health Care in Texas, recently tackled successful product standardization initiatives. Here’s how they approached the process and the lessons they learned.
Beaumont: hernia mesh
Having previously sourced hernia mesh—a high-volume product for hernia repair—from many suppliers, Beaumont Health wanted to standardize to one vendor while also meeting contractual requirements and allowing carve-outs for exceptions.
Hernia mesh is considered a challenging category to convert because many surgeons are passionate about the mesh they use, says HealthTrust Physician Advisor and general surgeon Bruce McIntosh, M.D., Vice Chief of Surgical Services at Beaumont Hospital in Troy, Michigan. Dr. McIntosh played a key role in the standardization.
“There are many surgeons you’re trying to satisfy with a lot of different types of mesh, who might use particular ones based on the application. The goal was trying to find a sole supplier who could accommodate the vast majority of needs,” Dr. McIntosh explains. “From there, we had to determine a way of negotiating to enable appropriate carve-outs when there weren’t other options available.”
Part of the conversion involved depleting the inventory of existing mesh products by returning it where possible or swapping it out with the new supplier’s products, which took about four months. The pandemic delayed this timeline, since hernia surgeries are typically elective.
Physician communication was vital during the conversion, with Dr. McIntosh facilitating surveys that were sent to the system’s highest-volume hernia surgeons to determine which mesh components were most important to them. Physicians then attended presentations on the clinical attributes of various products, where they could ask questions.
Various mesh supplier candidates were whittled down through this process, which included developing an “exception list” when the primary supplier did not offer a clinically equivalent product. Some Beaumont surgeons spoke up to say the new product wouldn’t work for a specific use and pointed out that what they used in the past was effective.
“In those cases, I think we all agreed that it was reasonable to allow them to continue to use that product because there was a defined reason they chose it in the first place,” Dr. McIntosh says. “We really focused on the higher-volume physicians and ensured that their input was heard throughout the entire process.”
The conversion timeline totaled approximately 15 months. Since March 2021, Beaumont has recorded about 95% compliance with the new hernia mesh, meeting an 80% benchmark in the first month. Cost savings are still being measured, with a tally expected by the end of 2021.
“I think the overall success of this initiative can be attributed to having physician leaders guide the process,” Dr. McIntosh adds.
Steward Health Care: surgical attire
In November 2020, Steward Health Care seamlessly converted from surgical togas to AAMI protection level 4 surgical gowns among orthopedic surgeons at four of its 45 hospitals throughout the United States. HealthTrust was integral to Steward’s efforts.
Mitchell and her HealthTrust colleagues shared compelling information with Steward officials. The results of clinical trials indicated that the switch could lead to significant cost savings without raising risks for surgical site infections or other negative patient outcomes.
“The evidence was there, and we had the support from HealthTrust with all their documentation,” says Cheryl Anderson, DNP, MBA, RN, BSN, System Director of Value Analysis at Steward, based in Dallas. “They saw an opportunity, identified it quickly and provided us the clinical literature and financial implications. We’ve been fortunate to not have any negative results or issues with the conversion.”
For orthopedic surgeons performing total joint replacement and other physically rigorous procedures often involving saws and drills, surgical attire needs to be especially durable and protective. Steward orthopedic surgeons wear a disposable hood in addition to the newly chosen surgical gown, a face shield and other elaborate gear often referred to as a “space suit.”
Anderson notes that there isn’t any clinical literature that states togas provide better patient care outcomes or decrease contaminants in the operating room. Togas also cost nearly double the price of the new AAMI level 4 gown and hood combination, which means the switch has the potential to save Steward about $47,000 per year.
From the start, Steward physicians and OR directors were engaged in the conversion process. They received extensive communications, including clinical literature, photos and comparative descriptions of surgical togas and gowns.
“We thought there might be some pushback, but there was none,” Anderson recalls. “That was because of all the clinical documentation indicating that the OR togas did not decrease surgical site infections.”
Other health systems contemplating a new standardization effort should do so methodically, Anderson advises. “Follow your process, and be sure to do your homework by reviewing the available clinical literature and thinking about what’s best for the patients.”
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