Doing More With Less
Sterility, Storage are Big Challenges for OR Materials Management
By Kathryn Dix
Managing the materials associated with the daily functions of an operating room (OR) has long been a concern of healthcare workers. Frustrated by financial restraints, cost-conscious facilities are returning to the drawing board to find innovative solutions including old-fashioned space conservation or the addition of a separate materials manager for the OR.
Adding that staff member to the equation was the answer for New York City's Hospital for Special Surgery. According to Susan Kreiss, FAHRMM, director of materials management, one of the biggest assets of their OR is having a designated materials manager. "We are a surgical hospital that does 15,000 procedures a year," she says. "We've had a separate OR materials manager for years. It is an extremely valuable position."
"Larger hospitals tend to [create that position], although I could make an argument that no matter what the size, the return on investment is there," says Thomas Hughes, president of consulting firm Concepts in Healthcare, Inc.
Hughes has concerns about who fills this position, however. "We don't want somebody who's just taking orders. We want somebody who will create teams and look at cost management issues. This person really administers supply cost management within the OR."
More should be required from the materials manager than simply keeping what physicians want on the shelf, Hughes explains. Because a hospital's OR supply budget often parallels that of the facility's pharmacy, Hughes says the materials manager should manage inventory much like the pharmacy does.
Cost containment, continually at the forefront of a hospital administrator's concerns, is more important than ever. "I have a huge initiative in place that is being carefully monitored by senior management," Kreiss says. "Most of my colleagues are doing the same thing and some of the larger hospitals in New York have created materials management positions specializing in cost containment."
Hughes concurs. "The OR directors who are pressured internally to reduce costs are making a very good case for the need for such a position," he says.
Filling the materials manager position often requires choosing between a candidate with a long history of supply-chain management experience or someone with an extensive medical background, such as a nurse.
"Do you want to hire somebody with tons of training in supply who doesn't know a scalpel from a syringe, or do you want a nurse who knows nothing about materials?" Hughes asks. "I would lean toward the latter as long as the person was able to get some formal training [in supply-chain management]. I think you can learn materials, but it's very difficult to learn what a nurse knows."
That training, Hughes proposes, can be obtained by the materials manager attending seminars and joining professional organizations, or by hospital administrators contracting with a consulting firm to identify benchmarks in performance. "It's more expensive than a seminar, but much more effective," Hughes adds.
Challenges for Materials Management
Sterility is another concern for proper materials management. "Event-related sterility is challenging," says Sue Banschbach, director of surgical services at St. Francis Hospital in Tulsa, Okla. "Its adoption requires us to re-educate the staff to identify package integrity without the dependence on an expiration date to determine sterility. It is a cultural change that takes a long time to complete."
Reusing single-use items is a growing trend that triggers additional sterility concerns. "There are some fairly substantial savings to reuse, but it's not being done in-house; it's being outsourced," says Hughes. "That's probably the most significant event [among current sterility issues]."
Another worry is the separation of clean and soiled materials, Hughes continues. "That's one of the basic principles a nurse or a clinician appreciates, but some hospitals are not designed to support those basic concepts," he says.
Desperately Seeking Storage
Another trend is that of separate storage for OR materials. "Many larger hospitals, ours included, have a hybrid situation in that slow-moving, high-dollar, critical instruments and supplies are handled by the OR," says Banschbach. "This would include supplies for implants, both orthopedic and cardiovascular."
However popular the trend may be, many healthcare organizations frown on multiple inventory locations, Banschbach cautions. Routine commodity goods are kept in central stores. "In addition, older ORs often sacrifice what was once storage area for sterile supplies in exchange for renovated OR space, forcing relocation to central stores," she continues. "Newer facilities seem better designed to accommodate storage, but it is unlikely they would become completely independent from stores."
Having a contained, secure room for OR supplies is necessary, but can also be an invitation to carry more inventory, Hughes says. "If I were building an OR, I would want to keep a minimal amount but full range of supplies as close to the user as possible, with the exception of a case cart system," he asserts.
Keeping supplies in the OR is not always a possibility due to space constraints. "New ORs and other revenue-producing spaces are created by administration without any thought to where the supplies are to be stored to support them," Kreiss says. "I just lost a supply room to create a new am surg OR. It never ends."
Storage is also an issue for Banschbach. "As for procurement, the advent of 'just in time' inventory to reduce PAR levels requires intense monitoring to prevent outages," she maintains.
"The OR never gets enough space," Hughes agrees. "But one of the advantages to not having space is not having a lot of inventory. I'm not saying that inventory management should be dictated by space, but think about what the space in the OR produces in the way of revenue. You don't want that space tied up with keeping inventory on the shelf. Space is a resource you're just not going to get," he continues. "You have to do better with what you've got."