ICPs, Nurse Managers Play Critical Role in Product Selection
By Kathy Dix
Product evaluation and selection might appear a mundane task to the average Joe, but that average Joe's health and safety depends on the ability of the product evaluation committee (PEC) to choose the best overall materials and equipment.
Humans always have tried to get the best deal on their purchases, often sacrificing quality for cost. But modern consumers, especially those charged with the task of preserving others' health, must balance quality against cost and, in these modern days, the additional consideration of time.
The cost/quality/time principle states that when purchasing a product, it is possible to obtain two of the factors above, but never all three. Low cost and high quality might mean a long turnaround time to receive the product. A combination of high quality and speedy delivery might necessitate a higher cost. PECs must determine which two factors are most crucial, then choose their stock products accordingly.
A product evaluation program has several benefits for the facilities that choose to adopt the policy -- improved patient or healthcare worker (HCW) satisfaction, improved inventory control (and therefore improved costs) and competitive pricing.1
The Association for Professionals in Infection Control and Epidemiology (APIC) recommends that new products and devices be evaluated to ensure that personnel can be trained in its use and to circumvent any issues concomitant with a new, unfamiliar technology. APIC suggests that products to be considered must be safe, effective and conducive to "high-quality patient care;" that they be employed by a committee with "clearly defined responsibility and authority;" that they be evaluated based on "objective criteria;" that a trial be conducted before selecting a product; and that an annual review should be done of the policies and procedures associated with product evaluation and selection.
Such products should conform to the Association of periOperative Registered Nurses (AORN)'s recommendations as well as those of the PEC, and APIC suggests that the PEC be comprised of people in the following roles:
- Materials management
- Medical staff
- Infection control
- Clinical engineering
A PEC has the Herculean task of assessing numerous products and materials and determining which ones best suit their facilities -- and their budgets. But each committee takes a slightly different approach.
In the past, infection control issues were not always included in product evaluation. But in 1976, the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) recommended that infection control be considered in product selection that impacts sterilization, disinfection, cleaning and decontamination. Evaluators then had to add that consideration to those of quality, safety, cost, standardization and serviceability.
Managed care has generated a greater consideration for cost-efficient medical care, at least in most facilities.
"The product selection process has become more formalized with various committees, etc., that have complicated the process," observes Tom Hammond, vice president of sales at Regent Medical. "However, hospitals are still very interested in standardization, value, safety and quality. Those demands and expectations have not changed with time."
For example, Hammond points out, one brand of surgical gloves might represent a cost savings up front, but if the product is prone to rips and tears and HCWs have to double-glove each time, the cheaper gloves may not be a better value.
"That's the reason for the evaluation committee -- in trying to standardize, in trying to provide the right kind of mix between price and quality, and I think there's still a recognition of that value, at least in our industry," he adds.
Suppliers of healthcare products are affected directly by the PEC. First, they must ensure that their product is presented to the committee, but direct contact with the PEC is not always allowed. There are several ways to introduce and influence the healthcare facility to view a new product fairly, Hammond notes. These include:
- Individual presentations detailing the value and efficacy of your product to individual and group decision-makers within the healthcare facility
- A formal presentation to the standardization committee if direct contact with the committee is allowed
- Education presentations to various organizations, at which decision-makers are present
- Direct-mail pieces sent to decision-makers explaining product features, benefits and value
The challenge of introducing new products to the "standardized" offerings of a hospital or other healthcare facility is that people resist change. If surgical gloves are under consideration, for example, it is difficult to please everyone. A surgeon's preference might be for the gloves she became accustomed to in medical school.
"Again, the individual preference becomes an overriding consideration," Hammond says. "If the hospitals can figure out a way to standardize, to get everybody to change at one time, it is much easier. Often, they do re-approve an existing product because it is the simplest and easiest path forward. The challenge for the non-incumbent is to create the reasons for the healthcare facility to change. It is very difficult to standardize products like surgeon gloves that are very personal-type products. Therefore, new contenders must demonstrate value to be considered."
Once a PEC determines that a certain product may be suitable for its facility and wishes to test it, it is unlikely that they will accept another hospital's trial results. Instead, they will want to trial the product themselves, Hammond points out. This, he adds, is only possible if the product has prior regulatory approval to be used in the market.
During a short trial period, potential users will be given the chance to use the product under several different scenarios. But cost plays a part in the trial -- some facilities insist that the product be provided gratis for their trial.
"There is a split between those who absolutely require that you give them the products for evaluation and those who will purchase," Hammond explains. "Usually if they purchase it, there is some kind of guarantee. For instance, it's an evaluation guarantee -- if you buy the product and don't like it, we'll refund what you purchase, but if you continue to use the product we'd like you to pay for it."
"Sales representatives receive commissions for the sale of products -- even for evaluations," Hammond comments. "Hospitals often recognize the value in having a representative in service and will conduct the evaluation and will therefore consider purchasing the product."