By Kathryn Dix
Managingthe materials associated with the daily functions of an operating room (OR) haslong been a concern of healthcare workers. Frustrated by financial restraints,cost-conscious facilities are returning to the drawing board to find innovativesolutions including old-fashioned space conservation or the addition of aseparate materials manager for the OR.
Adding that staff member to the equation was the answer for New York City'sHospital for Special Surgery. According to Susan Kreiss, FAHRMM, director ofmaterials management, one of the biggest assets of their OR is having adesignated materials manager. "We are a surgical hospital that does 15,000procedures a year," she says. "We've had a separate OR materialsmanager for years. It is an extremely valuable position."
"Larger hospitals tend to [create that position], although I could makean argument that no matter what the size, the return on investment isthere," says Thomas Hughes, president of consulting firm Concepts inHealthcare, Inc.
Hughes has concerns about who fills this position, however. "We don'twant somebody who's just taking orders. We want somebody who will create teamsand look at cost management issues. This person really administers supply costmanagement within the OR."
More should be required from the materials manager than simply keeping whatphysicians want on the shelf, Hughes explains. Because a hospital's OR supplybudget often parallels that of the facility's pharmacy, Hughes says thematerials manager should manage inventory much like the pharmacy does.
Cost containment, continually at the forefront of a hospital administrator'sconcerns, is more important than ever. "I have a huge initiative in placethat is being carefully monitored by senior management," Kreiss says."Most of my colleagues are doing the same thing and some of the largerhospitals in New York have created materials management positions specializingin cost containment."
Hughes concurs. "The OR directors who are pressured internally to reducecosts are making a very good case for the need for such a position," hesays.
Filling the materials manager position often requires choosing between acandidate with a long history of supply-chain management experience or someonewith an extensive medical background, such as a nurse.
"Do you want to hire somebody with tons of training in supply whodoesn't know a scalpel from a syringe, or do you want a nurse who knows nothingabout materials?" Hughes asks. "I would lean toward the latter as longas 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 nurseknows."
That training, Hughes proposes, can be obtained by the materials managerattending seminars and joining professional organizations, or by hospitaladministrators contracting with a consulting firm to identify benchmarks inperformance. "It's more expensive than a seminar, but much moreeffective," 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. "Itsadoption requires us to re-educate the staff to identify package integritywithout the dependence on an expiration date to determine sterility. It is acultural change that takes a long time to complete."
Reusing single-use items is a growing trend that triggers additionalsterility 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 sterilityissues]."
Another worry is the separation of clean and soiled materials, Hughescontinues. "That's one of the basic principles a nurse or a clinicianappreciates, but some hospitals are not designed to support those basicconcepts," he says.
Desperately Seeking Storage
Another trend is that of separate storage for OR materials. "Many largerhospitals, ours included, have a hybrid situation in that slow-moving,high-dollar, critical instruments and supplies are handled by the OR," saysBanschbach. "This would include supplies for implants, both orthopedic andcardiovascular."
However popular the trend may be, many healthcare organizations frown onmultiple inventory locations, Banschbach cautions. Routine commodity goods arekept in central stores. "In addition, older ORs often sacrifice what wasonce storage area for sterile supplies in exchange for renovated OR space,forcing relocation to central stores," she continues. "Newerfacilities seem better designed to accommodate storage, but it is unlikely theywould become completely independent from stores."
Having a contained, secure room for OR supplies is necessary, but can also bean invitation to carry more inventory, Hughes says. "If I were building anOR, I would want to keep a minimal amount but full range of supplies as close tothe user as possible, with the exception of a case cart system," heasserts.
Keeping supplies in the OR is not always a possibility due to spaceconstraints. "New ORs and other revenue-producing spaces are created byadministration without any thought to where the supplies are to be stored tosupport them," Kreiss says. "I just lost a supply room to create a newam surg OR. It never ends."
Storage is also an issue for Banschbach. "As for procurement, the adventof 'just in time' inventory to reduce PAR levels requires intense monitoring toprevent outages," she maintains.
"The OR never gets enough space," Hughes agrees. "But one ofthe advantages to not having space is not having a lot of inventory. I'm notsaying that inventory management should be dictated by space, but think aboutwhat the space in the OR produces in the way of revenue. You don't want thatspace tied up with keeping inventory on the shelf. Space is a resource you'rejust not going to get," he continues. "You have to do better with whatyou've got."