In healthcare, we want consistent results based on common practices. We see such common practices executed in protocols, standard operating procedures, and checklists. With such emphasis on continuity, we should wonder why healthcare contracting shouldn’t exercise the same level of effort. Consider the following actual stories.
A facility wanted to obtain additional portable defibrillators to replace older ones. The nurse told the contracting/purchasing she wanted a specific type. When contracting asked why, the nurse said that she needed replacements for the old defibrillators and the replacement defibrillators needed to be the same make and model as the old ones. The result was that the nurse received the least expensive model of defibrillator and not the one she recommended.
The second story relates to a hospital purchasing systems (HPS). The HPS allowed the local purchases of goods and services for the efficiency of the system but from a catalog of pre-approved vendors. For the most part, it is a good system. However, one day an authorized person made a purchase of a piece of medical equipment that was not in the HPS catalog of pre-approved vendors.
What are the problems? In the first scenario, the importance of standardization has nothing to do with cost, but the standardization of care. Human factors and usability are concepts that drive human interaction with systems and learning. All defibrillators don’t look or function alike. This is critical. If all healthcare professionals are trained on a single style of defibrillator versus multiple types, they are more likely to perform the defibrillating task consistently based on common training and common device. When standardization is driven by human factors and usability testing there are substantial benefits; while not always the least expensive, there is a reduction of risk relating to potential adverse events which may occur.
In the second scenario, the HPS standardized the procurement methods and practices which the hospital uses to protect itself. For instance, only doing business with vendors that are ethical and provide the best overall value to the hospital. Additionally, each pre-approved vendor has a product recall protocol in place to ensure communication flow on recalled products. In this scenario, the local purchasing person chose to go outside of the HPS and created vulnerability in the HPS system, potentially affecting a patient’s safety. How might this affect a patient’s safety? In this case, there is no affirmative duty, on the part of the vendor, to report product recall information to the HPS.
Every day we look at methods and processes that affect the overall operation of our healthcare systems. Contracting people must understand that standardization does not only mean the common practice, it has human value in learning and replication in emergencies. For processes, our contracting people must fully understand the HPS so that they make decision consistent with the HPS and not subordinate it to that which is cheaper or newer. By better understanding the requirements and the system we operate in, we are better able to achieve the outcomes!
JAMES N. PHILLIPS JR., MPA, CFCM, NCMA Fellow, is an Acquisition Professional working at the Department of Veterans Affairs National Center for Patient Safety. Disclaimer: his comments are that of his own and do not reflect that of the Department of Veterans Affairs or the National Center for Patient Safety.