In my work with hospitals across the country on utilization projects, I have encountered multiple types of value analysis (VA) programs in various stages of maturity. Some programs have multiple committees with representatives from all areas of the hospital, and specific project managers designated to each initiative. Some are in the midst of centralizing their VA programs among various hospitals that are now part of an IDN. Others have a small group of supply chain and contracting experts trying to gain traction at Nursing Practice Councils with a value analysis process still to be clearly defined. What I have found, and what we all as VA and Supply Chain professionals need to remember, is that even if your value analysis program is in transition, you don’t have to wait for the charter and full committees to be set up before you get started improving clinical care and reducing costs. Sometimes small projects can also yield big wins.
Investigate and save
Large projects, such as sutures, typically take a lot of time and planning. Vendors are called in, inventory is reviewed, and physicians are brought to the table. This hard work is well worth it as evidenced by the large amount of dollars saved and inventory streamlined. However, while value analysis teams plan and implement big projects, they can also choose smaller side projects to keep the ball rolling in other areas of the hospital. I am working with a stand-alone facility where value analysis is still more of a “new product introduction” team. However, they have strong support from their COO, and have contacts in key departments throughout the hospital. They are currently in the planning and initial working stages of some large utilization projects. In the meantime they have also identified smaller opportunities that will keep progress moving throughout the facility. For example, through their utilization analytics reports they saw they were spending more per patient on hot and cold therapy products than other facilities across the country. When they started investigating it became apparent that large size instant hot packs were frequently being used throughout the facility but were unsure why. They sent an email to the nurse education team and simply asked what they were used for. Labor and Delivery said they needed them for their patients, others cited a pain reduction initiative to provide complimentary therapies and administer fewer narcotics, and others were surprised these were even on their units. The natural question that followed was “do we need the large one, or is there an alternative?” Supply Chain worked with the nurses and their vendor to evaluate multiple options — various sizes, reusable, disposable, etc. Within a few weeks they decided to move to a medium hot pack instead. Simple. Quick. Effective.
At the same time, they had also identified another quick project for a different department. They could see that they were using a far larger amount of cohesive bandages (i.e., Coban or Corflex) than other facilities. The majority of these products were used in the phlebotomy lab. Now some of this usage is appropriate for patients with very delicate skin that can’t tolerate tape, or patients on blood-thinners that would have to keep the dressing on longer after a blood draw. But the question was asked, “Why do we use so much more?” Again, an email went to the lab director who consulted with her staff. They agreed that their usage and cost was more than what they thought it should be, and suspected it was being used in instances when paper tape would have been appropriate. They acted immediately. The lab supervisor worked with her phlebotomists to only use cohesive bandages when appropriate. They decreased the amount of cohesive bandages provided to the ER. Within one month of seeing their excess usage, they decreased their cohesive bandage quantity by 18 percent.
Building trust and credibility
This facility is in the beginning stages of setting up their VA team, yet they still made headway. Even though these small initiatives will not yield millions of dollars in savings, this was a great win. There was savings achieved by removing those large hot packs and reducing cohesive bandage usage, but perhaps the even bigger win came from asking the right question to the right person, and providing data to back it up. By simply asking “why” the end-users considered the best practice and protocols on their units and aligned their product mix accordingly. This is value analysis in action – with or without a well-established process. There was no huge roll out or committee discussion. By simply identifying an opportunity and raising a question, the end-user participated in a value analysis initiative whether they knew it or not. A seed was planted for future projects, clinical practice was maintained or improved, and real savings were achieved.
So the lesson is: Don’t forget (or overlook) the small stuff. Finding small opportunities to keep everyone in the hospital thinking about value analysis can be so important. Continue to tackle those large opportunities and fight for big wins, but also consider the small projects. Asking simple questions and getting end-users on your side will create small savings (that will add up), may actually improve your patient care, and help build your network of key contacts and champions. Your small wins help build credibility, nurture a culture of improvement, and help energize your team. Next time a big project comes up, you may have a nurse educator or lab supervisor you have worked with before that you can call on for help.
