ORLANDO – Not only should nurses and materials managers collaborate for the benefit of their organizations and their patients but they also should work together for the improvement of their facilities’ supply chain.

A panel discussion at the annual meeting of the American Association of Critical-Care Nurses (AACN) here in late May explored some of the ways to make it happen. Last month, Healthcare Purchasing News, which sponsored two panel discussions at the conference, explored the concept of nursing and materials management working together on effective buying strategies, the focus of the first panel.

The second session in the series, also moderated by HPN Senior Editor Rick Dana Barlow, took the topic a step further, focusing on "How Nurses and Materials Managers can Improve Supply Chain/Inventory Issues Affecting Patient Care." Speakers included Ian Crassweller, Director of Marketing, Temperature Management, Kimberly-Clark Health Care; and Deb Laughon, R.N., BSN, MS, DBA, Manager of Systems Improvement for Lakeland (FL) Regional Medical Center. Laughon is also an AACN Director and on the faculty for University of Phoenix, (Orlando, FL), teaching Masters programs for healthcare science and nursing.

Crassweller opened the discussion by sharing remarks from a meeting involving CEOs of 35 of the largest integrated health networks in the country, along with manufacturers. "We were talking about products and new technology and how hospitals assess those new technologies. But I think their comments are relevant to the issue of supply chain and inventory management. One comment was that, if the CEO really wanted to find out what was going on in the hospital…they talked to the nurses. What it reflects is that, when dealing with patient care issues, you need to go to the source of the information. If you want to consider a new product or new technology, or improvements to supply chain issues, the most successful strategy is to…approach the issue from the perspective of a patient care focus rather than a process focus.

"…When we’re in our day-to-day lives, doing things on the floor, caring for patients and dealing with those issues directly in front of us, we tend to lose sight of those concepts. But, as nurses, if you want to find out how things are working and if you want to make improvements to…the supply chain, you need to understand how things are working on the patient care floor, how good the processes are that they’re using, what the gaps are, what the areas of improvement are. I think if you approach them from a patient care impact perspective, you’re going to gain a lot more in impact on the primary objective, which is patient care."

He added, "It is often the case that improved patient care effects, also have cost reduction and cost management impacts. I think that’s often overlooked."

Crassweller then discussed the dynamics of the nurse-material manager relationship. "From what I’ve heard and seen there tends to be an adversarial relationship between nurses and materials management. And I have never understood that. Because if you consider that nurses understand – on a day-to-day basis – what the patient care issues are, and you think about the role of materials management, it strikes me that the relationship (between the nursing staff and materials management) offers a perfect bridge between those two issues.

"But it requires that you carefully manage that relationship. It requires nurses to go beyond understanding patient care impacts, and be able to articulate them, look for improvements, and articulate how those improvements can improve costs. It also requires the materials management team to look beyond line-by-line budget issues and consider how patient care issues can impact costs on a broader scale…

"Also, looking from a manufacturer’s or distributor’s perspective at the supply chain, you should challenge us to…provide clinical data and cost in use data that applies to real life situations."

Laughon then offered her opening comments, "When I was asked to speak, my initial thoughts about product supply, and applying those to critical care patients and critical nurses is that those issues are not really unique to critical care. They may become more urgent and important and have a higher dollar value, but when in an acute care setting, all clinicians have challenges facing them when the products they need for that patient are not available."

To illustrate her point, she related an anecdote from her experience in the hospital. "Nurses have a historical ability to be so creative. We’ve been known to even hide I.V. pumps in the ceiling tiles because we don’t have time to go look for them. I see you smiling", she laughed. "But that’s a real example of how challenged the nurse might be to have what she needs for that patient. It becomes a very powerful issue."

She explained the importance of collaboration between nurses and materials management, and the momentum toward that end over the years. Yet at the same time she noted, "There’s a barrier to that collaboration. We don’t talk the same language. And often when I visit a clinical area, those folks are so busy running around, they’re not listening. They don’t know that when we bring them something and say ‘look at this and tell me what you think’, it means they’re going to get this next week…The collaboration needs to be very succinct and articulate from both sides."

Laughon also highlighted the role she thinks vendors should play in the process. "I need you to listen to what my problems are and my patient issues, and then help me decide if your product can meet that, and if that’s been proven…not just sell your product. Nurses are sometimes dazzled by fancy gadgets and new technology, yet that may not be the solution to the problem."

It’s important to always relate how products impact patient care, as well as the daily routine of operations, she continued. "Nurses historically are not as articulate as they need to be. They’re talking about how it impacts their patient, but they’re not able to tell you, ‘that took me 30 extra steps’. We often don’t want to say those things, so we’ll actually just manage…and make it happen at any cost, rather than articulate what the barriers might be. And we may not even know what they are because we’ve done it that way for so long.

"Lastly, we must both have the same goals about the patient …In my mind, problems occur when one party either fails to hear or value the input of the other. If your goal is to sell a product, you might not hear that I really only need some of the aspects of the equipment, and that we’re possibly looking at wrong equipment."

Barlow then opened up the discussion to the nurses in the audience by asking them about the expectations they had of materials managers. One nurse talked about not having critical supplies late on a Friday afternoon, and how she felt that materials management didn’t understand the life-threatening urgency of having those supplies on hand. "They didn’t have a clue. They didn’t even go around and try to collect them from areas where maybe there were a few more until they got the backorder," she said.

Laughon offered this advice: "One of the strategies that we have is…a critical par level. Essential products are all numbered. When they get to that par level, then they distribute them one at a time. I was a house supervisor one weekend when we ran out of triple lumen catheters, and I thought, ‘this is not a good thing.’ But we really hadn’t run out. The rumor mill said we ran out. But Central Supply had recognized we were at a critical level. They had taken the last eleven, and they were giving them out one at a time and they knew at what point they had to do an immediate drop."

Another audience member, in his first year as a manager, asked if there was a neutral resource available to help determine which products would best meet the facility’s needs.

Crassweller suggested that, in many ways, the manager could be his own neutral resource. "You can challenge any supplier to provide the data that would allow you to make the assessment. I think all of you have the skills to do that. You have a lot of experience, you’ve been through schools, training programs, etc., and you should rely on that. You have the ability to assess the data that’s given to you."

Laughon referenced the fact that hospital associations often provide quantitative analyses of various products, and praised the manager for asking the question. "As a new manager, it is so overwhelming and you do have to make decisions that are going to last because you’re not going to get that capital money again the next year."

Barlow added that ECRI and MD Buyline are two good independent sources that managers might find useful.

Crassweller also noted that, in hospitals that have them, quality managers could represent an independent assessment of how products can impact patient care issues.

When an audience member admitted her lack of knowledge regarding the materials management process, Laughon suggested that nurses take the time to "shadow" employees in the purchasing department and get to know their jobs. It’s the "walk a day in my shoes" philosophy. "As a new manager, we actually orient with the purchasing department. We go through how they do the charge master, understand the inventory management system, it’s a part of our orientation."

Another audience member, a nurse manager since 1989, commented that she’s earned two Masters degrees, one of which is an MBA, and contended, "Some hospitals don’t always respect what nurse managers do. They have the financial responsibilities in their units but oftentimes are not given the tools or resources they need to do that effectively."

Barlow noted that she’s not alone. In fact, a growing number of clinicians were receiving business degrees, while a number of materials managers were getting involved in nursing in order to speak the clinical language. He then asked, "What are some practical, common sense ways that materials managers can keep patient care concerns in mind, as well as for critical care nurses to keep the fiscal health of the facility in mind?"

To that, Crassweller spoke about value analysis committees as a venue for trading information; and he talked about the importance of expanding horizons, attending conferences and panel meetings that are outside of your area of expertise.

He then described the process of "is-mapping" and "should mapping," bringing together a cross-functional group and examining the gaps in processes and the steps required to accomplish a particular task. "When you do that and step back from it a minute, you often see things you hadn’t seen before. You can ask, ‘what are the options I have to improve that?’ And just by the extension of that process, you start to logically ask yourself, ‘what are the issues associated with that change?’ Not just from a patient care or nursing standpoint, but what are all of the issues?"

Agreeing with Crassweller, Laughon described the time-in-motion studies performed at her hospital where they observed employees performing various tasks. "We used stop watches and logs and wrote down what the person was doing and how long it took them, and then what the value of that activity was related to the patient. When they start to do that flow process, step by step, they may not be aware of what they’re doing. One example was a chest x-ray. It used to take 37 steps to get a chest x-ray ordered and completed, and by identifying the problems, we reduced it down to seven steps. And in today’s world of scant resources, every step is essential," she emphasized.

A final comment from Crassweller reiterated a key message: "I don’t think you will ever lose by collecting data." HPN