OR materials management

The first step to resolving this issue is to establish an OR materials management function that includes both sterile supplies and surgical instrumentation. However, there is more to surgical services than many recognize or understand. Surgical services management encompasses a larger and more diverse set of inventories and services than any other department in a hospital. The high-level list below illustrates just how enormous the inventory and management requirements for surgical procedures are. This list includes hidden sub-categories that require additional technical and clinical knowledge and management skills in order to ensure safe and positive patient outcomes.

• Sterile supply inventory management

• Mobile equipment inventory management

• Instrumentation inventory management

• Consignment inventory management

• Anesthesia equipment management

• Surgical table inventory management

• Disinfection and sterilization

• Case cart systems management

• Charge capture

• Environmental service management

• Waste management

• Budget reporting

• Surgical value analysis

• Capital budgeting

• Preference card management

• Vendor management

• Repair management

• Hospital mobile equipment management

In today’s hospitals, there are two staffing groups driving services for surgical suites. It’s important to understand the two organizations and how they function in their specialties in order to see how the separation of management responsibilities becomes a critical factor.

This group is composed of nurses, scrub techs, anesthesia techs, first assistants, and depending where you live, a number of other licensed or certified professionals. Their expertise is driven by direct patient contact and outcomes. Communication and teamwork with one another is critical in this group to ensure positive outcomes. However, they rely on a second group for service and materiel-related support. They participate in room turnover (including the important room set-up function, which in itself requires specialization). Knowledge in this group is much more technical, with little room for error. This group is required to be one step ahead at all times, ready to respond to change in an instant.

This group consists of personnel who have technical certification, but their education also requires hands-on, on-the-job training. They may at times assist with patient transport, but they are not directly responsible for patient outcomes. However, their specialization requires expertise in material services that directly support patient caregivers. OR materials management service providers ensure the proper flow and steady delivery of goods and services; from cleaning the floors to delivery of sterilized instrumentation. Service providers also must plan and think ahead so as not to cause delays or interruptions that will impact patient care.

The solution to achieving a highly productive and "healthy" surgical department is establishing an appropriate division of management responsibilities that addresses the real expertise needed for two critical functions: surgical patient care and surgical materials management.

Relationship management is critical to the success of the OR nurse manager due to the interdependency of the many patient care services in the hospital. Their time should not be spent dealing with daily materials functions such as budget variances, instrumentation/supply issues and vendor management.

A management split (removing material management aspects) allows OR nursing management the time to develop and manage perioperative services fully and well. It allows them time to build relationships with surgeons, anesthesiologists and staff. In addition, the OR nurse manager can build relationships with other interdependent patient care services such as PAT/POH, PACU, radiology, the lab, the surgical floor, ICU, PEDS, and the emergency room. Although OR nursing leadership and staff are not completely freed from dealing with materiel-related services, they can be more focused on patient outcomes, team building and surgeon satisfaction.

OR materials management is a non-nursing role based on an extensive understanding of multiple computer systems and programs, including inventory management, accounting, and OR scheduling and preference card management. The experience required for OR materials leadership must include a strong background in surgical devices and supplies, business, service and production.

Like the OR nurse manager, the OR materials manager will need to build supporting relationships outside the department with hospital materials management and various patient care areas. For example, the OR materials manager must work with the hospital materials manager to ensure compliance with contracts and vendors. The hospital purchasing department is ultimately responsible for purchase order placement, contract compliance with GPO, warehouse receiving/delivery, and primary vendor compliance.

Although the OR materials manager should not create a second purchasing department (there are controls that need to stay in place to support accounting and accountability to the CFO), this professional will need to act as a purchasing agent and will require extensive knowledge of the hospital’s purchasing processes, supply ordering, capital equipment processes, contract compliance, vendor management and inventory management.

An OR materials manager’s focus is on high-dollar, low-volume purchasing. He or she is dealing with a much more volatile supply system with additional supporting inventories and high expense. In contrast, hospital materials management is reliant on large-scale delivery systems institution-wide. Their focus is high-volume low-dollar hospital-wide supply delivery, with additional non-warehoused deliveries to departments such as the Lab and X-Ray.

The OR materials manager is responsible for the entire perioperative service division, which is the largest resource consumer in today’s hospitals. However, this is only a subset of the "customers" of the CS/SPD, which also supplies other hospital patient caregivers such as the ER, X-Ray, RT, and ICU with low-volume specialty supplies, equipment, and sterile instrumentation. The CS/SPD supports all patient care areas, providing everything from sterile instrumentation to large scale cleaning and disinfection of mobile patient care equipment such as IV pumps and code carts.

In addition, there is a bigger picture. As hospitals grow, so do hospital materiel management issues. Decentralizing this organization would not help this complex compliance and logistics challenge: it would add cost and lose the process efficiencies and specialized personnel required to properly manage an extensive system-wide reusable medical equipment inventory. In this context, having an OR materials manager allows both the OR and the CS/SPD to focus on their respective supply chain processes.

The OR nurse manager and OR materials manager should have an inter-dependent relationship. In order to achieve operational best practices and productivity, they must directly support each other. Both OR managers must collaborate as a team to attend as many of the same committees and meetings involving surgical services as possible. Department meetings must include both these managers and their staffs, to unite the surgical services entity. These two managers should also co-attend surgeon committee meetings to present their budget, block utilization and waste, and provide turnover reports together.

See Part two, "OR materials management: Breaking it down."