Face it. When economic growth erodes, budgets bloat, expenses erupt and revenues slip, so healthcare facility interest in value analysis tends to soar.

But value analysis shouldn’t be limited to reactionary decisions as healthcare organizations strive to justify new products and processes through the lenses of clinical efficacy and safety, as well as financial feasibility. It remains an ongoing function, regardless of how you define "value," and how you analyze and apply the results of your end-user and market research.

Ensconced in other industries for nearly six decades now, value analysis has clocked roughly half that time in healthcare. During that span of time value analysis efforts have generated positive and negative reactions.

As a result, Healthcare Purchasing News sought to trace value analysis’ progression by asking a variety of supply chain and value analysis experts to share success stories and failed attempts, which can be found exclusively at HPN Online (see links below) as well as highlight process roadblocks and rejections and how to overcome them.

In an accompanying feature these sources describe the current state of value analysis in one word, along with their reasoning.

On the surface, any value analysis program or project tends to begin with the best of intentions, clinically and cost-effectively justifying the use of some product or service for high-quality patient care.

But even the best of intentions may not guarantee the desired results and right outcomes. Resistance can rear its head for a number of reasons, including clinician preference, supplier relationships, comfort and familiarity over disruptive change and even less-than-cooperative, or more simply, combative, attitudes.

Some of these challenges can be traced to incomplete research fueling questionable recommendations, communication breakdowns or personal relationships.

How to sidestep the array of attitudes, excuses and other impediments – organizational and personal – that prevent value analysis efforts from progressing may be more of an art than a science. Yet no one is willing to dismiss the science.

1. Lack of leadership from the top. "Too often there is no clearly identified vision, mission, and organizational imperative to reach a defined goal," Glennon said. "Value analysis cannot be managed from the middle. It needs to start at the top and become a core element of the corporate culture."

2. Lack of active clinical engagement in the process. "Physicians and other clinical stakeholders need to be actively engaged in the value analysis process," he continued. "The conversation must change from ‘can we use/do we like this alternative clinical preference product’ to ‘why can’t we use this clinical preference product, which is being successfully used in so many other facilities, to save money for our facility?’"

3. Inertia and resistance to change. "It’s always easier to keep things the way they are," he observed. "Most people are mentally wired to maintain the status quo and resist change unless pushed to do so."

4. People typically don’t spend other people’s money as if it was their own. "It’s much easier to be disorganized, unfocused, inefficient, wasteful, complacent, resistant to change and driven by personal and departmental preferences rather than organizational needs when you’re not footing the bill yourself, he posited. "I don’t have evidence-based data to back it up, but anecdotally, my experience has been that proprietary hospitals and healthcare facilities are much better at doing value analysis than not-for-profits."

Michael O’Toole

"These attitudes are the culprit of a problem that many hospital VA programs deal with every day – team members finding creative ways to bypass the value analysis process," noted Michael O’Toole, director, value analysis, WellStar Health System, Marietta, GA.
 

Carla Stephens

Carla Stephens, WellStar value analysis facilitator, indicated that this is an all-too-common problem. "Sometimes team members have a hard time staying objective, so we have to present and review evidence-based clinical data when making new technology acquisition decisions," she said. "In the past, team members may have made decisions based on vendor relationships or bias that the vendors might have created towards alternate vendors/products. Our job as VA leaders is to eliminate ‘opinion-based’ supply decision making and move towards ‘evidence-based’ supply decision making."

Deborah Petretich Templeton

Deborah Petretich Templeton R.Ph., MHA, vice president, supply chain services, Geisinger Health System, Danville, PA, agreed. "Many of these [comments] are emotionally based reasons and not scientific-based or evidence-based reasons for not moving ahead with product reviews and comparisons," she said.

A perception that too many roadblocks makes any effort too great or what they’re doing today is "good enough so there is no need to explore other options" are the most frequent excuses, according to Dale Newman, RRT, MBA, product director, Premier Inc., Charlotte.

Dale Newman

"Value analysis programs need to contend with strong physician preference that often seem insurmountable, limited resources with which to manage projects in a manner to drive optimal results, and an organizational climate that resists change," Newman said. "At the same time the individuals driving value analysis often set up roadblocks to their own success by relying on manual processes and antiquated means of communication rather than embracing the innovative, automated technologies designed to support and streamline this effort," she added.

 

Start at the top

For value analysis to take root some point to the C-suite. Unless senior executives emphasize and reinforce the value that value analysis brings to the organization – pervasively permeating clinicians and administrators alike – the organization unlikely will reap the benefits that it can pass to the patients.

"Executive leadership has a significant impact on the success of VA programs and projects. Executives set the direction and priorities for their hospitals and can deliver the message that this is an organization-wide priority – not just supply chain," said Deb Radomile, R.N., MSN, MHA, clinical quality value analysis implementation manager, VHA Performance Services. "There are too many changes in healthcare for employees to determine which ones are important and which are just the flavor of the month. If they do not see executives talking about and supporting the value analysis process, they won’t consider it a priority either."

Pat Klancer

Pat Klancer, senior director, Supply Chain Diagnostix Services, Amerinet Inc., St. Louis, concurred that positioning drives consistency and stability, a ranking that should extend well beyond supply chain.

"The success of a value analysis program can generally be linked to the level of administrative support that it receives and the way that it is positioned within the organization," Klancer said. "The process requires a high level of support from administration to function effectively. A typical attitude in an organization with an ineffective process is that the value analysis process is a materials management initiative.

"Value analysis requires a true partnership between clinical and operational functions to operate effectively. Key clinicians taking both ownership and leadership of the process can greatly increase its success. Materials management then becomes the engine that helps the process function and not the process itself," she added.

But the buck doesn’t stop at the top, particularly when the top blesses it and passes it down through the ranks.

"The single most defeating act in a value analysis program is for an administrator to override the team’s decision and give in to a physician or other stakeholder who is not collaborative in the process and just simply wants their ‘way,’" emphasized Sue Hogan, R.N., clinical quality value analysis implementation manager, VHA Performance Services. "While it is a strategic imperative for a value analysis team to bring the right stakeholders and relevant data to the table for each and every initiative, it is crucial for senior leaders to believe in the process and support the decisions of the team."

Still, if a team doesn’t work together then it may not matter what the executives do, according to Geralyn Massa, CMRP, clinical quality value analysis implementation manager, VHA Performance Services.

"A lack of engaged team members can significantly impede progress," Massa noted. "It’s important to put a formal process in place that helps team members implement initiatives. Teams have a responsibility to communicate to their colleagues, determine and weigh a balance of objective criteria – function, quality, safety, outcomes and cost – and develop effective project plans with actions, assignments and target dates. These tools help team members engage and become results-oriented."

Bob Yokl

Without management support and a team approach that involves delegating responsibilities to more than just supply chain managers and value analysis coordinators, the "lack of advanced value analysis training in functional analysis, which is the primary building block for all value analysis studies," is a key challenge, argued Bob Yokl, Chief Value Strategist, Strategic Value Analysis In Healthcare, Skippack, PA.

"Without this skill set, healthcare organizations are not doing value analysis, but are really doing something else and then calling it value analysis," he added.

Much of this foundational work will reinforce the respect that value analysis deserves, insisted Barbara Strain, president, the Association of Healthcare Value Analysis Professionals, and director, supply chain analytics, University of Virginia Health System, Charlottesville, VA.

"Value analysis may not be taken seriously as a process that can work for all phases of value management in the healthcare continuum," Strain said. "The concept of value analysis has long been associated with common patient supplies such as catheters, dressings and masks rather than the robust process that it encompasses."

Klancer concurred that value analysis shouldn’t be limited to nursing commodities as the sole focus. "If it does, this becomes extremely self-limiting, due to the smaller financial impact that will arise out of those projects. Instead, value analysis must tackle the more challenging projects that fall under physician preference arena. Another untapped wasteland of opportunity is the purchased services contracting process," she added.

But Strain set the stage based on current events.

"In the coming days of healthcare reform value analysis will one of the key strategies for financial survival," she emphasized.

Internal combustion, production

With a structural framework that aligns and links chief executive support with those clinicians and administrators actually doing the work a value analysis program or project stands a better chance of succeeding. Plus, communication between the two must be fluid, particularly with upstream reporting of savings statistics, successful projects and action plans, according to Strain.

"Starting off with small wins can build up the credibility of VA programs," Templeton said. "When staff can visualize what value a new product can provide or they participate in choice, trials and decision-making the process of the value analysis becomes much more effective. There is nothing that says, ‘You are doing a great job in providing superior clinical products and patient outcomes while eliminating duplication and increased costs,’ than having senior leadership acknowledge the process."

Anthony Trupiano

Gaining senior leadership support is crucial, echoed Anthony Trupiano, vice president, supply chain, WellStar Health System. "When they understand the discipline of the value analysis process, they can defend the program when confronted by physicians or clinicians that complain or request an exception," he noted.

"It is only through commitment to drive the change, regardless of how difficult it may seem, that value analysis programs will [create] best practice and allow organizations to reap the rewards of cost savings with improved outcomes that come from a robust, data-driven process," Newman noted.

Grady outlined a simple blueprint that calls for gathering the data to identify if an item or process will provide savings or improve outcomes, then gathering input from all the key stakeholders. Once an initiative gains approval it needs to be properly communicated, inserviced if necessary, implemented and monitored for a year, she said. But it’s not foolproof.

"Often the savings of a good initiative does not materialize due to lack of monitoring, and the old items/ways sometimes make their way back in to the system due to persistent vendors," she added.

Dan Honeywell

"When budgets are tight, people think they have to select by price alone – not realizing that this can actually lead to higher spending," said Dan Honeywell, vice president, cost reduction and asset management, Integrated Medical Systems Inc., Birmingham, AL. "To avoid this, ask for a billing method that sets your annual budget, with no opportunity for additional or unforeseen charges. Hidden fees are a common way vendors can give you a low price now and make you pay later.

"Also, purchasers may not know they can ask to try out a product or service before being locked into a contract," Honeywell continued. "A trial is the most straightforward form of value analysis, and it involves the clinical team in a meaningful way."  

Taliaferro Adams, R.N., MBA/HC, MSN, clinical quality value analysis implementation manager, VHA Performance Services, shared a workable equation.

"One of the best practices that we have seen is to have the team lead be a person from the service line and an executive sponsor for the team being an individual from another area," she said. "It provides a very different dynamic and perspective. In addition, teams need to be helped through the process of overcoming the desire to avoid conflict. Until teams can have respectful discussion about their different points of view and needs, they cannot have discussion that leads to resolution. The paradox of conflict avoidance is that it leads to unresolved passive conflict."

Glennon insisted that top management support fuels the value analysis engine under the hood.

"It has to start with recognition by the executive team in the C-Suite that their leadership and ongoing active involvement is critical to the success of value analysis," Glennon said. "Only the executive team can make value analysis an organization-wide imperative, and not merely a materials management-supply chain job function. Everyone has a stake in the organization’s fiscal viability, and everyone must be held accountable to deliver results."

Still, supply chain leaders must carry the torch first, according to Klancer.

"Supply Chain leaders must take a proactive role to get value analysis programs recognized and supported by their executive team," she said. "Enlisting that support will be much easier when the program is well organized, and supported by a structure that is dynamic and successful. Projects and processes must support overall organizational goals, and build upon existing culture and programs."

Through such a merger cultural accountability must emerge.

Nancy Masaschi

"Organizations need to instill a culture of accountability across all levels of the organization," said Nancy Masaschi, director, clinical value analysis, MedAssets Inc., Atlanta. "By building a program structure that incorporates accountability into its model infrastructure, all levels of the organization will have ownership and responsibility for key elements of the program. 

"Resistance to change is a common barrier to the success of value analysis programs," she continued. "If the culture of the organization is not ready or prepared to address change management and endure the bumps and challenges associated with any major change, then success will be hard to find. Having organizational leadership that is engaged and supportive of the changes is needed to take the organization and value analysis to the next level of being a highly effective and performing program."

Excuses, excuses What are some of the typical and arguably more creative attitudes and excuses supply chain and value analysis professionals hear when they want to initiate a program or project? Here are a few popular refrains overheard. Maybe some are familiar to you.   • "We have been doing it this way for 25 years." • "Our area is different." – Karen Grady, value analysis and resource manager, University of Connecticut Health Center, Farmington, CT   • "I can’t be bothered."  • "It’s not my job." • "It’s too much trouble."  • "It’ll never work – they’ll never be willing to change." • "I’m too busy." – Tim Glennon RN, MSN, MBA, CMRP, vice president, clinical services, GNYHA Services Inc., New York   • "My hospital is different than our sister hospital down the street and this product/supply does not work for our patient population." • "We can’t standardize across the health system on this product category." – Bindi Shah, value analysis facilitator, WellStar Health System   • "Value analysis stifles technology innovation." • "Hospital ‘XYZ’ down the street doesn’t have such a rigorous process to approve a new technology/new products [so] why do we?" • "I’ve always done it this way – why do we need to change now?" • "The value analysis process takes too long!" – Michael O’Toole, director, value analysis, WellStar Health System, Marietta, GA   • "We’re different." • "We can’t use that." • "That isn’t like what we do now." • "How can we make another department use what we use even if we know it is better?" – Deborah Petretich Templeton R.Ph., MHA, vice president, supply chain services, Geisinger Health System, Danville, PA   • "We are doing just fine so there is no need to change." – Michael Neely, president, Perimeter Solutions, Atlanta

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