Quality. Safety. Cost of care. If you were to name three good reasons for controlling vendor access to your facility, these would likely be top-of-mind.

In previous months, I have touched upon the topic of implementing policies that address vendor access to patient procedure areas, but I believe this matter warrants more attention given our current healthcare environment.

Recently, I spoke to executives from two health systems who have implemented, or are on the cusp of implementing, extensive vendor access policies in their hospitals. Both stated that these polices were not meant to restrict or punish vendors, but to create a safer, more orderly work environment for hospital staff and vendors. Several other common themes were found in these discussions.

The need to implement more controlled and formal access polices came as a result of considering not only quality of care and patient safety issues, but also the potential financial impact of unrestricted contact between clinicians and vendors. One executive from a large integrated delivery network with nearly 1,000 medical residents on staff pointed out that the economic value of a lifetime of prescribing by these future medical personnel is astronomical, yet vendors can gain access to them with a box of doughnuts or a couple of pizzas.

Interestingly enough, the physicians on staff at these facilities have been completely supportive of the vendor access policy. The administrative team of one facility assured the staff that they were not interested in being an unreasonable obstacle to vendors, but simply wanted to be aware of their presence. Some physicians may be wary of increased attention to vendors and view it as interfering in their long-standing relationships. However, most welcomed the hospitals’ efforts to exert more control and help protect them from unwanted approaches by vendors. Clinical department managers also welcome the fact that formal vendor access policies give them a structured solution to how to deal with vendors.

When beginning to design a policy for your facility, you may want to consider some or all of the following steps, which are common to many hospitals and systems implementing vendor access policies. I can’t emphasize enough that these policies should be memorialized in materials management policy and procedures that are developed with the support of the various clinical areas that will be affected.

A formal policy typically addresses:

• guidelines for accessing patient care areas

• documentation of the vendor represent-ative’s credentials for providing a particular service and compliance with health and safety requirements

• procedures for the introduction of and reimbursement for new technologies

Vendors wishing to do business at the hospital are required to sign an agreement stating that they have read and understand the policy and agree to its terms. This agreement may also state the review or enforcement processes well as consequences for noncompliance.

Access to patient care areas. For safety reasons in particular, it is necessary to lay out the path vendors may take to reach patient care areas. Typically, this begins with a visit to the materials management department to check in, which often involves verifying the appointment time and who the vendor is there to see. No vendor should be allowed past this point without a firm appointment with a member of the hospital or medical staff. One facility has taken this accountability one step further and has implemented an automated telephone check-in system that records the vendor’s arrival and departure time from the facility.

To give hospital staff a visual assessment of who is on the floor, many facilities have implemented a badge system. The most sophisticated of these includes color-coded badges that instantly identify a vendor as having access to (a) the campus in general, (b) patient floors or (c) procedure areas. Hospital staff may be instructed to contact security if a vendor has wandered outside the permitted zone.

Credentialing. Granting access to patient care areas – and certainly to patients – is determined by the vendor’s qualifications to provide a specific level of service. Vendors are required to have their company-issued certification of their capabilities and training to provide specific services on file in the materials management department. These credentials determine the level of access as well as whether and how vendors are present during direct patient care, such as in the O.R. and cath lab.

Additionally, these outside professionals are spending nearly all of their time in hospitals near the acutely sick patients in your care. Therefore, it only makes sense to have documentation of immunizations, drug-of-abuse testing and criminal background checks as stringent as what is imposed upon your own full-time or temporary employees. Such measures protect your vendors’ health and safety as well. The cost for these tests can be assumed by the vendor as a cost of doing business with your facility.

Compliance with off-contract purchasing restrictions. The vendor access policy, to which the vendor agrees, may also require that vendors introduce all new technology through the standard process for your facility and that it be included on a contract prior to purchase. It is the responsibility of the vendor to verify that a technology is on-contract prior to bringing it into the facility, and failure to do so can result in the hospital’s non-payment for the item.

One executive discussing his new vendor policies has a "three strikes and you’re out" tally for violations. In a multi-hospital system, materials management manages the data that allows tracking of "strikes" by a vendor across facilities; banishment from one hospital is applicable to all hospitals in the system.

In these facilities, as well as many others in my experience, the materials management department is the central check-in point for vendors and is the driver of this initiative. But due to the widespread impact to the organization – quality, safety, cost of care – management of vendor access should be an initiative endorsed by the highest levels of administration.

Security staff should take the lead in monitoring vendor presence, but hospital staff must be educated to report violations so appropriate disciplinary action can be administered when needed. An effective policy roll-out should include comprehensive hospital and medical staff education about vendor access rules, which emphasize patient safety and quality of care. Your employees need to be intrinsically motivated to report violators despite the good relationships they have with these sales and service professionals. HPN