By Jean Day
In need of suture lasso, an operating room nurse rushes to the supply room finding the box on the shelf empty and no reserve in sight. She tracks down the materials coordinator (MC). “I need a suture lasso in OR 2, do we have any?" “They’re in the supply room," the MC responds and disagreement ensues. The OR nurse faces the uncomfortable task of reporting back to the surgeon, “I’m sorry we are out of stock." Anyone familiar with suture lasso knows there is really no substitution for such an item; the surgeon must now maneuver the suture retrieval and tying without the aid of this clever device. When unplanned stock depletion occurs, it is demoralizing for the MC.
MCs are not autonomous. Every person up and down the line depends on the MC to provide the materials they need to perform their jobs. Most MCs remain in a constant state of overwhelm, reacting to immediate needs and rapid turn rates of products, trying desperately to stay ahead of future consumption. Upon finding ordering patterns that net success - keeping quantities of product on the shelf - they soon repeat the same purchasing decisions day in and day out. Stocking surgical supplies, however, is quite unlike inventory management in other industries. A patient may be scheduled for a single hernia repair, yet the surgeon may consume two or more implantable meshes until the repair meets the surgeon’s satisfaction. The OR nurse may have contaminated yet another at the time the supply was opened onto the sterile field. In this example, one ruptured hernia resulted in consumption of three implantable meshes. The sufficient quantity of mesh on the shelf does not always equal the number of patients scheduled for a single hernia repair. It is easy to see that surgical supply management is nothing like replacing one flat tire with one new tire.
ASC inventory management is a dynamic fluctuation of specialty medical and surgical supplies. The incumbent occupying the role of Material Coordinator or Purchasing Agent is held to high standards of supply flow management typically under the constraints of limited space, just-in-time purchasing practices and expected compliance to a tight medical supply budget. How then does this miracle worker provide just the right product in just the right quantity at just the right time?
Successful MCs are steady and methodical, effectively employ the use of technology platforms and data analytics, develop efficient and automated purchasing practices, demonstrate deft attention to detail and are not easily daunted by challenges. In most surgery centers, the MC works alone and – depending on case volume or scope of services – may also fulfill a secondary role, such as surgical technologist, adding time-management to the challenge. Either way, the MC must possess a broad spectrum of skills and talents to be successful – maintaining a constant flow of products on the shelf, providing amazing customer service to the cast of direct patient care providers, accounting for incoming and diminishing inventory, entering data to keep a record of virtual inventory, negotiating with vendors to obtain best possible pricing, investigating and implementing cost saving opportunities – all while remaining amenable and diplomatic.
Unique Challenges for Materials Coordinators
The MC is held accountable by nearly every member of the ASC team. The OR nurse who is asking for something, such as the suture lasso, and finding none, will be the same OR nurse giving the MC a future directive. When a nurse is the recipient of a verbal tirade from the surgeon because the preferred product is unavailable, the very next person to take the heat is the MC. Reverting to self-preservation mode, the MC orders the product, no questions asked. Fearful of not having the needed product on hand, the incumbent MC tends to overstock. When purchasing decisions are made by demand rather than by a strategic plan, how can any MC hope to be successful in saving money?
The ambulatory surgery industry has a long history of providing quality services at competitive prices. As the Affordable Care Act further changes the delivery of health care services, ASCs most likely to survive are those most fiscally fit. The MC who continues down the hard-worn path of sameness – purchasing as they always have – may not remain endeared to the organization. Purchasing strategies of the future are apt to force more standardization in product selection with less influence by physician preferences.
Redundancy is another common inventory management problem. Many products of similar functionality differing by brand, size, shape or color are housed in surgery storage rooms. Not surprisingly, the more storage space available, the greater the problem. More than any other healthcare worker, physicians contribute to redundancy of supplies; after all, their unique preferences influence 70 percent of the costs associated with specialty product selection. To affect real change, these influential product consumers must be brought into the discussion.