- Email: [email protected]
OR Leadership: Product Evaluation and Cost Containment
CONTINUING EDUCATION
OR Leadership: Product Evaluation and Cost Containment 1.5 www.aorn.org/CE
CYNTHIA PLONIEN, DNP, RN, CENP; LORI DONOVAN, MSN, RN, CNOR, NEA-BC Continuing Education Contact Hours
Approvals
indicates that continuing education (CE) contact hours are available for this activity. Earn the CE contact hours by reading this article, reviewing the purpose/goal and objectives, and completing the online Learner Evaluation at http:// www.aorn.org/CE. Each applicant who successfully completes this program can immediately print a certificate of completion.
This program meets criteria for CNOR and CRNFA recertification, as well as other CE requirements.
Event: #15538 Session: #1001 Fee: Members $12, Nonmembers $24 The contact hours for this article expire October 31, 2018. Pricing is subject to change.
Purpose/Goal To provide the learner with knowledge specific to containing costs and evaluating products in the OR.
Objectives 1. Discuss common areas of concern that relate to perioperative best practices. 2. Discuss best practices that could enhance safety in the perioperative area. 3. Describe implementation of evidence-based practice in relation to perioperative nursing care.
AORN is provider-approved by the California Board of Registered Nursing, Provider Number CEP 13019. Check with your state board of nursing for acceptance of this activity for relicensure.
Conflict-of-Interest Disclosures Cynthia Plonien, DNP, RN, CENP, and Lori Donovan, MSN, RN, CNOR, NEA-BC, have no declared affiliations that could be perceived as posing potential conflicts of interest in the publication of this article. The behavioral objectives for this program were created by Rebecca Holm, MSN, RN, CNOR, clinical editor, with consultation from Susan Bakewell, MS, RN-BC, director, Perioperative Education. Ms Holm and Ms Bakewell have no declared affiliations that could be perceived as posing potential conflicts of interest in the publication of this article.
Sponsorship or Commercial Support No sponsorship or commercial support was received for this article.
Disclaimer Accreditation AORN is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.
AORN recognizes these activities as CE for RNs. This recognition does not imply that AORN or the American Nurses Credentialing Center approves or endorses products mentioned in the activity.
http://dx.doi.org/10.1016/j.aorn.2015.07.007 ª AORN, Inc, 2015
www.aornjournal.org
AORN Journal j 425
PERIOPERATIVE LEADERSHIP
OR Leadership: Product Evaluation and Cost Containment CYNTHIA PLONIEN, DNP, RN, CENP; LORI DONOVAN, MSN, RN, CNOR, NEA-BC
P
erioperative nursing leaders often ask “Why me?” when they are tagged with the responsibility of containing costs and evaluating products. The answer is simple. It is because perioperative nursing leaders have the greatest opportunity to affect costs and evaluate products. Where exactly in the cost containment and product evaluation process should a leader focus? Should one focus on leadership talents or management skills? The answer may be in the multifaceted approach required to achieve best-practice outcomes. Often, successful leaders in perioperative practice use a style of leadership referred to as transformational leadership. Transformational leaders set the direction and plan a vision. They accomplish objectives through inspirational motivation, intellectual stimulation, and individual
consideration.1 However, it takes more than just the charismatic skills of a leader to control quality and contain costs. Skills in management are equally necessary to achieve desired outcomes. For instance, in addition to inspiration, the management of a project requires attention to budget development as well as oversight of daily work. It involves incorporation of timelines, development and enforcement of policies and procedures, and supervision of team members. Outcomes must be monitored to identify and resolve problems and to continually refine processes. Administratively, balancing cost and quality is a high priority for OR leaders. The costs of surgical supplies and products can adversely affect an organization’s profitability. The purpose of this column is to discuss the process of surgical product selection and important factors to consider, such as quality and cost. http://dx.doi.org/10.1016/j.aorn.2015.07.007 ª AORN, Inc, 2015
426 j AORN Journal
www.aornjournal.org
October 2015, Vol. 102, No. 4
LEADERSHIP AND REFLECTIVE PRACTICE Managers should not underestimate the importance of critical thinking when managing quality and costs. To be successful in the 21st century, a manager must be a critical thinker.2 According to Baldoni,2 there is an enormous gap in the education of business leaders, with some leaders emphasizing quantitative skills over qualitative skills. Learners may be left to develop these skills on their own. Reflection is a skill with qualitative implications, often developed outside the classroom. As a perioperative leader, reflective thought and reflective practice are not easy to attain. Administrators at all levels often forego the mental effort of reflection that reveals insight in exchange for quick responses to urgent demands.3 Reflection has been proved to enhance the development of critical thinking skills, improvement of clinical reasoning, reduction of errors, and facilitation of practical wisdom.4 However, time is required for reflective thought. Slowing the pace is necessary for thoughtfulness to occur.5 The merit of reflection is not new. Aristotle taught that philosophically, reflection is central to the discernment of truth.3 American business theorist Chris Argyris emphasized reflection as key in achieving desired business outcomes with his concept of “double loop learning.”6 As a single loop, learning is realized through experience. The double-loop concept emphasizes the value of using reflection by stepping outside of an experience to reflect, conceptualize, and then incorporate what has been learned to improve processes and outcomes. The format is continuous learning with outcomes that can be applied directly to an organization’s bottom line.6 Success in managing people and practices within the OR setting demands critical thought supported by reflective practice. The information in this column is offered as an aid to leaders in their quest to improve standards and practices in the course of daily operations. It is imperative for leaders of perioperative services to take time to reflect and critically think through needs, options, and changes while confronting the challenges that face perioperative practice and creating new ways to overcome barriers.
QUALITY AND COSTS Innovations in surgical practice and new technologies are driving the integration of new products into all surgical settings.7 Quality, as well as costs, is a constant concern for the perioperative leader in relation to product selection. According to the Agency for Healthcare Research and Quality, surgical procedures account for almost half of all costs associated with hospital stays, even though they only
www.aornjournal.org
OR Leadership
comprise 29% of hospital stays.8 In contrast, reimbursement is continually denied by third-party payers. In some cases, reimbursement is arbitrarily reduced. As an example, Medicare’s cost-per-case method of reimbursement is based on diagnosis-related groups and is intended to cover all costs, inclusive of devices used in surgery. In the midst of rising costs of products, Medicare payments are decreasing.9 Surgical procedures are expensive, with an estimated increase in national health spending in the United States from $2.5 trillion in 2009 to $4.6 trillion in 2019.10 Perioperative directors need to be educated consumers related to cost containment, as well as related to quality in product evaluation and selection. The importance of product selection in the perioperative setting is further emphasized by AORN’s “Guideline for product selection.”11 AORN’s recommendations include establishing mechanisms for product selection, forming a multidisciplinary committee to guide selection, developing and implementing competencies for perioperative RNs related to product evaluation and selection, documenting the product selection process, developing specific policies and procedures for evaluating and selecting products, and implementing a process for quality assurance and process improvement (PI) to measure performance, costeffectiveness, and user satisfaction.
Cost Containment In organizations with surgical services, the OR is either the first or second (only to pharmacy) highest cost center in the medical center. From a consultation standpoint, when directed to look for cost containment and improvement, it is a matter of examining the source of the greatest profits and expenditures.12 Budgets are limited, and control of supplies is essential. In modern ORs, unused medical supplies are routinely discarded. It is estimated that more than 2 million lb per year of medical supplies are recoverable from large nonrural US academic medical centers.13 Johns Hopkins Hospital, a 952-bed facility in Baltimore, Maryland, recognized the opportunity to lower costs with an estimated $15 million savings opportunity in eliminating supply waste.14 As another example, Duke Regional Hospital in Durham, North Carolina, introduced a “postgame review” that involved identifying the most common and costly procedures, video recording the procedures with a focus on the supply table, and AORN Journal j 427
PloniendDonovan
reviewing the videos with the surgical team and supply chain personnel. Supplies and instruments never or rarely used were removed from future OR kits. The initiative is in its early implementation stages, but it is already having an effect by reducing supply costs and decreasing turnaround times.14 Cost savings can be achieved through simplistic measures. A large multifacility teaching hospital system in West Virginia achieved a 15% cost savings per case with a focus on physician preference cards. The team reviewed and updated more than 600 preference cards using historical data provided by [a web-based communication tracking service] to identify and remove items with a large variance between what was issued and what was actually used in surgical procedures. The team ran crossphysician or cross-procedure comparisons to identify which items were used in like cases, and then worked to remove unnecessary items. The team also used the system to color-code items on preference cards to identify those that were required to be issued. . . .15(p1)
Color code 1 correlated to items that the surgical team would automatically open and place on the sterile field. The surgical team would only open color code 2 items after consulting with the surgeon. Color code 3 items were not opened until the surgeon deemed it absolutely necessary. The central material services department placed color-coded bins on all surgical case carts so that personnel would identify material handling requirements for each item correctly. This reduced the number of overall transactions between central service and the OR. In designing measures of cost containment, leaders should appreciate and never underestimate the value of using quality processes as a tool. Lean and Six Sigma are improvement methodologies developed in the manufacturing industry that have been applied to health care industries throughout the world. As tools, they provide a systematic approach to achievement of quality improvement.16 By using these methodologies, quality and the bottom line can be improved. In the OR, improvements have occurred in case start times, turnover of cases, optimization of technology, scheduling, registration, admission processes, and charging mechanisms.17 For example, the processes worked for Valley Baptist Health System in Harlingen, Texas. The health care system conducted a Six Sigma project to reduce turnaround time between surgical procedures. In addition, the system sought to decrease variability, increase the percent of
428 j AORN Journal
October 2015, Vol. 102, No. 4
procedures under 60 minutes, increase surgeon satisfaction, and increase the capacity for surgical procedures. Results proved a 15% improvement in turnaround time, a potential for 1,106 additional procedures per year, and a potential revenue benefit of $1,355,282 annually.17
Standardization As a quality initiative, standardization is a high priority, provided the benefits of standardization to all practitioners outweigh the benefits of offering choices. Using familiar products enhances patient safety and clinical outcomes by providing predictability, reliability, and efficiency.7 In addition, standardization brings with it a magnitude of potential savings to the organization.9
Group Purchasing Organization Group purchasing organization (GPO) agreements provide cost-efficient avenues through negotiation of large purchase orders.7 In this way, GPO agreements support standardization. However, OR directors often are faced with challenges that may arise over physician preference for similar products from multiple vendors without regard to costs. Physician preference items can include high-dollar inventory (eg, cardiac stents; hip, knee, and spine implants). Unfortunately, physician choice frequently is based on factors unrelated to price and pertain to training, experience, or vendor relationships.9 Because multidisciplinary product evaluation committees are established to guide selection, it is imperative to include surgeons in the process. Various strategies may be used to “shape physician-induced purchasing behavior by orchestrating rather than dictating the physicians’ decisions.”9(p308) Two commonly used methods include the formulary model, in which limitations are placed on the range of manufacturers and products, and payment-cap model, in which price ceilings are used for particular item categories.9 Both methods require processes to define and evaluate equivalencies. The formulary model is more difficult to implement because of physicians’ resistance to top-down dictates. “The payment-cap model is more feasible because it preserves physicians’ choice while also restraining manufacturers’ power.”9(p307)
PRODUCT SELECTION Regardless of the individuals who sit on the committee, the work to be done is accomplished as a team. Choosing the right product to be used in perioperative services requires stakeholders to share knowledge and experience, ensuring that product safety and cost-effectiveness meet the needs of the users
www.aornjournal.org
October 2015, Vol. 102, No. 4
and the facility.18 The first priority of the team is to address the purpose of the product evaluation. This information refines the guidance and direction needed to achieve a positive outcome. When the rationale for a product is determined, the committee assesses and evaluates the product. Consistent criteria are identified to be used for each and every product review. Some factors to be considered include the following:
compatibility with required supplies and equipment, compliance with regulatory requirements, cost, ease of use, end-user requirements, environmental impact, single use or reusable, useful life, and vendor reputation and support.11
Information gathering is integral to the process of product selection. Quality and safety concerns exist when decisions are not evidence based.7 Committee members should research professional literature, obtain practical knowledge by contacting the vendor or current users at different facilities, and gain an outside perspective through discussions with competitive representatives.
Identifying Project Stakeholders The importance of engaging key stakeholders cannot be overstated. It is easy for current and former perioperative directors to share examples in which stakeholders were not engaged in the decision-making process, thereby preventing the achievement of desired results. For example, an organization planned to change vendors for endoscopic devices. Administrative leaders failed to bring surgeons into the early discussions and planning for the cost-saving initiative, so the surgeons did not have the opportunity to participate in decision making. The responsibility to implement the change in vendors, equipment, and supplies with the physicians was left to the perioperative directors after the fact. The surgeons were disgruntled and went to hospital administrators threatening to pull all their cases from the facility if they were forced to change products. Ultimately, that cost-saving initiative failed. Multidisciplinary product selection teams are recommended, as indicated in the AORN guidelines11 and supported by Dee Donatelli, MBA, BSN, RN, consultant at Navigant Consulting services, Dallas, Texas, in private correspondence. Ms Donatelli advises of an inherent value in a multidisciplinary approach for the evaluation and selection of all products,
www.aornjournal.org
OR Leadership
stating that the method of accomplishment will vary across organizations. Some organizations have a standard committee to oversee the entire process, whereas others have a steering committee that then engages other stakeholders based on the identified product. The essential component of a successful program is an overall framework that identifies the stakeholders, defines the selection process and measures of analysis, and implements controls for product management. Communication among the diverse team members and ensuring an understanding of the process is vital for sustained success. An initial step when identifying key stakeholders for the product selection team is to determine the end users of the product (ie, anyone who will come in contact with the new or conversion product). Ultimately, it is the end users who drive the success of the product, whether it is a new item or a conversion item. Depending on the product, stakeholders to consider recruiting for the product selection team may include the following: Senior managersdAdministrative support is vital, particularly for product approval and also conflict resolution between stakeholders.19 Perioperative nurses and techniciansdOR personnel provide user experience and practical knowledge to the team during decision making.7 PhysiciansdEngaging surgeons and anesthesia professionals is invaluable because the rationales cited for up to 61% of perioperative supply purchases are based on physician preference.20 Materials management, purchasing, and shared service providersdThese team members include procurement professionals who carry out decisions made during the product selection process.19 In addition to key stakeholders, risk management, infection control and prevention, and information technology personnel offer beneficial advice to the evaluation team7 because products used within the OR may also be used elsewhere within the health care facility. Clinical personnel who work inside or outside of perioperative services also should be selected for committees. There are examples of product selection and implementation scenarios that were unsuccessful because an outside department selected a product that affected perioperative services, but no one from perioperative services was on the production selection team. For example, an emergency department made a facility-wide decision to change bandage brands without engaging anyone from the perioperative services department. AORN Journal j 429
PloniendDonovan
The bandages selected did not meet the needs of securing orthopedic dressings, especially related to total knee arthroplasty. As a result, the OR had to use more bandages than previously planned, which negated any cost savings from changing the bandage brand. As in this example, it is crucial to consider the effect of a product-related decision on all areas in the facility. In another example, switching postoperative pain devices from one brand to another was done without engaging the postoperative areas. Consequently, the nurses were uncertain how to read the device for pain control and rehabilitation providers were uncertain how to secure the device for ambulation. With planning, positive outcomes are facilitated, as illustrated in the following scenario. A surgical department chose to improve patient outcomes by prewarming patients with warming gowns in the perioperative setting before surgery. In this situation, stakeholders in both the preoperative and postoperative settings were engaged to determine how this change would affect them. A member of the product selection team educated inpatient unit personnel about the prewarming process in preparation for patients arriving in the inpatient unit with a warming gown in place. Implementation was successful.
Value Analysis Only products that add value should be considered when selecting OR products. Added value may include outcomes related to safety, productivity, satisfaction, regulatory compliance, or market standing.20 Definitions of value analysis vary. However, the benefit in health care is a creative and analytical approach to evaluating the function of a product, service, or technology.12 The objective is to determine value at the lowest cost while providing an equivalent or better outcome in comparison to other productsdvalue can be defined as quality divided by cost, where quality is measured in outcomes, safety, and service.12 Value analysis is a path to PI. Methods of PI should be scientifically based through the study of evidence. Evidencebased practice involves gathering appropriate evidence, analyzing the evidence, and then incorporating the information into management decisions followed by postdecision evaluation.21 Incorporating evidence-based research into the analysis process improves the evaluation and selection of all surgical products. Employing clinically-focused PI methods assists in decision making, and sharing the logic discovered through research brings added value in enhancing support from end users.
430 j AORN Journal
October 2015, Vol. 102, No. 4
Advantages of linking evidence-based practice, PI, and value analysis include improving patient safety and clinical outcomes, using resources efficiently, and supporting and guiding the implementation of new health technologies.12
Evaluation Tools Evaluation tools help committee members maintain focus and can help team members identify relevant information for product selection. Figure 1 provides a list of items to be included in an evaluation tool for new products.7 The tool captures essential elements to be considered in product evaluation.
Single-Use, Reposable, or Reusable For nurse leaders, product selection is not only related to quality and cost. A third factor to consider is environmental responsibility. The AORN “Position statement on environmental responsibility” speaks to an expectation that perioperative nurses should “actively promote and participate in sustainability practices that preserve natural resources, reduce waste, and minimize exposure to hazardous materials.”22(p1) Specifically addressed in the position statement are selection of reusable equipment and materials that are of equal quality to single-use items and reprocessing of single-use devices according to federal guidelines. Consideration of quality, cost, and environmental responsibility must factor into decisions of all product purchases. Product decisions to use disposable products or reusable products that require cleaning and sterilization require cost analysis.23 If cost reduction is possible and quality can be maintained, these are deciding factors in choosing reusable products in place of single-use products. Over the years as higher standards have been adopted, reusable device manufacturers have had increasingly strict regulations to which they have had to conform.12 Reprocessors claim that the remanufactured device is actually tested at a higher standard than the original manufactured specifications. The logistics management (eg, disposal of, removal from the facility, restocking) of remanufactured devices adds complexity to the process; however, the cost is typically more than recouped with the savings of using remanufactured devices as opposed to purchasing new devices. Adopting a program that involves reusable products is an environmentally moral obligation. It also offers significant financial benefits to an organization while maintaining the highest patient quality standards.
www.aornjournal.org
October 2015, Vol. 102, No. 4
OR Leadership
Figure 1. Items comprising a new product evaluation tool. Reprinted with permission from Halvorson CK, Chinnes LF. Collaborative leadership in product evaluation. AORN J. 2007;85(2):334-352.
CONCLUSION Ensuring overall quality of care, efficiency of resources, and profitability requires a comprehensive approach with evidencebased solutions. Interdisciplinary collaboration and decision making are essential for success in product evaluation and cost containment. The expertise of OR leaders is invaluable in
www.aornjournal.org
coordinating product selection for perioperative services. AORN’s “Guideline for product selection”11 is an excellent resource for the evaluation and purchase of medical products in practice settings. Leaders and managers of perioperative services departments know that a mission inherent in the work is to transform and improve practice inclusive of quality and cost of products used.
AORN Journal j 431
PloniendDonovan
References 1. Doody O, Doody CM. Transformational leadership in nursing practice. Br J Nurs. 2012;21(20):1212-1218. 2. Baldoni J. Leadership: how leaders should think critically. Harv Bus Rev. January 20, 2010. https://hbr.org/2010/01/how-leaders -should-think-criti. Accessed June 9, 2015. 3. Moberg DJ, Calkins M. Reflection in business ethics: insights from St. Ignatius’ spiritual exercises. J Bus Ethics. 2001;33(3): 257-270. 4. Saperstein AK, Lilje T, Seibert D. A model for teaching reflective practice. Mil Med. 2015;180(Suppl 4):142-146. 5. Pierson W. Reflection and nursing education. J Adv Nurs. 1998; 27(1):165-170. 6. Argyris C. Double loop learning in organizations. Harv Bus Rev. September 1977. https://hbr.org/1977/09/double-loop-learning -in-organizations. Accessed June 9, 2015. 7. Halvorson CK, Chinnes LF. Collaborative leadership in product evaluation. AORN J. 2007;85(2):334-352. 8. Weiss AJ, Elixhauser A, Andrews RM. Characteristics of Operating Room Procedures in U.S. Hospitals, 2011. HCUP Statistical Brief #170. Rockville, MD: Agency for Healthcare Research and Quality; 2014. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb170-Operating -Room-Procedures-United-States-2011.pdf. Accessed June 9, 2015. 9. Montgomery K, Schneller ES. Hospitals’ strategies for orchestrating selection of physician preference items. Milbank Q. 2007; 85(2):307-335. 10. Terry K. Healthcare reform won’t slow medical costs until doctors get paid differently. CBS Money Watch. September 13, 2010. http:// www.cbsnews.com/news/healthcare-reform-wont-slow-medical -costs-until-doctors-get-paid-differently. Accessed June 9, 2015. 11. Guideline for product selection. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc; 2015:179-186. 12. Donatelli D. Adding more “value” to value analysis: an evidencebased performance improvement approach. Healthcare Purchasing News. March 2014. http://www.hpnonline.com/inside/2015-03/ 1503-BackTalk.html. Accessed June 9, 2015. 13. Wan EL, Xie L, Barrett M, et al. Global public health impact of recovered supplies from operating rooms: a critical analysis with national implications. World J Surg. 2015;39(1):29-35. 14. Nurse Executive Center. Untapped opportunities for saving millions. The Advisory Board Company. http://www.advisory.com/research/ nursing-executive-center/events/meetings/2014/2014-2015-nursing -executive-center-national-meeting-cno-roundtables/locations/ san-francisco/020915/untapped-nursing-opportunities-for-saving -millions/presentation?lo¼1. Accessed June 9, 2015. 15. Perry S. Preference cards as a ticket to savings. J Healthcare Contracting. October 2013:10-15. http://www.jhconline.com/ preference-cards-as-a-ticket-to-savings.html. Accessed June 9, 2015. 16. Mason S, Nocolay C, Darzi A. The use of Lean and Six Sigma methodologies in surgery: a systematic review. Surgeon. 2015; 13(2):91-100.
432 j AORN Journal
October 2015, Vol. 102, No. 4 17. Pexton C. Attention Six Sigma, you’re wanted in surgery. Six Sigma. June 2, 2015. http://www.isixsigma.com/new-to-six -sigma/dmaic/attention-six-sigma-you%E2%90%99re-wanted -surgery. Accessed June 9, 2015. 18. Stanton C. Selecting products safely. AORN J. 2011;94(6 Suppl): S99-S100. 19. Product selection and standardization. In: Optimizing Your Perioperative Supply Chain. Toronto, Ontario, Canada: Ontario Hospital Association; 2012. 4.1e4.48. https://www.oha.com/CurrentIssue s/keyinitiatives/SupplyChain/Documents/Chapter%204%20Final% 20-%20revised%20July42012.pdf. Accessed June 9, 2015. 20. Pennington C, DeRienzo R. An effective process for making decisions about major operating room purchases. AORN J. 2010; 91(3):341-349. 21. Pfeffer J, Sutton RI. Evidence-based management. Harv Bus Rev. 2006;84(1):62-74, 133. https://hbr.org/2006/01/evidence-based -management. Accessed June 9, 2015. 22. AORN Position Statement on Environmental Responsibility. Denver, CO: AORN, Inc; 2014. https://www.aorn.org/Clinical_Practice/Position_ Statements/Position_Statements.aspx. Accessed June 11, 2015. 23. Hoeksema J. Taking steps to control costs in the OR. AORN J. 2011;94(6 Suppl):S79-S84.
Cynthia Plonien, DNP, RN, CENP, is the director of the Graduate Program of Nursing Administration and a clinical assistant professor for the University of Texas at Arlington College of Nursing, Arlington, TX. Dr Plonien has no declared affiliation that could be perceived as posing a potential conflict of interest in the publication of this article.
Lori Donovan, MSN, RN, CNOR, NEA-BC, is the chief nursing officer at Texas Health Arlington Memorial Hospital, Arlington, TX. Ms Donovan has no declared affiliation that could be perceived as posing a potential conflict of interest in the publication of this article.
www.aornjournal.org
LEARNER EVALUATION
Continuing Education: OR Leadership: Product Evaluation and Cost Containment 1.5
www.aorn.org/CE
T
his evaluation is used to determine the extent to which this continuing education program met your learning needs. The evaluation is printed here for your convenience. To receive continuing education credit, you must complete the online Learner Evaluation at http://www.aorn.org/CE. Rate the items as described below.
PURPOSE/GOAL
6.
Will you be able to use the information from this article in your work setting? 1. Yes 2. No
7.
Will you change your practice as a result of reading this article? (If yes, answer question #7A. If no, answer question #7B.)
7A.
How will you change your practice? (Select all that apply) 1. I will provide education to my team regarding why change is needed. 2. I will work with management to change/implement a policy and procedure. 3. I will plan an informational meeting with physicians to seek their input and acceptance of the need for change. 4. I will implement change and evaluate the effect of the change at regular intervals until the change is incorporated as best practice. 5. Other: __________________________________
7B.
If you will not change your practice as a result of reading this article, why? (Select all that apply) 1. The content of the article is not relevant to my practice. 2. I do not have enough time to teach others about the purpose of the needed change. 3. I do not have management support to make a change. 4. Other:__________________________________
8.
Our accrediting body requires that we verify the time you needed to complete the 1.5 continuing education contact hour (90-minute) program: _______________
To provide the learner with knowledge specific to containing costs and evaluating products in the OR.
OBJECTIVES To what extent were the following objectives of this continuing education program achieved? 1. Discuss common areas of concern that relate to perioperative best practices. Low 1. 2. 3. 4. 5. High 2.
3.
Discuss best practices that could enhance safety in the perioperative area. Low 1. 2. 3. 4. 5. High Describe implementation of evidence-based practice in relation to perioperative nursing care. Low 1. 2. 3. 4. 5. High
CONTENT 4.
To what extent did this article increase your knowledge of the subject matter? Low 1. 2. 3. 4. 5. High
5.
To what extent were your individual objectives met? Low 1. 2. 3. 4. 5. High
www.aornjournal.org
AORN Journal j 433
OR Leadership: Product Evaluation and Cost Containment 1.5 www.aorn.org/CE
CYNTHIA PLONIEN, DNP, RN, CENP; LORI DONOVAN, MSN, RN, CNOR, NEA-BC Continuing Education Contact Hours
Approvals
indicates that continuing education (CE) contact hours are available for this activity. Earn the CE contact hours by reading this article, reviewing the purpose/goal and objectives, and completing the online Learner Evaluation at http:// www.aorn.org/CE. Each applicant who successfully completes this program can immediately print a certificate of completion.
This program meets criteria for CNOR and CRNFA recertification, as well as other CE requirements.
Event: #15538 Session: #1001 Fee: Members $12, Nonmembers $24 The contact hours for this article expire October 31, 2018. Pricing is subject to change.
Purpose/Goal To provide the learner with knowledge specific to containing costs and evaluating products in the OR.
Objectives 1. Discuss common areas of concern that relate to perioperative best practices. 2. Discuss best practices that could enhance safety in the perioperative area. 3. Describe implementation of evidence-based practice in relation to perioperative nursing care.
AORN is provider-approved by the California Board of Registered Nursing, Provider Number CEP 13019. Check with your state board of nursing for acceptance of this activity for relicensure.
Conflict-of-Interest Disclosures Cynthia Plonien, DNP, RN, CENP, and Lori Donovan, MSN, RN, CNOR, NEA-BC, have no declared affiliations that could be perceived as posing potential conflicts of interest in the publication of this article. The behavioral objectives for this program were created by Rebecca Holm, MSN, RN, CNOR, clinical editor, with consultation from Susan Bakewell, MS, RN-BC, director, Perioperative Education. Ms Holm and Ms Bakewell have no declared affiliations that could be perceived as posing potential conflicts of interest in the publication of this article.
Sponsorship or Commercial Support No sponsorship or commercial support was received for this article.
Disclaimer Accreditation AORN is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.
AORN recognizes these activities as CE for RNs. This recognition does not imply that AORN or the American Nurses Credentialing Center approves or endorses products mentioned in the activity.
http://dx.doi.org/10.1016/j.aorn.2015.07.007 ª AORN, Inc, 2015
www.aornjournal.org
AORN Journal j 425
PERIOPERATIVE LEADERSHIP
OR Leadership: Product Evaluation and Cost Containment CYNTHIA PLONIEN, DNP, RN, CENP; LORI DONOVAN, MSN, RN, CNOR, NEA-BC
P
erioperative nursing leaders often ask “Why me?” when they are tagged with the responsibility of containing costs and evaluating products. The answer is simple. It is because perioperative nursing leaders have the greatest opportunity to affect costs and evaluate products. Where exactly in the cost containment and product evaluation process should a leader focus? Should one focus on leadership talents or management skills? The answer may be in the multifaceted approach required to achieve best-practice outcomes. Often, successful leaders in perioperative practice use a style of leadership referred to as transformational leadership. Transformational leaders set the direction and plan a vision. They accomplish objectives through inspirational motivation, intellectual stimulation, and individual
consideration.1 However, it takes more than just the charismatic skills of a leader to control quality and contain costs. Skills in management are equally necessary to achieve desired outcomes. For instance, in addition to inspiration, the management of a project requires attention to budget development as well as oversight of daily work. It involves incorporation of timelines, development and enforcement of policies and procedures, and supervision of team members. Outcomes must be monitored to identify and resolve problems and to continually refine processes. Administratively, balancing cost and quality is a high priority for OR leaders. The costs of surgical supplies and products can adversely affect an organization’s profitability. The purpose of this column is to discuss the process of surgical product selection and important factors to consider, such as quality and cost. http://dx.doi.org/10.1016/j.aorn.2015.07.007 ª AORN, Inc, 2015
426 j AORN Journal
www.aornjournal.org
October 2015, Vol. 102, No. 4
LEADERSHIP AND REFLECTIVE PRACTICE Managers should not underestimate the importance of critical thinking when managing quality and costs. To be successful in the 21st century, a manager must be a critical thinker.2 According to Baldoni,2 there is an enormous gap in the education of business leaders, with some leaders emphasizing quantitative skills over qualitative skills. Learners may be left to develop these skills on their own. Reflection is a skill with qualitative implications, often developed outside the classroom. As a perioperative leader, reflective thought and reflective practice are not easy to attain. Administrators at all levels often forego the mental effort of reflection that reveals insight in exchange for quick responses to urgent demands.3 Reflection has been proved to enhance the development of critical thinking skills, improvement of clinical reasoning, reduction of errors, and facilitation of practical wisdom.4 However, time is required for reflective thought. Slowing the pace is necessary for thoughtfulness to occur.5 The merit of reflection is not new. Aristotle taught that philosophically, reflection is central to the discernment of truth.3 American business theorist Chris Argyris emphasized reflection as key in achieving desired business outcomes with his concept of “double loop learning.”6 As a single loop, learning is realized through experience. The double-loop concept emphasizes the value of using reflection by stepping outside of an experience to reflect, conceptualize, and then incorporate what has been learned to improve processes and outcomes. The format is continuous learning with outcomes that can be applied directly to an organization’s bottom line.6 Success in managing people and practices within the OR setting demands critical thought supported by reflective practice. The information in this column is offered as an aid to leaders in their quest to improve standards and practices in the course of daily operations. It is imperative for leaders of perioperative services to take time to reflect and critically think through needs, options, and changes while confronting the challenges that face perioperative practice and creating new ways to overcome barriers.
QUALITY AND COSTS Innovations in surgical practice and new technologies are driving the integration of new products into all surgical settings.7 Quality, as well as costs, is a constant concern for the perioperative leader in relation to product selection. According to the Agency for Healthcare Research and Quality, surgical procedures account for almost half of all costs associated with hospital stays, even though they only
www.aornjournal.org
OR Leadership
comprise 29% of hospital stays.8 In contrast, reimbursement is continually denied by third-party payers. In some cases, reimbursement is arbitrarily reduced. As an example, Medicare’s cost-per-case method of reimbursement is based on diagnosis-related groups and is intended to cover all costs, inclusive of devices used in surgery. In the midst of rising costs of products, Medicare payments are decreasing.9 Surgical procedures are expensive, with an estimated increase in national health spending in the United States from $2.5 trillion in 2009 to $4.6 trillion in 2019.10 Perioperative directors need to be educated consumers related to cost containment, as well as related to quality in product evaluation and selection. The importance of product selection in the perioperative setting is further emphasized by AORN’s “Guideline for product selection.”11 AORN’s recommendations include establishing mechanisms for product selection, forming a multidisciplinary committee to guide selection, developing and implementing competencies for perioperative RNs related to product evaluation and selection, documenting the product selection process, developing specific policies and procedures for evaluating and selecting products, and implementing a process for quality assurance and process improvement (PI) to measure performance, costeffectiveness, and user satisfaction.
Cost Containment In organizations with surgical services, the OR is either the first or second (only to pharmacy) highest cost center in the medical center. From a consultation standpoint, when directed to look for cost containment and improvement, it is a matter of examining the source of the greatest profits and expenditures.12 Budgets are limited, and control of supplies is essential. In modern ORs, unused medical supplies are routinely discarded. It is estimated that more than 2 million lb per year of medical supplies are recoverable from large nonrural US academic medical centers.13 Johns Hopkins Hospital, a 952-bed facility in Baltimore, Maryland, recognized the opportunity to lower costs with an estimated $15 million savings opportunity in eliminating supply waste.14 As another example, Duke Regional Hospital in Durham, North Carolina, introduced a “postgame review” that involved identifying the most common and costly procedures, video recording the procedures with a focus on the supply table, and AORN Journal j 427
PloniendDonovan
reviewing the videos with the surgical team and supply chain personnel. Supplies and instruments never or rarely used were removed from future OR kits. The initiative is in its early implementation stages, but it is already having an effect by reducing supply costs and decreasing turnaround times.14 Cost savings can be achieved through simplistic measures. A large multifacility teaching hospital system in West Virginia achieved a 15% cost savings per case with a focus on physician preference cards. The team reviewed and updated more than 600 preference cards using historical data provided by [a web-based communication tracking service] to identify and remove items with a large variance between what was issued and what was actually used in surgical procedures. The team ran crossphysician or cross-procedure comparisons to identify which items were used in like cases, and then worked to remove unnecessary items. The team also used the system to color-code items on preference cards to identify those that were required to be issued. . . .15(p1)
Color code 1 correlated to items that the surgical team would automatically open and place on the sterile field. The surgical team would only open color code 2 items after consulting with the surgeon. Color code 3 items were not opened until the surgeon deemed it absolutely necessary. The central material services department placed color-coded bins on all surgical case carts so that personnel would identify material handling requirements for each item correctly. This reduced the number of overall transactions between central service and the OR. In designing measures of cost containment, leaders should appreciate and never underestimate the value of using quality processes as a tool. Lean and Six Sigma are improvement methodologies developed in the manufacturing industry that have been applied to health care industries throughout the world. As tools, they provide a systematic approach to achievement of quality improvement.16 By using these methodologies, quality and the bottom line can be improved. In the OR, improvements have occurred in case start times, turnover of cases, optimization of technology, scheduling, registration, admission processes, and charging mechanisms.17 For example, the processes worked for Valley Baptist Health System in Harlingen, Texas. The health care system conducted a Six Sigma project to reduce turnaround time between surgical procedures. In addition, the system sought to decrease variability, increase the percent of
428 j AORN Journal
October 2015, Vol. 102, No. 4
procedures under 60 minutes, increase surgeon satisfaction, and increase the capacity for surgical procedures. Results proved a 15% improvement in turnaround time, a potential for 1,106 additional procedures per year, and a potential revenue benefit of $1,355,282 annually.17
Standardization As a quality initiative, standardization is a high priority, provided the benefits of standardization to all practitioners outweigh the benefits of offering choices. Using familiar products enhances patient safety and clinical outcomes by providing predictability, reliability, and efficiency.7 In addition, standardization brings with it a magnitude of potential savings to the organization.9
Group Purchasing Organization Group purchasing organization (GPO) agreements provide cost-efficient avenues through negotiation of large purchase orders.7 In this way, GPO agreements support standardization. However, OR directors often are faced with challenges that may arise over physician preference for similar products from multiple vendors without regard to costs. Physician preference items can include high-dollar inventory (eg, cardiac stents; hip, knee, and spine implants). Unfortunately, physician choice frequently is based on factors unrelated to price and pertain to training, experience, or vendor relationships.9 Because multidisciplinary product evaluation committees are established to guide selection, it is imperative to include surgeons in the process. Various strategies may be used to “shape physician-induced purchasing behavior by orchestrating rather than dictating the physicians’ decisions.”9(p308) Two commonly used methods include the formulary model, in which limitations are placed on the range of manufacturers and products, and payment-cap model, in which price ceilings are used for particular item categories.9 Both methods require processes to define and evaluate equivalencies. The formulary model is more difficult to implement because of physicians’ resistance to top-down dictates. “The payment-cap model is more feasible because it preserves physicians’ choice while also restraining manufacturers’ power.”9(p307)
PRODUCT SELECTION Regardless of the individuals who sit on the committee, the work to be done is accomplished as a team. Choosing the right product to be used in perioperative services requires stakeholders to share knowledge and experience, ensuring that product safety and cost-effectiveness meet the needs of the users
www.aornjournal.org
October 2015, Vol. 102, No. 4
and the facility.18 The first priority of the team is to address the purpose of the product evaluation. This information refines the guidance and direction needed to achieve a positive outcome. When the rationale for a product is determined, the committee assesses and evaluates the product. Consistent criteria are identified to be used for each and every product review. Some factors to be considered include the following:
compatibility with required supplies and equipment, compliance with regulatory requirements, cost, ease of use, end-user requirements, environmental impact, single use or reusable, useful life, and vendor reputation and support.11
Information gathering is integral to the process of product selection. Quality and safety concerns exist when decisions are not evidence based.7 Committee members should research professional literature, obtain practical knowledge by contacting the vendor or current users at different facilities, and gain an outside perspective through discussions with competitive representatives.
Identifying Project Stakeholders The importance of engaging key stakeholders cannot be overstated. It is easy for current and former perioperative directors to share examples in which stakeholders were not engaged in the decision-making process, thereby preventing the achievement of desired results. For example, an organization planned to change vendors for endoscopic devices. Administrative leaders failed to bring surgeons into the early discussions and planning for the cost-saving initiative, so the surgeons did not have the opportunity to participate in decision making. The responsibility to implement the change in vendors, equipment, and supplies with the physicians was left to the perioperative directors after the fact. The surgeons were disgruntled and went to hospital administrators threatening to pull all their cases from the facility if they were forced to change products. Ultimately, that cost-saving initiative failed. Multidisciplinary product selection teams are recommended, as indicated in the AORN guidelines11 and supported by Dee Donatelli, MBA, BSN, RN, consultant at Navigant Consulting services, Dallas, Texas, in private correspondence. Ms Donatelli advises of an inherent value in a multidisciplinary approach for the evaluation and selection of all products,
www.aornjournal.org
OR Leadership
stating that the method of accomplishment will vary across organizations. Some organizations have a standard committee to oversee the entire process, whereas others have a steering committee that then engages other stakeholders based on the identified product. The essential component of a successful program is an overall framework that identifies the stakeholders, defines the selection process and measures of analysis, and implements controls for product management. Communication among the diverse team members and ensuring an understanding of the process is vital for sustained success. An initial step when identifying key stakeholders for the product selection team is to determine the end users of the product (ie, anyone who will come in contact with the new or conversion product). Ultimately, it is the end users who drive the success of the product, whether it is a new item or a conversion item. Depending on the product, stakeholders to consider recruiting for the product selection team may include the following: Senior managersdAdministrative support is vital, particularly for product approval and also conflict resolution between stakeholders.19 Perioperative nurses and techniciansdOR personnel provide user experience and practical knowledge to the team during decision making.7 PhysiciansdEngaging surgeons and anesthesia professionals is invaluable because the rationales cited for up to 61% of perioperative supply purchases are based on physician preference.20 Materials management, purchasing, and shared service providersdThese team members include procurement professionals who carry out decisions made during the product selection process.19 In addition to key stakeholders, risk management, infection control and prevention, and information technology personnel offer beneficial advice to the evaluation team7 because products used within the OR may also be used elsewhere within the health care facility. Clinical personnel who work inside or outside of perioperative services also should be selected for committees. There are examples of product selection and implementation scenarios that were unsuccessful because an outside department selected a product that affected perioperative services, but no one from perioperative services was on the production selection team. For example, an emergency department made a facility-wide decision to change bandage brands without engaging anyone from the perioperative services department. AORN Journal j 429
PloniendDonovan
The bandages selected did not meet the needs of securing orthopedic dressings, especially related to total knee arthroplasty. As a result, the OR had to use more bandages than previously planned, which negated any cost savings from changing the bandage brand. As in this example, it is crucial to consider the effect of a product-related decision on all areas in the facility. In another example, switching postoperative pain devices from one brand to another was done without engaging the postoperative areas. Consequently, the nurses were uncertain how to read the device for pain control and rehabilitation providers were uncertain how to secure the device for ambulation. With planning, positive outcomes are facilitated, as illustrated in the following scenario. A surgical department chose to improve patient outcomes by prewarming patients with warming gowns in the perioperative setting before surgery. In this situation, stakeholders in both the preoperative and postoperative settings were engaged to determine how this change would affect them. A member of the product selection team educated inpatient unit personnel about the prewarming process in preparation for patients arriving in the inpatient unit with a warming gown in place. Implementation was successful.
Value Analysis Only products that add value should be considered when selecting OR products. Added value may include outcomes related to safety, productivity, satisfaction, regulatory compliance, or market standing.20 Definitions of value analysis vary. However, the benefit in health care is a creative and analytical approach to evaluating the function of a product, service, or technology.12 The objective is to determine value at the lowest cost while providing an equivalent or better outcome in comparison to other productsdvalue can be defined as quality divided by cost, where quality is measured in outcomes, safety, and service.12 Value analysis is a path to PI. Methods of PI should be scientifically based through the study of evidence. Evidencebased practice involves gathering appropriate evidence, analyzing the evidence, and then incorporating the information into management decisions followed by postdecision evaluation.21 Incorporating evidence-based research into the analysis process improves the evaluation and selection of all surgical products. Employing clinically-focused PI methods assists in decision making, and sharing the logic discovered through research brings added value in enhancing support from end users.
430 j AORN Journal
October 2015, Vol. 102, No. 4
Advantages of linking evidence-based practice, PI, and value analysis include improving patient safety and clinical outcomes, using resources efficiently, and supporting and guiding the implementation of new health technologies.12
Evaluation Tools Evaluation tools help committee members maintain focus and can help team members identify relevant information for product selection. Figure 1 provides a list of items to be included in an evaluation tool for new products.7 The tool captures essential elements to be considered in product evaluation.
Single-Use, Reposable, or Reusable For nurse leaders, product selection is not only related to quality and cost. A third factor to consider is environmental responsibility. The AORN “Position statement on environmental responsibility” speaks to an expectation that perioperative nurses should “actively promote and participate in sustainability practices that preserve natural resources, reduce waste, and minimize exposure to hazardous materials.”22(p1) Specifically addressed in the position statement are selection of reusable equipment and materials that are of equal quality to single-use items and reprocessing of single-use devices according to federal guidelines. Consideration of quality, cost, and environmental responsibility must factor into decisions of all product purchases. Product decisions to use disposable products or reusable products that require cleaning and sterilization require cost analysis.23 If cost reduction is possible and quality can be maintained, these are deciding factors in choosing reusable products in place of single-use products. Over the years as higher standards have been adopted, reusable device manufacturers have had increasingly strict regulations to which they have had to conform.12 Reprocessors claim that the remanufactured device is actually tested at a higher standard than the original manufactured specifications. The logistics management (eg, disposal of, removal from the facility, restocking) of remanufactured devices adds complexity to the process; however, the cost is typically more than recouped with the savings of using remanufactured devices as opposed to purchasing new devices. Adopting a program that involves reusable products is an environmentally moral obligation. It also offers significant financial benefits to an organization while maintaining the highest patient quality standards.
www.aornjournal.org
October 2015, Vol. 102, No. 4
OR Leadership
Figure 1. Items comprising a new product evaluation tool. Reprinted with permission from Halvorson CK, Chinnes LF. Collaborative leadership in product evaluation. AORN J. 2007;85(2):334-352.
CONCLUSION Ensuring overall quality of care, efficiency of resources, and profitability requires a comprehensive approach with evidencebased solutions. Interdisciplinary collaboration and decision making are essential for success in product evaluation and cost containment. The expertise of OR leaders is invaluable in
www.aornjournal.org
coordinating product selection for perioperative services. AORN’s “Guideline for product selection”11 is an excellent resource for the evaluation and purchase of medical products in practice settings. Leaders and managers of perioperative services departments know that a mission inherent in the work is to transform and improve practice inclusive of quality and cost of products used.
AORN Journal j 431
PloniendDonovan
References 1. Doody O, Doody CM. Transformational leadership in nursing practice. Br J Nurs. 2012;21(20):1212-1218. 2. Baldoni J. Leadership: how leaders should think critically. Harv Bus Rev. January 20, 2010. https://hbr.org/2010/01/how-leaders -should-think-criti. Accessed June 9, 2015. 3. Moberg DJ, Calkins M. Reflection in business ethics: insights from St. Ignatius’ spiritual exercises. J Bus Ethics. 2001;33(3): 257-270. 4. Saperstein AK, Lilje T, Seibert D. A model for teaching reflective practice. Mil Med. 2015;180(Suppl 4):142-146. 5. Pierson W. Reflection and nursing education. J Adv Nurs. 1998; 27(1):165-170. 6. Argyris C. Double loop learning in organizations. Harv Bus Rev. September 1977. https://hbr.org/1977/09/double-loop-learning -in-organizations. Accessed June 9, 2015. 7. Halvorson CK, Chinnes LF. Collaborative leadership in product evaluation. AORN J. 2007;85(2):334-352. 8. Weiss AJ, Elixhauser A, Andrews RM. Characteristics of Operating Room Procedures in U.S. Hospitals, 2011. HCUP Statistical Brief #170. Rockville, MD: Agency for Healthcare Research and Quality; 2014. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb170-Operating -Room-Procedures-United-States-2011.pdf. Accessed June 9, 2015. 9. Montgomery K, Schneller ES. Hospitals’ strategies for orchestrating selection of physician preference items. Milbank Q. 2007; 85(2):307-335. 10. Terry K. Healthcare reform won’t slow medical costs until doctors get paid differently. CBS Money Watch. September 13, 2010. http:// www.cbsnews.com/news/healthcare-reform-wont-slow-medical -costs-until-doctors-get-paid-differently. Accessed June 9, 2015. 11. Guideline for product selection. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc; 2015:179-186. 12. Donatelli D. Adding more “value” to value analysis: an evidencebased performance improvement approach. Healthcare Purchasing News. March 2014. http://www.hpnonline.com/inside/2015-03/ 1503-BackTalk.html. Accessed June 9, 2015. 13. Wan EL, Xie L, Barrett M, et al. Global public health impact of recovered supplies from operating rooms: a critical analysis with national implications. World J Surg. 2015;39(1):29-35. 14. Nurse Executive Center. Untapped opportunities for saving millions. The Advisory Board Company. http://www.advisory.com/research/ nursing-executive-center/events/meetings/2014/2014-2015-nursing -executive-center-national-meeting-cno-roundtables/locations/ san-francisco/020915/untapped-nursing-opportunities-for-saving -millions/presentation?lo¼1. Accessed June 9, 2015. 15. Perry S. Preference cards as a ticket to savings. J Healthcare Contracting. October 2013:10-15. http://www.jhconline.com/ preference-cards-as-a-ticket-to-savings.html. Accessed June 9, 2015. 16. Mason S, Nocolay C, Darzi A. The use of Lean and Six Sigma methodologies in surgery: a systematic review. Surgeon. 2015; 13(2):91-100.
432 j AORN Journal
October 2015, Vol. 102, No. 4 17. Pexton C. Attention Six Sigma, you’re wanted in surgery. Six Sigma. June 2, 2015. http://www.isixsigma.com/new-to-six -sigma/dmaic/attention-six-sigma-you%E2%90%99re-wanted -surgery. Accessed June 9, 2015. 18. Stanton C. Selecting products safely. AORN J. 2011;94(6 Suppl): S99-S100. 19. Product selection and standardization. In: Optimizing Your Perioperative Supply Chain. Toronto, Ontario, Canada: Ontario Hospital Association; 2012. 4.1e4.48. https://www.oha.com/CurrentIssue s/keyinitiatives/SupplyChain/Documents/Chapter%204%20Final% 20-%20revised%20July42012.pdf. Accessed June 9, 2015. 20. Pennington C, DeRienzo R. An effective process for making decisions about major operating room purchases. AORN J. 2010; 91(3):341-349. 21. Pfeffer J, Sutton RI. Evidence-based management. Harv Bus Rev. 2006;84(1):62-74, 133. https://hbr.org/2006/01/evidence-based -management. Accessed June 9, 2015. 22. AORN Position Statement on Environmental Responsibility. Denver, CO: AORN, Inc; 2014. https://www.aorn.org/Clinical_Practice/Position_ Statements/Position_Statements.aspx. Accessed June 11, 2015. 23. Hoeksema J. Taking steps to control costs in the OR. AORN J. 2011;94(6 Suppl):S79-S84.
Cynthia Plonien, DNP, RN, CENP, is the director of the Graduate Program of Nursing Administration and a clinical assistant professor for the University of Texas at Arlington College of Nursing, Arlington, TX. Dr Plonien has no declared affiliation that could be perceived as posing a potential conflict of interest in the publication of this article.
Lori Donovan, MSN, RN, CNOR, NEA-BC, is the chief nursing officer at Texas Health Arlington Memorial Hospital, Arlington, TX. Ms Donovan has no declared affiliation that could be perceived as posing a potential conflict of interest in the publication of this article.
www.aornjournal.org
LEARNER EVALUATION
Continuing Education: OR Leadership: Product Evaluation and Cost Containment 1.5
www.aorn.org/CE
T
his evaluation is used to determine the extent to which this continuing education program met your learning needs. The evaluation is printed here for your convenience. To receive continuing education credit, you must complete the online Learner Evaluation at http://www.aorn.org/CE. Rate the items as described below.
PURPOSE/GOAL
6.
Will you be able to use the information from this article in your work setting? 1. Yes 2. No
7.
Will you change your practice as a result of reading this article? (If yes, answer question #7A. If no, answer question #7B.)
7A.
How will you change your practice? (Select all that apply) 1. I will provide education to my team regarding why change is needed. 2. I will work with management to change/implement a policy and procedure. 3. I will plan an informational meeting with physicians to seek their input and acceptance of the need for change. 4. I will implement change and evaluate the effect of the change at regular intervals until the change is incorporated as best practice. 5. Other: __________________________________
7B.
If you will not change your practice as a result of reading this article, why? (Select all that apply) 1. The content of the article is not relevant to my practice. 2. I do not have enough time to teach others about the purpose of the needed change. 3. I do not have management support to make a change. 4. Other:__________________________________
8.
Our accrediting body requires that we verify the time you needed to complete the 1.5 continuing education contact hour (90-minute) program: _______________
To provide the learner with knowledge specific to containing costs and evaluating products in the OR.
OBJECTIVES To what extent were the following objectives of this continuing education program achieved? 1. Discuss common areas of concern that relate to perioperative best practices. Low 1. 2. 3. 4. 5. High 2.
3.
Discuss best practices that could enhance safety in the perioperative area. Low 1. 2. 3. 4. 5. High Describe implementation of evidence-based practice in relation to perioperative nursing care. Low 1. 2. 3. 4. 5. High
CONTENT 4.
To what extent did this article increase your knowledge of the subject matter? Low 1. 2. 3. 4. 5. High
5.
To what extent were your individual objectives met? Low 1. 2. 3. 4. 5. High
www.aornjournal.org
AORN Journal j 433