As a critical-care nurse with 16 years' experience in the intensive-care unit, orthopedics and general surgery, Karen Miguel said she often found herself wondering if "the people that bought the mattresses were talking to the people who bought the sheets, because the sheets never fit the beds."
Purchasing commodity items such as linens, gloves and sheets should be a no-brainer for hospital purchasing departments, right?
"You have no idea," sighed Chuck Mauro, director of materials management at the University of North Carolina Hospitals in Chapel Hill. "There is no such thing as a simple conversion. You can't convert tongue blades without (roiling) somebody."
Historically at odds with the clinicians for whom they purchase supplies of every kind, material managers are now forging symbiotic relationships with their internal clinician customers through an emerging area of expertise known as value analysis. Value analysis professionals, who go by various titles such as clinical value analysis specialist or director of value analysis, are typically registered nurses. Although they most often report to the finance side of hospital operations, they are firmly rooted in the clinical side, bridging the cultural gap between harried, overworked nurses and pocket protector-wearing material managers.
"My mantra is: evaluate our current situation, determine what our needs are with the current situation and then see if a new opportunity fits in there to fill that need," said Miguel, whose title at six-hospital Partners HealthCare in Boston is corporate clinical project manager. "Nursing is a real chameleon profession. We have a great ability to think on our feet. I think every (hospital area) needs a clinical person. I think it can help everywhere."
Value analysis, as defined by the Association of Healthcare Value Analysis Professionals, or AHVAP, is "a process that engages the clinical consumers of products and services in an evidence-based review to determine the clinical and financial impact of adding new products and technologies to the hospital product formulary."
For example, a wound dressing that saves 50% of the typical cost may entice hospital purchasers, "But if the clinical people have to use three times as much, then you really haven't gained anything," Miguel said. It's the job of value professionals to point out such product failings to hospital purchasing departments.
No one is sure to what extent value analysis professionals have penetrated hospital purchasing, but the association itself has grown exponentially since the AHVAP began five years ago as an informal group of professionals who e-mailed each other, said Kathleen Stickane, the association's president. Eventually, someone suggested they put faces to the e-mail addresses. As a result, 47 of the 80 people participating in the e-mail group showed up for the group's first annual meeting in 2003 in Chapel Hill, where Stickane is clinical resource utilization specialist at the University of North Carolina Hospitals.
The group subsequently incorporated as a not-for-profit. The bylaws require all members to be involved in a clinical value analysis program at a hospital or health system, and full, voting members must be nurses. Vendors are not allowed to join the organization, nor are suppliers even permitted to sponsor any of the association's initiatives or programs.
"We feel we would like to try this on our own without outside influences at all," Stickane said. "Though we do feel (vendors) have good information to share with us, we don't want even a hint of favoritism."
To date the group has processed 211 membership applications and there are 180 members, said Cindy Christofanelli, the AHVAP's president-elect and the director of value analysis at three-hospital Memorial Health System in Springfield, Ill. Of the active members, 140 are registered nurses. About 82% of members have been in their current position less than five years and about 5% have been in their current role more than 10 years, Christofanelli said.