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Announcement of outcome of President-Elect vote. Nomination and election of new Executive Board Members. Nomination and vote for new Nominating Committee Chairperson.
Spotlight on Issues
Outsourcing: The Good, the Bad and the Ugly
In today's down-turned economy, outsourcing may seem like a four-letter word – both from administrators who question whether they can even consider the move financially, and from CS professionals who are concerned that an outsourcing partnership could force them right out of their job.
While there are no hard and fast rules regarding outsourcing, three panel experts who spoke Sunday, May 3, to a jam-packed ballroom of attendees, agreed on what healthcare organizations – and, especially, CS departments -- should do to weigh the options and determine whether outsourcing (in whatever capacity) is right for them. The trio – Lynn Class of IMS, Nancy Stierheim of ISH and Cory Nestman of SterilTek – answered a series of questions regarding CS outsourcing and provided insightful take-home messages for all in attendance.
A number of factors can lead to a facility's decision to outsource the CS function (or aspects of it): rapidly evolving technology and a limited amount of equipment resources to manage devices effectively; costly instrument repairs and the need for high-dollar capital equipment to keep up with increasing demand, insufficient staffing; ongoing and unresolved complaints from CS customers, space constraints; and the desire to convert the CS department or part of it into revenue-generating space.
Still, challenges alone do not automatically translate into the need for outsourcing. “The focus [surrounding the decision to outsource] has to be on the patient. Outsourcing in not something that should be done suddenly and it can't be taken lightly,” stressed Nestman.
Among the first steps in evaluating the outsourcing option is assessing the issues and determining which challenges are impacting the CS department and the overall facility most. A consultant may be a good investment, the experts agreed, because they can provide an unbiased perspective on the department and any pertinent process improvement initiatives that could be implemented to benefit the facility and patient outcomes. A written recommendation from a consultant is beneficial so the CS department and hospital executives can more carefully assess whether the existing culture of the facility – and the available resources – will facilitate these changes.
“Always have a consultant do an assessment, in writing, and get a return on investment on the implementation,” urged Stierheim. Even a staffing analysis performed by a consultant can go a long way toward helping to justify the need for more help in CS; outsourcing may not even factor into the equation.
To compare costs and ROI, it's imperative that CS departments and C-level executives have a firm handle on the costs associated with managing certain tasks in-house versus outsourcing (taking into consideration any hidden or ancillary costs that may surface with outsourcing). If it's been determined that a particular function of CS is better off being outsourced (perhaps regarding the management of specialty equipment or linens, for example), Nestman pointed out the importance of doing adequate research to determine which outsourcing partner can best meet their needs (a rural facility, for example, may find it difficult for an outsourcing vendor to meet their expectations).
To prepare CS staff for the possibility of outsourcing, communication is critical. While much of the discussion surrounding outsourcing may happen in the office of hospital executives, CS staff (and especially a champion in the department with decision-making power) must be included in discussions. Other key constituents who should be involved in the process include human resources, infection control, a representative from the OR and administrators. “We service every department in the hospital, so everyone (including finance and beyond) needs to buy in for it to be successful,” said Stierheim.
How should facilities prepare for addressing the possibility of job loss or displacement to staff?
“A reduction in staff may be a reality of outsourcing,” but not always, according to Class. She reasoned that an outsourcing partner may choose to keep existing staff or pick and choose. “Human resources should be involved so they can do their best to find them a job elsewhere in the facility, especially for top performers.” Oftentimes, however, outsourcing simply alleviates some of the burden from existing staff, without the need for staffing reductions, the panel pointed out.
If a facility does opt for outsourcing, a successful partnership will again hinge upon effective ongoing communication and a clearly negotiated contract that outlines all objectives, goals, responsibilities, and expectations.
“Have at least monthly meetings with administrative staff to evaluate [quality] matrixes” and ensure that the contractual agreements that were made are being met on both sides, said Class, adding that initially, facilities should be witnessing noticeable improvements (within 90 days or so). “For an outsourcing partnership to be effective, everyone's goals and values should be properly aligned.”
Loaner Instrumentation
Ask virtually any CS professional if they've encountered challenges and headaches associated with loaner instrumentation and they'll likely respond with an emphatic “Yes!” That's certainly been the case for Bob Marrs, CSCST, CHL, director of sterile processing at St. David's Medical Center in Austin, TX. Marrs delivered a heartfelt session on the subject that earned him a standing ovation from the filled-to-capacity ballroom Sunday afternoon.
Marrs touched on the some of the key challenges related to loaners, such as the impact they can have on time and productivity (staff and equipment), the operating room, the vendor, and above all, the patient. Much goes into the process of bringing in loaners – from the inspection, checklists and sign-off at the point of delivery and receiving, and the availability of manufacturer processing instructions to ensuring that each and every loaner set that enters the facility is thoroughly cleaned and sterilized in-house (“Never, ever trust that a loaner instrument has been cleaned – even if the vendor tells you it is,” Marrs stressed.) and that the instruments then make it back to the vendor successfully.
Of course, those aren't the only factors. CS staff, many of whom are already time-crunched and resource-strapped, are finding themselves backlogged with loaner instruments and, as a result, are often being asked by the OR to cut corners to turn them around more quickly. Extended cycle times and heavy sets are another major issues, as is the fact that self-contained biological indicators may not be resistant enough or appropriate for use (per ISO standard 12161). While some of these challenges can't be avoided, Marrs said it's imperative that CS professionals “fight the fight” and stay committed to doing what's right. In his case, he avoided last-minute loaner pile-ups by posting signs on entry and exit points alerting vendors that the department will no longer process instruments unless they are delivered the day before the procedure (unless it truly is an emergency that warrants an impromptu loaner delivery).
As for extended cycle times (which can destroy some devices if they are exposed to lengthier processing), he applauded one vendor – SYNTHES – for its decision to address user needs by eliminating the need for extended cycles.
“We have the power to ask the same of other vendors,” Marrs said. He encouraged attendees to obtain the letter by SYNTHES announcing the change and use it as incentive to nudge other vendors in the same direction. More than anything, though, he urged attendees to stand firmly in their decision to do what's right for the sake of patient safety – even if it means facing strong resistance along the way (Marrs certainly practices what he preaches).
“Sometimes, I feel like our patients have no advocates. We have to be that advocate that our patients need,” he explained. “We are the most important people in the hospital. No one else can do our job. We have to continue to do what's right.”
12:00 p.m. –
12:30 p.m.
Orientation for new Board Members
12:30 p.m. –
2:30 p.m.
Directors Board Bruncheon
Sponsored by Belimed
12:30 p.m. –
2:30 p.m.
Lunch on your own
2:30 p.m. –
3:45 p.m.
General Session:
Spotlight on Issues: Good, Bad and Ugly
3:45 p.m. –
4:00 p.m.
Break
4:00 p.m. –
5:15 p.m.
General Session:
Loaner Instrumentation
5:15 p.m. –
5:45 p.m.
Orientation for first time attendees