Managing the changeover of surgical sutures

Hospital Healthcare Europe

 

Clinical Procurement Manager,

NHS Lothian, Edinburgh, UK

NHS Greater Glasgow and Clyde is the largest Health Board in Scotland, providing healthcare to more than 1.2 million people and employing more than 40,000 staff.

NHS Lothian services over 800,000 people, the second largest residential population in Scotland.

Whereas Covidien surgical suture use in NHS GGC was running at 70–75% in mid–2011, it was considerably less in Lothian: 10–15%, compared to 85–90%  Johnson & Johnson Ethicon.

This is a case study of how Covidien surgical suture use was moved toward its target of 85%.

As with any healthcare project, the focus had to remain on cost sensitivity: to save costs on all clinical consumables, from towels and swabs to heart valves and implantables. Having to deal with 55 surgical suites across the NHS Lothian Board, there had been previous attempts, for example in paediatrics, but surgeons had always been inclined to stick with what they had. Clearly a major focus would have to be moving surgeons onside.

The key driver came in mid-2011, when contract prices increased in a climate of cost saving. The need for rationalisation  was highlighted: for example, the NHS Lothian Board was using between 250 and 300 codes of Ethicon suture. Safety and quality of Covidien sutures were not not perceived as major issues as obstetrics/gynaecology had long been using them. So with the quality argument addressed, the change management process began. Gill Bowler, Clinical Procurement Manager, supervised the change, which was carried out by the Theatre Supplies Liaison Officer.

The target was simple, unambiguous and repeatedly communicated: a cost-saving, 85% changeover to Covidien surgical sutures across 55 surgical suites in NHS Lothian. Conversion was neither viewed not communicated as a trial, but rather as an authentic conversion, one theatre at a time, to Covidien sutures, where possible/appropriate. Rationalisation of the number of codes (above) was imperative.

Champions of the process were represented by Board and Hospitals’ senior management, Clinical Directors, Chief Nurses and Clinical Nurse Managers. The goals of cost savings, rationalisation and conversion efficiency were communicated from the top, in a collegiate but non-aggressive manner, with new financial targets set and agreed. Savings would be realised as codes were converted. Buy-in from the stock controllers in theatres – the buyers – was critical, as purchasing was moved from a National Distribution Centre to individual order lists, and theatre teams were asked for cost savings per unit.

Apart from conversion champions from NHS GGC, by far the major external champion was Covidien itself. A constant source of clinical evidence, Covidien support came in the form of a suture specialist and a nurse advisor, both with clinical backgrounds. Regular meetings with staff (initially fortnightly), one theatre suite at a time, served to reassure and persuade theatre staff in the direction of the goal.

Clear, frequent, face-to-face communication, theatre-by-theatre, involving all stakeholders and champions, was the glue that held the process together. Change is more difficult for some than for others, and patience and time were key allowances.

Conversion difficulties were addressed suite-by-suite. Stock controllers in theatres were given responsibility for purchasing, and were given particular attention.

The tendency of some theatres to retain the status quo was removed by communication of the goals of rationalisation and cost-saving efficiencies.

Surgeons’ insistence on like-for-like conversion was met with a patient winning-over, on the basis of clinical evidence.

Plastic surgery suites are the last to convert, and Covidien is providing the clinical evidence that is a necessary part of the process. On the other hand, the cardiac theatres were quickly up to 65–70% changeover.

Within the first 12 months, 60–70% out of the target of 85% changeover was achieved. Progress to December 2012 (all codes, all theatres) was encouraging. A November peak in Johnson & Johnson Ethicon usage was explained by the fact that extra orders were placed immediately before Christmas and then dropped in December, while those of Covidien rose. The combined figures for January and February 2013 have continued this trend, showing a current average usage of Covidien sutures running at 65%, compared to 35% for Johnson & Johnson Ethicon. The process continues.