Even before we opened our orthopedics and pain management surgical center in July 2004, we knew procedure packs for disposable supplies would be essential to getting our three ORs and one procedure room set up quickly and turned over fast.

And they have been. But we've also learned the efficiency of opening only one item instead of doz-ens means that sometimes your staff may unwrap supplies your surgeon doesn't ask for. If you don't use all the supplies regularly, you'll lose out. It may not be the biggest line on your budget, but a few dollars here and there, multiplied by hundreds of procedures, and you're talking about more than a little bit of unused supplies going to waste.

That's why standardizing your procedure packs' contents makes sense. You know the benefits of cross-training your staff. Consider it cross-training your supplies. Here are a few angles on making standardization work.

Keep it simple
Procedure packs are most cost-effective when they include high-volume items. So reduce contents to only the essential items to do the procedure. Try to narrow the contents to the items most of your facility's surgeons use in that procedure.

You can accomplish this by reviewing surgeons' preference cards; we had our surgeons send over their preference cards even before we opened. If 90 percent agree on an item, include it in the pack. Even if only 75 percent agree, we include it because it saves time the majority of the time.

However, we'll wrap seldom-used items separately, either individuallly or maybe even as a second kit for a particular surgeon. It may be more work to unwrap these additional items, but we'll absorb the two minutes it's going to take to save money on unused supplies in the main pack.

Be sure to take some time to periodically review what gets used and what gets discarded during a procedure. Have your materials manager keep an eye on it, or look it over when you do your monthly case costing.

Encourage your frontline OR staff to monitor supply use, too. Once a staff member asked why we had a basin in our shoulder packs if it was never used. Since the doctors never asked for it and didn't know it was in our procedure pack, it continued to be included in the packs. If you have everyone keeping an eye out, you'll have more solid evidence for making changes.

Making your pitch
It almost goes without saying that cost savings is the major motivation for physician-owners to standardize. Money talks, so start here. Get your medical director involved, to lead from the top down, and arm yourself with numbers.

At a board meeting, you can use this as a starting point for discussion. "Some of you are using this product," I'll explain, "but here's an alternative and here's how much it would save in the long term. What do you guys think about using this product?"

Even though the items at issue are usually basic, inexpensive items, the cost savings associated with the change would be significant. Your surgeons, however, might still resist change.

If your doctors aren't flexible enough to see the big picture in terms of cost, then it's time for argument No. 2: efficiency. The surgeons who are set in their ways probably aren't opposed to saving money; they're just reluctant to accept change, and they can make standardization difficult. But they don't want to deal with slow turnover and cases delayed by missing supplies - they want to do their cases and go home. Appealing to surgeons' efficient natures is key.

The difference makers
How do you tell a surgeon who has consistently good outcomes that he could be more cost-effective? You don't want to compromise patient safety or challenge his standard of care. So go after what matters. Compare products that are equal in efficiency, but may be significantly different in cost. I call these the difference makers.

Case costing is therefore essential. At board meetings, I let each surgeon know his overall average time and cost for a selected procedure. The peer pressure associated with this review often leads a surgeon to make a change for the economic benefit of the facility. Have preference cards on hand so your surgeons can compare their track records.

We have 15 physician-owners, and it's not always easy getting them to agree on one plan, especially if it involves supply preferences. But if you keep in mind that surgeons generally like empirical evidence, a little persuasion goes a long way.

You don't have to make a unilateral switch to start the process. Find a vendor willing to supply you with complimentary sample packs that incorporate economical substitutes. Let the surgeons trial the contents in surgery to see if they notice the difference - and make sure you have the standard item nearby, just in case.

Most consideration should go to the most expensive items. For less-expensive items, the ones where any brand will work, identify your cost priorities and how fanatical you want to get about the details. A couple cents isn't much of a difference maker, but what about a couple dollars? And what if you have 10 items you can save 10 cents each on? That can start to add up.

Adapt and compare
As you're re-evaluating the costs of your packs and ensuring standardization's benefits are taking effect, make sure vendors are, too. When we started out, we ordered our packs from the manufacturer that supplied our surgeons at their former hospital. In fact, we asked the manufacturer to increase production of that hospital's pack for us. After we began adapting them, we sent our packs to another vendor in hopes of getting a lower price. If they can, you win. If they can't, you've already won.