Soon after accepting my position as materials manager for Marysville Surgical Center in Marysville, Ohio, I looked at ways to reduce our per-case supply costs. To start, I focused on our procedure packs. You'd be surprised how much you can save by re-organizing your packs. My facility has saved $32,000 per year since I pulled unused supplies from our packs and replaced pricey items with less expensive options. But it's more than "out with the old and in with the new" — and cheaper. Here's how I overhauled our packs, and how you can do the same at your facility.

Value analysis
As evidenced by the yearly savings achieved at my center, streamlining your procedure packs is a cost-effective approach to supply management. But in order to be cost-effective, at least 95 percent of a pack's contents must be used every time one is opened. To achieve that threshold, do what we did.

We've made many changes in our packs since Marysville Surgical Center opened in 2004. Currently we're working with our fourth generation setup. To ensure our packs were used properly, my center started a value analysis committee, consisting of the facility's administrator, materials manager, director of nursing, corporate vice president, two RNs and two surgical techs. The makeup of your center's committee is dependent on your staffing levels, but be sure to select members from each clinical and business area to ensure the group has a big-picture view of your supply buying policies. Meet monthly and fill the committee's seats with outspoken employees who aren't shy about telling it like it is. You need to hear about the bad in order to make it good.

Compile a list of your entire supply inventory, from the highest-dollar supplies to the lowest-cost items. You'll likely find that procedure packs will fall within the top 10 supply item expenses. Next, review each specialty's supply usage and crosscheck each procedure pack's opening with the supplies actually used during the procedure. Also note the supplies that are stocked separately, but were still pulled for procedure pack cases.

Have your surgical techs track the unused supplies in each procedure pack, as they're in the perfect position to do so. Review their findings at the monthly meetings of the value analysis committee. Constantly monitor the list of supplies that get used and compare it to those that don't get used. As a rule, you should either eliminate or replace with another item supplies that don't get used on a routine basis.

During your monthly reviews, weigh the pros and cons of including a supply in your procedure pack. Base the decision on the staff's feedback as well as pricing concerns. Pull more expensive items — I'd say any supply costing more than $5 each, or more than $10 for sure —from packs and purchase them separately. Our center has chosen to not include gloves in our packs. Another large cost-saving decision involved the removal of clip appliers and trocars from laparoscopic packs. We now buy these items separately at a cheaper price. We've also chosen to limit our procedure packs to "basic item" supplies by removing most of the big-ticket items.

Getting skinny
Comparing products that are equal in quality but different in price is a great way to save money. For the items in your packs that are used constantly, focus on less expensive options. Shop around for deals on such basics items as adhesive bandages, shave kits, lap sponges, towels and syringes. By targeting supplies with viable alternatives, you'll often find similar items that cost a little less. I call this process "skinning down" the supplies. Now more than ever, you have to be pickier about the supplies you're willing to utilize.

Purchasing reps will be the first to provide the information you need to shop for less, but only if you establish a strong rapport with them and govern the rules of the games they play. Stay in touch with your vendors and nurture each relationship. I'll accept calls from all reps and will meet with those who show up unannounced, regardless of how busy I am or how bad my mood might be. You never know which smooth talker will be the one to help when you're in a pinch or on the hunt for a bargain. The few minutes you spend with vendors will be paid back when you're haggling over the last few dollars in supply negotiations.

When hunting for less expensive alternatives to supplies in your packs, ask multiple vendors — at least three or four — for samples that can be tested by your staff and surgeons. Play each rep's quoted prices against the other's and never — and I truly mean never — accept the first price you're offered. Reps will get wind of your shopping around. It's always in your best interest to ask for a better deal because if a company truly wants your business, they'll find ways to secure it — often by letting you name your price. Stay current on your group purchasing contracts. Some items may be listed on incorrect tier levels or may have incorrect pricing entered from your supplier.

Schedule an evaluation period — a month should do — for the new products you plan to add to procedure packs. This is key. Surgeons are one of the most important steps in this whole process; no two surgeons will use the exact same supplies the majority of the time. Work closely with them and encourage a common agreement for most procedure pack items. While your docs' preferences are often the determining factor when it comes to supply purchasing, the surgical team must have a chance to voice their opinion.

But how do you build a consensus from numerous opinions? Tag each item being trialed to differentiate it from the others in the procedure pack. When staff see the tag in the OR, they'll know to test and observe its efficacy during surgery. Ask them to record their thoughts at the conclusion of the case and be sure to make that an easy process. During a recent glove trial I created reaction forms that required staff to simply circle "superior," "acceptable" or "unacceptable" following numerous questions of the product's features. In the glove trial they responded to queries about the gloves' texture and feel, among others. Collect each reaction form, record the feedback and present the data in graph form for review by the value analysis committee. The ultimate decision will rest with the committee, but it will make that decision after reviewing the cumulative results of the staff's trail.

Waste not, want not
Treat your facility as if you were part-owner. Make solid business decisions and don't go overboard with purchasing supplies that you may not need. Remember, less is usually more in the world of materials management. Procedure packs help you remain efficient and flexible by letting your facility tailor them to fit your physicians' preferences. Every item that must be pulled separately for each procedure adds labor, time and additional inventory costs. Packs reduce the time and costs associated with ordering and stocking supplies but only if most of the packs' supplies are used constantly. If you're wasting procedure pack supplies, you might as well throw cash in with your solid waste.