People are often surprised when they learn that the 17 surgeons at our facility all use the same brand and type of surgical glove. "How did you get them to agree on one?" they ask. It was easy: I took the direct route. I made a plan to buy just one kind of glove, and I stuck to it. Let me explain.

Single-minded goal
When we opened our multi-specialty ASC in January 2005, our intention was to stock only one type of surgical glove. Early on, during a meeting with the surgeons, I set forth the ground rule for gloves. What we're going to do, I said, is find the best glove that works for all of you. I limited their options — 2 latex-free gloves that had been pre-selected for them — and asked which choice they liked best.

There was some initial skepticism from the physicians. In the surgical workplace, we all have things that are close to our hearts, and for surgeons, nothing is closer to their hearts than their fingers. You've probably heard them during safety scalpel trials complaining that the blades "just don't feel right." Asking them to change the gloves they wear can be an even greater flashpoint.

Convincing choices
How did we defuse this potential conflict? First, we sought out quality. In narrowing the field of product candidates down to two, we didn't rule out a glove because we thought it was too costly or because it wasn't on contract. Our only hard-and-fast rule was that it had to be latex-free. Our inventory manager ordered 2 top-of-the-line options and we gave our surgeons a choice between what we believed were the best gloves available at the time.

Second, we relied on staff buy-in. There's a lot of credibility and trust between a physician and his surgical team. Some of our nurses have been working with a particular surgeon for 10 or 15 years. The staff knows what the surgeons like, and the surgeons listen to them. As we reviewed the available products and made the selections we'd later present to our physicians, our nurses and scrub techs served as a testing panel, trying on a few of the gloves for comfort, fit and feel. This helped to rule out, for example, gloves that didn't have a generous width between the lower thumb knuckle and the base of the pinky. A squeeze there is a sure sign that a glove will fatigue the wearer's hand.

Then, having tried the gloves themselves, our OR staffers were our champions who could sweet-talk the surgeons and generate some enthusiasm. The nurses and scrubs said, "These are really nice, you've got to try these," talking a surgeon into donning a new glove, if necessary, and making him think it was his idea.

Reasons for reduction
These efforts — putting forth a quality product and enlisting staff support — seemed to convince surgeons to give some consideration to standardization. I didn't have to argue the point too strenuously. But that's also because they knew the rationale behind streamlining our glove purchasing.

If you can standardize anything on your supply budget — suture, IOLs, reduction forceps, whatever — if you can get your surgeons to agree on 1 product, you're going to save money. Since our facility has only been buying 1 glove from the beginning, I don't have before-and-after supply budget numbers to compare, but it's clear that ordering just one type of item will cost less than ordering six or eight, and buying that one item in bulk can reduce costs as well.

ASCs frequently tout their cost-efficiency credentials. Given the oft-cited statistic about the one-third of ASCs that fail and the one-third that break even, strategic thinking on supplies can benefit a facility. But if your physicians own a piece of the facility, it also benefits them. "Less cost to the facility is more money for you": That's 80% of the argument I didn't have to make right there. The other 20% was, we're going to standardize either your gloves or your implants. If we're going to spend money, which would you rather we spend the money on? The item on which your patient's outcome depends, or the glove you're in for outpatient surgery's relatively brief cases?

Reducing your inventory by consolidating glove choices saves space and declutters your shelves. I've seen storerooms where a wire shelf, 6 feet high with 5 shelves down, was entirely filled with boxes of different sizes of different brand gloves. Good luck finding your or your surgeon's preference in a hurry. For us, 1 shelf holds all of our gloves. If expired gloves or discontinued choices are problems for your facility, standardizing can be an effective solution against waste.

Standardizing our surgical gloves also gave us a measure of control over a pressing patient and employee safety issue. In recent years, latex allergies have become a huge concern in the healthcare workplace. Prolonged exposure can trigger sudden reactions in staff. Patients can walk into our facilities unaware of their sensitivity until symptoms endanger their safety. We wanted to open our ASC as a latex-safe facility, so both of the options we offered our surgeons were latex- and powder-free — much to the dismay of the surgeon who thought his inexpensive latex favorite would surely make the cut.

Making the decision
We gave our surgeons 2 high-quality, comfortable, latex-free options and asked them to trial each glove for a month. We asked them to write an evaluation note on how each felt, their likes and dislikes for each, and then choose between them. We made sure every surgeon got a say in the matter.

It was no surprise that comfort, easy donning and doffing, and high tactile sensation are the chief qualities that surgeons look for in a glove. What was surprising was that most of our surgeons agreed with most of our staff on which glove to choose: the powder-free polyisoprene glove that we now stock. When new physicians bring cases to us, they get the glove we use. If a surgeon should refuse, I'd reply, "Bring your own gloves from the hospital, then, because I'm not buying them."

Come January our center will have been open for 6 years and our glove choices have remained constant. There's little that would make me consider changing brands. If I received reports from surgeons and staff that the quality of our glove had became inferior, that sizing or some other aspect had changed, we'd run another trial. Until that time, we can count our choices on 1 hand and still have 4 fingers left over.