HIGH QUALITY OR staff shouldn't be waiting on someone to pull an instrument or relying on flashing because a screw fell out or a tip fell off.

Of course you look at price, but you want to be sure you're getting top-quality instruments that will hold up. Buying right the first time saves you money over the long-term. Durable instruments that are constructed properly shouldn't rust with normal, careful handling. You might have to pay a bit more, but it's an investment.

Speaking of investing, make sure you have an extra instrument set or two for a couple reasons. First, to avoid jamming central sterile processing on busy days (which helps ensure techs carry out their duties correctly). And, second, in case an instrument does break, you'll have a backup available immediately and won't be crippled for the day, the week — however long it takes to get a replacement.

Every set is stripped down and standardized to the essentials. To accommodate surgeon preferences, any variances are in peel packs and pulled just for those surgeons. For example, every ophthalmic surgeon seems to have a preferred chopper.

If something new and shiny comes along, we'll trial it on the caveat that it doesn't mean we're going to buy it. An instrument that's a hit and, more importantly, can be used by many surgeons, gets heavier consideration. For just 1 doc, though, we'll probably tell him it's not in the budget. Because, well, it's not; you have to be choosy to keep instrument costs down.

Develop trusting relationships
When we became multi-specialty and moved locations 3 years ago, we had to bring our instrument supply up to speed. The process was surgeon-driven to some extent, but we went with vendors we already trusted when adding ENT, urology and other specialty-specific instruments. That's because (a) we had developed good relationships with the reps and (b) we could trust the companies to stand behind their products for a long time.

It's not that you can't get some great instruments from boutique companies. And it's not that there aren't enduring boutique instrument-makers. You just want to check them out thoroughly because if something happens to the instruments in 5 years, you'd hope the companies would stand behind them.

But as much as price and the instrument itself matter, having a relationship with reps is a big deal. They can take care of you when you need an instrument quickly, and I find it gives me the confidence to negotiate better deals, because I feel comfortable interacting with them.

Consider repair and maintenance
We take very good care of our instruments — our reprocessing techs are dedicated to that area, and one even specializes in delicate ophthalmic instruments — as a way to keep our repair/replacement budget under control. Which isn't to say we don't try to save in that area.

We've sent instruments to a third-party vendor for repair and even used to have a vendor that would pick up, repair and drop off instruments. We've mostly moved toward sending items to the original manufacturers for repair, and we've had good luck. I've never felt they advised buying a new item (rather than fixing) undeservedly.

Right now, I'm looking at a repair, maintenance and purchase contract with a manufacturer. We'd get flat percentage discounts on all new purchases, a discount on repairs and up to 50% off replacement instruments. We'd be responsible for shipping to the manufacturer, but return shipping would be free. We're trying to get the other facilities in our healthcare system on board so we can maximize the discounts. There's no minimum commitment on our parts, but it sure would encourage us to buy from the vendor — it's almost like a loyalty program. Plus, we'd get price protection for the 2-year contract term.