We"ve all heard the glove trial horror stories, the switchover plans that start with the best laid plans but wind up astray in endless evaluation processes, staff and surgeon resistance, glove hoarding and ultimately a return to the drawing board. I"m happy to report that here at Glens Falls Hospital, our experience was much more positive. We ended up reducing the number of gloves styles we stocked (from seven to three) and the number of companies we purchased from (from four to one). We completed our trial in just three weeks. And in the first year, I figure we"ve saved $10,000. More importantly, we"ve had no complaints or problems with our choices. Here"s how we did it, and how you can, too.
Scrapping our old system
Our first step was to scrap our old system, which was riddled with inefficiencies.
- Seven from seven. At the time, our hospital used seven different gloves from seven different manufacturers, two of which weren"t on contract, meaning we were paying list price. We got that way because we had never put our foot down when someone would ask for a specific glove. As a result, we had trouble controlling prices. Remember, the main way that facilities can save when purchasing surgical supplies such as gloves is to buy them in large quantities and negotiate volume discounts.
- Shelf space. With shelf space already at a premium, stocking so many different types of gloves complicated our supply management.
- Quality. Lastly, we simply weren"t satisfied with the quality of many of the gloves we purchased, some of which had holes, stuck-together fingers and poor sterile packaging.
We set a goal of having a new system in place within 90 days of starting the trial. It was important to meet the deadline both to keep the changeover as unobtrusive as possible. The last thing administrators, staff and surgeons wanted was a disorganized trial that dragged on and on. So we had to keep things moving at a good clip. And we had to be mindful of our two directives:
- Reach consensus on a single company"s product line.
- Select gloves with a comfortable fit and good quality.
We knew that if we could accomplish both of these, we could save money and control quality. We also knew that if the trial gloves didn"t save us money as well as meet with staff approval in terms of comfort, fit, latex sensitivity and infection control, we"d have to re-trace our steps. The pressure was on.
Analyze selection and value
Seven glove manufacturers are in our GPO. To keep the trial within the time limit, we decided to accept bids from just three of the companies. Immediately, we eliminated those companies whose gloves we were dissatisfied with and then further narrowed the list based on reputation and our working history with the companies.
Each of the three companies submitted bids based on our facility"s usage. Our hospital"s Value Analysis Committee (VAC) then reviewed each bid. The VAC is a multi-disciplinary committee. For example, as perioperative materials manager, I helped examine cost issues that didn"t immediately jump out when we first compared the raw bid data, but were important for apples-to-apples comparisons. A prime example: How many pairs of gloves come in a box? If one company sells 50 pairs per box and a competitor sells 40, you must compare per-glove prices, not per-box prices. Once we made this adjustment, we our cost saving projections were much more realistic.
We also had our latex committee report on the latest literature on latex sensitivity and allergy. Based on its recommendations, we chose not to go completely latex-free, but continue with powder-free gloves because powder in combination with latex is associated with much higher risks of latex sensitization and allergy.
During this first week, we also brought in sales reps from the three companies to help us select trial glove styles. Our only pre-requisite apart from the requirement that all three company"s trial gloves must be low-latex and powder-free was that we needed different styles appropriate for different procedures - such as a separate orthopedics glove.
In selecting the gloves, it"s very important to work with sales reps you trust. In one case, we had done a lot of business with the company and the rep was a wiz at cross-referencing different styles and fits - if many staffers preferred a certain glove type of glove, he could immediately quote other gloves with comparable feel and fit. We selected three basic styles as a rule of thumb but also had other alternatives, including a latex-free option and some different fits, if none of the three proved appropriate.
Our infection control department then analyzed glove performance. As we received trial gloves from the companies, we sent them to an independent lab to test their latex content, permeability and chemical barrier figures. The cost was nominal (about $200) and it took only about two weeks to get the data. Our infection control group then reviewed these figures and made corresponding recommendations. When we obtained the results, we were satisfied that we had high-quality options to present to our staff.
Keep staff informed and involved
Our staff knew all along that we planned to reduce the number of gloves we"d stock. One week before we brought them gloves to trial, we made clear that two goals were non-negotiable: they must rank which company"s gloves they liked best and they had to make their opinions known immediately so we could keep the trial on schedule.
So how did we get buy-in? We made participation fun and went about the task of running the trial with enthusiasm and a positive attitude. We also took great interest in everyone"s opinions and made the whole surgical team - from every surgeon to every tech - feel an important part of the change.
We held fitting sessions in the lounge. Physicians tried on different surgical gloves and chose the size and style they liked best. We filled out evaluation forms for them as they stated their preferences and then asked the docs to sign them. To encourage participation, we gave away candy and served bagels and donuts. To give the fittings even more visibility we hung up posters around the hospital and even blew up some of the gloves like balloons and painted faces on them, hanging them around the room and outside the lounge door. The result: About 65 percent of the surgeons we credential at the hospital took part in the fitting.
We then created one more effective participation incentive -- we simply pulled all of the old gloves out of circulation and replaced them with the trial gloves. In addition to our surgery department, the trial also involved our hospital"s labor unit, cardiac cath lab, interventional radiology and emergency room.
We then recorded every participant"s preference info, printed it out and posted it in every OR. As some people changed their preferences after actual OR use, we noted the changes on that form. I also increased my visibility around the facility. I walked the OR hallways and made frequent visits to our ORs to question staff and docs about their glove preferences and concerns and then had them sign off that they had replied to my questionnaire. Although we asked everyone for written user comments, we received very few of those.
Three weeks after we started the process, we finalized the choice of three styles from a single manufacturer. Much to our happiness - and relief - we heard not a single complaint. We donated our old gloves to local veterinary clinics and to a third-world country.
I"m very proud of our results. One year after the switch, our staff and physicians are happy with their glove choices and we"ve already saved $10,000, based on our annual glove usage and the per-glove cost - we"re saving between 16 cents to 89 cents per pair, depending on the style.
A little luck never hurts
In some ways, I realize we"ve been fortunate. For example, we unquestionably lucked out when we did our sizing trials. Because everybody found a glove that fit and felt reasonably comfortable, even if it wasn"t his first preference, we didn"t have to hold additional fittings or trial different styles. That"s why we were able to conclude the trial after three weeks. We had good planning, but we had some good luck, too.
We also now had an established process in place to deal with obtaining additional gloves from our supplier, if necessary. Very recently, we found that one of our nurses had been diagnosed not only with latex allergy but also with sensitivity to all types of rubber, se we now have to carry one alternative glove. Rather than re-invent the wheel or compromise our cost savings, we simply scaled the process down to meet her needs, finding her a non-rubber glove from our supplier that met her style and fit preference and then ordered small quantities for her personal use. Everyone else still use one of the original three styles.
The bottom line? Successful and timely glove trials are about 90 percent good planning and execution and about 10 percent good luck.