Although outpatient surgery facilities place a huge emphasis on saving time and money, they recognize the value of investing both when they are purchasing capital equipment. Our latest reader survey on capital equipment buying habits indicates that facilities are relying more on OR managers, administrators, and staff to provide input for choosing equipment such as tables, surgical lights, and sterilizers, and they are willing to pay more to ensure that the equipment they purchase will satisfy their surgeons and staff, as well as provide long-lasting value. We surveyed 500 readers for this survey; 53, or 11 percent, responded.

No one group of decisionmakers has the most influence on all equipment purchases, our survey indicates. Most of our respondents (79 percent) say that, overall, buying equipment is a shared decision, with surgeons, administrators, and staff all playing relatively equal roles, although the final decision usually rests with a few individuals. Says an OR materials coordinator at a Pennsylvania facility: "We want to make sure everyone is involved in the decision, although the final decision lies with the nurse director and myself." A few facilities have developed formal committees, with representatives from many different departments, to oversee these decisions. Linda Lund, the director of perioperative services at the Regional West Medical Center in Scottsbluff, Neb., says that in her facility, "any capital equipment purchase over $25,000 is reviewed by a committee consisting of four administrators, four physicians and four staff with final approval ability." An administrator at a Maryland facility states that selection is always a shared decision, "and then the choice is presented to the Medical Executive Committee and partnership meeting."

Some respondents indicate that they are tapping employees and departments that, until now, had not played a large role in capital equipment decisions. Says one director of surgical services at a Louisville, Ky., hospital, "Materials management is playing a more significant role than they did previously."

Perhaps not surprisingly, different decisionmakers exercise different levels of influence, depending on the equipment being chosen. Fifty-one percent of our respondents indicate that administrators or OR managers have the most influence when choosing OR tables; 30 percent say that staff have the most impact. Administrators and staff also have the most impact on sterilizer purchases; 72 percent of our respondents say administrators or OR managers have the most impact on these purchases and 28 percent say that staff have the most impact. Surgeons have the most influence on surgical light selection; 57 percent of our respondents identify them as having the most impact on these purchases. They also have the most impact on OR microscope purchases; 92 percent of our respondents name them as the most important decisionmakers for these devices. Anesthesiologists have the most influence on monitors (77 percent); also, not surprisingly, 98 percent of our respondents say they have the most impact on anesthesia machine selection.

The impact of non-physician staff on choosing capital equipment may be increasing, according to our survey. Forty-seven percent of our respondents indicate that administrators' and OR managers' impact on choosing capital equipment has increased over the past five years, and 38 percent say that staff now have more of an impact. Only two percent feel that OR managers and administrators have less of an impact, while nine percent feel that staff have less influence. While surgeons and anesthesiologists undoubtedly play major roles when selecting equipment, their influence, in some facilities, seems to be reaching a plateau, and, in some cases, decreasing. Consider that while 30 percent of our respondents say their surgeons' impact has increased, 47 percent say it has stayed the same, and 21 percent say it has decreased. Equal numbers of respondents (13 percent) say that the influence of anesthesiologists in their facilities has increased or decreased; most respondents (72 percent ) say that it has stayed the same. More than one respondent alludes to the shift of influence that may be occurring in many facilities. Says a technology director from an Ohio hospital: "Surgeons have a weighted voice in purchase decisions, but they do not have the exclusive voice."

Our survey indicates that the preferences of both surgeons and staff are the most important factor when it comes to purchasing equipment. When asked to rate surgeon and staff preference, cost, reputation, technical innovation, and service availability from one to five (one being the most important and five being the least important), 66 percent rate surgeon and staff preference as number one or two. Cost is the next most critical factor; 58 percent rate it either one or two. Technical innovation and availability of service were equal in importance (36 percent rated each factor either one or two).

"The assistance and availability of the company representative to help with set up and service are extremely important for both new and used equipment," says an OR supervisor from an Idaho surgery center. Company reputation was considered to be less important than the other factors, with only 17 percent of respondents rating it one or two.

Although cost is a significant factor, many facilities seem to be willing to spend extra to ensure quality. Says a facility manager from an Ohio hospital: "Our capital equipment purchases last until they wear out. We buy top-of-the-line items that will last use and abuse." Says a respondent from another Ohio hospital: "We purchase by quality, ease of use, and cost-in that order."

Most facilities that we surveyed, 75 percent, plan to buy new equipment, but many are willing to give refurbished equipment a try: 11 percent say that they will definitely buy refurbished, while 11 percent say that they may purchase either. Fifty percent of our respondents agree that refurbished equipment offers the same or better value than new equipment; only 11 percent say it offers a poorer value, and 32 percent have no experience with refurbished equipment.

An OR supervisor from an Idaho surgery center states that refurbished equipment may offer comparable value to new equipment, but she urges vigilance when purchasing the latter: "I have found both new and used equipment can be cost saving, but have the warranty and service contracts spelled out clearly in writing before you purchase used equipment."

As financial pressures continue to increase, facilities will undoubtedly be examining every penny that they spend even more closely. It may be fair to say that the comment of a surgical services director for a New York hospital will become their mantra: "At a time when finances are limited, it is important to get the best value for your dollars spent."