The latest installment of the #PWChat series centered around the topic of the lack of physician involvement in equipment & medication purchasing. It was co-hosted by Matthew Loxton (@mloxton), Healthcare analyst: Quality Assurance; and Frederick Southwick, (@FS_Southwick), Patient Safety Advocate.
The interactive chat was based on their recently published article.
Below are the highlights from the chat. You can read the full transcript here, by scrolling down to the corresponding responses.
Question 1
Q1: Why don’t physicians get included in the setting of purchasing policies as a matter of process? Given their deep understanding of the delivery of care, shouldn’t there be mandatory approval by a physician who uses the equipment or supply?#PWChat pic.twitter.com/E1utDsDDqp
— Physician’s Weekly (@physicianswkly) August 13, 2019
A1: Several factors, but no good reasons.
Physicians tend to work shifts rather than office hours, they tend to be physically distant from admin offices, and they tend not to be thought of as part of the procurement process. #PWChat— Matthew Loxton (@mloxton) August 13, 2019
A1: One of the big factors is perhaps the signaling that goes on around procurement – physicians are often not in the meetings, email groups, and distribution lists to even know that something is to be procured #PWChat
— Matthew Loxton (@mloxton) August 13, 2019
A1: A small factor may be that physicians intentionally or inadvertently exclude themselves by looking on procurement as “something admin does”, or admin see as something physicians are too busy to do #PWChat
— Matthew Loxton (@mloxton) August 13, 2019
Good question! I think that I would see how things worked with the cheaper items first and not go with brand name items. If things were good enough, I would continue to work with them. It also depends on what you are doing with them. #PWchat @PWchat
— Dr. David Epstein (@MVP_Pediatric) August 13, 2019
A1 #PWChat Physicians have a reputation for being unreasonable and at times self-centered. Each physician trained using specific equipment and desires that same equipment and can lead to an excess inventory and increase cost. Administrators prefer to avoid these confrontations
— Frederick Southwick (@FS_Southwick) August 13, 2019
Question 2
Q2: Do physicians have access to the programs or systems in which requirements are set and purchases made?#PWChat pic.twitter.com/mGA4AN48sY
— Physician’s Weekly (@physicianswkly) August 13, 2019
A2: Procurement decisions, criteria, and requirements are often set up and adjudicated by means of Enterprise Resource Planning (ERP) systems like SAP, NetSuite, Sage. Physicians may not even know these exist #PWChat
— Matthew Loxton (@mloxton) August 13, 2019
A2: For security reasons, ERP systems may not be accessible in the wards of clinical offices, and may require changes to the virtual or even physical network segmentation #PWChat
— Matthew Loxton (@mloxton) August 13, 2019
A2: ERP systems are notoriously arcane in how they work and what the GUI looks like.
To use them for procurement input, physicians may need to learn a whole new nomenclature and application behavior #PWChat
— Matthew Loxton (@mloxton) August 13, 2019
Question 3
Q3: Is physician satisfaction or rating of product quality part of the purchasing process? Just as consumer reports poll consumers about the products they use, shouldn’t physicians and nurses be polled to determine the products they find most effective and most valuable?#PWChat pic.twitter.com/fdMaLY5Y1a
— Physician’s Weekly (@physicianswkly) August 13, 2019
A3 I am not aware of polling or grading of products by physicians, PA’s or nurses. This makes sense and should be encouraged. Open table have rating scales for restaurants shouldn’t instruments undergo similar evaluation? #PWChat
— Frederick Southwick (@FS_Southwick) August 13, 2019
A3: This would seem to be a no-brainer that procurement processes would actively seek user feedback. However, this is seldom done anywhere in most orgs. Stuff gets bought based on $ and fit to written reqs #PWChat
— Matthew Loxton (@mloxton) August 13, 2019
Question 4
Q4: Do low-rated products get subjected to a review or a ban? Do highly rated products get promoted in the purchasing process?#PWChat pic.twitter.com/vETjSxJkk7
— Physician’s Weekly (@physicianswkly) August 13, 2019
A4: Another seeming no-brainer, but staggeringly few orgs seek feedback intermittently, let alone in a purposeful and predictable way.
While individuals certainly do ask how something is working out, a documented process is needed #PWChat
— Matthew Loxton (@mloxton) August 13, 2019
A4: Feedback suggests that occasional informal feedback on product or device performance is solicited from physicians, but even for high-investment devices, this is often not part of a predictable process #PWChat
— Matthew Loxton (@mloxton) August 13, 2019
Question 5
Q5: Are purchasing decisions made in places or at times that exclude physicians? Are physicians siloed out of product and purchasing discussions?#PWChat pic.twitter.com/FKoJs6yE20
— Physician’s Weekly (@physicianswkly) August 13, 2019
A5: Physicians often work hours and locations that make attendance of product review or requirements-gathering meetings problematic.
This may systematically exclude physician input in procurement #PWChat
— Matthew Loxton (@mloxton) August 13, 2019
A5 I suspect this is usually the case. Administrators will claim physicians are too busy and aren’t available and want instruments based on individual preferences rather than based on value. #PWChat
— Frederick Southwick (@FS_Southwick) August 13, 2019
A5: Requirements meetings may take significant time, but physician feedback or input could be short, or delivered by an emissary #PWChat
— Matthew Loxton (@mloxton) August 13, 2019
Question 6
Q6: Do clinicians know to whom they can send broken or defective examples for examination? Are there power struggles with particular people over purchasing decisions?#PWChat pic.twitter.com/dx9D5olxx9
— Physician’s Weekly (@physicianswkly) August 13, 2019
A6 It seems like this is always “somebody else’s problem”, so broken stuff gets hoarded and eventually thrown away, but seldom finds it’s way up a path to informing better decisions #PWChat
— Matthew Loxton (@mloxton) August 13, 2019
A6 Surgeons and interventional radiologists would be best to comment on this issue. i know their have been problems with insertion needles severing catheters leading to migration to the right heart requiring a safety report #PWChat
— Frederick Southwick (@FS_Southwick) August 13, 2019
A6 Maybe we need a kind of quarterly 5S program that tags broken, defective, or undesirable stuff.
No names, no pack drill, but an amnesty day on bad stuff#pwchat
— Matthew Loxton (@mloxton) August 13, 2019
Question 7
Q7: Do clinicians get sample products to examine or try before purchasing? Is there a mature piloting process in which clinicians can test out prospective products as part of evaluation?#PWChat pic.twitter.com/Z3pq6y1eKV
— Physician’s Weekly (@physicianswkly) August 13, 2019
A7: This is not the same as the free drug samples provided by pharma reps.
We are talking samples of proposed products that can be used in a clinical setting to see if they perform well in a real life environment #PWChat
— Matthew Loxton (@mloxton) August 13, 2019
A7: Here we are looking for a systematic release of samples to the clinical environment, deliberate tracking and recording of performance, and structured feedback on performance #PWChat
— Matthew Loxton (@mloxton) August 13, 2019
A7: The feedback suggests that while samples are sometimes given to wards, this is seldom done in a deliberate, controlled, and structured manner, reducing the opportunity to make informed procurement decisions #PWChat
— Matthew Loxton (@mloxton) August 13, 2019
Question 8
Q8: Some companies provide lodging, meals, etc to influence physician choices of equipment. Do you avoid such conflicts of interest? Do you think such circumstances are a problem? #PWChat pic.twitter.com/x85akdudpj
— Physician’s Weekly (@physicianswkly) August 13, 2019
A8: Feedback is that anything that looks like a reward is carefully monitored, but vendors are highly creative, and can seek to influence decisions #PWChat
— Matthew Loxton (@mloxton) August 13, 2019
A8 This was certainly true in the past, but most medical schools have strong conflict of interest reporting requirements and also there is a public site that reports all services and fees provided to physicians by companies. #PWChat
— Frederick Southwick (@FS_Southwick) August 13, 2019
A8: A bigger problem maybe is that procurement decisions are often not made by physicians, and physicians often have scant insight into who does, whether there is undue influence, and to what degree physician input directs purchases #PWChat
— Matthew Loxton (@mloxton) August 13, 2019
A8 To my knowledge administrators do not have to report gifts from medical device companies. This a potential serious loophole #PWChat
— Frederick Southwick (@FS_Southwick) August 13, 2019
Question 9
Q9: What are the key factors in having physician voice integrated in purchasing decisions, and how do we get there?#PWChat pic.twitter.com/kgmLhQbhvX
— Physician’s Weekly (@physicianswkly) August 13, 2019
A9 Physicians take on leadership roles in your health systems and create an effective system to objectively evaluate new products. This will save money. Physicians need to be willing to put in the time. Shouldn’t this service be paid for by the health system? #PWChat
— Frederick Southwick (@FS_Southwick) August 13, 2019
A9: The 1st and foremost factor is getting physicians voice into the process.
Getting product samples in their hands early, getting their requirements upfront, and soliciting early feedback on performance #PWChat
— Matthew Loxton (@mloxton) August 13, 2019
A9: A final point is that time spent on documenting requirements, vetting products, and providing structured feedback on performance saves time and avoids frustration later #PWChat
— Matthew Loxton (@mloxton) August 13, 2019
