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JUNE 1999, VOL 69, NO 6 PRESIDENT’S MESSAGE Let‘s talk about purchasing power n the 1960s, Peter Drucker coined the expression “knowl- edge worker” to reflect the new role of workers in a world economy shifting from the pro- duction and distribution of goods to the production and distribution of knowledge and information.’ Drucker gives an example used by the pharmaceutical industry- their actual products are not “pills” or “ointments” but the knowledge about education and health care associated with the products. In this economy, wealth is created by information and knowledge. In another book, Drucker specifically identifies nurses among those who actually do most of the knowledge work in health care organizations. He cites the nurse’s economic value related to the skill and knowledge employed in patient care.? It is the perioperative nurse’s skill and knowledge that forms the founda- tion of purchasing power-the ability to influence the acquisition of products or services. The value of knowledge workers is that they know more than anyone else in the organization about something in particular, according to Thomas Petzinger.’ Perioperative nurses add value to themselves and their organizations because of their unique knowledge and experi- ences caring for surgical patients. PERCEIVED CONSTRAINTS If the existence of purchasing contracts makes you conclude that you have no influence in purchas- ing decisions, ask yourself: How are purchasing decisions made? By whom? Based on what crite- ria? As a perioperative nurse, you play a critical role in answering each of these questions. Prospective reimbursement and managed care mandate that pur- chasing decisions no longer are made by one individual. They are made by a group of people. The group can include purchasing agents, materials managers, surgi- cal services directors, administra- tors, surgeons, and nurses. The most effective groups will include the people with the greatest knowledge of the patient and the product’s use, effectiveness, and intended purpose. Administrators are wise to tap into the knowledge resources of their employees. When the expert users are not included in decision making, expensive mistakes are more like- ly to occur. If you are of the opinion that your expertise is not a valuable commodity, consider how it has been put to (lucrative) use by cost- reduction specialists hired by many health care institutions. Many of the supply-reduction and cost-savings recommendations made by consultants come directly from interviews with clinical staff members who already have identi- fied areas of waste and duplication (ie, unused “toys,” three kinds of silk ties, two types of aortic punches). My point is not that perioperative nurses should not cooperate with consultants. My point is that we should recognize and articulate to administra- tors our collab- orative role in identifying unnecessary or wasteful inven- tory and share in the recogni- tion of enhanc- ing cost-effectiveness. PATRICIA C. SEIFERT ENHANCING YOUR PURCHASING POWER Perioperative nurses are faced almost daily with new technology, new products, and new tech- niques. Serving as a patient advo- cate can be accomplished by focusing on the patient, practicing lifelong learning, understanding the health care system, building relationships, and sharing your expertise. Focus on the patient. You have the knowledge and experiences to determine the needs of your patient population and how to identify which equipment and supplies are best suited to the sur- gical procedure for your individ- ual patient. Does your cardiac patient have preexisting bleeding tendencies that contraindicate implantation of a valve prosthesis requiring chronic anticoagulation? Is your laminectomy patient aller- gic to latex? Does your mastecto- my patient have extremely frail skin with minimal adipose tissue? These considerations all have implications for the kinds of prod- ucts required to achieve success- ful outcomes. Your awareness of 1092 AORN JOURNAL

Let's talk about purchasing power

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JUNE 1999, VOL 69, NO 6

P R E S I D E N T ’ S M E S S A G E

Let‘s talk about purchasing power n the 1960s, Peter Drucker coined the expression “knowl- edge worker” to reflect the

new role of workers in a world economy shifting from the pro- duction and distribution of goods to the production and distribution of knowledge and information.’ Drucker gives an example used by the pharmaceutical industry- their actual products are not “pills” or “ointments” but the knowledge about education and health care associated with the products. In this economy, wealth is created by information and knowledge.

In another book, Drucker specifically identifies nurses among those who actually do most of the knowledge work in health care organizations. He cites the nurse’s economic value related to the skill and knowledge employed in patient care.? It is the perioperative nurse’s skill and knowledge that forms the founda- tion of purchasing power-the ability to influence the acquisition of products or services. The value of knowledge workers is that they know more than anyone else in the organization about something in particular, according to Thomas Petzinger.’ Perioperative nurses add value to themselves and their organizations because of their unique knowledge and experi- ences caring for surgical patients.

PERCEIVED CONSTRAINTS If the existence of purchasing

contracts makes you conclude that you have no influence in purchas-

ing decisions, ask yourself: How are purchasing decisions made? By whom? Based on what crite- ria? As a perioperative nurse, you play a critical role in answering each of these questions. Prospective reimbursement and managed care mandate that pur- chasing decisions no longer are made by one individual. They are made by a group of people. The group can include purchasing agents, materials managers, surgi- cal services directors, administra- tors, surgeons, and nurses. The most effective groups will include the people with the greatest knowledge of the patient and the product’s use, effectiveness, and intended purpose. Administrators are wise to tap into the knowledge resources of their employees. When the expert users are not included in decision making, expensive mistakes are more like- ly to occur.

If you are of the opinion that your expertise is not a valuable commodity, consider how it has been put to (lucrative) use by cost- reduction specialists hired by many health care institutions. Many of the supply-reduction and cost-savings recommendations made by consultants come directly from interviews with clinical staff members who already have identi- fied areas of waste and duplication (ie, unused “toys,” three kinds of silk ties, two types of aortic punches). My point is not that perioperative nurses should not cooperate with consultants. My point is that we should recognize

and articulate to administra- tors our collab- orative role in identifying unnecessary or wasteful inven- tory and share in the recogni- tion of enhanc- ing cost-effectiveness.

PATRICIA C. SEIFERT

ENHANCING YOUR PURCHASING POWER

Perioperative nurses are faced almost daily with new technology, new products, and new tech- niques. Serving as a patient advo- cate can be accomplished by focusing on the patient, practicing lifelong learning, understanding the health care system, building relationships, and sharing your expertise.

Focus on the patient. You have the knowledge and experiences to determine the needs of your patient population and how to identify which equipment and supplies are best suited to the sur- gical procedure for your individ- ual patient. Does your cardiac patient have preexisting bleeding tendencies that contraindicate implantation of a valve prosthesis requiring chronic anticoagulation? Is your laminectomy patient aller- gic to latex? Does your mastecto- my patient have extremely frail skin with minimal adipose tissue? These considerations all have implications for the kinds of prod- ucts required to achieve success- ful outcomes. Your awareness of

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different products, whether heart valves, alternatives to latex, or various positioning and protective devices, reinforces your role as patient advocate.

The US Food and Drug Administration is increasingly interested in safety factors and ergonomic considerations in the development and use of surgical products and devices. Perioperative nurses are can identify potential hazards and suggest improvements in product performance. Participate in prod- uct evaluations at your institu- tion, at AORN Congress, and other educational meetings and make recommendations for prod- uct selection based not only on cost, but also on safety factors, effectiveness, and other quality indicators. Work with company representatives to initiate the safe use of new products, evaluate their effectiveness, and report product performance problems.

Be a life-long learner. Leaming what is new in surgery is both a challenge and commitment. AORN Congress exhibits are a one-stop shopping mecca that provides opportunities for leaming. You may not be buying a new OR bed, autoclave, or lighting fixtures, but your institution is likely to be look- ing for some new product or device. Find out what is new, what is better, and what is more suitable to your needs and to your patients’ needs. Visit companies’ web sites to learn about new products. Continuously improve your clinical knowledge and skills. Keep up with nursing and surgical literature related to your specialty areas to familiarize yourself with the latest trends in technology and clinical practice. Anticipate the develop- ment of new products related to these trends. Review A 0 R ” s

“Recommended practices for the evaluation and selection of prod- ucts and medical devices used in perioperative practice settings” and “Recommended practices for use and selection of barrier materials for surgical gowns and drapes.”“

Share information about new products that may be more

efficient and/or less expensive than current items.

Discuss new products and their value to your situation with product representatives. Share the names of your OR purchas- ing team members (eg, director, materials manager, clinical spe- cialist, surgeons) with the exhibitors and plan to meet with product representatives who have products of special interest to you. Share your business card with exhibitors; have cards made for yourself if you do not have them. When you return to your institution, share the names of the exhibitors who have appeal- ing products with the members of your purchasing team.

Understand the system. Recognize that the buyer or pur- chasing agent is only one of many people involved in pur- chasing decisioms Be aware that contracts are renegotiated. Learn what the negotiation and renego- tiation schedule is, and provide input to the people responsible. Understand the regulations

affecting products and devices to enhance your compliance with the many existing rules and reg- ulations. If your institution has a product evaluation committee, get to know the members of the committee and offer your expert- ise on issues affecting your clini- cal specialty. Your most valuable asset in these negotiations is your clinical knowledge and expertise, and no one else has the insights, the relationships, or the experiences you bring to the bargaining table.

Build relationships. Your influence is enhanced by the rela- tionships you develop with your colleagues, administrators, pur- chasing agents, supply managers, and industry and product repre- sentatives. Communicate with surgeons and perioperative col- leagues about procedures and patient-specific needs. Share information about new products that may be more efficient and/or less expensive than currently used items. Invite administrators and financial executives to observe surgery or tour the OR. Their ability to have a mental picture of supplies and equipment being used when they are reviewing budgets makes requesting new items easier to justify.

Get to know the staff mem- bers who prepare patient bills and be available to answer ques- tions about charges that may not be clear. Participate in product evaluation committees. If the sur- gical services director is the department representative, offer your services as a clinical expert to the representative and other committee members. Your expertise is valuable in deciding between two similar products or in substantiating the need for a new or different product.

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Build and maintain relation- ships with the product represen- tatives. They often are product experts and can provide inser- vice programs about new prod- ucts or orient staff members. Do not allow the existence of con- tacts to prevent cultivating and maintaining the relationships. Over the years, I have known many people who are product representatives and have enjoyed helping new representatives learn about the OR culture, nurs- es, surgeons, and other members of the health care team. If a product representative stops by without an appointment, I always try to make the time to say hello and set up a future appointment. Your support of industry enables the representatives to support you with continuing education, scholarship grants, and leader- ship development. These are a few examples of the ways that

industry supports AORN and its members at the local and the national levels.

product information from the AORN Congress and other con- ventions back to colleagues. Invite surgeons and other members of the surgical team to meetings where product information will be shared. Present inservice pro- grams on the use of products and their application to safe, effective patient care.

New product development is an important area in which peri- operative nurses have collaborated with industry. As members of the surgical team who use products and view product performance, nurses provide important informa- tion concerning development and improvement. From the Peers towel clip (named for Jerry G. Peers, AORN past President and Executive Director) and the

Share your expertise. Bring

Baumgarten needle holder (named for Gwen Baumgarten, former head nurse at the Texas Heart Institute), to current and future minimally invasive devices and instruments, nurses can provide input into ergonomically sound and clinically safe products.

CONCLUSION

ally increasing in this era of the knowledge worker, but only if you create what Leland Kaiser calls a mental model of yourself as a knowledge worker whose expertise creates value to your organization.b

Your purchasing power is actu-

PATRICIA C. SEIFERT RN, MSN, CNOR, CRNFA

PRESIDENT

President Seifett can be contacted by telephone, (800) 755-2676 x 83 1 I ; e-mail, SeifettPC@aol. com; or fax, (703) 237- 1259.

NOTES

Harper Business, 1993).

Truman Talley Books, 1992).

Women Who are Transforming the Workplace and the Mar-ketpluce (New York: Simon & Schuster, 1999).

4. “Recommended practices for the evaluation and selection of products and medical devices used in periopera- tive practice settings,” Standards, Recommended Practices, and Guidelines (Denver: Association of Operating Room

1. P F Drucker, Post Capitalist Society (New York:

2. P F Drucker, Manuging for- the Future (New York:

3. T Petzinger, Jr, The New Pioneers: The Men and

Nurses, Inc, 1999) 293-296 “Recommended practices for use and selection of barrier materials for surgical gowns and drapes,” Standards, Recommended Practices, and Guidelines (Denver: Association of Operating Room Nurses, Inc, 1999) 245-248.

5. B S G Dawes, “New products, new information, new needs,” Orthopedic Specialty Assembly Newsletter 6 (Spring 1999) 124.

6. L R Kaiser, “Opportunities and challenges facing health care professionals in the new century,” speech pre- sented at the 46th annual AORN Congress, San Francisco, 29 March 1999.

Call for AORN 2000 Congress Research Poster Abstracts The deadline for submitting abstracts for research posters to be displayed at the 2000 Congress in New Orleans is Oct I , 1999. For more information, send

an e-mail to [email protected] or call AOR”s Fax on Demand at (800) 755-7980 and request the free document #5224 for details.

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