The Death of Surgeon Preference

If you were stranded on an island for the rest of your life, what one food would you choose to have an endless supply of? We have all answered this question at least once in our lifetime, but why do people love to ask it and what are they trying figure out about us when they do?

 

All About the Preference

 

Ultimately, these types of questions all boil down to identifying a person’s preferences. The definition of a preference is “something or someone that is wanted more than another,” and the beautiful thing about preference is there is generally no right or wrong. It's just a matter of personal opinion.  We all have preferences and understanding how these decisions impact a person across a variety of topics is one of the best ways to get to know them better. Do you like going to the movies? Which is your favorite genre of music? Naturally, having the luxury of choice and doing things we prefer over things we don’t prefer is proven to help us to feel more comfortable and in control.  But if this is true, why do those of us in healthcare have a tendency to look down on a surgeon’s preference? After all, if there is any place on earth you want someone feeling comfortable and in control it’s during surgery, right? 

 

As it stands today, and unfortunately for our surgeons, the concept of surgeon preference is dying. Like frogs in tepid water slowly coming to a boil, clinical preferences are being taken away from physicians at a slow, but steady rate. Healthcare cannot continue to operate on 1% margins. Hospital resources are simply too thin to negotiate with one off-vendors, and supply chains are completely obedient to the concept that healthcare must standardize to survive. With each passing day, more surgeons will be forced to comply with hospital contracts and inventory standards while continuing to complete their unique and complex lifesaving events on a daily basis.  That is unless we, as clinical staff and good stewards to all future patient’s safety, can find a way to cool down the rising water temperature just long enough to endure healthcare’s journey through digital transformation. At which point technology will enable us to overcome current logistical limitations associated with accommodating moderate levels of preference.  

 

Sustain Surgeon Preference: 3 Simple Steps

So, what’s the answer? How do we turn down the heat and keep surgeon preference alive? Well, it's actually fairly simple:

  1. Document surgeon preferences.

  2. Establish an accountable preference scale

  3. Analyze associated costs for your facility or health system.  

Step 1: Documentation

In most hospitals today, surgeon preference items have never actually been documented. Instead, the knowledge exists in the minds of the surgeon and in the minds of their most trusted clinical team. The frequency and level of issues we have come to accept as the norm, is nearly unbelievable, merely because we have not taken a few extra minutes to properly document surgeon preferences. Think about your own facility, how many times can you recall coming across an inaccurate instrument mid-surgery? It is clearly a newly replaced item, similar to what was seen before but not at all identical. What happened in that moment when your surgeon went to use said instrument? We’ve all been there…and we can bet it wasn’t pretty. Oh the stories we can all recite… but it’s important to take into account the possibility that the same instrument may have been improperly ordered more than 10 times over the past few years.  The difference is documentation. I recommend printing out your count sheets for one specialty and sitting down with the most experienced OR specialty leader.  In 30 minutes or less, you can more than likely assign your surgeon’s names to each preferred instrument line.  Once documented, store this information in your asset management system and build a master list that can be shared, referenced, and even analyzed. 

 

Step 2: Accountable Preference Scale

If China can create a social credit score for their entire population, then our hospitals can measure acceptable levels or norms for preferences across multiple hospitals, specialties and even procedures. For example:

  • If 20 of your surgeons perform a total knee procedure with 3-5 trays and one surgeon uses 11, who should be held accountable for reducing their total # of trays?

  • If an average cardio vascular surgeon has 12-15 unique instruments in your inventory that are preference items and another surgeon has 75 instruments, how do you deal with the variation in preference?

  • If you have 700 surgeons whom have preferences that range between 3%-15% of their inventory and one that has preferences for 45% of their inventory, shouldn’t that at least be considered in a performance review? 

A certain level of preference has to be expected, particularly in an environment such as surgery.  Rather than follow this pendulum swing toward no preference, we can use simple math to define and differentiate between acceptable and excessive preference.

 

Step 3: Analyze Preference Costs

Supply costs are hospitals second largest cost next to labor and are growing a twice the rate. Hospitals are incentivized to reduce costs as quickly as possible, so standardization and minimalization of physician preference take a front seat because it is the obvious, low hanging fruit in the facility.  However, given recent data analysis over a sizable number of hospitals, the actual opportunity within surgeon preference pales in comparison to the savings that result from the removal of unused and unwanted surgical instruments. Coupled with the implementation of simple care and handling techniques that can extend your instruments span of life, there is tremendous opportunity right in front of us. I recommend you utilize your newly documented preference list to measure how many preference items you have in inventory. What is the cost of that preference item vs. the so-called equivalent? How many of them are you ordering on an annual basis? Unless you are accommodating significant preference across the spectrum of implants, the analysis will speak for itself. Even if you decide against accommodating preference, there is real value in knowing what your hospital currently spends per year ensuring your surgeons remain comfortable and in control of their surgical procedures.  

  

At the end of the day, I am proposing we control unnecessary variance or preference levels and use more clear data to drive accountability and truly measure costs.  Once the facts are known, I can assure you the rising temperature on surgeon preference will slow down and probably even shift altogether.  As a patient, and within reason of course, I like the idea of knowing my surgeon has the instrumentation he or she wants and feels comfortable with. Just the same, if I ever happen to be stranded on an island for the rest of my life it better have my favorite Chicago-style pepperoni pizza.  

Brian Reed