TOPIC : Value Based Purchasing

(1) Conduct library and internet research to create an annotated bibliography based on your topic (Value Based Purchasing) in the HCS project. Cite references into a bibliography and format your reference into a list conforming to the APA style.

(2) Use 3 resources/citations for annotated bibliography. All these resources should be journal articles, books, or published reports (do not use unpublished web resources). Summarize your citations and reflect upon their contribution on describing your group’s topic on the project.

The Case: Issues with Standardization of Products

You are the OR Director at Metropolitan Suburban Hospital. You’ve come to realize that there are two major companies that manufacture sutures for the operating room. At this time your operating room is using the most popular sutures on the market. The leading competitor gives you a proposal for switching sutures. By using their comparable sutures your hospital could potentially save almost $2 million next year.

In order to see if the sutures are acceptable, you begin a clinical trial. The trial consists of new sutures being offered to the surgeons, with a representative explaining the similarities and differences. After using the suture, the surgeon is to fill out an evaluation, assessing how he/she perceived the suture to handle and whether or not it was truly equivalent to the old suture.

The company supplied a representative to be in charge of this evaluation. The representative was an extremely attractive young lady, who not only explained the sutures, but was also quite flirtatious toward the surgeons. She wore loosely fitting scrub suits and made a habit of bending over and picking up product from her cases that were always on the floor. The surgeons, for the most part, found her attractive and pleasant. After they were done with the surgery, she would hand them the evaluation form. Not surprisingly, most of the surgeons gave the new suture very high ratings.

The data were compiled and showed that the new suture was not only comparable, but may be even preferred over the old suture. The results of the survey were presented at a meeting of the Surgical Executive Council, a group comprised of the leadership of surgeons in the hospital. Interestingly enough, the presentation was done in the absence of any representatives from the company. After the presentation was completed it was suggested that, since the two suture product line were equivalent, there did not seem to be any reason why the hospital should not go with the product that would have save the $1.8 million.

At that point there was a lot of dissension among the surgeons, who stated that they would not use the new suture. Furthermore, if they were forced to use a new suture, they would consider taking their work to a nearby hospital. Being perplexed by this, you asked them how they could have evaluated the suture so highly even they thought so poorly of it. To a person they all stated they did not wish to offend the representative and they falsely evaluated the sutures.

The repercussions of switching the sutures became so great that the hospital was forced to return the original suture, despite several of the senior surgeons indicating that it probably made no difference in terms of outcome as to what suture was used. This was definitely a minority opinion.

Case Questions
1. What are the pertinent issues in this case?
2. What were the problems with the way evaluation of the product was designed and carried out?
3. What are the supply-side and demand-side implications of this scenario?
4. Design a method for product evaluation that would eliminate bias and assure the collection of accurate data.
5. Knowing surgeons are creatures of habit, how might one design a clinical trial that could make surgeons more comfortable with using a new product?

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Product Standardization

Standardization Case Study
The case of Metropolitan Suburban hospital testing and clinical trials of sutures that were supposed to replace old sutures and potentially save the hospital two million dollars a year raises some pertinent questions about the role of bias in clinical testing. In an ordinary setting, evaluation is supposed to be conducted in an environment lacking undue influence from an outside party either implicit or explicit. In a clinical setting or in other areas where a new product is supposed to hit the market and compete with what has been in use, efforts should be made to randomize and blind the products. Blinding and randomization are achieved by prepackaging different products and making them look as similar as possible then allowing the consumers to give an expert opinion. In the trials conducted at the Metropolitan Hospital, the pertinent issues were that the study was conducted in a way that intimidated the concerned parties since the sales representative was present when they assessed the product. The other pertinent issue was that such a design of the test exposed the surgeons who would feel obliged to endorse the product that they felt was inferior because the study did not allow for anonymity. The sales representative was authorized to control the process handing over the documents where the merits of the new sutures would be recorded. Vendors are allowed in the operating room, but they are not to be allowed to dominate the process. In an ideal setting, the manner of kitting should be as per specifications, and the surgeons are at liberty to demand non-interference through flirtatious attempts or unnecessary demonstrations.
To eliminate bias in research endeavor or a clinical trial of a product, all efforts should be made to ensure that the persons conducting the research do not readily recognize which product is under test. The...
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