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The development of an integrated system for the management of pharmaceutical and surgical consumable products across a group of private hospitals : innovation report

By Dena Van den Bergh


Continued pressure to reduce costs and manage healthcare delivery in risk-based reimbursement\ud environments, has, internationally, resulted in hospitals adopting different methods to manage\ud pharmaceutical and surgical consumable products. An initial review of systems of management of\ud these products showed that the trend is to manage them separately. Pharmaceutical products are\ud managed using dedicated resources and structures in each hospital, which may be difficult to\ud establish and sustain in smaller, non-academic hospitals. Amongst other factors, the absence of a\ud classification system and a lack of utilisation information hindered the development of management\ud systems for surgical consumable products. In addition, traditional materials management processes\ud applied to these products, often do not adequately address the impact that these products have on\ud clinical care. In this study, the decision was made to develop an integrated system for both\ud pharmaceutical and surgical consumable products and to adopt a systems approach in which all\ud hospitals in the group were included as a single system.\ud The study was multi-methodological with the design being contextual and qualitative and the\ud research strategy, exploratory and descriptive. A multi-phased, action research approach was used,\ud comprising of three (3) cycles, two (2) in which the integrated system was developed and enhanced\ud and a third in which it was independently tested in 19 newly acquired hospitals.\ud The result of the three (3) cycles was an implemented integrated system across 43 acute-care\ud hospitals in the group comprising six (6) processes namely: a product selection process,\ud information technology (IT) support system, a hospital implementation process, measurement and\ud management tools, pharmacy capability and a supplier strategy and interface process. These\ud processes included several key unique features, such as one (1) product selection team for all\ud hospitals, a surgical classification system based on functional therapeutic uses, a single IT system\ud and utilisation review capability for all products, extending the role of pharmacy departments in\ud hospitals to include the management of surgical consumable products and an integrated quality\ud assessment process for both types of products. By the end of the three (3) cycles (September\ud 1999), the product selection process covered 66,5% of value of product spend, the percentage\ud reduction in the number of products used was 68% and the value of products purchased that\ud complied with specified products and suppliers was 90%. Ongoing and further application showed\ud that the integrated system could be sustained in existing hospitals, applied to a further four (4)\ud newly acquired hospitals and expanded to include specialised pharmaceutical and surgical\ud consumable products in cardiac catheterisation laboratories. By September 2003, the total spend\ud on pharmaceutical and surgical consumable products had reached R1,7 billion. The product\ud selection process covered 67,6% of total spend, the compliance value reached 95% and there were\ud additional financial improvements realised.\ud Following a further literature review, limitations and improvements to the approach were identified\ud and further adaptations were added as concepts in the graphic representation of system. One (1) of\ud these was to show the integrated system as an open system. The second adaptation highlighted\ud the systems-based input-process-outcomes feedback concept that is critical to continuous\ud improvement of the system. In the final progression, a systems approach to strategic planning and\ud management was incorporated in order to provide a structured approach for adapting to the rapid\ud and ongoing changes in healthcare and aligning the system of management of pharmaceutical and\ud surgical consumables to the overall business strategy.\ud Overall, this research study succeeded in bringing new perspectives and an innovative approach to\ud the management of pharmaceutical and surgical consumable products by developing and\ud implementing an integrated system for both products, establishing essential processes with key\ud unique features and tools, and the application of a systems thinking approach. Four (4) areas of\ud further research are suggested, namely testing the integrated system in other contexts, improved\ud methods of measurement of quality of care, extension to other areas of healthcare and use of the\ud systems approach in other areas of the business

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  1. (2000). AHL Annual Report and Financial Statements.
  2. (2003). Competitor Analysis.
  3. (2005). Customer Feedback Report.
  4. (2001). Pharmaceutical care management: A modern approach to providing seamless and integrated health care. doi
  5. (2000). Coalition Working Group: Principles of a sound drug formulary system.
  6. (2004). ASHP guidelines on the pharmacist's role in the development, implementation and assessment of critical pathways.
  7. (1983). ASHP statement on the formulary system.
  8. (1996). Code of ethics for pharmacist.
  9. (2002). Health-system pharmacy: New practice framework and leadership model.
  10. (2000). From the sharps safety front. Materials managers, clinicians team up to resolve sticky issue. Materials Management in Health Care,
  11. (2001). Branching into finance. Duties expand beyond the realm of purchasing and supply chain management.
  12. (1996). Using systems thinking to increase benefits of innovation efforts. [Online]. Avaialble at: // www. thinking. net/SystemsThinking/ systems_thinking>. Accessed on 16/04/2004.
  13. (2002). Crafting a change message to create transformational readiness. doi
  14. (2002). The practice of social research. South African Edition. Cape Town:
  15. (2000). Restrictive antibiotic policies - how effective are they?
  16. (1999). Medical Aid: The load shifts.
  17. (2001). Introduction to Health Services Management. 2nd ed.
  18. (2001). The big health squeeze.
  19. (1993). Social change through collective reflection with Asian nongovernmental organizations. doi
  20. (2001). The practice of nursing research:
  21. Available at: //www. dictionary. doi
  22. (1995). Reengineering: A light that failed.
  23. (1995). Organisational development research (ODR): Instruments.
  24. (1997). Systems thinking: A requirement for all employees.
  25. (1995). What is participatory research? doi
  26. (1993). ASHP national survey of hospital-based pharmaceutical services -
  27. (2004). New providers in UK health care. doi
  28. Pharmacy intervention monitoring -a clinical tool.
  29. (2000). Postgraduate programs using action research. doi
  30. (2004). [Online]. Available at: //www. dictionary. com/ integrate>. Accessed on 18/06/2004.
  31. (1991). Cogenerative learning.
  32. (2002). Forcing costs down.
  33. (1999). Five frogs on a log: A CEO's field guide to accelerating the transition in mergers, acquisitions, and gut wrenching change.
  34. (1999). Rational pharmacotherapy in the Netherlands: Formulary management in Dutch hospitals. doi
  35. (2001). A comprehensive system for managing medicines in secondary care.
  36. (2003). Reflections on reciprocity in professional development: Learning partners as professional learning teams.
  37. (1995). Total systems intervention: critical success factors for a systems based problem solving system.
  38. (1994). A view from a managed care provider. doi
  39. (1994). The illusive logic of integration.
  40. (1994). Action research: A few details, a caution and something new. doi
  41. (1986). Action research and human interests.
  42. (1998). The manager's pocket guide to systems thinking and learning. Amerherst:
  43. (2000). The Systems Thinking Approach to Strategic Planning and Management. doi
  44. (1993). Reengineering the corporation. doi
  45. (2000). Fortress and formularies.
  46. (2000). Implementing yesterday's promises.
  47. (2002). Material strategies.
  48. (2003). Equipped to care and save. Supply Management,
  49. (1995). Promoting rational prescribing: An international perspective. doi
  50. (2000). Afrox Healthcare: Patients will reward patience.
  51. (1997). Ready for change.
  52. (1999). Health care technology assessment - the South African health care system in transition.
  53. (1991). Action research as method.
  54. (1992). The action research planner. doi
  55. (1996). Innovative work environments: The role of information technology and systems.
  56. (2002). Using medicines wisely.
  57. (1995). Why transformation efforts fail. Harvard Business Review, March/April: 59-67 LANGLEBEN, doi
  58. (1996). Learning organisations [Online]. Available at: //www.
  59. (1985). Naturalistic inquiry. doi
  60. (1995). Pharmacists as agents of change for rational drug therapy. doi
  61. (1997). Hospital formulary and drug selection.
  62. (2000). Action research in health care.
  63. (1992). Basiese begrippe: Metodologie van gedragwetenskappe.
  64. (2001). Pharmaceutical restrictions - possible effect on patient/physician buy-in of disease management programs. doi
  65. (2004). Joining sides. doi
  66. (1998). An overview of the methodological approach of action research.
  67. Available at: //www. doi
  68. Action research in graduate management research programs. Netherlands: doi
  69. (1999). Nursing research principles and methods. 6t' ed.
  70. (2000). A systems-based framework for continuous improvement: A service sector application.
  71. (1996). Organization in health services.
  72. (2001). Introduction to health service management. Cape Town: Juta
  73. (2004). Advances in postoperative pain management: The pharmacy perspective.
  74. (1990). The fifth discipline. doi
  75. (2000). Managing medicines: The optimising drug value project.
  76. (1991). Mirror to hospital pharmacy in Southern Africa. Braamfontein:
  77. (2004). Reining in the sales reps. Health Forum Journal.
  78. Available at //www. hospitalconnect. com/healthforumjournal/ jsp/ article>. Accessed on 09/04/2004.
  79. (1997). Structure and activities of hospital drug committees in Germany. doi
  80. (1997). The Health Business: Assessing Managed Health Care. "
  81. (1998). Centre for Devices and Radiological Health.
  82. (1999). The way I see it. A view of the private health care system.
  83. (1998). Overview of the South African Health-Care Industry", Private Health Care Industry Review.
  84. (1999). Formularies: Who benefits? " Private Health Care Industry Review.
  85. (1991). Participatory action research. doi
  86. (1995). Encounters with participatory action research. doi
  87. (1998). Financial and material management. doi
  88. (1996). Some principles and procedures for the conduct of action research: New directions of action research. doi
  89. Models for action research. doi
  90. 0.1996. New directions in action research. doi
  91. Action learning, action research and process management: theory, practice and praxis. doi
  92. Action research: The basis for teaching, learning and professional development. Technikon Pretoria.

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