Educating perioperative managers about materials and financial management

APRIL 2005, VOL 81, N O 4 Home Study Program

Home Study Program Educating perioperative managers about

materials and financial management he article "Educating perioperative managers about materials and financial management" is the basis for this AORN jotirnal independent study. The behavioral objectives and examination for ths program were prepared by Rebecca Holm, RN, MSN, CNOR, clinical editor, with consulta- tion from Susan Bakewell, RN, MS, BC, education program professional, T Center for Perioperative Education.

Participants receive feedback on incorrect answers. Each applicant who successfully completes ths study will receive a certificate of completion. The deadline for submitting this study is April 30,2008.

Complete the examination answer sheet and learner evaluation found on pages 817-818 and mail with appropriate fee to

AORN Customer Senn'ce c/o Home Study Program

2170 S Parker Rd, Suite 300 Denver, CO 80231-5711

or fax the information with a credit card number to (303) 750-3212.

You also may access this Home Study via AORN Online at h ttp://www.aorn.org/journal/homestudy/default. h tm.

BEHAVIORAL OBJECTIVES After reading and studying the article on materials and financial management

for perioperative managers, nurses will be able to

1. describe difficulties that perioperative managers experience when assuming materials management responsibilities,

2. discuss lessons learned from the market analysis survey of surgical services managers in the Navy,

3. identify requirements for implementing a course in materials and financial management,

4. explain the cost:benefit ratio of providing this course, and

5. identdy civilian sector applications.

MANAGEMENT

This program meets criteria for CNOR and CRNFA recertifica- tion, as well as other continuing education requirements.

A minimum score of 70% on the multi- ple-choice exomination is necessary to earn 3 con- tact hours for this independent study.

Purpose/Goal: To educate periopera tive nurses about options in moteriols and financial managemen t education.

798 AORN JOURNAL

Davis APRIL 2005, VOL 81, NO 4

Home Study Program Educating perioperative managers

about materials and financial management Eric Davis, RN

upplies and equipment in the OR can account for more than 50% of a S hospital’s inventory assets and

costs.’ As a whole, however, the health care industry only allocates approximately 21% of its total costs to supplies. In comparison, the manufacturing industry allocates 50% to 70%.* Con- sequently, the OR is an area ripe for cost cutting strategies and standardization: and hospital chief executive officers are starting to treat O h like businesses!

Surgical services departments often are managed by experienced perioperative nurses who have strong clinical knowledge of surgical procedures and an understanding of the need for the myriad materials and equipment required for ~urgery.~ Now, however, these managers are being called upon to have not only superior clinical skills but equally superior business skills.6 In addition, a surgical services director can spend up to 50% of his or her time deal- ing with supply i s s~es .~ Unfortunately, in the majority of ORs, including those in the US Navy, managers have no formal training k materials or financial management, even though they are responsible for one of the most costly clinical areas in the hospital.

COLLABORATING WITH MATERIALS MANAGERS

It can be difficult for a surgical services manager to transition from the clinical environment to an administrative position without the tools necessary to perform the job. Many managers assume that the materials management department will ensure that all material issues are handled efficiently and effectively. The majority of materials man-

agement executives, however, have no health care experience and are not knowledgeable about the unique requirements of modern surgical suites, including the desire to keep large inventory levels on hand.

Many hospital executives may ask their materials managers to get more involved in managing inventory levels in the OR as a way of controlling expenses;8 however, this can lead to con- flict with surgical services managers who want to maintain control and autonomy in their area. A survey conducted in 1998 reveals that the OR’S top need from the materials management department is improved response time, while materials manager’s top need from the OR is to reduce current inventory level^.^ This difference in depart- mental objectives is why perioperative nurses routinely order and store extra supplies--especially critical or unique items-as a way to avoid the purchasing process.

MANAGEMENT

ABSTRACT ONE OF THE MOST resource intensive illpas

in many hospitals is the OR, which often accounts for more than 50% of a hospital’s materials management budget,

SURGICAL SERVICES MANAGERS often have no formal training in materials and financial management, but they are held accountable for one of the most costly clinical areas in the hospital .

A PROGRAM PROPOSED for Navy perioperative nurse managers is a five-day course that covers the basics of Navy medical materials and financial management as they apply to the OR. Application strategies for the civilian sector also are discussed. AORN 81 (April 2005) 801-812.

AORN JOURNAL 801

APRIL 2005, VOL 81, NO 4 Davis

Perioperative nurses often view the supply chain as beginning when a truck pulls up to the loading dock of the hospital and concluding when supplies are delivered to the OR.’” There is room for improvement for both the OR and materials management departments, and this begins with education and collaboration. Surgical services managers can establish a better working relationshiD with materials man-

Surgical services managers can

establish a better working

relationship with materials

managers by learning about the basics of

inventory management.

foundation

t

agers by learning about and understanding the basics of inventory management and value analysis methods.

Unfortunately, there are no formal training courses in materials management for perioperative nurses. There are financial management courses for health care personnel, but the unique aspects of supplies and equipment in the OR environment call for a course that specifically addresses these issues for OR managers.

TRAINING FOR NURSES The Navy Nurse Corps

has a well-established, 12- week perioperative nurse training program. Al- though this program provides a strong clinical

for novice perioperative nurses, it does not provide an adequate level of knowledge related to supply, equipment, and financial issues unique to perioperative nursing. Lack of knowledge forces perioperative nurses pro- gressing up the administrative and clinical ladder to learn about fmance and supply management by trial and error.

Conversely, before being assigned as head of a materials management de-

partment at a Navy facility, Medical Service Corps logisticians must attend a 12-week financial and materials management course. These officers have a strong foundation in health care administration and the accompanying financial experience, but they lack the clinical skills necessary to understand the intri- cacies of the surgical setting.

Bringing perioperative managers together with personnel in the materials management department to form a good working relationship is critical to optimizing supply logistics. Relation- ships among knowledgeable team members provide an invaluable resource for controlling costs and ensur- ing fiscal responsibility.’ Educating perioperative managers in the basics of materials and financial management can help achieve this goal; however it should be stressed that the purpose of an introductory course is not to allow perioperative nurses to assume the logistician’s role but to educate perioperative nurse leaders so collaborative working relationships are optimized.

LESSONS LEARNED Although government purchasing

and procurement is different from that in the public sector, the Navy can learn and adopt initiatives from the business community. For example, the Efficient Healthcare Consumer Response (EHCR) is a study commissioned for the health care industry and funded by manufac- turers, health care providers, and trade associations to examine ways in which the supply chain influences costs and care! Each year, approximately $83 billion is spent on consumable medical- surgical products; $23 billion of this is directly related to the supply chain process. The EHCR report concluded that $11 billion could be cut from supply chain costs by implementing its initiatives.” The lessons in the EHCR show that by improving how the supply chain

802 AORN JOURNAL

Davis

works, not only are costs reduced, but time is gained, standards are increased, and clinical outcomes can be enhanced! Navy health care can contribute to the $11 million savings if managers learn the supply process and establish more collaborative relationships.

Additionally, a study conducted by AORN reveals that 84% of surgical services managers have some level of purchasing power or influence, and 86% attend A O W s annual Congress to identify new products and technology.12 Educating perioperative managers on the financial and regulatory aspects of purchasing will help them understand the language of vendors in terms of purchasing and procurement.

Finally, a better and more standardized education program on materials management needs to be established for managers who use the Naval medical supply chain because of the unique requirements and issues of overseas medical facilities and front-line operational medical units (eg, hospital ships, fleet hospitals). Lessons learned from the war in Iraq show that shortages of much needed medical supplies and equipment stress some medical teams, who resort to sharing supplies or sheer innovation to treat patients when their supplies run

MARKET ANALYSIS To determine the need for and

requirements of a materials and financial management course for surgical services managers in the Navy, a survey was sent to a select sample of current perioperative managers at 24 Navy hospitals. Included in the survey were the directors of the two perioperative RN training sites. The survey response rate was 85%. Table 1 shows the respon- dents’ demographics.

Table 2 shows the results of the survey related to the usefulness of the proposed course. Seventy-seven percent of

TABLE 1 Surgical SeM’ces Manager Demographics (N = 22)

Standard Mean deviation

Years of management experience 6.54 3.31

Number of ORs in facility 6.6 4.88

Median Range

per month 135 30-1,OOO Number of procedures

surgical services managers rated their relationship with their materials managers as “very good” or ”good,” and 68% rated their personal knowledge of materials and financial management as “very good” or “good.“ This was not surprising based on the managers’ years of experience in OR management; however, 64% of the managers rated their staff nurses’ knowledge level of materials and financial management as ”fair” or ”poor.” Eighty-two percent of perioperative managers believed that the proposed course would be “very useful.” Finally, 50% of managers believed that staff nurses should attend the course two to four years after basic perioperative training, and 32% thought that they should attend one to two years after basic perioperative training. Only 18% believed they should attend more than four years after basic perioperative training.

Although it would be ideal to survey all perioperative RNs in the Navy, the managers’ responses clearly show the need for a formal course in materials and financial management for junior perioperative nurses. A SWOT (ie, strengths, weaknesses, opportunities, threats) analysis for the proposal revealed the following. 0 In the strengths category, survey data

strongly supported implementation of a course. There is no formal education process in the financial and materials management area of perioperative services in the Navy, although a facilities and educational

AORN JOURNAL 803

APRIL 2005, VOL 81, NO 4 Da\?is

TABLE 2 Surgical Services Manager Survey Data (N = 22)

%tal sample (pe=-ge)

Manager's relationship with materials manaqen 50 27 23 0

Manager's knowledg e of supply, b udget, and financial principles

Good 32 36

very good

Fair Poor

23 9

%ff nurses' knowledg e of supply, b udqet, and financial principles 0 36

very good Good Fair 55 Poor 9

Usefulness of proposed course Verv useful 82 US&.d Not useful

18 0

Proposed length of course 1-2 days 41 3-5 days More than 5 days

55 4

Method of instructi on In-house (ie, Naval Medical Education and Training Command) Mobile training team 36 Online (ie, web-based) 9

55

Attendance should be - yea n after basic OR trai ning 1-2 32

50 18

support network currently is in place. Procurement processes could be standardized throughout all Navy medical facilities, and there is a strong cost saving potential.

0 The weaknesses of the plan include that the large amount of content to be taught in one week creates a potential for low retention by students. It may take several years to break even on course expenses.

0 There is an opportunity because this would be the first and only formal Navy nursing management course

available. In addition, financial and materials management knowledge by staff nurses is rated as fair to poor. There was a perceived threat of Medical Service Corps logistics officers attempting to take over.

Based on the survey results, it was con- jectured that a course in finance and materials management for perioperative nurses could not only increase efficiency and decrease the supply chain costs in the OR, but it could train junior perioperative nurses in the Navy in an area they would be expected to know

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how to navigate successfully in the future.

STAFFING AND RESOURCES REQUIREMENTS A course such as the one proposed

could be implemented successfully with minimal staffing and facility mod- ifications. Data from the survey show that 55% of department heads believed the course should be taught at the Naval Medical Education and Training Command (NMETC) in Bethesda, Md. The NMETC is the premier educator for Naval executive level medical managers, so it was considered appropriate for staff members at the NMETC to administer and teach the course.

Attending the course as a full-time student and away from individual facilities helps ensure that both students and their nominating hospitals are commit- ted to a successful completion. The classroom environment also provides a better opportunity for networking and interac- tion between students from different hospitals with similar and dissimilar problems and issues. An online course would make ths type of networking difficult if not impossible. The location of the NMETC in Bethesda also offers several opportunities for field trips (eg, Navy Medical Logistics Command, Bureau of Medicine and Surgery) and is close to potential guest speakers. In addition, the NMETC already has

an established student administration department with required staffing and application procedures. The classroom at the NMETC used for the current Medical Service Corps financial and materials management course can be used between sessions of this course, which currently are held twice a year. In addition, staff members working on the financial and materials management course can help the OR course coordinator with course development and resources because there is significant overlap of the content. Requirements

for the OR materials and financial management course coordinator would include 0 being a perioperative Nurse Corps

officer who is master’s prepared; 0 successful completion of a depart-

ment head tour at a military treatment facility or a tour as the OR materials manager at Portsmouth, Va; Bethesda, Md; or San Diego, which are the three largest Naval medical centers;

0 completion of a one-week educational design program and the 12-week financial and materials management course conducted at the NMETC;

0 completion of basic instructor school; 0 an ability to plan effectively; and 0 good organizational and interdisci-

plinary coordination skills.

COURSE DESIGN The survey indicated that 55% of OR

department heads believed that the proposed course should be three to five days in length. With the addition of health care financial management content, the course would have to be at least five days in length.

Table 3 shows a proposed schedule for the five-day course. Course content is based on the 12-week financial and materials management course and input received from the survey. The course covers a broad spectrum of issues unique to medical materials and financial management for perioperative services and also covers other issues specifically relevant to Navy perioperative nursing, including medical logistical issues unique to the Fleet Marine Forces, Fleet Hospitals, and floating assets.

Instruction on biomedical equipment maintenance is included in the course content because of the frequent use of the equipment in the OR and its potential to affect surgical procedures. Perioperative managers and biomedical

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TABLE 3 Surgical Services Managers Materials

and Financial Management Course Schedule prtdiry Review

MondPy Welcome/ Intluduction

Navy medicine resource brief

-@w Review

Wedneeday Review

mtuldslg Review

Capital budget P-

Variance analysis

Strategy in pumhasing and materials management

Budgeting and finandal overview: Part I

Introduction to materials lTLaMgement

Budgeting andfinatrcial overview: part n

Information systems for logistia overview

Operational issues: Marine corps

1100

- 1200

Prime vendor overview (group

organization) P-Q

Operational issues: shipboard/hospital ships

LUnCh Lunch Lunch Lunch

Field trip to local prime vendor facility (group P e g Organization)

Lunch

Guest speaker 1300 Logistics and transportation

R o d U d standardization

Information technology in Purchasing

1400

- 1500

Reuse of single usedevices

€valuation/ checkout

Government purchase card fundamentals

Defective/ haZardOUS materialreports

Appropriations and contracting principles

PuFchasing Ethical issues in Vendor relations

1600- 1630

Case study Case study Case study

repair department members should collaborate in this area." A separate mod- ule on the reuse of single use devices (SUDS) is included because this is a hot topic in the perioperative materials management field and involves several regulatory and ethical consideration~.'~

Instruction on financial aspects of health care management reflects the

close correlation between these techniques and efficient materials management. In addition, perioperative nurses have a tendency to view costs as a simple price comparison and, often, need exposure to more advanced techniques, such as a cost-benefit analysis, that realistically show the cost of own- ership.I6 Standardization concepts are

AORN JOURNAL 807


a

6

Marketing/advertising Accreditation, budgeting, preparation Application and selection First/second course date Evaluation/critique

E O 4 E c. E 0)

3 -. 5i

A

0

Figure 1 This Gantt

chart repre- sents the

impiementa- tion plan for

the perioperative nurse

manager materials and

financial management

course.

1 2 3 4 5 6 Months

included in the course content because perioperative nurses are instrumental in the decision to standardize.”

The course also includes a field trip suggested by one of the survey respon- dents. The field trip allows students to gain valuable insights into industry to better appreciate the entire supply chain process. Case studies are presented at the end of each day of instruction to help synthesize the learning objectives of the day and encourage class dialogue.

The heavy course content and limit- ed time available for instruction require prerequisites for the course, including 0 being a perioperative staff nurse

with at least three years of experience after completion of the basic perioperative RN course;

0 successful completion of the Naval correspondence course, “Navy medical and dental material readiness,” whch provides a basic understanding of the Naval medical supply sys- tem; and

0 a basic working knowledge of spreadsheet applications to successfully solve budget problems.

Officers enroute to a department head or assistant department head position are given priority placement in the course.

The course textbook is Operating Room Mmzagement.’8 This textbook was

7 8 9 10 11

selected because it has several chapters dedicated to financial analysis and a well-written chapter on materials management. Case studies are available throughout the text, which are used for class discussions. Students can keep the text for use as a reference in their future management positions.

The intent of the instruction is not to produce finance or materials management experts, but to provide an understanding and working knowledge of materials and financial management procedures and processes. This will assist them in the day-to-day management of their perioperative departments and in establishing more collaborative relationships with their materials management counterparts.

With the help of the NMETC, the course can be accredited. In addition, offering fully funded nursing continuing education units would create more of an incentive for students to attend.

DEVELOPMENT SCHEDULE Figure 1 is a Gantt chart of a pro-

posed implementation plan for the course. The timeline from course approval to teaching the first course is six months. The course initially would be offered twice per year to refine the initial course and measure how students

808 AORN JOURNAL

affect the Navy's perioperative environment after completing the course. The initial class size would be 15 students per class (ie, 30 students per year) to facilitate con- structive interactions between instructors and students and to encourage maximum participa- tion. Larger class sizes would have a greater effect on hospitals send- ing staff members to the class, and many students might not be able to attend because of operational commitments.

After implementation

TABLE 4 Estimated Costs per Fiscal Year

Total estimated expenses $109,600 Student travel 15 students per course, 2 courses per year, 1-week course in Bethesda, Md

Travel to Bethesda from permanent duty station Travel to permanent duty station from Bethesda

$8,250 $8,250

Total $16,500

Miscellaneous expense Total

$6,000 $42,000

Miscellaneous Textbooks and course material $3,000 Miscellaneous supplies Bus fees Course coordinator billet Total

$1,000 $1,250

$45,600 $50,850

Total $250

and measurement of the effects of the training, more classes per year can be added as time, space, and resources permit. Advertising and marketing can be accomplished through a quarterly Navy perioperative nursing newsletter, the tri-service perioperative sympo- sium at the AORN Pre-Congress, and \Tia the NMETC web site.

The resources and assets of the NMETC can help the course coordinator implement the program, especially i f the coordinator does not have experience in accreditation and educational theories and strategies. Successful implementation strategies, as well as unsuccessful ones, can be shared by c>xperienced NMETC staff members.

FINANCIAL PLAN Table 4 shows the direct expenses of

conducting the course twice a year for 30 students. Although the cost may seem high initially, students would be traveling from a multitude of locations and would be staying in the Bethesda area. Table 5 shows the potential cost savings of the course if all Navy ORs were able to reap a cost savings of $5

per procedure because of the increased efficiency gained by perioperative nurses who take the course.

The survey results provided monthly caseloads for individual facilities, and the $5 per procedure savings is a conservative estimate of the potential direct savings that could occur throughout the Navy based on the knowledge gained and shared by students. Figure 2 shows the total costs and savings based on $5 per procedure and $10 per procedure respectively. Saving $5 per procedure would yield a positive costbenefit ratio of 3.25. This means that for every dollar spent on teaching the course, the Navy would realize a direct savings of $3.25. The overall savings based on saving $10 per procedure is even more dramatic; it has a positive cost:benefit ratio of 6.5. Obviously, there is a great potential for costs savings.

In one example, nurse-initiated standardization of knee arthroscopy supplies yielded a per procedure savings of $245.55.'' The ability to use variance analysis techniques allowed one hospital's surgical services department to reduce the cost of breast

AORN IOURNAL 809

TABLE 5 Cost Savings Based on

Surgical Procedures Performed

Facility 29 Palms Beau fort Bet hesda Bremerton Charleston Cherry Point Great Lakes Guam Guantanamo Bay Jacksonville Kcflavik Lejune Lemoore Naples Oak Harbor Okinawa Pendleton Pensacola Portsmouth Rota San Diego Sigonella Yokosu ka Misc/Operational Total

Procedures per month

75 60 600 200 120 150 140 220 30

400 35

400 100 80 130 350 350 280 925 60

1,000 45

120 80

5,950

Procedures per Ye=

900 720

7,200 2,400 1,440 1,800 1,680 2,640

360 4,800

420 4,800 1,200

960 1,560 4,200 4,200 3,360

11,100 720

12,000 540

1,440 960

71,400

Total savings per year $5 per procedure x 71,400 = $357,000

biopsy procedures by 64%, which yielded a yearly savings of $46,000." The conservative estimates for the perioperative nurse course are based on only 30 students per year attending. As more students attend, the cost savings per procedure also will grow.

These numbers are only representa- tive of the tangible savings in supply costs per surgical procedure. They do not include the intangible savings provided by increased efficiency and pro- ductivity gained through better collaboration with the materials management department. In addition, reducing OR inventory results in decreased inventory carrying costs, and working with surgeons to standardize products also results in cost savings. Improved com- munication between the OR and the materials management department also allows facilities to reduce inventory,

which can result in saving money on these costs.' Other potential benefits include improvement in patient care, reduction in the number of errors, decreased surgical procedure times, and increased satisfaction among perioperative staff nurses and surgeons. Surgical services managers who are knowledgeable about materials management also may be more productive.

Although the potential cost savings are great, the course coordinator should collaborate with OR department heads at individual military treatment facilities to establish objective

cost-savings criteria per facility. This helps establish the actual direct cost savings the program provides. Other facilities have shown improvement in their supply strategies, to include increasing inventory turnover rates; reducing inactive inventory; reducing average supply costs per procedure; and removing unnecessary, redundant, and inefficient links in the supply chain by using technology." One facility was able to reduce its steps in the supply chain from 32 to 1L2I

APPLICATION TO THE CIVILIAN SECTOR The Navy's size and vast geographi-

cal footprint mean that a formalized course like the one proposed can be successful. Large hospital systems also may find this model useful. Most small hospital systems or stand-alone facilities, however, probably cannot produce a

810 AORN JOURNAL


Figure 2 Savings over total expenses were estimated based on saving $5 per procedure and

saving $10 per procedure.

program such as the one proposed, but there are elements that these facilities might find useful. It is important that staff nurses interested in perioperative management be exposed to materials and financial management.

Other options for individual facilities include using the perioperative management resources produced by AORN, which offer an informative overview of general management concepts from understanding financial reports to managing meetings. In addition, more management and financial inservice programs should be conducted in department meetings and at local AORN chapter meetings. AORN also offers a certificate program in perioperative management in collaboration with the University of Colorado, Denver. This program can be complet- ed entirely online as can a certificate program in ambulatory surgery administration that covers much of the basic core competencies required of perioperative managers.

Hospitals also can develop their own in-house resident programs, such as the ones developed by Parkland Memorial Hospital in Dallaszz and the Johns Hopkins Hospital in Baltimore. Developing this type of education program can be financially advantageous to the hospital, as is evidenced here. In addition, hospitals that employ more effective nursing leaders report increased nurse satisfaction, increased group cohesiveness, decreased job stress, and decreased Creating training programs for novice nurse managers demonstrates a com- mitment and investment by an institu- tion to growing their own. Clinical nurse managers who perceive that they are well prepared for their role demonstrate higher job satisfaction.24 Many options are available, but perioperative leaders need to initiate and refine these ideas.

800,000 I 700,000

600,000

500,000

0 400,000

2 300,000

200,000

100,000

0

+I E 3

f

9" L

Total savings a ~ota l expenses

$5 savings $10 swings per procedure per procedure

THE BENEFITS Managing surgical services materi-

als and supplies is key to controlling hospital The surgical services department is one of the most supply intensive units in a hospital, and perioperative managers need to be inti- mately involved in the medical supply chain and the financial responsibility that comes with it. If they are not for- malIy trained in the basics of this sub- ject, however, it is difficult for perioperative managers to succeed. Concepts such as standardization, procurement, budgets, and value analysis can be difficult to learn outside of a formal education program.

Navy health care facilities extend the medical supply chain further than their civilian counterparts, which requires perioperative nurses in the Navy to be even more knowledgeable about the supply process to maximize efficiency.

A broad knowledge base garnered from experience in the OX, as well as an ability to interact with physicians and nursing sta8, administration, finance and other areas in the hospital, seems to require the multidimen- sional personality that most perioperative nurses p0ssess.j

Educating perioperative nurses and

AORN iOURNAL 8 1 1


using their expertise to optimize the supply chain and reduce costs makes sense. *3

Eric J. Davis, RN, MSN, CNOR, LCDR, NC, USN, is perioperative department head at the US Naval Hospital in Sigonella, Italy.

Editor’s note: The opinions or assertions contained in fhis article are the private v i e m of the author and are not f o be coil- striied as oficial or as repecting the viezus ofthe US Navy or the Departnzenf of Defense.

1. D L Baker, D L Hale, “Potential cost saving opportunities: The supply chain,” SSM 9 (April 2003) 33-38. 2. M R Leenders et al, Purclzasiiig and Supply Maizagement, 12th ed (New York: McGraw Hill, 2002). 3. F Doyle, C Weisbrod, ”Endless possibili- ties: Using the Internet in the supply chain process,” SSM 8 (February 2002) 24-28. 4. R Haugh, ”Materials coordinator brings value to ORs. Cost and efficiency needs create position for a specialist,” O R Manager 14 no 3 (1998) 20-21. 5. C A Malone, ”Perioperative materials mana er inventory specialist, supply coorfin&or . . . A rose by any other name,” Seiniizars in Perioperafive Nursing 9 (April

6. W J Sheehy, “Efficient health care consumer response: Lessons for the OR manager,” Siirgical Services Maiiagemeiif 7 (February 2001) 19-22. 7. “A supply chain with stronger links,” OR Manager 15 no 1 (1999) 23-24. 8. R Haugh, “Execs want more attention paid to OR supply inventory,” OR Manager 13 no 10 (1997) 6.

NOTES

2000) 49-52.

9. L S o h a d a ) ”OR, materials. Stronger partnerships needed,” OR Malinger 14 no 3 11998) 12-17. 10. D Donatelli, “Realizing opportunity in the health care supply chain,“ SSM 8 (June

2002) 4345. 11. ”Supply chain efficiencies could save billions,” OR Manager 13 no 3 (1997) 24. 12. “The purchasing influence of the perioperative RN,” SSM 8 (December 2002) 49- 51. 13. G Fuentes, “When surgery is a battle- field,” Navy Times (October 20,2003) 22. 14. R H Stiefel, ”Updates to the JCAHO medical equipment management standards,” SSM 7 (December 2001) 36-39. 15. B Schultz, “Materials management,” in Perioperative Services: Administration, Resource Management, and Patient Care, ed C Frye, C Spry (Gaithersburg, Md: Aspen Publishing, 2000) 1-12. 16. L Groah, “Budgeting for financial success,” in Perioperafive Services: Administra- tion, Resource Management, and Pafienf Care, ed C Frye, C Spry (Gaithersburg, Md: Aspen Publishing, 2000) 1-35. 17. D Karr. “Standardization and cost savings,“ Surgical Services Management 5 (April 1999) 32-38. 18. R A Gabel, Operating Room Management (Boston: Butterworth-Heinemann, 1999). 19. C E Dendy, G F Senn, “Improvement through benchmarking,” Surgical Services Management 5 (April 1999) 20-26. 20. G Hersch, P Pettigrew, ”Reenergizing the supply chain,” SSM 8 (December 2002)

21. “A more seamless process with out- sourcing,” OR Manager 18 no 11 (2002) 1-2. 22. B Kalo, P Jutte, ”Head nurse to nurse manager: Easing the transition,” Journal of Nursing Staff Development 12 (March/April

23. M P Maguire, K L Spencer, K H Sabatier, “The Nurse Manager Academy: An innovative approach to managerial competency development,“ Nursing Leadership Forum 8 no 4 (2004) 133-137. 24. D Gould et al, ”The changing training needs of clinical nurse managers: Exploring issues for continuing professional develop-

41-47.

1996) 86-92.

ment,“ Journal ofAd;dnced Nursing 34 (April 2001) 7-17. 25. D G Sundstrom. S Graves, ”Cost con-

.

tainment: Preparing for the next decade,” Surgical Services Managemen t 2 (July 1996) 29-33.

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Educating perioperative managers about materials and financial management

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