Paul De Raeve, Secretary General of the European Federation of Nurses Associations (EFN) places the value-based public procurement nurse under the spotlight in Europe
Nurses have a key role in addressing the financial and sustainability challenges of the health and social care ecosystem, therefore, they should be involved in the procurement co-design from an early stage, working with procurement officers, to secure funding and successful outcomes. Creating an inclusive relationship between clinical and procurement staff is a crucial first step to ensure that both financial and clinical benefits are considered from the outset.
My personal account
Materials and services designed without engaging nurses in a systematic way compromise safety and quality, as tools could become ‘engineering products tested in labs’, but not ‘fit for purpose’ for end-users.
As a former senior procurement nurse, my focus was on translating nurses/doctors
/patients’ needs related to materials for public procurement into technical requirements, as well as proactively co-designing devices with the industry to achieve better patient outcomes and lowering down nurses’ workload. A good example was the neonatal ICN incubators, where, instead of the total price, €20 million for 15 high intensive
care incubators, the research focussed, together with a National Aeronautics and Space Administration (NASA) expert, on developing high-quality foam for mattresses, so neonates’ skin, comfort, struggle for life, became the first criterion in public procurement.
The innovative and provocative approach was welcomed by neonatal units in Europe and procurement officers capturing the clinical perspective covering safety and quality indicators linked to procurement. Public procurement and its selection criteria, need to be transparent, including its scores, as the motivation for not selecting a specific material/tool/service becomes key in the value-based procurement process.
In this context, the frontline nurses’ voice is crucial, with the analysis of the material/tools testing and finally, the frontline continuous professional development to facilitate deployment is driving ‘small changes into big differences.
Nurses engagement with procurement
Frontline nurses, using a vast range of clinical products, are uniquely qualified to offer a detailed insight into what items do and do not work. But the industry needs to understand ‘codesign’ better, to make procurement less intensive for the nurses’ frontline. The implementation of the EU Directive on the prevention of sharps injuries within healthcare settings, from May 2013, is a case in point. Healthcare facilities identified the existing
sharps products used and, where appropriate, to find replacements that complied with the Directive’s requirements. Nursing staff were responsible for defining the technical specifications of the products – a central part of the procurement process and one in which their clinical expertise was crucial.
The development of a procurement nurse has become more common across the EU. This nurse acts as a bridge between clinical activity and the contracting/commercial requirements of a care organisation. The role requires a wide range of clinical experience, the ability to understand complex clinical treatments and excellent communication and interpersonal skills. Clinical procurement nurses (CPN) can come from a range of clinical backgrounds including theatre, critical care, ward managers or other roles that require engagement across all levels of the multidisciplinary team. The CPN role can cover:
- Liaising between procurement and clinical teams to agree and control standardised products and devices across an organisation;
- Support and coordinating complex clinical procurement exercises where critical appraisal or formal clinical evaluation is required;
- Ensuring that legislative and regulative procurement laws and guidelines associated with medical devices and patient care are considered and communicated correctly;
- Developing multidisciplinary input into a clinical products and devices review process through clear protocols, policies and product groups;
- Actively promoting research activity to identify new innovations or technologies that advance safety and quality;
- Observing product utilisation in practice, collecting staff feedback, identifying training needs.
However, the entire process of selecting and purchasing material and services are often managed by procurement departments. Often by health economists, resulting in the prioritising of financial considerations over product usability and clinical suitability in the
EU mechanisms – bring innovation into the market
In 2014, the European Parliament passed the Directive 2014/24/EU1 which aims to improve procurement by promoting quality and innovation while considering longer-term costs, as well as environmental and social factors. The Directive provides more freedom to contracting authorities supporting the use of flexible procedures and allows a greater interaction with the market, as it introduces negotiation and competitive dialogue formats.
Also, the Directive encourages industries selling to public authorities to define the best
price-quality ratio, equivalent to value for money and it allows public authorities to consider full life-cycle costs rather than just the up-front purchase cost.
The European Commission, through DG Connect, has given an initial drive to value-based procurement (VBP), seen as a useful mechanism to bring innovation into the market. Under Horizon 20202, the EU increases support for groups of public procurers who work together on innovation procurement through two approaches: Pre-Commercial Procurement3, that offers public procurers to share risks and benefits of procuring R&D and to address challenges of public interest for which no satisfactory technological solution is not yet available on the market; Public Procurement of Innovative Solutions4, in which public procurers act as launching customers of innovative goods or services which are not yet available on a large-scale basis and may require conformance testing. This is applicable when contracting authorities/entities, possibly in cooperation with additional private buyers, acting as a lead customer for the procurement of existing “innovative” solutions (not the R&D services to develop them) that are not yet available on large-scale commercial basis due to a lack of market commitment to deploy.
Although several initiatives started in the healthcare sector, it remains uncertain how the end-user, in particular nurses and patients, drive this process to guarantee access and outcomes.
Making the right choices about which equipment and supplies the hospital, community care practices or even research centres buys can make a huge difference to the quality of care, patient safety and outcomes. To foster a shift to a value-based procurement using a multi-disciplinary approach and resulting in the most economically advantageous tendering, nurses become frontline drivers of choosing the materials co-designed with and for the end-user. Nurses using clinical products every day can indicate the best and easiest solution to achieve the best results. The EFN believes that:
- Every local procurement team should have relevant clinical expertise at the appropriate time to support effective procurement decision making;
- Healthcare organisation, including primary care centres, boards should include procurement nurses to make sure investments turn into better outcomes;
- The procurement process must include identifying the needs of the frontline for a product/service;
- Procurement strategies and decisions should be transparent and quality/patient safety should take priority over quantity and costs;
- Procurement processes should be proportionate to the value, complexity and risk of the services contracted, but should not be overly bureaucratic and;
- Member States should be in line with EU Directives and explore procurement collaboration between Member States in order to reduce costs with suppliers.
The position of nurses on the frontline of patient care, using a vast range of clinical products on a daily basis, including IT equipment, leaves them uniquely qualified to offer detailed insight to make the public procurement process a success.
1 https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX%3A 32014L0024
4 https://ec.europa.eu/digital-single-market/public-procurementinnovative- solutions