Feature / Hands-on savings

Back in 1987, South Warwickshire was experimenting with the role of savings officer. Jean Arrowsmith wrote about swapping nursing for working for the treasurer.

At the start of this year I was a ward sister on an acute surgical ward. The district treasurer changed all that when he decided I should be the first savings officer for South Warwickshire Health Authority.

I have now been in post for four months and despite my initial fear and reluctance, I am thoroughly enjoying my role. We have actually achieved savings, increased staff awareness at ward level and improved working relationships with the supplies department.

Gloves are a good example of what we do. Due to the advent of AIDS, all staff now wear gloves for most procedures involving the patient and this has resulted in escalating expenditure. We used our estimated year’s supply of non-sterile latex gloves in just three months, at a cost of £18,000

Trials by health authorities to persuade staff to change to a cheaper glove have on the whole been unsuccessful. People will always choose the superior product, even if the lesser product is perfectly adequate.

Having carried out trials to ensure the product was acceptable, I obtained a computer printout of every ward’s order for that month and showed ward staff the savings that could be made. On just one week’s order, casualty could have saved £80.00.

I visited and discussed the glove order with every ward sister. Three months later, the most recent order printout confirms a change in practice in the wards visited. If this continues, we will have a saving of £24,200 over one year.

I didn’t visit the non-acute hospitals but wrote to them with the information. I also telephoned their nursing officers, but these hospitals have not changed practice.

The gloves will not make much difference to our savings. But we have learnt that the personal visit is important in persuading people to change practice.

It can also be difficult to change medical practice. To restrict doctors to cheaper gloves, we cleared the shelves of all the ‘posh’ gloves at the time of the mass doctor/houseman hospital changeover, working on the principle that what they’ve never had they’ll never miss.

In my first four months, we have saved more than £50,000. We made savings in staff time by virtually disbanding user groups since nobody ever put their good ideas into practice, and a newsletter keeps wards informed of changes.

We are producing a user catalogue to enable a more streamlined range of products, while giving a more detailed description. At present the list looks more like a mail order catalogue!

Some of the products and issues we are working on include:

- Oxygen equipment

- Dressing packs will be discontinued. As nursing practices change, the traditional dressing pack is no longer required.

- Comparing costs of disposable items with traditional items. Discussions on re-using disposable products, using cheapest bag available for naso-gastric suction

- Examining pathology laboratory techniques and assessment of:

- Faecal occult blood testing on wards

- Stricter criteria for blood/path lab testing rather than full blood count on nearly every occasion

- Increasing the age for routine pre-operative X-rays

- Non-sterile bubble tubing for suction and humidification

- Agreement sought for using the cheapest urine ward testing kit

- Lectures to student nurses on how to order goods efficiently and the importance of being cost effective when using equipment

- Assessment of district pressure sore prevalence and computer printout on lotions and potions being used.

- PR visit to all nursing unit meetings where costs for each department are presented – for example, in casualty – cost of dressings, drugs, X-rays, nurses, doctors, lighting, heating and so on. In this way, each nurse is made to feel she can affect the budget of her department.

Staff at ward level often have bright ideas with respect to saving money. They can now contact me and I can investigate and, where appropriate, introduce the ideas into custom and practice. In the past, staff have been reluctant to suggest ideas due to the fact that staff believed that ‘they’ never did anything about it. Well now ‘they’ have.

I have had good co-operation from all staff approached. This is partly because I am ‘one of them’. Also, they felt sorry for me being lumbered with a desk job in finance!

I do miss the contact with patients and the student nurses, but I enjoy working normal hours. But, at the end of the day, my main satisfaction will be when, as a result of my savings, no beds are lost and more nurses can be employed to help assist those nurses already under so much pressure at ward level.

This is an edited version of an article that appeared in the HFMA Newsletter in September 1987.