Why the breast implant scandal is bad news for procurement in the health sector

The scandal over PIP breast implants is leading to considerable worry for thousands of women, and will also have a significant cost to governments (as well as some private sector organisations) around the world. But there is also a risk of long-term damage to the cause of procurement in the health sector.

If you meet and talk to professionals in that sector, as I do from time to time, you will hear one phrase regularly in answer to the question, “what’s the biggest barrier to procurement progress and success”?  And that answer is is “clinical preference”.

That’s the ability for medical professionals, from nurses to surgeons, to determine the equipment, consumables, or devices they want to use based on their own medical judgement rather than via objective, value for money decision. It’s particular prevalent at the top end of the profession – not surprisingly, surgeons for example quite rightly want to have considerable input into the choices of equipment and devices that they use.

Now value for money in this context clearly has to include the medical outcomes, so it is totally appropriate for medics to have that input. A drug might be cheap but if it doesn’t work it has no value. Equally, a more expensive and long lasting artificial knee joint is better value than one that is 30% cheaper but needs replacing in half the time.

But often clinical preference conceals other factors; medics who just don’t want to change or invest in their own re-training to use better equipment or devices; or at worst, who have relationships with suppliers that may bring factors into play beyond pure clinical effectiveness.

So procurement professionals have to work hard to persuade clinicians that objective, rational decisions around selecting suppliers and products are to everyone’s benefit. (Here’s a good example we featured a while ago of a hospital procurement function in Durham doing just that).

Unfortunately, the breast implants story has given ammunition to every clinician who wants to stick with their favourite product, at whatever cost. It appears that the implants that are now under review – and that recipients can have replaced free of charge by the National Health Service in the UK – were “approved” for use.  And they also appear to have been the cheapest on the market.

So I suspect a good procurement person in a hospital would have been saying to clinicians, “implants are not particularly risky from a medical point of view, we have no long-term evidence on variable lifespan across different brands, so we should buy the lowest cost implants that have passed the quality threshold”.  And that may well have been the PIP product now under investigation.

That’s what I would have been saying in that position certainly. And look at what’s happened - the cheapest turned out to be the wrong choice, because they were made with non-approved raw materials, which is of course why they were the cheapest. (It’s a vindication of the old adage really – you get what you pay for.  And I wonder whether any clever procurement person asked why they were so cheap)?

So now, any clinician, faced with procurement making an argument for change in another product area, based on value for money, is going to be able to shake their head, remind procurement of what happened with implants, and carry on buying their favourite artificial joint, stent, endoscope...

And that might be for good and genuine reasons, or it might not. But procurement’s position has been weakened by this whole affair.

Voices (2)

  1. Pete:

    This is one that I struggle with. I, like most readers I suspect, are familiar with the issue of ‘professional preference’. Civil engineers have a very clear idea of the grade of concrete they want and their preferred supplier regardless of the commercial benefits of an alternative. They cannot be persuaded. Investment bankers demand the IT that they want. Someone who can make a $million in a morning has a louder voice that the IT compliance nerd. Marketing and legal spend – notoriously difficult to encourage compliance.

    The greater good of compliance is a very difficult message to get across and maybe it’s just me but I think it’s because we need to learn to empathise more and we need to evangelise better.

    Having said that, if I’m about to go under the knife – I think I’d be inclined to suspend my purchasing compliance obsession and go along with whatever the surgeon wants.

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