Procured in very high volumes across every specialty, surgical gloves are too often evaluated on unit price alone, with little regard for the broader costs and outcomes that determine their true value. This study demonstrates how a European value-based procurement framework can be adapted and applied to generate practical insights into their true value.
The procurement challenge
Most healthcare systems have historically treated procurement as a price-reduction exercise, delegating purchasing to group purchasing organisations that bulk-buy on behalf of multiple providers. While value-based healthcare — the paradigm first articulated by Michael Porter and Elizabeth Teisberg in 2006 — has gained significant traction in the reconfiguration of services, investment in technology and the measurement of outcomes, the supply chain function has been comparatively slow to adopt a value-based approach. Until recently, little practical guidance was available to help supply chain professionals turn the concept of value-based procurement into effective action at the individual, team or organisational level. Two conceptual models have since emerged to address this gap: the American Cost, Quality and Outcomes (CQO) Movement, launched in 2013, which promotes multidisciplinary value analysis committees within hospitals, and the European MEAT Value-Based Procurement (VBP) Framework, which provides a structured set of cost and outcome criteria derived from the EU’s 2014 public procurement directive requiring that contracts be awarded on the basis of the Most Economically Advantageous Tender.
Approach
We chose surgical gloves as an extreme example of a high-volume consumable whose value is poorly understood. Gloves are indispensable to the aseptic barrier between patient and clinician, yet are frequently procured solely on the basis of price. Since the global Covid-19 pandemic prevented hospital fieldwork, we used the 41 criteria in the MEAT VBP Framework as the basis for structured interviews conducted via Zoom with surgical glove marketing practitioners and procurement experts. These interviews were corroborated by a targeted literature review. Our objective was to identify which of the Framework’s cost and outcome criteria applied to surgical gloves and, for each applicable criterion, to propose definitions and value impact metrics that decision-makers could use to describe, quantify and compare glove value.
Key findings
Of the 17 cost criteria in the original Framework, we identified ten that apply to surgical gloves — spanning purchase price, delivery, staff training, infrastructure compatibility, storage, shelf-life replacement, disposal, medical staff time, infrastructure usage and unplanned failure rate. For each we proposed formulae through which value can be calculated when cost data are available. Notably, the cost implications of glove failure extend well beyond inventory replacement: a perforated glove can increase the risk of surgical site infection, the treatment of which can add up to €30,000 to a patient’s care costs through extended hospital stays, additional testing and readmission. On the outcomes side, we found the Framework’s original criteria too broad for a specific consumable, so we defined eight tailored outcome criteria. These addressed patient benefits (reduction of surgical site infection risk and allergic or anaphylactic reactions), healthcare professional benefits (reduced occupational exposure to blood-borne pathogens, reduced latex allergy risk and glove impact on dexterity and tactile sensitivity) and provider or system benefits (training and education support, strategic fit and reduction of medico-legal claims).
We validated the adapted Framework by applying it qualitatively to a specific product — the Biogel PI Indicator System — to demonstrate that the model can readily describe the potential value impact of a named surgical glove across all four stakeholder groups: patients, professionals, providers and health systems.
Implications
The study showed that the MEAT VBP Framework provides a highly practical and adaptable means of imposing both structure and rigour on a value analysis process. Even when used qualitatively, the Framework is capable of delivering meaningful insights into the value of a medical consumable and enabling side-by-side comparisons of the value offered by different products. However, the work also revealed limitations. The biggest frustration was the lack of access to detailed cost data that would have enabled the Framework to be used quantitatively rather than solely qualitatively. We recommended that future studies employ micro-costing techniques — the direct enumeration and costing of every input consumed in the treatment of a patient — to populate the value impact metrics we proposed and thereby synthesise clinical and financial evidence into a compelling business case for any medical device or consumable.
The paper also suggested a simplified version of the Framework that places benefits for healthcare professionals alongside patient outcomes in the core of value, reflecting the reality that the aseptic barrier protects both sides of the surgical drape.
Stanberry B, Bothma G, Harrison K. Using the MEAT VBP Framework to analyse and understand the value of surgical gloves: an explanatory case study. Health Econ Rev. 2021 Jul 6; 11(1): 23. DOI: 10.1186/s13561-021-00325-z
