Sticking with the Best

Smith & Nephew

T J Smith himself founded the company more than 150 years ago, making cod liver oil in Hull, England. As one might surmise, he got his nephew involved in the growing business and by WWI they were supplying bandages to the armed forces before moving on to develop ever more progressive wound care products. Nowadays, following the company’s acquisition of several US medical businesses, Smith & Nephew is quoted on the New York Stock Exchange as well as in London, but headquarters for woundcare remains in the port city of Hull.

Australia counts as the fourth largest market in the world for Smith & Nephew, “unusually high for a multinational company,” acknowledges Paul Brennan, Marketing Director ANZ of the Healthcare Division, based in Mount Waverley, Melbourne.

For the Australian and New Zealand markets, Smith & Nephew distributes a range including fracture management, compression garments, stockings and face masks in addition to wound products. Whilst some basic wound products may be used in sports bags and home cabinets, Smith & Nephew has focused on developing new technologies in wound products that promote faster healing. These are available in Hospitals, Home and Retail Pharmacy.

It is vital that one should examine the full cost equation rather than simply comparing product costs. Paul tells of one corporate client that stopped buying the products having found a competitor who was “unbelievably cheaper.” But a year later that client was back at Smith & Nephew, having discovered that the downstream cost, especially in terms of wastage and nursing time taken to apply and re-apply dressings, meant the ‘cheaper’ range just wasn’t effective nor a money-saver; they actually spent more.

Wounds and their treatment have been called a ‘silent epidemic’. A 2009 report in Europe found that in the medical community, management of wounds takes up over half of all resources. It is Smith & Nephew’s contention that, “The human cost of wounds is measured in pain, distress, embarrassment, anxiety, prolonged hospital stays, chronic morbidity or even death. Much of this suffering is preventable. Contrary to common belief, the tools and techniques for the reduction of the human burden of wounds do not imply extra costs to the system; overall, they reduce it.”

In most developed countries, current estimates indicate that wounds account for almost four per cent of total health system costs, and that this proportion is increasing. Hospitalisation itself is the main cost driver (typically, a patient who might otherwise be released must remain in use of an expensive bed until his/her wound/s are sufficiently healed), followed closely by nursing time, an important resource that could be deployed in other ways to benefit current patients, or used to increase the ability of the system to treat more patients. “With best practice and optimum materials, all these costs can be significantly reduced,” says the company. Infected wounds, always a risk in medical establishments, are a serious health care issue, adding significantly to overall system costs.

In a study quoted by the company (Hurd T, Zuilliani N, Posnett J. Evaluation of the impact of restructuring wound management practices in a community care provider in Niagara, Canada. Intl Wound Journal 2008, 5:295-303), a community health care provider in Canada implemented a radical reorganisation of wound management practices designed to ensure that available resources, particularly nurse time, were being used in the most efficient way. Overall, improvements in wound management practice led to some quite dramatic cost reductions, with a net saving of $3 to 8 million in the provider’s wound care budget.

It is important to realise that not all dressings are equal, says Paul. Smith & Nephew makes a wide range of dressings and choosing precisely the correct one for any application is part of the battle, he points out; the company carries out a lot of training to this purpose. But the design of the products is also vital and here, the company prides itself on innovation. He says the company’s strength and differentiator is the way in which it, “engages very intimately with clinicians and patients with their wounds and how they manage them. From understanding what their challenges are, we actually design to the need, not to ‘this is what we can make’.”

In some cases these products are a little more expensive in terms of basic product cost (though in other cases slightly cheaper); but if a dressing lasts three times as long without need for change, while protecting the wound better, it is clear to any health professional – even without a calculator – that is it likely to improve the bottom line as well as the healing process.

The message should be well received but is not always clearly so, says Paul. Sometimes the procurement function is far distant from clinical opinion and purchasers simply comparing two items on a spreadsheet and commoditising them might choose the ‘cheaper’. “But where there is clinical engagement they may take a closer look and see there is benefit in choosing our product because of all the activity benefits and savings it will bring. Our products should make a difference to the clinical activity, which is where most of the cost is. If we can decrease the frequency of a dressing change, or improve the dressing so that it does not fail prematurely, then we can maximise the resources being used to manage patients with their wounds.”

The company employed ethnographic researchers (who are anthropologists) to go out and hold in-house video meetings with 6,000 patients to find out how they live their daily lives – how they are limited by the dressings they use, or what can they not do because of the dressings. We are talking not about a cut or graze here, but serious wounds that may take a year to heal and require constant care to maintain the healing process. Such wounds are always subject to interruption when it comes to changing the dressing, and always at the risk of damage to the healing tissue after a slight knock or bump, for example; that is the clinical side of the equation. but there is the human cost too: many people with a serious wound – post-operative, for example – may not feel up to being seen in public with an obvious wound-dressing; they worry it may be unsightly, it may smell in some way, or may even ‘leak’. Not to mention the pain and trauma that can be caused by removing the old dressing.

Allevyn Life, a development of the Allevyn range that Smith & Nephew already offers, is launched in January 2013. Based entirely on that ethnographic research, the shape has been changed – no more squares because the human anatomy lacks straight lines. These are quad-lobal, enabling a better fit around the body’s complex curves so it is not constantly trying to lift itself from the skin. A special silicon adhesive reduces trauma on removal. A foam layer quickly absorbs moisture and stores it in a lock-away core of solidifying crystals (more than doubling the typical life of the dressing before changing while ensuring the exudate remains invisible) while a bump guard is built in to reduce the risk of damaging the tender tissue being grown underneath.

Dermal Care is another new development just being launched, designed to help prevent pressure ulcers. It is a range of dermal gel pads ( kind of ‘external cushioning’) that redistribute pressure to protect critical areas, typically used on bony areas to help prevent skin damage from pressure, most notably the heel and sacrum, and washable for re-use by the same patient.

The company has been carrying out research in hospitals in Victoria (though the results are applicable throughout the Commonwealth). Using these and other new products, some 228 nursing hours per week were saved by eliminating unnecessary dressing changes. “That is the equivalent of several people full-time.” You cannot solve the funding crisis in the health service by looking only at consumables, says Paul, although at Ballarat the saving on the latter was some $30,000 per year; but overall “they improved their funding, reduced expenditure, and improved the patients’ length of stay by an average of a couple of days.” Better patient outcomes and better bottom line – an enviable pair of product benefits that would repay more investigation.

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April 27, 2018, 9:01 AM AEST

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