Transcript

We have to balance those trade-offs. And of course, we want the best for the patient. So it's the optimal protection for the skin and the skin integrity. So I actually think that this question gets really to the, I would say, the core of modern healthcare, because we as clinicians and every other clinician, they work within those constraints, to be honest. None of us, wherever you live, wherever you work, we have unlimited resources. And I don't think pretending otherwise would be helpful. So we need to be very careful. 

But I also think that sometimes we frame the conversation in, for me at least, not in the right way, in the wrong way. So we tend to ask ourselves, what is the cheapest dressing? When perhaps, for me at least, and for many of my colleagues, the most important question is, what is the greatest value for this patient over the entire episode of care? And that is a very different question than what's the cheapest dressing at this point. 

So procurement in healthcare often focuses on the unit cost of a product or a device, to be honest, because it's quite easy to measure. But patients, they don't experience a unit cost. They experience what matters to them. And that's the outcome of the treatment. 

So imagine that, for example, a dressing that is more expensive initially, but stays in place longer, reduces pain during the removal, prevents the adhesive-related skin injury that was discussed previously, reduces nursing visits, and also will shorten the healing time. I think there is a high chance that on paper, this dressing, this device, will cost more. But in reality, it may save both money and maybe even more importantly, it will also save suffering. 

And I think we sometimes underestimate what we call the hidden cost of skin damage. A relatively small area of maceration or an adhesive injury can lead to additional dressings, more nursing time delayed healing increased infection risk and of course also reduced the confidence of the patient. So those downstream costs they are rarely captured when procurement decisions are made and at the same time I think we also should be very pragmatic. Sometimes clinicians simply don't have access to every product that they would like to use. And in those situations, I really recommend and I encourage people to focus on what they can control and not on what they can't control. 

So a good assessment, as I discussed, costs nothing except the time. Gentle adhesive removal also costs nothing. Taking 30 seconds to examine the surrounding skin during every dressing change costs nothing. So listening to what your patient is telling you also costs nothing. So sometimes improving technique has a bigger impact than changing your products. 

Another perspective I think is becoming increasingly important is precision. So not every patient needs to have the most advanced or expensive intervention. So what we need is to identify those patients whose skin is genuinely at high or higher risk and really should be our target for our resource allocation. And that's where I'm going back to assessment and risk assessment becomes so extremely valuable. So rather than just applying the same strategy to everyone, we have to personalize care, precision medicine, and we have to invest where the potential benefit is greatest. 

And perhaps the final thing around this question is that products, they don't improve outcomes on their own. We visited hospitals with fantastic formularies, but inconsistent practice. And those hospitals with relatively limited product ranges, they also achieved excellent outcomes because the assessment was systematic, the education was strong, and the teamwork was excellent. 

So just to conclude, products, they really matter. But the people and the processes and especially the clinical reasoning matter just as much as the product that you've selected.