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CSR Briefing: Meryl Bushell

Spring 2012

When good procurement can be a life and death factor.

Not many people consider procurement as a life or death profession. But the choices we make can have far-reaching consequences for the users of the goods and services we source. While conversations about ‘health and safety’ are often met with a shrug, greater awareness of how procurement’s actions affect these issues can save lives and prevent countless injuries.

The early 2000s saw several incidents where hospital patients inadvertently received excess doses of their drugs. This resulted in fatalities. Each of these cases involved the use of interactive medical devices (IMD) to administer the medication. In one case a premature baby died after receiving 10 times the required dose of diamorphine; in another somebody lost their life after receiving a dose 24 times too high after a daily dose was miscalculated as hourly. On a third occasion, a fatality followed the omission of a decimal point and a tenfold overdose. Each of the cases was investigated and in each of them the main finding was one of human error, with a recommendation of more training for those programming the devices.

But scratch below the surface and it is possible to see that procurement may have had some role to play in these terrible tragedies. While human error was the main finding, in all three cases it was noted that the design of the devices also contributed.  For instance, the IMD alarm went off in error and the nurse cancelled it manually. The alarm cancellation button was next to the x10 dosage increase button and the nurse accidentally hit the wrong button. In the second case, two nurses failed to calculate an hourly dose for a four-day infusion correctly: they divided the total dose by 4 instead of 4X24, but the IMD programming for hourly dosages were confusing and added to the problems. In the final case, the IMD did not recognise decimal points in numbers higher than 99.9 and so when the nurse programmed in 130.1 ml it was translated as 1301ml.

Poorly designed equipment was a factor in all three cases. How high up on the adjudication criteria did ease of use and safety come for these procurement exercises? Sourcing was also involved in other ways: in a drive to reduce costs, a wide range of IMD devices were in service in each of the hospitals. Each time a procurement exercise took place, a different machine was chosen as the most cost effective. As a result, the nurses needed to be trained across a range of different devices, making it more likely that they would be unfamiliar with the quirks of each model. A requirement for more balanced procurement outcomes might have
saved lives.

Most buyers probably do not think they can impact user safety significantly, but I would beg to differ. It was pleasing to read in the papers recently that the procurement practices for London’s new Crossrail project require all suppliers delivering items to their sites to meet safety standards designed to protect cyclists. Crossrail is Europe’s biggest current construction project and so far 1 in 10 of the lorries delivering to the site have been turned away for breaches of the cyclist safety specifications, which include such things as proximity sensors, alarms, blind spot mirrors and warning signs. It’s an example of where socially responsible procurement can really make a difference.

All CPOs could introduce Crossrail’s simple measures on the transportation of inbound goods and the transport industry would soon wake up to cyclist safety. But there must be many other opportunities where CPOs could lead the way for their companies and their industries.
Writing specifications that produce intrinsically safe designs, placing health and safety high on the adjudication criteria and then ensuring compliance are things all senior buyers should be concerned about. The trouble is, health and safety is so often perceived as dull and it is certainly not viewed as an area where high flyers’ reputations are made. Pity. 

Meryl Bushell is a business coach and consultant, and former CPO at British Telecom

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