Brooke Berson, R.N., Director, Clinical Resource Management
Duke University Health System, North Carolina
The following edited interview was conducted by Robert W. Yokl, Managing Editor, Healthcare Value Analysis Magazine
Brooke Berson, R.N, is a graduate of Duke University’s Fuqua School of Business with a Master’s in Business Administration. Berson has held the position of Director, Clinical Resource Management at Duke University Health System, North Carolina, for 13 years. Berson is a founding member of the Association of Healthcare Value Analysis Professionals and is an active member of AHVAP’s marketing committee.
(HVAM) Can you tell us a little bit about your background and how you got into value analysis?
(BB) After graduating from nursing school in 1985, I immediately went into bedside nursing and in 1987 started ICU nursing. I came to Duke in 1988 and have worked probably in every ICU but my most recent experience, and longest experience, was in the surgical ICU. I went to business school in the 1990’s and from that experience wanted to parley what I knew and the business acumen I had gained at business school into a new profession. I didn’t want to throw away all that I had learned, so I wanted to incorporate my experience in nursing with what I was going to do. I didn’t want to completely switch away from patient care. There was a job in purchasing and my first title was clinical resource utilization specialist, which was an industry title for value analysis at that point. There was a new supply chain executive, and she had a clinical resource specialist at her previous IDN. She hired me and I became Duke’s first value analysis professional. When I started with the job, I basically had to write my own job description which was very challenging. I found myself at a job coping with definitions that I knew nothing of. At that time, I didn’t know what value analysis was. It was a challenge to even get my arms around it.
(HVAM) Who were some of your early mentors in value analysis and how did they help make you the value analysis professional that you are today?
(BB) I saw some value analysis articles written by Cindy Christofanelli, Sally Simpson, Barbara Strain, Kate Miller, Jan Neworth, and Melanie Miller (founding members of AHVAP) and reached out to them by phone and e-mail. They were instrumental in helping me learn the language of value analysis and the supply chain, as well as provided me with guidance, templates, policies, etc.
HVAM) Back in 2003, you were a founding member of the Association of Healthcare Value Analysis Professionals. What was the genesis for you to form a new association?
(BB) We started an informal group of value analysis practitioners in July 2000 with the goal of making AHVAP into a professional group. We had our first informal meeting in Chapel Hill whereby everyone agreed to start a formal group. By 2003 we had 100 members of AHVAP. At the time, I didn’t foresee the success that AHVAP is today. In the early days, under the leadership of Kathleen Stickane, Cindy Christofanelli, Melanie Miller, and Barbara Strain, AHVAP flourished through expanded membership, formalizing the structure, and signing an agreement with an association management company.
(HVAM) Could you give us examples of some of your most recent value analysis successes?
(BB) We have a technology committee with several physician members that has been very beneficial. We look at our past purchases and where the industry is going in the future to give us a baseline. For example, we looked at cardiac output monitors, which were invasive in the past, but now are noninvasive. This gets us thinking about what the technology will be in the future and how we can use this information from articles and literature to leap frog to another technology, so we're not constantly changing our standards with every piece of equipment that comes on the market. Our committee also uncovered an issue with cardiac output monitors that even the manufacturer didn’t know about. Duke won an award because we found this defect in the monitors. That’s why I think evidenced-based value analysis is really root cause analysis. It’s not so much, “I want this,” and, “Why?” It’s, “What are the outcomes?”
(HVAM) What are some of the most important skills you feel are necessary to become successful in value analysis?
(BB) The most valuable value analysis skill I have is being a nurse, but I understand that a lot of value analysis professionals aren’t nurses. While this isn’t a hard and fast rule, it has helped me in my profession. Also, my business school education has helped me to expand and apply the concept of value analysis to even my hospital’s service agreements. Lastly, the skills I have acquired in organizing, networking, and benchmarking all have helped me to understand the efficacy of the products I buy and how this relates to our patients and their safety, and to our front line staff.
(HVAM) What do you think some of the biggest challenges facing value analysis professionals are and what should they be doing to overcome these challenges?
(BB) The biggest challenges I see is one, not having your healthcare organization engaged, top down, in saving money and improving quality outcomes. Second, not having your clinicians driving your evaluation process. Too often, procurement is leading product changes. I think there are organizations where purchasing comes in and dictates what’s going to happen, and then it’s a big challenge to win over your clinicians to the strategies and tactics of value analysis. Clinicians can be won over not by encouraging them to save money, but by helping them understand the marriage between product purchasing and evidence-based practices.
(HVAM) It’s been 10 years since AHVAP was formed and since then value analysis has really come into its own. How do you see VA in the next 5 to 10 years?
(BB) That’s a good question because that’s what we are all thinking about. Pricing has just about been exhausted and will remain so. We now need to look at utilization, which isn’t a new concept to generate new savings. I also believe that scientific evidence-based value analysis is a brilliant idea, since it mergers clinical and product efficacy and cost together. We have been doing scientific evidenced-based reviews at Duke for some time. These two practices are where I see value analysis practitioners going over the next 5 to 10 years to continue to save money.
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