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How one manufacturer takes on the challenge of incontinence.

It is easy to overlook the humble "diaper," used to treat one of life's more embarrassing health problems. The tendency is simply to "clean up" the problem and move on, without thinking too much about it. Applying such concepts as research, technology and professional education to the "diaper" seems - well, incongruous.

The fact is, incontinence management is no different from other fields of healthcare in making use of all three concepts. That's true, certainly, of the major manufacturing and marketing giants in the field, which have the financial wherewithal to take their products to the next level of value. Recently I was invited by one such company to witness this process in action.

SCA Hygiene Products (formerly SCA Molnlycke) is a leader in the European "inco" product market, commanding an average of 20% of the markets in western Europe and positioned as market leader in Germany, France and the United Kingdom, under the brand name Tena. Its "heavy inco" (nursing-home-level incontinence) products were introduced into the United States a few years ago under the Promise brand name and have about 12% of the market. The company also continues to expand throughout Latin America, Japan, Australia and other countries.

For all its size and growth aspirations, SCA Hygiene has a unique marketing goal: to sell fewer product items per customer. For example, the company is working to get U.S. facilities to reduce their average 6.5 diaper changes per day closer to the European average of a little over 3. "Today's product is so dry and comfortable," explained Vice-President of SCA Hygiene Products-Incontinence Care Ingela Ternstrom, "that more frequent changes are not needed." The key these days, rather, is appropriate product selection and individualized care planning - a concept that has been a tough sell in the United States, she said, partly because of a mindset favoring frequent changes, and partly because facilities had no economic incentives to do otherwise. Now, however, with the Medicare Prospective Payment System (PPS), all that has changed, said Ternstrom. "PPS has, for us, been an opportunity because it is in line with our fixed reimbursement thinking and our emphasis on lowest cost in use."

To help facilities achieve cost-efficient utilization, the company's Promise Guaranteed Cost Program is set up to give facilities a grasp of which specific products are needed for which residents for how long, and to plan care accordingly. This cost monitoring and close control of utilization are where the savings come from, Ternstrom said. The company supports this by educating key nursing personnel in this new approach. In short, "We're not just selling diapers," said Ternstrom, "we're selling a way of caring for incontinence."

Behind this value-added approach is the technology that goes into the product itself. Absorbency has come a long way since what was then SCA Molnlycke, a major paper product concern, ventured into the inco market in 1972 at the behest of a Swedish physician crusading against the use of catheters in incontinence management. Its products have since gone through some 25 design modifications, making them ever more high-absorbency, leakproof and comfortable to wear.

Olle Carlbark, SCA Hygiene's product development manager, walked me through the research process such a modification would go through: setting the goal, creating the plan, offering ideas and then tests, tests and more tests before (if all goes well) launch.

To conduct those all-important tests, SCA maintains a large, well-ordered laboratory where workers at test benches handcraft the proposed products or design modifications. These test items are then subjected to absorption testing, independent focus group discussions involving prospective customers, use by actual nursing home residents and then development of production process changes. This latter function is carried out using full-size manufacturing machinery set up in a special on-premises shop, which then disseminates its findings to the relevant manufacturing facilities around the world.

This painstaking, often highly secret, process can take years to bring a product to market, Carlbark noted. Research and development for inco products occupies 90 full-time personnel in the company's Gothenburg headquarters - clearly a significant investment. "The strength of this process," said Carlsbark, "is that we work closely with the customer."

Not all companies, of course, go to such lengths in research and development and training. Several companies in Europe, for example, do very well simply selling cheap knock-offs of SCA Hygiene products, company officials note. But if customers expect more than just product from a company - if, as many customers do these days, they are looking for expert guidance on optimal, most cost-efficient utilization - then companies like SCA Hygiene offer them a place to turn. It represents the "value-added" answer to the "cheap is best" mindset that has always hindered long-term care quality improvement.
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Title Annotation:SCA Hygiene Products
Author:Peck, Richard L.
Publication:Nursing Homes
Article Type:Company Profile
Date:Aug 1, 1999
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