Streamlining Sterile Processing Workflow, Published Nove 2005

1. SELF-STUDY Series
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November 2005
A roadmap to optimizing
This series of self-study lessons on central service
topics was developed by STERIS.
sterile processing workflow
Earn CEUs
The series can assist readers in maintaining their by Dan Johnson, SterilTek Inc.
CS certification. After careful study of the lesson,
complete the examination at the end of this sec-
tion. Mail the complete examination and scoring fee
to Healthcare Purchasing News for grading. We will
There are a number of trends that are pressuring Costs associated with ineffective and ineffi-
notify you if you have a passing score of 70 percent sterile processing departments (SPDs) in today’s cient workflows often go unexamined, unmea-
or higher, and you will receive a certificate of comple- healthcare industry. Here are just a few of them: sured and therefore, unmanaged. In an
tion within 30 days. Previous lessons are available • Higher surgery volumes increasingly competitive world, poor workflow
on the Internet at www.hpnonline.com. • Overburdened process capacities compromises the effectiveness of the operation
• Inadequate instrumentation availability and impacts the level of customer service that
Certification • Reduced or under-skilled staff you can provide. Conversely, open, efficient
• Viable sterile processing outsourcing alter- and effective workflow positions you for growth,
This in-service has been pre-approved by the
natives operational cost savings and a competitive ad-
CBSPD for 1 Contact Hour. Follow the CBSPD CEU
None of these are going away soon, and in- vantage. In addition, workflow can affect many
Protocols for pre-approved in-services. The proto-
creasing spending on capital equipment, space, parts of your healthcare organization, including
cols can be found on CBSPD website
instrumentation and human resources is not central sterile staff, O.R. nurses, your processes
sterileprocessing.org or by calling CBSPD office at
necessarily going to buy the long-term answers and even your technologies.
908-788-3847.
needed to effectively address these concerns. In a hospital, an effective sterile processing
However, there are some proven methods that workflow incorporates the specifics of your re-
Learning objectives can be borrowed from other industries to im- processing operation and related systems, auto-
prove healthcare operations. mates wherever possible, and eliminates
1. Understand the importance of
Some healthcare industry administrators are redundancy and process variability. This all helps
workflow optimization for sterile
beginning to view their SPDs in the same way to reduce errors and improve speed and quality.
processing departments.
that manufacturing executives view their facto- Workflow is a valuable tool and it lies at the
2. Understand the potential benefits ries. They are embracing concepts long adhered heart of your healthcare organization.
of implementing a workflow to by manufacturing firms to deal with similar Eli Goldratt’s business objective in his book,
optimization program. types of concerns. Among the concepts gaining “The Goal,” is “to reduce operational expense
a foothold is the process improvement method and reduce inventory while simultaneously in-
3. Understand how managers
known as Lean. Lean concentrates improve- creasing throughput.” This statement aligns very
should approach an
ment effort along the workflow, known as the well with the goals for a sterile processing de-
optimization program.
value stream, to identify and drive out waste partment. Ultimately the goal of your workflow
4. Learn how to use some of the and variability from the processes. should be to provide your customer with the
basic tools used to identify Increasingly, efforts are being directed toward best quality product, at the volume required, at
process waste and optimize improving the circular flow of reprocessing the proper time, at the proper cost. This trans-
workflow. work from the O.R. through the SPD and back. lates into a central sterile customer service goal
5. Understand the benefits and The goal is to produce more and higher quality that has been defined by a leading sterile pro-
mechanics of how to map the cessing consultant as 100%3; 100% clean and
work with the same resources by improving
SPD process. process efficiency throughout the operation. sterile instruments, 100% complete instrument
Workflow optimization is all about develop- sets, delivered to the O.R. 100% on time.
ing processes to promote a rational, logical and
efficient flow of work. In a hospital SPD, the Characteristics of optimal
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process is about determining what is of value to workflows
your customers, how to deliver more value to There are three key characteristics of effective
them, how to accomplish more with the re- workflows:
sources available, and how to satisfy the supply 1.They are compatible with current systems and
needs of the operating room. they streamline existing methods. This limits
the additional investments that must be made
Why does workflow matter? and the systems that must be learned by your
Workflow optimization relieves your staff from employees.
performing non-productive repetitive tasks and 2.They can be applied across similar functional
AND helps you to cultivate an environment that seeks departments. The same workflow should be
to improve efficiency, strengthen customer re- effective in an on-site sterile processing de-
lationships and reengineer processes to be leaner partment, an off-site reprocessing center or an
and more productive. Workflow optimization O.R. reprocessing room.
positions a sterile processing department for 3.They are consistent. Reprocessing tasks are
growth. simple, repeatable, reliable and efficient.
November 2005 • HEALTHCARE Purchasing NEWS® • www.hpnonline.com
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What managers should know steps into the other activities that you may find
OR Sets Up Case
To ensure process improvement success, there unnecessary.
are three recommendations that sterile pro- It is important to note that not all non-value-
cessing management should follow. First, adding activities can or should be eliminated.
Instrument OR Performs
Storage Procedure
take action: don’t be paralyzed by what you These are activities that may be essential to the
don’t know, or think you don’t know. The operation of your department. Examples in-
Process Control
key is to gather all the information that clude in-service training, safety meetings,
• Policies
you can within a reasonable time, ana- CP Sterilization OR Breaks Down inspections, etc. Your goal is to identify
• Procedures
Case
lyze it, determine the action steps and and eliminate unnecessary non-value-add-
• Work
implement them. Then do it again. Try ing activity.
Instructions
as you might, first results will seldom be • Identifying waste: Experienced sterile
perfect, but change has been made in the Instruments Placed processing consultants routinely reveal waste
CP
Assembly In Transport Cart in the process flow and work that helps manag-
right direction. To quote an axiom bor-
rowed from manufacturing, “Now and bet- ers streamline activities. Some typical examples
CP
ter is better than perfect and never,” or in the of waste that have been identified in SPDs are:
Figure 1
Decontamination
fabled words of Taiichi Ohno, former vice presi- 1. Labor
dent of Toyota Motor Corporation, “Just do it.” •Quality inspections after the set is completed
Secondly, it is wise to actively involve your bring an instrument set through its entire repro- versus IT solutions and certification to ensure
employees and customers in your improvement cessing cycle. It will also help you to analyze proper set preparation
efforts. No one knows the pitfalls and makeshift these activities to determine if they are value- •Time spent looking for an item that should be
operations that have been developed over the added functions or are not. Activities that add readily available
years better than the people who do the work value to the product or service are those that the • Improperly staffed SPDs or O.R. reprocess-
every day and no creative source is more readily customer would be willing to pay for, that physi- ing rooms
available or willing. Your hospital customer will cally improve the fit, form or function of an 2. Overproduction
also be happy to help you improve your prod- item, or that are done correctly the first time. •Excessive stat washes or flash sterilization in
uct or service level and to identify where a po- Non-value-added activities take time, resources the O.R. (done frequently but not used only for
tential change will have impact. These are your or space but do not add value to the product. an immediate procedure)
most creative resources. Make good use of them. Typical examples are rework at any point in the 3. Space
Finally, be prepared for resistance. Making process, searching or waiting for instruments or •Non-linear workflow from decontamination to
changes within an organization is hard work supplies, waiting on machine cycles, or double sterile storage, requiring storage racks and trans-
and people have a natural reluctance to change handling. portation routes
since it challenges their comfort zone. Some In creating the process map each of the ac- •Non-reprocessing supplies stored in work
people feel threatened when change is proposed. tivities identified in the map is timed and areas
You must work to help people understand what, charted. This enables you to clearly identify 4. Defects
why and how, and remove the fear - or make actions that are non-value-added and therefore •Sets put up with missing instruments, extra in-
not moving forward a greater negative conse- wasteful. Waste is anything that impedes the struments or wrong instruments
quence. Show that you are a strong leader dedi- flow of product as it is being transformed in the •Improper count sheets or documentation
cated to the improvement process. Leading value stream. This means anything that may •Instruments not returned to decontamination
change is not a part-time job. It requires daily prevent central sterile from efficiently deliver- in their original container
attention from leaders who fully understand the ing 100% clean, sterile and complete instru- •Sets returned with instruments missing
scope of the project and who won’t get caught ments to the O.R. on time, every time. Process 5. Time
up in each day’s distractions. I recommend en- mapping also highlights constraints or bottle- •Improper staff scheduling doesn’t meet
gaging the services of a knowledgeable change necks (areas where current demand is greater workload demand
agent to facilitate the improvement process, plan than the current ability to supply) in your pro- •Assemblers waiting for a set from the decon-
and lead improvement activities, and demon- cesses. The process map becomes the launch tamination area
strate and teach effective techniques. pad for additional improvement activities. A • Miscellaneous material (linens) arriving in con-
more detailed subsection of the process map is tainers from the O.R. that slow decontamination
shown in Figure 2. 6. Safety
Step 1: Mapping your Central
•Ergonomically poor workstation layouts cre-
Sterile workflow
ate reaching and excessive movement
Step 2: Improving functions and
Optimizing your sterile processing functions be-
•Sharps, fluid and other hazardous material in
workflow
gins with understanding your workflow; the path
containers at the decontamination stage
your instruments take as they cycle through their Once the process and value stream maps are
• Work process simplification: The in-
daily routine. The first step in this process is to completed, you can begin the improvement
tent of simplification is to promote the utiliza-
develop a process flow and map. The process processes. There are a number of activities that
tion of equipment and facilities to their full
map is a visual representation of the surgical in- are instrumental to effective workflow optimiza-
capacity by reducing bottlenecks and develop-
strument reprocessing cycle. The key to success- tion. These activities include:
ing a smooth flow of materials, work and com-
ful process mapping is to first get the primary • Streamlining; eliminating or mini-
munication. Simplification focuses on the
process steps down, then dive deeper into each mizing non-value-adding steps: Al-
elimination or reduction of unnecessary work,
piece of the map, ultimately uncovering each step though the order in which these activities are
See SELF-STUDY SERIES on page 32
and layer of complexity. A sample process map in performed is not critical to your success, there is
Answers
its initial simplified state is shown in Figure 1. some logic to streamlining and simplifying the
Performing this mapping activity will help work processes before moving on. By stream-
10. d
1. d
2. b
3. b
4. b
5. b
6. b
7. d
8. d
9. a
you to identify all of the actions required to lining and simplifying first, you avoid factoring
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Instrument Set Assembly
SELF-STUDY SERIES from page 31
rework, fatiguing motions, long trans-
ports, and complicated paperwork Set is
complete ,
by using easier methods and mecha- print Count
Sheet
nization. It im-
proves quality
by improving Scan After assembly
Repair I nst rument
work practices individual scan t o Purple
Maintenance returned to set
inst rument s, Repair /
flag f or or scanned to
and inspection mult iple Maint enance
instrument peg board
scenarios Bin
techniques,
and reduces Instrument Inst rument
Scan Scan
accidents and Scan
Track PAR
infections by Instrument instrument
Set missing levels of
replacement f rom
Yes
inst rument s instrument
eliminating hazards, reviewing work available? “Pegboard” t o
stock
set
conditions and encouraging proper Instrument
Scan
cleaning within the SPD. No
Set placed in
To determine the priority for work container or
w rapped -
Set scanned to
simplification, look first at your bottle- H old Set quality check
Supervisor Hold location,
and attach perf ormed
neck operation, the one for which any decision supervisor
missing list
review s daily
improvement will help a whole group
or speed up the entire process. Second, Barcode
Make Scan
select a job on which a lot of time is subst itution,
write on Count
spent. Improvements will be greater for Sheet if
Off -Site works
needed
with On-Sit e to
these than for smaller tasks. Any task find instrument
that involves a lot of chasing around, left at hospital
Supervisor
hard work or inspection steps is a prime okays
incomplet e set
candidate for simplification. Instrument for sterilizat ion
assembly often offers simplification
opportunities, from providing all
needed materials within the technician’s Remarking
After assembly
2D mark perf ormed and
scan to
reach to eliminating unnecessary ma- invalid on instrument
Orange
instrument returned to
Remark Bin
terials and instruments from the set. Situ- use
ations in which the working conditions Instrument
Scan
are undesirable are also ripe for simpli- Extra Inst rument s
fication. instruments or Aft er assembly used to
Extra belongs
peel packed scan to Ext ras complet e set s
in anot her set
Work simplification can only be ac- inst rument s in Blue Bin or scanned to
set peg board
complished with an open mind, and
Instrument
no work process can be taken for Scan
granted. The steps to work simplification are Aft er assembly Instruments
scan to Inst rument s Peel Packed,
Extra is a
straightforward: Singles Peel t aken to Peel wit h barcode
single item
Pack Yellow Pack station f or each
1. Select the job or function to be improved. Bin inst rument
2. Break the job down in detail. Make a process chart. Inst rument
Scan
Similar to the process map discussed earlier, the process
Figure 2
chart is a picture of all the steps; operations, transporta-
tions, inspections, storage and delays that occur for a particular instru-
5. Implement the new process, ensuring that all involved persons are
ment set. When developing the process chart follow the instrument set
adequately trained in the new process and have the opportunity to
through its entire cycle. Be certain to note the time and distance associ-
provide feedback on the changes.
ated with each step in the process. Only then can you account for
6. Review, measure and repeat. Continuous improvement is a never-
improvement.
ending cycle.
3. Question each detail; is it necessary and does it add value for the
• Capacity line balancing: Reprocessing capacity refers to the abil-
customer?
ity of the process to handle the workload that is expected of it, matching the
4. Develop the new method. The basic principles in developing a new
output of the preceding operation and the requirements of the next. SPD
process chart include:
process flows can show capacity variations of 100% or more, meaning that
•Reduce the number of steps (ask why is it done, why is equipment used,
one step in the process can handle twice as much, or more, as the other
where is it done?)
steps. This imbalance causes waste in the over-capacity areas and backlogs,
•Arrange the steps in the best order (ask why is done there, why in this
clutter, and late deliveries in the under-capacity areas.
order, why is it designed this way?)
Too often managers think in terms of maximizing the utilization of a
•Make the steps as efficient as possible
piece of equipment rather than optimizing capacity for the entire process.
•Reduce handling
For example, the production capacity of an SPD’s washer-disinfectors and
•Combine steps
sterilizers is often found to greatly exceed the capacity of the assembly
•Shorten moves
technicians working between the disinfection and sterilization processes.
•Provide the most economical means to move the set through the process
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Step 5: Scheduling process
Many CS managers neglect to address the grow- but is necessary in order to separate the clean
ing backlog of work in the assembly area. and dirty areas within the SPD environment. The sequence of the SPD operation must be
There are two linked elements to the capacity Therefore, we typically set up a decontamina- logical and easily understood, and must flow
picture. The first element is the capacity analy- tion room, containing the handling of any dirty without interruption or delay. It is important to
sis, which will tell you the number of pieces of instruments and supplies, followed by partition- “push” instrumentation through the decontami-
equipment (washers, sterilizers, etc.) and instru- ing walls that provide the separation between nation function as quickly as possible on a first-
ment set assembly workstations that are required dirty and clean areas, within which the mechani- come first-served basis due to the need to clean
to meet a given level of demand. The second cal washers are placed. The assembly area is bio-hazards from instruments as quickly as pos-
element is the identification and proper utiliza- normally set up as a separate department, and sible. However, once the instruments have been
tion of the process constraint or bottleneck. the quality check and sterilization functions fol- pushed through the decontamination process,
Capacity analysis: A capacity plan or model low it in line. the assembly technicians can apply the “pull”
for an SPD begins with an accurate workload Further, each workstation, whether in the semi- method to prioritize their work according to
picture. In most cases this workload is the direct automated decontamination area or in the more customer demands. At this point, they have the
result of a given number of O.R. procedures. labor-intensive assembly area, must be set up option to choose which instruments to process
The steps taken to determine workload are: and arranged so that all necessary, frequently and thereby pull them through the process based
1. Identify the sources of instrument reprocess- used items are easily accessible (within arm’s on the O.R. schedule, their order of priority and
ing for the SPD. reach) and always available. Items that are less any missing instrument needs from the O.R.
2. Determine the number of procedures within frequently used can be placed in cabinets or draw-
these identified sources. ers or on shelves at the work station and any item Step 6: Measuring process
3. Determine the number of instrument sets, that is not used routinely can be removed and performance
ridged containers, single instruments, etc. placed in an easily accessible storage area. Processes must be supported with strong metrics
commonly associated with these cases. Properly designed seating, floor fatigue mats, that align with a hospital’s values. We all mea-
4. Establish the timing of the workload arrival and ergonomically arranged workstations help sure what we value. On a personal level, we
at CS. create a safe, clean and relatively pleasant work value financial solvency. Therefore we measure
This information can then be analyzed in con- environment. These elements, in conjunction money; our income and bank account levels,
junction with data on the SPD’s reprocessing with well-defined processes and expectations and and we adjust our activities and expenses ac-
equipment load capacities, cycle times, etc. Ul- management support, help to ensure that em- cordingly. Measures like this create a link be-
timately the capacity analysis provides you with ployees are consistently productive and efficient tween what we value and our action.
a picture of your SPD’s washer, assembly sta- in their processes. Organizations need to measure what they
tion and sterilizer requirements. value as well. In this case, they need to measure
The bottleneck: In ‘The Goal’, the bottleneck is Step 4: Standardized work what matters to the SPD and its customers. Ef-
defined as “any resource whose capacity is equal practices fective metrics for SPD processes help us to
to or less than the demand placed upon it. A non Standardized work practices define how a task establish the differences between perception and
bottleneck is any resource whose capacity is should be performed and lets everyone involved reality, gather facts that lead to sound decision
greater than the demand placed on it. Bottle- in the process know the most efficient way to making, identify process bottlenecks, and evalu-
neck flow should be on par with demand. The complete the task. It is impossible to establish a ate our customer’s satisfaction level. Metrics also
key is to balance flow, not capacity.” baseline or best practice and make consistent, provide a baseline against which we can mea-
We need to identify the process point that is across-the-board changes when people perform sure our performance and notice improvements
least capable of meeting demand, the bottle- the same task differently. Without standardized and whether the gains are being sustained.
neck, and manage that point. The first step is to work practices, continuous improvement is not There are two purposes for developing con-
ensure that the bottleneck operation is properly attainable and abnormal events go undetected. sistent metrics and measures within an organiza-
scheduled and staffed to handle the reprocess- Standardized work practices must be devel- tion. First, there is a need to measure the impact
ing workload that is coming into it. This in- oped by those performing the tasks. These prac- of any improvement. Successful improvement
cludes having needed supplies available. Next, tices should then be documented in procedures requires a measurement system to track progress.
ensure that the operation and its equipment is and work instructions, with applicable detail to This weaves accountability into the initiative
functioning at its peak performance. The last diagrams and training aides. All employees and provides a tangible picture of the
place in your process that you want mechanical should then be trained in the acceptable practice organization’s efforts. In order to accomplish
troubles is at your bottleneck. Thirdly, acquire and management should follow up to ensure this task a baseline must be determined, so mea-
additional pieces of equipment or staff to meet that the practices are adhered to. surement must begin at the start of the improve-
demand, if it is determined from the capacity This approach helps to ensure flexibility and ment effort or it must be ascertained by methodical
analysis. responsiveness to the O.R.’s ever-changing needs review of past records.
Manage the remaining process to the level of by providing clearly written instructions that The second purpose is to sustain and then
throughput you are capable of at the bottleneck can be followed by even the most inexperienced drive additional improvements within the same
operation. Balancing flow is much like conduct- CS technician. It also helps with identifying prob- processes. According to the authors of “Six
ing an orchestra. All parts need to be in synch. lems in the process or practice and leads to con- Sigma,” the breakthrough management strat-
No musician gets extra credit for finishing first. tinuous improvement. Process changes and egy, organizations “need to establish improve-
improvements are continually encouraged, and ment goals, referred to as Stretch Goals, which
Step 3: Workstation and they are documented and trained as they occur. focus people on changing the process rather
operations sequence layout Rather than stifling creativity, the continuous than tweaking the existing processes. This can
In general, the most effective SPD is laid out in improvement process empowers employees to lead to exponential improvement.”
a somewhat departmentalized, linear flow. This offer solutions and make choices within optimal There is a rule of process improvement that
is contrary to the thinking of Lean proponents, boundaries. states, “We can’t change what we don’t mea-
See SELF-STUDY SERIES on page 34
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SELF-STUDY SERIES from page 33 encountered during a project employed SPD to write down and follow up on, it likely isn’t
staff as runners, to collect instrumentation and important enough to complete. An action item list
sure,” and its corollary: “Don’t measure what
durable medical equipment from 5 O.R. floors, containing a description of the problem, the name
you won’t change.” It is important that mea-
bring it to CS, clean the durable medical equip- of the person who brought it to the improvement
sures be properly focused on elements of the
ment, and then return the items to central sup- team’s attention, planned resolution steps, assign-
operation that reflect what you value and want
ply. This represented a considerable workload ment of responsibility and due date should be cre-
to improve. For example, if customer satisfac-
expansion that we have not observed in other ated. This tool provides the necessary
tion is valued by your SPD, then there must be
hospitals. information to ensure effective and timely
a way to continually measure that value. First,
•Productivity; defined as items or tasks completed completion of the improvement task and feedback
identify what steps in your processes are critical
within a given time-frame. This measure en- to the employee who initiated the action item.
to customer satisfaction. Next, correlate your
sures that your department is performing effec-
process map to the elements that are critical to
tively and requires that reasonable expectancies
improving customer satisfaction. This will help In summary, it doesn’t take a
(standards) be established for each key task in-
you to focus improvement efforts on the right crisis, but it helps…
cluded in the workload.
parts of the process. We’ve discussed many elements for optimizing
•Skill mix and competency; is a measure of skill
It is also important to understand the impact of workflow and have looked at what it takes to
attainment, both individually and organization-
the measures you introduce, since organizations employ these elements in your own SPDs. It
ally. Identifying skill sets required for the suc-
and individuals have a natural tendency to per- often takes considerable stress and strong out-
cessful operation of an SPD and the competency
form in accordance to how they are measured: side forces for a hospital to begin making major
rating of each employee provides powerful in-
•If efficiency is your primary measure, then changes to its processes and practices. These
sight to training needs and your ability to move
people will be efficient at specific tasks that they forces may stem from an inability to perform at
cross-trained employees to understaffed areas
perform, but will not necessarily perform con- expected service levels, or growth rates that are
during peak demand.
sistently all day long or complete the tasks that limited by space, equipment and other resources,
There are variations of these metrics, as well as
are a departmental priority. or infection rates that are out of control, just to
additional measures that can be used. Select those
•If piece count is used as a measure of produc- name a few. Any of these can motivate your
that best suit your organization and its objectives.
tivity, they may select work that is less difficult hospital to look at how it conducts business and
or time-consuming, unless this workload is prop- force it to make substantial changes.
erly assigned and controlled by management. Step 7: Active management/ But it doesn’t have to take a crisis. Forward-
•If equipment utilization is the key measure then supervisory techniques thinking managers can drive the change effort
focus will be on running cycles, regardless of • Communication by recognizing that their current processes are
how filled to capacity the equipment is or the Management’s daily interaction with their less than perfect. Organizations that are healthy
priority of the job. workforce is often undervalued or neglected. are often in a better position to make dramatic
The right selections of measures accurately Typical rationalizations and excuses given to improvements simply because the resources are
capture department and individual performance. explain why supervisors are not spending ad- available and the process can move forward
Performance factors should be tracked, posted, equate time and energy in the midst of their without an extreme sense of urgency. Take the
discussed and corrective action taken to adjust people and processes include: “I don’t have time first step by understanding your process as it
less-than-desirable trends. Timeliness of the mea- to spend with my people;” “my people all know exists today and identify the first opportunity
sure is important as well. A manager or em- what to do, I don’t need to follow-up;” and for improvement. Now you are on your way
ployee who is aware of poor trends early can “that’s micro-managing.” down the workflow optimization road. HPN
make appropriate corrections and impact results A cycle of supervisor-to-employee communi- Dan Johnson is a senior professional services consult-
early. Too often, managers look at performance cation, especially effective assignment-giving and ant for SterilTek Inc., a wholly owned subsidiary of
indicators once each month and react with “that’s routine follow-up, is critical to the success of the STERISCorporationthatspecializesinprocessimprove-
old news”, and “I have this month to worry SPD. Regular interaction ensures that the pro- mentandmanagementconsulting.Heworkswithhos-
about”. The same is true of employees. Employ- cesses that have been established and the practices pitals nationwide to improve their CS operations and
ees should have a clear understanding of what is that have been standardized are being followed support O.R. growth. Johnson has more than eleven
expected of them and productivity should be and that problems are being identified and acted years of consulting experience in healthcare and other
plainly defined as output or results per hour. upon quickly. Nothing in the process or practice industries. His resume includes Lean Process facilita-
Some key metrics that can be used within an tion, process design, capacity planning, management
should be taken for granted by supervisors or
SPD are: training and organizational development. He is certi-
employees. The frequent result of neglecting su-
•Customer satisfaction and quality, defined in fied in Production and Inventory Control, APICS, and
pervisory interaction is that SPD staff, with the
the goal of 100%3. This includes measures of holds a Masters degree in Operation Management
very best of intentions, will begin to do things
cleanliness and sterility of instruments presented from the University of Arkansas.
their own way, deviating from accepted, standard
to the O.R. and completeness and timeliness of procedure and causing the process to drift. References:
sets delivered. • Problem resolution and documentation 1) Jeffrey Liker, Becoming Lean, Productivity Press, 1998.
•Demand; what is the workload amount and 2) Womack, J.P. and D.T. Jones, Lean Thinking: Banish Waste and
Beginning with the waste and bottlenecks dis- Create Wealth in Your Corporation, New York, N.Y.: Simon &
timing to CS. This metric assists you in under- covered by process mapping and workflow Schuster, 1996.
standing bottlenecks and staffing requirements. 3) Eliyahu M. Goldratt, The Goal, North River Press, 2nd edition,
optimization activities, it is paramount that the
1992.
•SPD hours per procedure; this is a benchmark improvement tasks be set down in a document 4) John Kimsey and Jim Barton, The Sterile Processing Factory
by which you can compare your staff perfor- that provides for effective control and follow- Goal: 100% Cubed. Infection Control Today, April 2005.
mance level against that of other institutions. A 5) Mikel Harry, Ph.D., Richard Schroeder, Six Sigma, The Break-
up. Another process improvement rule states: through Management Strategy, Currency / Doubleday, 2000.
caution about using this performance indicator “If it isn’t written, it isn’t done.” This simply 6) Yasuhiro Monden, Toyota Production System, Industrial Engi-
as a staffing level determinant is that not all SPDs neering and Management Press, Norcross, Ga., 1983.
means that far too many things are on our plates
perform identical tasks, and therefore the metric each day and if the task isn’t important enough
may not be exact. For example, one SPD we
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Continuing Education Test-November 2005
A roadmap to optimizing sterile processing
workflow
CIRCLE THE CORRECT ANSWER
1. Workflow optimization in the SPD 5. Which of the following SPD 8. Primary tools used to optimize
can help address which of the workload functions are best workflow include:
following challenges? scheduled and prioritized using a a) Streamlining and work process
Pull system?
a) Process inefficiencies simplification
a) Transport of dirty instruments to the
b) Varying reprocessing demand b) Capacity line balancing and
SPD and decontamination
c) Poor resource utilization standardized work practices
d) All the above b) Assembly and sterilization c) Workstation layout and staff
c) Decontamination and sterilization scheduling
d) Case cart assembly and d) All the above
2. Two of the best sources of ideas for decontamination
process improvement are:
a) CS supervisors and technicians 9. A bottleneck is any resource whose
b) CS technicians and O.R. staff 6. A process map is: capacity is equal to or less than the
c) Instrument vendors and hospital a) A map showing transportation routes demand placed upon it.
management from the O.R. to CS a) True
d) a and c b) A visual representation of the surgical b) False
instrument reprocessing cycle
c) A document providing work
3. Value-Added activities are those 10. Why are metrics and performance
instruction to the CS technician
that take time, resources or space, measures important in SPD?
d) None of the above
but do not add value to the a) To measure the impact of
product. improvements
a) True 7. SterilTek Inc.’s 100%3 SPD goal b) To identify tasks that may be
b) False includes: eliminated
a) 100% clean and sterile instruments c) To sustain gains made and encourage
b) 100% complete instrument sets additional improvement
4. Assembly of sets missing instruments c) 100% on time delivery to the O.R. d) a and c
is an example of value-added work d) All of the above
a) True
b) False
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