Lessons from Unexpected Places :
How Manufacturing Best Practices Can Transform Sterile Processing Departments
By Mary Olivera , MHA , CRCST , CHL , FCS
It may be forgotten over the course of a day saving lives , treating patients , and putting out figurative fires , but a hospital or medical facility is indeed a business . There are employees — the doctors , nurses , support staff , the maintenance crew — and there are customers — the patients , their family members , and even other departments . There are standards to uphold and people to please , and there is feedback to take in and processes to refine . As patients ( and even employees ) increasingly do their research before committing to a facility , it ’ s imperative that hospital leaders do what they can to make sure that the experience is positive for all involved .
While the healthcare system has laid out a variety of tools and metrics to grant facilities “ best in service ” recognition , the byzantine approach to awards , benchmarks , and what it all truly means leaves much to be desired . Rather than reinvent the wheel , we at OSPECS Consulting prefer to look outward , to the companies and industries from which we have much to learn on the topics of streamlining , service , and quality .
In the 1970s , Toyota developed and fine-tuned a manufacturing process that would ultimately allow the company to deliver what customers wanted , when they needed it , and at the highest quality possible . There were two keys to the process : eliminating waste from the production line and building flexibility into the process so the company could find efficiencies among staff , equipment , and space . These principles became known as The Toyota Way or the Toyota Production System ( TPS ) and are the foundation for Toyota ’ s manufacturing best practices that are respected and implemented the world over .
The goals of the sterile processing department ( SPD ) in any healthcare organization aren ’ t — or shouldn ’ t be — any different from Toyota ’ s : we aim to provide excellent care to our customers ( patients ), we strive to deliver a safe and quality product when our customer needs it , and we do all of it in the shadow of our very own production line ( instrument reprocessing ). And while a goal of 100 percent cleaned , completed , and on-time instrument trays may seem lofty , it is achievable with the right process in place .
Here are five ways The Toyota Way can transform your SPD :
➊ Eliminate waste by eliminating steps that do not add value .
Taiichi Ohno , the Toyota executive who is credited with the development of TPS , described waste , or muda in Japanese , as any production activity that incurs resources but does not add value in the process or for the customer . Remember : the goal is an error-free surgical instrument tray delivered when it ’ s needed for surgery , and anything that is not in service of that goal is waste . Use the framework below to identify the steps in your current processes that do not add value for your customers .
Brainstorm with a cross-functional team to weed out waste in areas you may miss .
● Overproduction . Is your team assembling more trays than are needed or are they producing the correct number of trays needed to supply the operating room ( OR ) schedule for the day ? Review the next day ’ s surgical schedule to determine what types of surgical trays are needed to fulfill demand without interruption . Use available scanning technologies to flag the trays that will be needed first . If the department uses a manual system , use a color tag process to alert technicians to the trays that need to be reprocessed first .
● Processing . Is your team assembling trays with hundreds of instruments that never get used during a procedure ? Select your most frequently used trays and analyze their contents for frequency of use among the surgeons . Ask the surgical scrub technicians , the service line nurses , and the physicians involved which instruments can be removed from the sets . Hospitals that have performed this exercise have reduced assembly time and enhanced productivity .
● Defective trays . A defective tray is any tray that does not meet the quality standard set forth by the hospital and is not in safe , working order the first time it is opened . A substandard tray is any tray that is missing instruments , has bioburden , includes packaging defects , or includes broken instruments . The best way to produce error-free trays is to mimic a manufacturing process . We must : i . be able to fulfill the order as quickly as possible ii . have the production instructions ( IFUs ) before we begin the assembly process iii . have all cleaning tools required in the instructions for use iv . have replacement instruments in stock at the workstations v . have a small inventory of all types of components that may be needed to assemble the trays vi . be able to come to a safe stop whenever a non-conformity occurs vii . continuously improve and simplify the process