Why a Tried-and-True Process is the Right Process for Our New Way of Doing Things
By Mary Olivera , MHA , CRCST , CHL , FCS
We do not have to think back too far to remember the days of sterile processing quality audits done by the naked eye or “ bioburden or corrosion ?” questions answered by the flick of an eraser head . It was , to be sure , a simpler time in operating rooms ( ORs ) with reusable products , fewer complex instruments , and less focus on quality control , but the sterile processing department ( SPD )’ s role in a procedure ’ s success was mostly overlooked .
Thankfully , however , the perceived value of sterile processing has increased in conjunction with technological advances in the OR and our SPD equipment , processes , and approaches are now seen as equally as important as the operating rooms we serve . ( As a measure of how far we have come , note that my first foray into sterile processing was not in an SPD at all but as part of central supply . My team distributed linens , medical supplies , and reprocessed surgical trays from the OR .)
SPDs are now treated as they should have been all along : as the frontline for preventing hospital-based surgical site infections . Our now-separate departments are outfitted with an array of sophisticated equipment to ensure that the OR ’ s tools are properly decontaminated and processed , and that improperly cleaned or high-level disinfected instruments or equipment do not reach the operating room where they can cause harm .
Sterile processing professionals should take this evolution – of technology , of the SPD ’ s understood value and importance – to heart and strive for better processes , consistent growth , and high-quality product outcomes . Where better to look for an approach on how to do these things than to an industry and a company that has achieved all three ?
In a previous article titled “
Lessons from Unexpected Places : How Manufacturing Best Practices Can Transform Sterile Processing Departments ” ( HHM , Vol . 2 No . 11 ; Nov . 2020 ), I covered how the Toyota Production System ( TPS ) principles can be adapted to a sterile processing department in order to consistently deliver a safe and quality product to the operating room . At the core of TPS is the notion that all team members can and should be engaged in the continuous improvement of their work , something that can only happen in a professional culture dedicated to teamwork , collaboration , and performance improvement .
With that notion in mind , the Toyota Production System is comprised of 14 business principles , broken down into four categories , that are geared to improve its vehicle manufacturing process . Fortunately , these processes are as applicable to improving an SPD as they are to churning out Corollas .
Here we will dive deep into seven TPS principles in category two : “ The right process will produce the right results .” Principle 1 is omitted purposely in this article .
• Principle 2 : Create continuous process flow to bring problems to the surface . Problems have a way of showing themselves when we pay enough attention , so take a good , hard look at how you are doing things .
• Analyze your current SPD process to determine excess steps and redundancies that can or do delay instrument reprocessing . How ? Create a visual representation of all the steps a technician must take to complete a task . Spaghetti charts and process workflows are helpful tools . This is an exercise that works best when the whole team is involved . Everyone should come away with the figurative and literal whole picture of what it takes to get something done .
• Use your spaghetti chart to redesign the process to achieve the highest workflow efficiencies , minimizing actual steps and redundancies .
• Talk to your team to learn which items are used most frequently when assembling and packaging trays . Redesign workstations to keep these items within easy reach . These items will most likely include basic instruments , indicators , tamper proof locks , inspection materials , and the like .
• Principle 3 : Use “ pull ” systems to avoid overproduction . Overproduction can be just as wasteful as underproduction . Why do more if you can do the right amount ?
• Analyze instrument tray usage data to determine if the current inventory supports the demand for the most frequently used surgical trays .
• In collaboration with the OR , create PAR levels for the surgical trays based on utilization data . This process will avoid overproduction of trays that are not used frequently or are not needed on specific days .
• Review the next day ’ s surgical schedule early afternoon to get ahead of the workload and to have the time to effectively allocate resources .
• Maintain open communication with the OR to confirm the customer demands are being met rather than working on trays that are not needed .
• Designate liaison and / or provisions teams to ensure the OR have what they need , when they need it , and in the amount they need it in .
• Principle 4 : Level out the workload ( heijunka ). “ Work like the tortoise , not the hare .”
• Many SPDs have fixed schedules in which most of the technicians are scheduled in the morning shift but the
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