highest volume of work is , in fact , during the evening shift . Scrutinize your SPD technicians ’ schedules against peak hours for throughput of surgical instruments . If a high volume of instrument trays needs reprocessing when your team is not working , alter schedules to meet demand .
• Flexible and split shift schedules can be beneficial and allow staffing to be assigned during high peak hours .
• Rely on asset management systems that can forecast the resources needed to support the demands of the operating room .
• Principle 5 : Build a culture of stopping to fix problems to get quality right the first time . Solving problems early on can prevent bigger problems down the line .
• Quality in medicine is the degree to which healthcare services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge . At baseline , that “ desired health outcome ” is that our patients get better , or at the very least , suffer less from pain . Quality must drive the outcomes of our processes and systems should be built to support the improvements .
• Establish quality audit processes for teams to follow and use the latest inspection tools to ensure improperly clean instruments do not reach the surgical site .
• Set process improvement goals , establish benchmarks for outcomes , and implement an audit process to determine if benchmarks are being met . Collaborate with your team to develop the criteria for audit . A few good places to start are the accuracy of decontamination , compliance with established standards , and physician and patient satisfaction scores .
• Empower team members to stop the process if they detect quality failures and to provide feedback on how things can be done better .
• Harbor a culture of “ doing the right thing for the customer ” ( The Toyota Way , Liker ). In this case the customer is the OR , the patients it serves , and physicians and support staff .
• Principle 6 : Standardized tasks are the foundation for continuous improvements and employee empowerment .
• Create standard processes based on regulatory and accrediting standards . Incorporate into policies and procedures standards and medical devices instructions for use ( IFU ) that can be duplicated every time the task is performed . Outline the process in standard “ how-to ” worksheets and incorporate images or illustrations on how to properly complete a task .
• Provide training every time the process changes or a new device is introduced in the department .
• Competencies should be measured before a technician is assigned to perform the tasks .
• Principle 7 : Use visual control to bring hidden problems to light .
• Use of visual indicators to prompt adherence to proper protocol . Simple and short but effective “ how-to ” worksheets with images of how to perform complex tasks should be available in the areas where tasks are performed . Be sure to laminate or otherwise make use of durable materials for worksheets and signage . They must be regularly cleaned and decontaminated .
• Eliminate or consolidate forms and excessive paperwork that do not add value to the process .
• Continuously review and fine tune the process .
• Principle 8 : Use only reliable , thoroughly tested technology that serves your people and your process .
• Embrace new technology to support your technicians and their tasks and train your team on how to properly use it .
• Use equipment with high-efficiency functions to maximize load capacity and throughput . Ensure all efficiency and efficacy tests are performed according to the manufacturer ’ s recommendations before using the equipment .
• Use technology to trace surgical instruments from reprocessing to the OR and back again to fulfill the requirements of instrument traceability and infection control . If you do not know the source of infection , you are powerless to prevent another one in the future .
• Seek new technology that can help improve processes more quickly .
The above principles , as laid out by the Toyota Production System , can set the bar for the continuous process improvement and the kinds of results that we all want to see in our sterile processing departments and facilities . With buy-in and commitment from your team , you can transform your department into one that can deliver surgical instruments trays 100 percent cleaned , completed , and on time 100 percent of the time .
As Taiichi Ohno said , “ without standards , there can be no improvement .”
Mary Olivera , MHA , CRCST , CHL , FCS , has actively participated in the monitoring , surveying and training interdepartmental staff in the proper cleaning , decontamination and sterilization practices and has been highly committed to the standardization of interdepartmental processes . Currently , she is the president and CEO for OSPECS Consulting , LLC . a company dedicated to facilitating process re-engineering in healthcare organizations .