Download - Optimizing Sterile Processing Workflow
Optimizing Sterile Processing Workflow
A Roadmap to Success
Source: HealthCare Purchasing News, Nov 2006: A Roadmap to Optimizing Sterile Processing Workflow , Dan Johnson, SterilTek Inc.
Trends Pressuring Sterile Processing Departments
Higher surgical volumes Overburdened process capacities Inadequate instrumentation availability Reduced or under-skilled staff Viable sterile process outsourcing
alternatives
New View of SPDs as Factories
Lean Process
Concentrates improvement effort on workflow (value stream)
Identifies waste Eliminates waste Eliminates process variability
Processing Circular flow
Increasingly efforts are being directed toward improving the circular flow of reprocessing work from the O.R. through the SPD and back, with the goal to:
Produce more quality Produce higher quality Improve process efficiency Work with same resources
Workflow Optimization
Developing processing to promote rational, logical and efficient workflow
In a hospital SPD, you must determine: What is of value to customers How to deliver more value to them How to accomplish more with available
resources How to satisfy the supply needs of the O.R.
Why Does Workflow Matter?
Eliminates non-productive, repetitive tasks Cultivates an environment that seeks to
improve efficiency Strengthens customer relationships Reengineers processes to be leaner and
more productive Positions SPDs for growth
The Costs of Inefficiency
Ineffective and inefficient workflows often go unexamined, unmeasured and unmanaged.
Poor workflow compromises: Effectiveness of the operation Level of customer service Many areas of the healthcare facility
SPD staff OR staff Technologies
Efficient SPD Workflow
Incorporates reprocessing operation and related systems
Automates when possible Eliminates redundancy Eliminates process variability Reduces errors Increases speed Improves quality
Ultimate SPD Workflow Goals
Provide customer: Best quality product At the volume required At proper time At the proper cost
100%3
100% clean & sterile 100% complete instrument sets 100% on time delivery
Characteristics of Optimal Workflows
Compatible with current systems and they streamline existing methods
Applicable across similar functional departments
Consistent
What Managers Should Know
To ensure process improvement success: Take Action
Gather information Analyze it Determine action steps Implement them Then, do it again
“Now and better is better than perfect and never” –unknown
“Just do it.” –Taiichi Ohno, former vice president of Toyota Motor Corporation
What Managers Should Know
Actively involve employees and customers Staff understands pitfalls and makeshift
operations Staff is available, valuable, and willing creative
resource Customers will be happy to help you improve
product and service level Customers can identify potential change
impact Customers also creative resource
What Managers Should Know
Be prepared for resistance
Change is hard work in an organization People have a natural reluctance to change Change challenges comfort zones Proposed change is threatening
“It must be considered that there is nothing more difficult to carry out, not more doubtful of success, nor more dangerous to handle than to initiate a new order of things.”
---Niccolo Machiavelli
What Managers Should Know
Leading Change Show dedication to the improvement process Leading change is not a part-time job Change requires daily attention Don’t get caught up in daily distractions Engage the services of a knowledgeable
change agent Facilitate improvement process Plan and lead improvement activities Demonstrate and teach effective techniques
Another Day in CS!
Step 1: Mapping your Central Sterile Workflow
Optimizing the sterile processing functions first begins with a process flow and map. Visual representation of the reprocessing
cycle Focuses initially on the primary process steps Dives deeper into the process to uncover
process layers of complexity
Sample Process Map - Simple
OR Sets Up Case
Instruments PlacedIn Transport Cart
CSDecontamination
CSAssembly
Instrument StorageOR Performs
Procedure
OR Breaks DownCase
CS Sterilization
Value Added Activities
Process maps help in identifying value-added activities within the process
Characteristics of Value Added Activities Customer is willing to pay for Physically improve the fit, form, or function of
an item Performed correctly the first time
Non-Value Added Activities
Non-value added activities = Waste Characteristics of Non-Value Added Activities
Take time, resources, or space but do not add value to the product
Rework at any point in the process Searching or waiting for instruments or
supplies Waiting on machine cycles Double handling
Constraints / Bottlenecks
Process mapping also assists in identifying process constraints or “bottlenecks”
Process Constraint = Area where demand is greater than the current ability to supply
Step 2: Improving Functions and Workflow Optimizing Workflow
Streamline Identify Waste Work Process Simplification Capacity Line Balancing
Streamline
Eliminating and minimizing non-value added steps in the process
Quick hits to produce quick results Not all non-value added can or should be
eliminated
Identify Waste
Labor Waste Quality inspections after the set is complete
versus IT solutions and certification to ensure proper set preparation the first time
Time spent looking for an item that should be readily available
Improperly staffed SPD or other reprocessing areas
Identify Waste
Overproduction Excessive stat washes or flash sterilization in
the OR when instrument set is not used for an immediate procedure
Space Non-linear workflow from requiring storage
racks and transportation routes Excessive movements, poor ergonomics Non-reprocessing supplies stored in
reprocessing work areas
Identify Waste
Defects Sets put up with missing instruments, extra
instruments, or wrong instruments Improper Count Sheets or documentation Instruments not returned to decontamination in
their original container/tray Sets returned with instruments missing
Identify Waste
Time Work schedules that do not align with
workload requirements (too many technicians too early in the day as an example)
Assembly staff waiting for instruments from decontamination
Instruments arriving from the OR with extra items, missing items, or non-instrument items that slow down decontamination process
Work Process Simplification
Deep dive into detailed process steps Increase process utilization and capacity Develop smooth flow of materials, work and
communication Eliminate
Unnecessary work Rework Fatiguing motions Long transports and complicated paperwork
Work Process Simplification
Prioritize Select activity that benefits the entire process Select activity that a lot of time is currently
spent on - greater benefit than smaller tasks Select activities that currently require a lot of
chasing or looking for items, hard work, inspections, or non-desirable work conditions
Work Process Simplification
Prioritize – Instrument Assembly example Provide all needed materials within the
technician’s reach Eliminate unnecessary materials from
instrument sets Remove unneeded instruments from set to
reduce the set size and simply the assembly Provide accurate count sheets, IT solutions, or
pictures to assist in the assembly process
Work Process Simplification Steps
Keep an open mind and no work process can be taken for granted – question everything!
1. Select the job or function to be improved 2. Process chart the job in detail
All operational steps Transportations Inspections Storage Delays Time and Distance
Work Process Simplification Steps
Sample Instrument Assembly Process Chart
Extra instruments in
set
Set is complete
Instrument requires repair
or maintenance
Set missing instruments
Extra belongs in another set
Extra is determined to be a common peel pack item
Ente in IMS Repair Log and place in
IMS Bin
Set Complete?
Yes
Place instrument in Peg Board inventory
Place instrument in Peel Pack Bin
QUALITY CHECK* In correct basket* Properly Cleaned* Properly sent through washer
Add internal indicator and
fill out external load card for
container
Sign, document and
date Count Sheet
Keep tray at table area for
pick-up
Supervisor checks log and enters into PC
Instruments given to IMS
for repair
Instruments returned and logged into IMS Repair
Log
Instruments placed in
Return Repair bins by
specialty
Assembly entire set firstbefore looking for missingInstruments.
Find Missing Instrument1. Look at Repair Log at table2. Look in Today’s Extra Bin3. Call OR if applicable4. Check Returned Repairs bin5. Use Peg Board if common non-marked instrument is needed
Yes
If specialty item is out for repair, place on Hold Shelf
Place set on Today's
Incomplete ShelfNo
Missing Itemout for Specialty
Repair?
No
Supervisor checks Hold
Shelfdaily
Fill out Hold Ticket and place in set
Assigned person tries to complete sets
at 8pm and 2am
May use Peg Board or
substitutes for marked
instruments
Set Complete?
Yes
No Hold or Send?
Hold
Send
Fill out Missing Instrument
sticker
Set Complete?No
Yes
Peel Pack instruments at
regularly scheduled
times
Place instrument in Today’s Extra
Bin
Instruments used to
complete sets
Assigned person empties
Today’s Extra Bin at 6am
Peel Pack?
Yes
No
Peel Packs taken to
sterilization area
Work Process Simplification Steps
3. Question each detail 4. Develop a new method
Reduce the number of steps Arrange the steps in the best order Make the steps as efficient as possible Reduce handling Combine steps Shorten moves Provide the most economical method
Work Process Simplification Steps
5. Implement the new process 6. Review, measure, and repeat
Work Process Simplification Steps
Sample Instrument Assembly Are instruments brought to the assembler? Are extra instruments readily available to
replace missing? Are all needed materials within reach? Is the walking and transporting minimized? Can sets assembled per hour be increased? Can time to assemble each set be decreased? Are clear procedures available to handle non-
conforming situations?
Work Process Simplification Steps
Streamlined and Simplified in Assembly
Work Process Simplification Steps
Streamlined and Simplified in Decontamination
Capacity Line Balancing
Capacity: The amount of work a person, equipment, or process is capable or producing during a given amount of time
Capacity Requirement: The amount of work a person, equipment, or process is required to produce during a given amount of time
Capacity Line Balancing: Matching the capacity of each operation within a process to the requirements of the next
Capacity Line Balancing
Optimize the capacity of the entire process! First, perform a Capacity Analysis
Determine customer workload – often considered OR soiled instruments entering decontamination
Establish the arrival pattern or timing of workload
Utilize cycle times and work standards Determine needed resources to provide the
required capacity to handle the workload
Capacity Analysis
Instrument
Washers
Assembly
Sterilizers
Cart Washer Cycles for Case Carts and Containers
Cyc
les
Instrument Washer Cycles for Instruments, Containers, Singles, and Basins
0
5
10
15
20
6a 7 8 9 10 11 12p 1 2 3 4 5 6p 7 8 9 10 11 12a 1 2 3 4 5 6a 7 8 9
Cyc
les
Cycles Started Minimum Cycles Backlogged
Assembly Hours: Instrument and Linen
0
5
10
15
6a 7 8 9 10 11 12p 1 2 3 4 5 6p 7 8 9 10 11 12a 1 2 3 4 5 6a 7 8 9
Ho
urs
Inst. Assembly Hours Inst. Backlogged Hours Linen Assembly Hours Linen Backlogged Hours
Sterilizer Cycles: Instruments, Singles, Basins, and Linens
0
1
2
3
4
6a 7 8 9 10 11 12p 1 2 3 4 5 6p 7 8 9 10 11 12a 1 2 3 4 5 6a 7 8 9
Cyc
les
Cycles Started Cycles Backlogged
Capacity Line Balancing
Second, balance the capacity Identify the capacity restraint or “bottleneck” Ensure that the bottleneck operation is
properly scheduled and staffed to handle the reprocessing workload that is coming into it
Ensure that the operation and it’s equipment is functioning at it’s peak performance
Acquire additional pieces of equipment or staff to meet demand
Capacity Line Balancing
A typical balanced reprocessing cycle
A typical non-balanced reprocessing cycle
Washers SterilizersAssemblyOR65 Items 64 Items 60 Items 73 Items
2005 Upgraded Process
Items/Hour
Washers SterilizersAssemblyOR65 Items 56 Items 38 Items 73 Items
2005 Upgraded Process
Items/Hour
Step 3: Workstation and Operations Sequence Layout Linear flow for operational efficiencies but
also necessary to separate soiled, clean, and sterile items
All necessary and frequently used items are available within arm’s reach
Properly designed seating, fatigue mats, and ergonomically workstations
Step 4: Standardize Work Practices
Determine best practice and standardize to it Involve the people doing the work Document practice in procedures and work
instructions Train, train, and train Follow-up to ensure compliance Encourage continuous improvement and
change
Step 5: Scheduling Process
Ensure the sequence of CS operations are logical and easily understood
Schedule people, equipment, and processes to ensure smooth flow without interruptions or delays
Schedule to support the capacity line balancing except for the “push” of decontamination
Step 5: Scheduling Process
Push: Decontamination should “push”
instrumentation as quickly as possible to assembly without regard to capacity balancing
“Push” ensures instruments are quickly cleaned and identified as being in CS
Pull: Assembly and sterilization can then “pull” the
instrumentation through according to capacity restraints and customer requirements
Step 6: Measuring Process Performance Measure what you value Differentiate between perception and reality Measure based on facts Identifies process issues and bottlenecks Evaluates customer satisfaction level Provide a baseline to monitor improvement
Measuring Process Performance
Two purposes for developing consistent metrics and measurements within CS Ensure performance meets expectations while
driving accountability To measure the impact of any improvement
while driving additional improvement efforts
Measuring Process Performance
All measurements require a “goal” Sustainable goals reflect current process
performance such as hitting your budget Stretch goals focus people on changing the
process rather than tweaking the existing one
Measuring Process Performance
“We can’t change what we don’t measure.”
“Don’t measure what you won’t change.”
Focus your measurements on what you value and what you want to improve.
Measuring Process Performance
Track, post, discuss, and take action based on the performance factors being measured
Timeliness of measurement and feedback is of utmost importance
Employees should have a clear understanding of what the customer and management expects of them for every task they perform – both quality and productivity
Measuring Process Performance
Key CS measurements Quality: Defects per total items produced Customer Experience: Positive experiences
per total experiences CS Labor Hours per Procedure Productivity Skill mix and competency
Step 7: Active Management / Supervisory Techniques Communication
Continuous cycle Effective assignment giving and follow-up Regular interaction to ensure processes are
being followed Leads to problem identification and resolution Nothing in the process or work practices
should be taken for granted
Active Management / Supervisory Techniques Problem Resolution and Documentation “If it isn’t written – it isn’t done.” Use an Action Item tool or at least a simple
To-Do list.
Summary
It Doesn’t Take A Crisis – But It Helps… Change is usually a response to negative
circumstances – but this doesn’t have to be the reason
Start today by mapping and understanding your process and identifying your first opportunity for improvement