Need Help Improving Instrument Care?

The sterile processing staff at Winchester (Va.) Medical Center reprocesses trays of instruments sent to them from 15 ORs. That's a lot to manage, so perhaps it's no surprise workflow issues once derailed a process for moving instruments through the department efficiently and effectively. "We needed help streamlining the way we worked," says Susan Riley, RN, the hospital's operating room business manager. "It's very hard to break habits and routines. It's even more difficult to make repeated attempts at making change happen. An outside expert with new ideas and a fresh voice can help."

But not all consultants approach the job with the same methods or intentions. "Some are deeply aligned with equipment manufacturers or major industry players," says Dave Norton, MS, MBA, a former Lean process consultant. "That doesn't make them ineffective, but they sometimes approach the project with preconceived opinions and outline an improvement plan to get you to solutions they deem necessary without understanding your needs."

He says the consultants you want to partner with make suggestions based on how your facility functions, then teach your staff to find and make needed improvements. They're interested in spending time learning about what makes your department tick instead of arriving with a predetermined set of process-improvement goals and a boilerplate punch list of tasks.

"They should spend weeks watching the flow of instruments during the busiest of times and lulls in the action, and observe how your team interacts," says Ms. Riley. "They need to look at the whole process before making suggested changes, which shouldn't disrupt your current workflow."

Ms. Riley admits it's not easy to relinquish power to an unfamiliar professional who you've given permission to create the change you've struggled to make happen. "But if you buy into the process, it can make a big difference," she adds.

After partnering with the right consultant, begin building trust and clear lines of communication. "You need to know they have your best interest in mind," says Ms. Riley. "Once you do, let them do their thing."

Consultants can help gather every staff member involved in instrument care, from surgical personnel to sterile processing managers, and drill down to how trays move through the OR-SPD circuit. "They're able to map out the process to look for repetitive or unnecessary steps — and identify ways to make it more effective and efficient," says Ms. Riley.

For example, Ms. Riley's consultant suggested that members of the OR team should roll individual carts full of soiled instruments to the sterile processing department as soon as they're ready instead of waiting to move several at a time. Doing so prevents a bottleneck of carts in sterile processing that makes it difficult for reprocessing techs to keep pace with arriving instruments.

If you buy into the process,it can make a big difference.
— Susan Riley, RN

Ms. Riley says her consulting team assigned designated runners to move about the sterile processing department, a role that let reprocessing techs remain active at decontamination workstations. "One person is feeding the others work based on need," says Ms. Riley. "That was a brilliant suggestion."

The team of consultants also helped her organized storage racks — reworking shelving configurations and adjusting shelf heights based on the size of instrument pans — in order to eliminate wasted space and maximize capacity.

During his consulting days, Mr. Norton made sure sterile processing teams were comprised of interchangeable parts — skilled professionals who mastered every aspect of instrument care.

He also used to marvel at the number of facilities who treated instrument reprocessing as an art instead of a science. "Very few department leaders established a standardized work process and required their teams to follow it," he says.

Standardization is one of the biggest lessons Ms. Riley learned from her consultants. "We made sure everyone, no matter the time of day or volume of work, approached tasks the same way every time," she explains.

Mr. Norton instructed facility leaders to record how long it took instruments to go through the entire sterilization circuit, from ORs through sterile processing and to storage. He also demanded that all sets of reprocessed instrument sets were returned to ORs in perfect condition, meaning all items were present and properly sterilized. He expected perfection, but surely would have settled for a 90%-plus success rate, right?

"No," he says. "I meant every single set. If you measure time and quality, and improve upon both of those elements, costs will decrease."

The best consultants ultimately end up feeling like valuable members of your staff. "They were with us forever," laughs Ms. Riley. "The full team was here for several months before they slowly dwindled in numbers as we learned how to implement the process improvements they suggested. We had direct and indirect contact with them for at least a year. They took ownership in our success, which was nice. They truly wanted to make a difference." OSM