“They work in a fast-paced, pressure-filled environment surrounded by bacteria-slicked instruments,” says John Beakes, chairman of Operational Performance Solutions, a lean process consulting firm in Westminster, Md. “And they’re barely making a living wage. It’s time to appreciate and value the work they do.”

Dr. Nichol says his 2-hospital system hosts 19,000 cases each year, and loses nearly $1,000 per case in hard waste and decreased OR capacities caused by instrument reprocessing errors and inefficiencies. “There are 51 million surgeries performed in the United States each year,” says Dr. Nichol. “This is a potential $50 billion waste problem that we have the know-how to solve in the next 10 years.”

But how? Dr. Nichol’s hospital is at the forefront of efforts to reimagine sterile processing and is still having trouble making meaningful changes.

Increasing how much techs earn is a good place to start. Some Chick-fil-As starts its workers at $17 per hour, according to Ms. Prince. She says her hospital used to pay reprocessing techs $4 less. The director of surgical services rewrote the job description based on the complexity of the responsibilities of the job and was able to bring them up to a slightly higher pay grade.

Paying more for surgery’s dirtiest job addresses only part of the issue. Adventist Hospital’s director of surgical services is also working with local community colleges to develop an associate’s degree program for sterile processing, but that’s far from the norm across the country. “The real problem is that there is not a national standard with respect to post-secondary education,” says Dr. Nichol. “Reprocessing techs need advanced training in subjects like chemistry, informatics, instrument identification, infection control and waste disposal. The reason there is no standard curriculum is because people don’t get paid much to do the job. Why would deans of colleges start a program for professionals who are making $15 an hour? How will they pay for their education?

“Developing education and solving the salary issue will be critical to where we need to go,” he says.

Those are big solutions to a layered and complex problem, but you can make a difference in your facility by spending time in the sterile processing department and finding solutions within your own space.

• Assess the process. Analyze every aspect of the reprocessing cycle, looking for obvious signs of waste, over-production and wasted movements. Gather everyone involved in the process, from surgeons to reprocessing techs, because each of them thinks they know exactly what everybody else is doing, but can’t know for certain until they all look at the flow of instruments together. Sit in a room with sticky notes or a whiteboard and literally note each step of the process, however seemingly small you think an aspect might be. Ask everyone in the room to describe exactly what they do and what part of the process they own.

“It never ceases to amaze me what happens when you get all of these people in the same room and start visually assessing the process,” says Rachel Mandel, MD, MHA, an independent healthcare consultant based in Washington, D.C. “People look at each other and say, ‘I didn’t know that you did all that.’”

When people from different departments and roles start talking, they break down silos and begin to understand how the entire instrument care process works and how their roles fit into the big picture.

“The people who do the work are the subject matter experts who know what their processes are,” says Dr. Mandel. “They just need somebody to help them change their way of thinking, the way that they look at a problem and how they can solve it.

“Respect the opinions of the people who are doing the work. It’s their expertise that’s crucial to driving the changes that will result in real improvement, and they’re the ones who will sustain it.” • Build a bond. There’s a disconnect between the operating room and central sterile because the 2 sides might not appreciate what the other ones do and go through on a daily basis. You can bridge the communication and culture gap by looking at Dr. Nichol for inspiration.

“Not every surgeon is willing to walk through sterile processing to see how it really works,” says Mr. Beakes. “That’s magic, and it doesn’t happen everywhere. It’s those humble leaders who want to know how they can improve the jobs of $15-per-hour techs who will change health care.”

Have staff members from each area walk in the other’s shoes for a day, so they gain an appreciation for the responsibilities they have and the pressures they face. “If both groups can see that and appreciate how much they depend on each other, it really helps to develop the teamwork needed to keep instrument flow going,” says Dr. Mandel.

Efforts to improve the performance of sterile processing will fail if you don’t address related issues in the OR. For example, pre-treating instruments with enzymatic cleaner immediately after they’re used in the OR keeps bioburden from hardening and hinged tools from locking up.

“That’s an enormous help to the sterile processing staff, who work extremely hard to decontaminate instruments before sterilization,” says Mr. Beakes.

Part of Littleton Hospital’s orientation program for all new reprocessing techs involves shadowing an OR nurse for a couple days. “It gives them an opportunity to see how instruments are used during surgery and meet members of the surgical team, including the surgeons,” says Ms. Prince. “The best surgeons pay the most attention to those people when they come into the room because they know how important they are.”

Surgical techs and nurses must also complete ongoing competencies to demonstrate that they pretreat instruments properly with enzymatic cleaner and string sharps together to limit injury risks for reprocessing techs. Ms. Prince also explains why bioburden makes instruments impossible to sterilize, a factor she says many OR staff don’t fully comprehend.

• Maintain productivity. Reprocessing techs should be able to close their eyes and know where a specific brush or cleaning pad is located as they move between workstations. Techs also shouldn’t have to leave their workstations to walk across the room to grab the supplies they need to decontaminate instruments — they should be able to stand at their workstations and be productive on an ongoing basis. To help them maintain that level of productivity, assign a dedicated staff member who can do the running for them to make sure everyone has everything they need to do their jobs well.
• Keep case carts moving. It might seem logical to wait until 3 or 4 case carts are ready for transport to the OR before loading them into the elevator for the trip to sterile processing, but be careful of assuming you know the solutions to apparent problems before you’ve worked through the process. Batching case carts actually leaves reprocessing techs waiting around for instruments, and overwhelms them when they arrive all at once. Instead, get into the habit of rolling carts full of dirty instruments to the decontamination area as soon as cases end, so techs are kept busy with a steady stream of tools.

“It’s counterintuitive to move individual carts, but continuous flow is a robust engineering principle,” says Mr. Beakes.

• Invest in technology. Reprocessing techs deserve to work with the latest technologies that can make their jobs much easier to manage. Instrument tracking software that lets them match individual tools to specific trays improves their accuracy and efficiency, and lets them locate trays wherever they are in the facility. It can also give them instant access to current digital reprocessing instructions for each of the thousands of instruments they treat. That sure beats flipping through a dusty binder of outdated information. Also keep in mind that outfitting sterile processing with the latest technology could make your facility more appealing and increase the talent pool from which you can hire.