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The Cost Savings of Managing Your Instrument Trays Like Toyota
By: Casey Czarnowski, BA, CRCST, CSPDT, CIS, CER
Instant optimization occurs when you focus on these three areas of waste.
Sterile processing leaders understand that efficiency is paramount when it comes to instrument management, and they often look outside the healthcare industry for help.
Prime example: Many facets of the Toyota Production System (TPS) can improve virtually any sterile processing department’s (SPD) instrument tray management processes. To improve your tray optimization, the three primary wastes you can address are inventory, overproduction and motion. Here’s how to manage your trays like the efficiency experts at Toyota.
Before even attempting an optimization project, you’ll want to gain the full support of the C-suite. Finding an executive sponsor ensures a much smoother overall process. Better yet, developing a pilot project with two or three surgeons creates buy-in among the providers in your facility. When presenting a set optimization project to executive leadership, touting the cost savings will be an important part of your presentation. Cost-saving opportunities with set optimization are many, with some less obvious than others. Increasingly, experts are finding ways to incorporate TPS-style processes into their own SPD workflow. Sterile processing managers and other facility leaders can learn much from the TPS, including standardizing work, efficiencies and stopping processes before a problem or dangerous situation occurs. There are plenty of resources available to leaders on TPS, including websites, books and consultants, and many facilities have used this philosophy to great effect in various aspects of their organization, including sterile processing, material management, environmental services and many others. For set optimization, the three primary wastes you should address are inventory, overproduction and motion.
• Inventory. It’s the obvious place to start. Many healthcare facilities are carrying too much unused inventory in the form of backup instrumentation. This translates into insurance costs as well as unused money sitting on a shelf or in a drawer. Walk into many SPDs, and you can find hundreds or thousands of instruments in cabinets, drawers or hanging on a wall waiting to be utilized. Done carefully, optimization decreases the need for excessive instrument backup and allows facilities to unload a portion of their inventory and purchase more intelligently. Excess backup inventory also takes up space, a major consideration, especially in smaller outpatient facilities.
Facility leaders can learn a few things from the efficiency of the manufacturing industry. Below are the eight wastes of the Toyota Production System (TPS). How many wastes in the TPS are relevant to processes at your own facility?
- Defects — when the product does not meet customer requirements for functionality.
- Overproduction — when more product or elements of the process are produced than are needed.
- Waiting — when there is too little or inefficient production that causes a segment of the process to lack work.
- Neglected talent — when skills and knowledge of individual workers are ignored or not utilized to increase the efficiency of the process.
- Transportation — when products, tools and materials are moved unnecessarily.
- Inventory — when more material is stored than is needed for the process, or when more products are stored than customer demand requires.
- Motion — when workers make unnecessary movements or efforts to complete their portion of the process.
- Extra processing — when portions of the process are completed to a higher degree of quality/completion than required.
— Casey Czarnowski, BA, CRCST, CSPDT, CIS, CER
Storage is a major consideration at nearly every surgical facility. Storage conditions of sterile instrumentation are defined by national guidelines and standards, and are carefully examined during accreditation surveys. Reducing the volume of sets in a controlled and monitored environment can lead to cost savings by reducing how much monitored space is needed for sterile storage. When designing a set optimization program, remember to calculate future savings when considering space needed for expansion or expanding service lines with new providers.
• Overproduction. It’s remarkably common for only a small percentage of the instruments in an OR instrument set to be utilized. Instrument bloat occurs when surgical tools are selected or added to a set by multiple providers over time. These items add up and grow over the years, but never seem to disappear after providers leave the organization. Common examples include specialty retractors favored by specific providers in hip and shoulder replacement sets. By including specialty retractors in every total hip or shoulder set, overproduction leads to extra time in the SPD cleaning and inspecting instruments that may be rarely or never used. A leaner method is to create smaller sets or package individual instruments that are placed on surgeon-specific preference cards, while leaving the general total sets to contain only retractors universally used by most or all providers.
With funding for positions tighter than ever, cutting down on cleaning and inspection of rarely or never-used instruments represents an important way to get the most out of each person in the SPD. The sets of extra-long instruments for use in abdominal procedures on bariatric patients offer a good example of separating lesser-used instruments out of general procedure trays. By knowing their patients, providers can call for extra-long instruments as a set when they are needed and avoid having a set overrun by instruments that won’t be used on all procedures. Extra-long instrument sets are already common in facilities and can be used as a positive example of instrument reduction when starting a new set optimization project.
• Wasted motion. This is most obvious when calculated in terms of OR time. Many facilities use OR time — calculated in minutes — to gauge the efficiency of their processes, and to evaluate ways to reduce turnover time. Calculated into OR time, of course, is the count process that facilities use to prevent unintended retained surgical items (URSIs) in a procedure. A URSI is obviously devastating for a patient, and it’s also something that can largely be prevented with a stringent, efficient count policy coupled with adjunct technology. Reducing the number of instruments involved in the pre- and post-procedure counts can save minutes per case, and over the course of a year can have a big impact on facility finances, without jeopardizing patient safety. For the purposes of a set optimization plan, another positive aspect of calculating savings based on the waste of motion is that facilities look carefully at OR time, and baseline data may already exist for a pilot study.
A surgical instrument set optimization program is hard work, and it involves the entire perioperative team, as well as finance, purchasing, facilities management and others. Meticulous planning and data collection must be done for the process to add real benefit to the facility and, ultimately, the patients. With a clear purpose, adequate data and potential cost savings in mind, you can reduce waste and save time, which ultimately benefits your entire facility. Surgical instrument set optimization creates an abundance of advantages for your OR, SPD and patients. OSM
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