A ROADMAP FOR EFFICIENCY We trimmed the waste between sterile processing and the OR.

If you look closely at how your sterile processing department and OR work together, you may see what we found — a system weighed down by many unnecessary and inefficient steps, all of which led to frustrating delays and plenty of wasted dollars. It wasn't anyone's fault. It had just evolved that way over time thanks to workarounds, bloat and a "We've always done it this way" attitude. And while people occasionally griped about it, no one knew exactly how to fix it. Until, that is, we took a big step back and methodically mapped out the 50 or so steps involved in getting used instruments from the OR to sterile processing and back again. It took some time — we spent many hours observing and went through many packs of sticky notes — but it was time well spent.

Creating a map using sticky notes
To do it, we used a process called value stream mapping. That may sound complicated — it's the term they use in lean and Six Sigma projects — but it's not rocket science. You just need a general understanding of the basic idea, which is to use observation to pinpoint value- vs. non-value-adding types of activities. It's logical and practical and chances are it's a tool your facility could use to unearth a lot of opportunities for improvement. As statistician W. Edwards Deming says, "If you can't describe what you're doing as a process, then you don't know what you're doing."

What we knew was that there were a lot of delays, bottlenecks and work inefficiencies between central sterile and the OR. So the first thing we did was bring people together from the different departments, feed them breakfast and start to evaluate all the steps there are in cleaning an instrument tray. It was kind of like putting a puzzle together. We used a lot of sticky notes to document the process and map it out on a wall — all the nuanced steps involved in getting a dirty instrument back from the OR and returning it to the OR clean, and how long each step takes. That was how we began to uncover and eliminate the wasted time and energy that were gumming up the works.

LAYING IT OUT Use sticky notes to map out all the steps involved in getting a dirty instrument back from the OR and returning it to the OR clean.

One fix at a time
Eventually we had a complete draft of the process, which we then put through a period of validation. We said, "This is what we learned, this is what you told us. Do you agree?"

Incidentally, we knew you don't go into the process with the idea that you'll fix everything immediately. First, you look for low-hanging fruit — things that are easy to improve. For us, that meant removing 4 large carts full of unused, extra or unusable equipment along with 7 large empty carts that were taking up lots of space. Then, by focusing on what you consider to be the ideal scenario, you develop a roadmap for incremental improvement over time.

That's what we've done and what we continue to do. It takes time and effort, but it's a gift that keeps giving, saving us time and money every day. We identified 2 key areas of focus: case-cart assembly and what happens from completed cases to decontamination. Here are some of the things we discovered and accomplished:

• We easily exceeded our goal of reducing our flash rate from around 16% to less than 5%. It's now around 2%.
• Many instruments that were being stored were simply taking up space — they weren't being used anymore. There were trays that had been set up for doctors who'd worked here once or twice a long time ago. Some of those had instruments that were reusable and could be put back into service. Others were so old and outdated that no surgeon would ever use them again. Those we had taken away by the biomedical department.
• By consolidating and getting rid of so many instruments, we were able to clean out an entire quadrant, freeing up several rows of shelving and trays. That alone made the whole area run much more smoothly.
• We changed how the OR processed information, making it easier for staff both upstairs and downstairs to track trays as they moved through the process. Previously, there was no clear procedure for what happened when physicians finished cases and put equipment back into containers and trays to send them down for decontamination. That made it nearly impossible to know where equipment was at any given point in time. To reduce delays in receiving, we have an OR nursing assistant check the hallway every 30 minutes for carts ready to be sent down for decontamination. We also held an in-service for OR staff on dirty cart preparation.
• We reevaluated and improved how we pick cases and get things ready to go up to the OR.

Worth the effort?
How much time and money are your processes wasting? Might there be dozens of opportunities for improvement? Unless you take a long, hard look, you may never know.