Author: Deb Haley, RN, CNOR, CSPDT, MBA | Director of Clinical Services

Accuracy and efficiency are constant battles in SPDs. We know the importance of proper sterilization, but when instrument kits pile up, the focus can naturally shift to the ticking clock.

The truth is your department can accomplish both speed and accuracy, but it might take some extra legwork. Enter the Lean method.

Developed by Toyota for vehicle manufacturing, Lean improves processes through simplification—and enabled Toyota “to become the world’s highest quality, most productive automotive manufacturing organization.” Over the last decade, health organizations have implemented Lean and found similar success. One SPD attained a 250 percent ROI over a six-month period, saving both time and money and reducing the number of errors per week by 45 percent.

Whether you’re just starting to implement Lean or your facility has been using the method for years, here are a few principles to guide you as you seek to improve processes and positively affect patient outcomes:

Do: Provide your employees with experienced guidance.

SPD employees juggle a lot. Urgent issues and tasks can arise at any moment. At the same time, improvement only happens if it’s given focused attention. So if your employees are new to Lean, don’t dump everything on their shoulders at once. Instead, give them a hand by providing them with a “Lean advisor” who knows the methodology like the back of their hand and has a laser focus on improvement. This way, your employees have someone to turn to for help to implement Lean as they get familiar with the methodology, and nothing will fall through the cracks in the meantime.

Don’t: Expect your employees to master Lean right away.

The point of Lean is not just to improve processes—it’s also to build long-term skills in employees that will help them continue improving processes over time. Those skills don’t appear after just one training session.

Do: Collaborate with other departments to improve efficiency.

Are you doing more work than you need to? Does your team frequently experience times of feast and times of famine in terms of how much work needs to be done?

If you’re not collaborating with other departments in your facility, you’ll probably have a hard time identifying the reasons for these realities (which are actually inefficiencies).

Take, for example, this Censis case study: An OR wouldn’t deliver case carts full of used instruments to the SPD until there were several of them ready for sterilization. This “batch” approach saved OR personnel trips up and down the elevator, but it resulted in a feast-or-famine environment in the SPD that negatively impacted the SPD’s efficiency and accuracy. When the OR changed to a “one-piece-flow process,” moving each individual case cart to the SPD when it was ready for sterilization, SPD performance significantly improved.

Changes like this require conversations and, yes, collaboration with other departments, but their benefits make those efforts worthwhile.

Don’t: Assume that current practices are the most efficient.

As much as possible, be process-agnostic. In other words, don’t tie yourself to any process or procedure that hasn’t proven its efficacy in measurable ways—and reevaluate what seemed effective in the past.

Do: Establish clearly written work procedures.

When a team utilized Lean to identify the reasons for missing instruments at The Academic Medical Center, one of their biggest takeaways was to write out clear work procedures and post them where they could easily be seen.

If procedures aren’t standardized in any official way, it’s easy for processes to vary among staff and become inefficient. The best solution may also be the simplest: Write it down and hang it on the wall.

Don’t: Think you only need to do Lean once.

One-time improvements are great, but Lean is meant to be an ongoing effort that continually improves processes. No process will ever reach perfection, which means Lean methods will always be able to uncover inefficiencies and offer solutions.


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Role of healthcare apparel and other healthcare textiles in the transmission of pathogens: a review of the literature. March 31, 2015.

Study of bacterial flora associated with mobile phones of healthcare workers and non-healthcare workers. June 9, 2017.

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