Co-Authors: Rachel Mandel, M.D., MHA and Marlin D. Minnis

Welcome to Lean In, a series of three articles by Rachel Mandel, MD, MHA (OPS) and Marlin D. Minnis, Director of Strategic Initiatives of Censis. Rachel and Marlin will lay bare some of the common challenges that negatively impact the provision of quality SPD services and patient safety, as well as the benefits of Lean interventions in removing the barriers to process improvement.  They will not only discuss the obstacles themselves, but present them from the perspectives of SPD Leaders, OR Leaders, and Healthcare Senior Leadership.  This team approach is crucial to the success of any Lean engagement that will not only improve and streamline SPD but sustain those improvements over time.

Operational challenges can be defined as any unplanned influences that disrupt the smooth flow of assets and services throughout the process life cycle of surgical assets from Sterile Processing Departments (SPD) to the Surgical Suite and back to the SPD causing unexpected outcomes.  Let’s review a few of these challenges and the importance of each from the perspective of different levels of management. All of these challenges or obstacles can be eliminated by a Lean approach to process improvement.


Sterile Processing Leadership

This group of leaders may find themselves continually challenged by the operational challenges that are a direct result of poor communication between SPD, the Operating Room, and scheduling services. The Manager is expected to instantaneously solve these conflicts and requirements on a daily basis.  These communication inefficiencies also impact their ability to plan properly and obtain the resources, both human and material, that are necessary to be successful. Communication challenges can be present at different points in the SPD process and result in added expense, delays, and undesirable outcomes.

+ Lack of Pro-Active Loaner Management – If SPD is not informed in advance via timely communications of the need for a loaner tray, or the arrangement to utilize a loaner tray, the Manager is left with the challenge of managing a last-minute request and instrument requirement.  This challenge, if not corrected, creates immediate bottlenecks in operational efficiency engendering unnecessary delays and a strain on established quality control protocols. The existence of a smooth communication process that links the scheduler, the vendor, the Surgeon’s Office, SPD, the OR, and the Surgeon is critical.

+ Missing or Unavailable Instruments – Lost or unavailable instrumentation is, unfortunately, a common challenge.  Some of the underlying factors associated with this frustrating circumstance include staff’s lack of instrument knowledge, poorly updated count sheets, inaccurate or updated preference cards, and an ineffective backup inventory system in place for both non-sterile (Peg Board) and sterile (Peel Pack) instruments. The SPD Leaders are responsible for the continuous training and education of their staff, and operational processes that support OR functions.


Perioperative Leadership

These leaders are responsible for the overall operational performance of the team and can find themselves accountable at any point in service provision for the inability of the team to deliver the high level care their patients and stakeholders expect.   

+ Unavailability of Needed Instrumentation – The Perioperative Services Leader is typically responsible for ensuring the overall smooth operation of SPD in order to satisfy the surgeon’s surgical needs while keeping all operating rooms running at capacity. This is difficult to do without clear visibility into the surgical instrument needs required to maintain daily and weekly demands. This places an undue burden on perioperative staff who are trained to be care givers and not inventory management specialists.  This challenge, if left uncorrected, creates surgical delays, frustrates surgeons as well as staff, and hinders operational efficiency causing underutilization of OR surgical capacity. In a prior Lean-SPD engagement, the team with OPS guidance achieved a 41% improvement in cycle time and a 45% decrease in errors per week.


Healthcare Senior Leadership

Senior leaders in healthcare organizations struggle to stay competitive in a market where surgeons have many choices as to where and how their patients are provided needed services. Insurance companies are placing pressure on surgeons to utilize the most efficient and cost-effective surgical sites. Additionally, leaders need to maintain a high level of surgeon & perioperative staff satisfaction while providing efficient patient throughput that does not increase cost nor impede quality care. 

+ Surgeon Dissatisfaction with Operations, Scheduling and Instrument Availability –  This obstacle to operational efficiency can be related to many factors. A few of these are lack of real-time surgical resource analytics (process times, productivity, and set utilization), poor preference card maintenance, block scheduling, and delays caused by increased I.U.S.S practices.  If left unresolved, these situations create uncertainty in the operating room schedule and a loss of confidence in the system which, in turn, causes frustration and turn-over inefficiencies.  These turn-over delays impede an OR’s ability to achieve full utilization of surgical capacity, resulting in loss of revenue and increased expenses which impacts overall operational efficiency. It is possible to achieve a 100-200% improvement in staff and surgeon satisfaction with a culture change in these areas supported by Lean performance improvements.

+ Patient Safety and Organizational Excellence – Surgeons and other clinicians hold the administration and leadership responsible for the safety of their patients and process. There is no place that this is more evident than in the processing of surgical instruments so that they are sterile, safe and free of bioburden. If there are issues with bioburden and or the absence of well-established best practices, the organization is at risk for negative survey findings from regulatory organizations. A well-functioning SPD sets a standard of excellence that reinforces an organization’s brand and positive reputation.

Transitioning from a Manual Process to Automated Instrument Management

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