Cover Story

The 2002 HPN Central Service Department of the Year:

The Cleveland Clinic

by Curt Werner

Although fans of the hometown Indians might frown on the analogy, The Cleveland Clinic — arguably the central service world’s equivalent to the New York Yankees — used its size and an impressive collection of financial and human resources to its best advantage and came away as the 2002 winner of the Healthcare Purchasing News Central Service Department of the Year award.

It can rightfully be said that the larger institutions have the means as well as the motive to improve their performance, teamwork, efficiency and the like. But it’s still up to the hospital and its managers and staff to fulfill that potential, and the prestigious Ohio medical center certainly did that. In overwhelming fashion, The Cleveland Clinic finished as the top vote-getter from judges in an outstanding field of hospitals to win this year’s honor. One judge even handed the Clinic a perfect score, the only such accomplishment on the score sheet. Among the leaders in the field were runner-up Virginia Mason Medical Center in Seattle, as well as Women’s Hospital, Baton Rouge, LA, and Baylor University Medical Center, Waco, TX. Congratulations are in order for all entries. Each of these facilities submitted impressive credentials.

“World class care deserves a world class processing department.”

In 1998, the surgical processing department (SPD) of The Cleveland Clinic stepped up efforts to improve their delivery of quality products to their customers. In order for the staff of the SPD to achieve their goals, they needed to update their department’s mission statement and plan a comprehensive strategic plan that was sensitive to the needs of their customers. This plan also needed to be communicated to their customer and provide opportunity for customers participation with very little time taken away from patient care.

The fundamental values that form the foundation of the Cleveland Clinic culture: quality, integrity, compassion, collaboration, and commitment. The mission of the surgical processing department: “To provide surgical instrumentation and related hardware which has been decontaminated, inspected, assembled, packaged, sterilized, stored and delivered according to quality assurance procedures for the operating rooms in a manner to support and accomplish the goals and objectives of The Cleveland Clinic.”

Today, the SPD supports 59 surgical operating rooms with an annual caseload of 34,000-plus surgical procedures, performing 16,800 sterilization loads and processing more than 373,860 sets of instruments to include the inspection and handling of over 6.25 million reusable surgical medical devices per year. This type of performance and statistical indicators would not be feasible without the professional dedication of the 70 FTEs in the SPD.

But this story is more than just numbers. It’s about how one SPD achieved success and won this year’s award. “Customer Service is the key,” says Richard Schule, who has led the department since 1994 and sounds as much like a motivator as a department head. “Never get discouraged over the day’s events. Perseverance and a positive attitude will endure.” With that in mind, the SPD has developed and implemented numerous tools to meet and exceed their customer’s expectations.

Innovative ideas

The Clinic developed several resource tools designed to raise the level of efficiency and awareness of the production process. For example, the SPD assisted in the development and implementation of an instrument daily usage report from the OR scheduling system. This report identifies the types and quantities of instruments needed to support the next day’s surgery schedule and to help prioritize the workload.

Inside the department, visual aids were posted throughout the production process featuring oversized graphics portraying the loading of washer loading racks with reusable medical devices, instrument tray assembly, sterilizer loading cart set up, sterile storage and case cart production, to help staff identify with consistent replication of quality production. 

Another improvement was the way in which sharps were reported to the staff and SPD customers. The staff took a site visit to Invacare, a large homecare products supplier. Says Schule, “We noticed how a picture of a green safety cross was colored to represent the number of injury free production days for a given month. The SPD created a picture of a syringe with 31 squares to represent each day of the month and to have a colored square for each day that a sharps event takes place.”

Improvements begin with a will to do and knowledge to understand the reasoning. The SPD staff at Cleveland Clinic came to recognize the importance of communicating with their customers as well as with each other. With that in mind, a “communications board” was designed to capture monthly statistics and include production indicators and volume. “This board allowed us to communicate safety issues such as the number of sharps incidents that were occurring each month in addition to what types of sharps the staff were being exposed to,” says Schule. “Such communication has been received favorably by our customers, and the raised awareness has reduced sharps occurrence by 64 percent.”

Publishing a department newsletter

Taking the pulse of the needs of customers is critical for success, and the Clinic’s SPD has challenged itself to develop better methods to reach out and communicate with their customers. “SPD believes communication to be the weak link when it comes to most system failures,” says Schule. “SPD felt it was important to identify and quantify the work being performed for their customers and to share this information. This led to a department newsletter called The Exchange, which began as a bi-monthly. The OR nurse managers found the information valuable and informative. The newsletter was a catalyst for other divisions or departments within surgical services to develop their own such as the post anesthesia care unit, operating room and surgical support services.”

Problem solving

Earlier this year, the SPD experienced a problem with unsterile trays being identified at the point of use by customers. The SPD staff decided that their instrument tracking system, Materials Management Microsystems, had the capability of identifying which trays had implants and required a biological. It also had the capability of identifying when a tray of instruments was required for an upcoming case. Says Schule, “Why not identify and prevent an unsterile tray from being added to a case cart pull? Working closely with the company we were able to incorporate into the tracking system a mechanism for mapping a specific tray on instruments to a sterilization cycle. If a tray is scanned to a case cart pull and has not been logged into a sterilization cycle, the tracking system will alert the technician that they have an unsterile tray and prevent the technician from continuing the task until he/she has acknowledged the alarm notice.”

At Cleveland Clinic, sheer quantity is acceptable quality is not sacrificed. The SPD staff takes pride in the work that is accomplished with each passing day. They realized by sharing their data they would reduce frustration and raise the level of awareness of the customer. The staff felt it was time to tell their story and express their needs and expectations in hope of raising the level of service provided. Consequently, here are just a few of the ideas that have made a lasting impression upon their customers.

• Monthly indicator reports. 

Capturing data had been taken for granted. The department had always collected statistics but had no reason to share the numbers. The monthly indicator report was created to capture statistical data, and has helped justify the number of FTEs and equipment in the department. Data is now shared with the SPD staff and external customers alike.

• Department productivity standards. 

The department created an agreed-upon department standard for productivity that obliged technicians to maintain a specific level of output. This has helped push those employees to the next level, and the staff has indicated they are ready to set a higher goal in the upcoming year. The first year the standard was set low in order to bring everyone up to speed and leave no one behind. This strategy has improved turnaround time for customers and has motivated the staff to excel.

• Redefining what is fair and equitable.

The SPD staff has grasped changes in the business approach of running an SPD. The efficiencies gained have allowed them to enjoy higher salaries through promotions and annual raises. The Clinic’s tracking system has helped mediocre staff improve and develop their skills and productivity by challenging them to achieve established departmental standards set by their peers. Department standards are reviewed annually to meet the needs of the customer and the demands of the surgical schedule.

• Root cause analysis redefines processing technique and wins Cost Savers Award. 

In a project that was begun in May, the SPD was awarded the Cost Savers Award sponsored by Sterilization Cassette Incorporated for reducing costly repairs of their customer’s TEE probes. “Our customer was experiencing six-figures worth of repairs due to damage,” says Schule. “A diverse group met and performed a root cause analysis to determine each step in the cleaning and disinfecting process. A transfer container was introduced and its mesh tip protector was properly placed which helped resolve the costly repairs. We went from six figures to zero dollars in repairs. In addition to the customer, our technicians were very proud of their accomplishments. We saved significant dollars in addition to learning the new process of root cause analysis, and it has proven to be a process we have utilized in other challenged areas.”

• Teamwork.

The SPD consistently reaffirms “why we do and what we do” with its staff, says Schule. “In the healthcare profession we tend to become complacent at times. Involving your customers in decisions that will affect their outcomes improve your efficiency. The SPD staff has realized that implementation of process changes have been better received with collaboration with their customer on process improvements from the very beginning. 

The Cleveland Clinic’s SPD has also made great strides in areas such as quality assurance, documentation, committee representation, education and training, cross-training, certification, and cleaning verification. Their achievements are literally too many to list. All in all, there is no doubt this fine staff enjoyed a great year in 2002 and richly deserves its designation as 2002 Healthcare Purchasing News CS Department of the Year for 2002.

Healthcare Purchasing News would like to thank 3M and their generous contribution to the HPN Congratulatory Award for the 2002 CS Department of the Year.

HPN

December