But when CS is responsible for more than one fast-paced hospital, the logistical challenges multiply – and the goals for a streamlined, top-performing function may seem frustratingly out of reach. Put simply, in such situations, any additional service requests (or demands) placed on CS may become the proverbial straw that breaks the camel’s back.

Amazingly, for two CS departments operating hand-in-hand at separate Centra Health hospitals in Lynchburg, VA, that couldn’t be further from the truth. Much like the health system itself, which holds a four-time ranking as one the top 100 cardiovascular centers in the nation, as well as the prestigious nursing excellence Magnet Award from the American Nurses Credentialing Center, the CS teams at Lynchburg General and Virginia Baptist Hospital have earned bragging rights all their own — and the well-deserved honor of being named Healthcare Purchasing News’ 2007 CS/SPD Department of the Year.

Teamwork and dedication exemplify these departments. Although a staff of 25 operate out of Lynchburg Hospital, a 270-bed emergency and critical care center with national recognition for its orthopedic and cardiac programs, and 13 are based three miles away at VBH, a 317-licensed bed regional facility offering full-service family care for those in Central Virginia, they essentially function as one well-oiled machine. Both departments follow the same process, have identical systems in place and the same administrative reporting structure that flows up through the director of materials management and, subsequently, through Centra Health’s chief financial officer. Aside from that, the staff works interchangeably between the two facilities, and share one highly efficient manager. Make no mistake, it’s a process that works.

Because CS manager Erle Shepard splits his time between the two hospitals during the week – two days at each and then dividing his time between the hospitals on the fifth day to lend adequate support and encouragement – he relies heavily on two strong and capable coordinators (one at each hospital) to keep the departments running smoothly in his absence.

"I have a terrific team and I have all the confidence in the world in them," he raved.

Likewise, the hospitals have a high level of confidence in Shepard and his staff and have come to rely heavily on their services — a level of trust that eludes many CS departments. Not only do they efficiently manage the critical instrument processing function – in January alone, a combined 20,932 items were decontaminated and sterilized – CS also manages its own perpetual inventory, as well as the operating rooms’, and to a lesser degree, also manages inventory for nursing units. About 90 percent of the perpetual inventory managed by the CS departments is for the OR.

Shepard, who assumed the Centra Health CS manager position nearly six years ago, acknowledged that the perpetual inventory project was a complex one, requiring cooperation and teamwork of CS and the OR, and the hiring and reallocation of staff into the surgery core to place inventory on a perpetual system and automate the case cart system. This relieved more than 12 nurses from the inventory process and allowed more time for them to care for patients.

"CS had to gain an understanding of the supply chain within the operating rooms and core, and blend it with the processes of the software system," Shepard noted, adding that some of CS’ tasks included identifying each inventory item, creating bin locations, and rearranging shelving and storage units to house the inventory coming over from surgery.

When the project first got off the ground, there was some initial trepidation between both parties. "Understandably, there can be some turf issues that arise because of the fear of not delivering," reasoned Lewis Addison, senior vice president and chief financial officer for Centra Health. "But it didn’t take long before CS earned their trust and proved that the [function] was in the right hands."

Some chalk that up to the CS teams’ flexibility and Shepard’s previous surgical inventory experience and understanding of key business functions. Shepard has been working in CS since 1981 and moved from a prominent Phoenix-based medical center to assume the CS manager position at Centra Health – a move that almost immediately began benefiting the Virginia health system.

"It’s a terrific combination. Erle has an understanding of logistics and perpetual inventory that some CS managers don’t," said Tom Lawton, the director of materials management to whom Shepard reports. "I’m also impressed by how the CS staff is so committed to quality and customer service. They do their very best and consistently exceed customer expectations."

Clara Stratton & Tracey Tyler discuss case car pick ticket

Erle Shepard, CS Manager and Tammy Spencer, Surgical Director

Linda Elmore & Jeanette Beaner, Instrument setup

Confidence in CS, which was admittedly lacking when Shepard first arrived at Centra Health, soon became contagious and led to a number of new opportunities that allowed the team to shine. The department is now responsible for four perpetual inventory locations. It moves 23,495 items weekly, with a whopping average daily value of $4,368,868.

CS’ ever-growing responsibilities currently include all of sterile processing; flash sterilization; case cart set-up and filling; inventory ordering; crash cart, isolation cart and ENT cart management; management of all patient care equipment and floor instrument trays; all activity in the surgery core from inventory ordering; stocking of the OR’s core and room; data entry on all surgery case cards for patient charging; running items to the OR team during cases; and making after-hours trips to the storeroom for the nursing department. While the long list of duties has increased, the same can’t be said for inventory. From 2004 to 2007, the teamwork demonstrated by CS and the OR has led to an inventory reduction of $919,237, with $452,626 of that being accomplished in the first five months of 2007 alone. Also impressive is the department’s 99.9 percent case cart fill rate and a return rate running an average of just 15 percent per week.

"They have a phenomenal inventory plan," raved OR director Tammy Spencer. "I’m so impressed and comfortable with their inventory management skills. Their inventory management system is always on target and I have the ability to sort the data they provide a million different ways. They’re always very accommodating with our needs and are always looking for new opportunities."

Custom procedure kits were also overhauled by CS. Through third party benchmarking, the department saw an opportunity to design custom procedure modules that would better serve the facility from a cost and efficiency standpoint. If the team wasn’t confident that a module would drive efficiency, it wasn’t used. Ultimately 23 modules were created in all, with the first ones slated for roll-out at the end of August. By implementing the modules, Shepard is predicting a 50 to 60 percent reduction in the items his team will have to pick.

Spencer, a former CS manager herself, said she appreciates the quality focus Shepard and his staff place on instrument processing and management – and the genuine teamwork that takes place between CS and the OR. "ORs always have a high expectation of CS, and Erle and his staff deliver. It’s nice to work at a hospital where CS and the OR truly do work together and are striving toward the same goals. I can say that what we’ve all been able to accomplish is incredible – it’s a different ballpark from what I’ve seen [elsewhere]."

Nicole Andrews, CS Decontam

Holly Connelly & Alberta Waugh, OR wrap room

Taking over cleaning of telemetry and other cables is yet another added function of CS. Though previously performed by Centra Health’s intensive care unit staff, the infection control department believed the task could be more safely performed by CS. The department met with the nursing staff and devised a plan for how the cables should be prepared for CS to ensure safe transport and proper cleaning and disinfection.

"We trialed it for a month to work the bugs out. They immediately saw the time savings on their end that freed them up to do other tasks, which made them really come on board. Now we [handle cables] for several departments, not just the ICU," said Shepard.

Through proper planning and dedication to quality and efficiency, CS was also able to take on a laundry list of other tasks, including addressing an isolation gown shortage by adding an additional round to restock isolation carts; freeing up much-needed hallway space by utilizing a closet right inside the door for isolation instead of a cart in the hallway (currently, CS brings the supplies up, stocks the closet and then checks it when making rounds); replacing the storeroom exchange cart system within the surgery department with a par system that allowed CS to eliminate the duplicate cart and improve storeroom staff efficiencies; eliminating CS inventory from the storeroom by ordering and storing the items in its inventory, which made it possible to store additional inventory
to meet the nursing department’s needs; supplying nursing units with necessary items – a task that was previously pegged for the nursing supervisor (currently, the nursing units call CS to
retrieve needed items, a process that increases inventory security in the storerooms); and supporting the implementation of point-of-use inventory and charging tool for 46 supply locations across both hospitals.

"The department is now fully integrated into the surgery core and the supply chain of the hospital," explained Shepard.

Not surprisingly, CS’ success has led even more departments to seek its supply management services – so much so, in fact, that there’s now a waiting list. Currently, CS is in the process of reconfiguring shelves to accommodate some additional items from the OR; switching to disposable towels helped free up much-needed space and time spent de-linting and folding. Shepard and his team also had to redesign the room layout to accommodate additional carts.

Judy Davis, picking case cart

Erle Shepard & Ethel Wilson discussing productivity numbers

The CS staff pulls together to do whatever necessary to complete a job, even if it means working late, coming in early or filling in for an absent coworker. And they don’t seem to mind. "We take pride in what we do and we aren’t doing it alone. Erle is always right there with us to offer support," said VBH’s CS coordinator Clair Stratton.

Debra Shaw, Stratton’s counterpart at Lynchburg General, agreed. A former labor and delivery LPN, Shaw (who still maintains her LPN licensure) was lured to CS six years ago because of the flexible hours – a move she said has proven highly rewarding. "We work hard, but it’s a great environment because we all work as a team. If someone needs help, we’re all there to lend a hand."

Although Shepard and his team are always willing to explore new opportunities, space constraints are making it difficult to immediately tackle each one that arises. "Right now, we don’t have the space, so there’s a waiting list. But we are always interested in exploring other areas where we think we can make a difference. It’s a big feather in our cap when you have nursing units and specialty departments coming to us for help and relying on our expertise."

Indeed, at Centra Health CS could just as easily stand for "Customer Service." Getting there requires extensive training and ongoing education, beginning with a 90-day new-hire orientation and training provided by a seasoned certified Technician II. The organization also enforces mandatory training ranging from corporate compliance to utilities management, as well as a wide range of inservice programs. Further proof of its commitment to continuing education is its attendance at the local Virginia Association of Central Service’s spring and fall educational meetings, as well as at IAHCSMM and ASHCSP conferences. Beyond that, the organization offers certification incentives, whereby Centra Health reimburses staff for the costs of the certification exam when they pass, and promotes them to a salary-increasing Tech II position. Shepard, an IAHCSMM instructor, provides the study material and helps teach the course. Of the 36.4 full-time CS employees, 44 percent are certified, with another eight in the process of acquiring certification.