Miles Brinley, CRCST
Onur Tekin, CRCST
Odessa Macklin, CRCST
Chris Coupland, CRCST
Bekira Mehmedovic, CRCST, CIS
Irvin Francis Kyle III, CRCST, CIS, CHL
Stephen Morris, CRCST
Jennifer Hay-Fernandez, CRCST
Junior Peralta-Pena, CRCST
Luis Barsallo, CRCST
Arlene Scisney, CRCST, CIS, CHL
Yasmin Tumbarell Arguelles, CRCST
Brittani Humphrey, CRCST
Tyler Hayden, CRCST
Daniel Gnagy, CRCST
Elma Mustic, CRCST
Patricia Richardson, CRCST
Derrick Daniels, CRCST
Laura Machado, CRCST
by Rick Dana Barlow
fter several years
of performance and process improvements that help you finally engineer your
Sterile Processing & Distribution (SPD) department to operate more
effectively and efficiently you might wonder what to do next beyond
maintaining the quality status quo.
Fortunately, the Sterile Processing team at Louisville,
KY-based Jewish Hospital really doesn’t have to do that. As part of the
statewide regional integrated delivery network KentuckyOne Health, which
also includes the University of Louisville Hospital several blocks away,
Jewish’s SPD team already knows where it’s heading next and how: unification
in two locations.
With a newly constructed footprint scheduled to debut next
month, Jewish Hospital’s SPD team will be poised to function as the hub of
reprocessing services for itself and its KentuckyOne "downtown campus"
partner University of Louisville Hospital.
Even though KentuckyOne Health formed in 2012, Jewish
Hospital’s construction project predated the IDN’s launch with the new
organization’s staffers and patients clearly benefiting from the foresight.
"Only afterwards was [it] considered as a piece of the vision for
integration," noted Weston "Hank" Balch, CRCST, CIS, CHL, System Director,
Sterile Processing Operations for KentuckyOne’s downtown Louisville campus.
Both hospitals are pursuing greater collaboration as the duo
continues to integrate, according to Robert "Bobby" Parker, CRCST, CIS, CHL,
SPD Manager, Jewish Hospital.
But Balch acknowledged that complete integration remains a few
"Our vision for integration is divided into the three tiers of
‘People, Processes, and Surgical Assets,’ Balch said. "A successful
integration will be a campus where every SPD employee is competent at each
facility, all processes are standardized, and surgical assets are utilized
to their full potential."
Jewish’s SPD team certainly is no stranger to assisting other
local hospitals and medical centers with staffing and projects. Last June,
the team helped their colleagues and counterparts at Saints Mary and
Elizabeth Hospital as it underwent an SPD renovation.
"Their team continued to wash and assemble their instrument
trays, but they did not have access to their steam sterilizers during the
project," Parker recalled. "All their packaged items were transported to
Jewish Hospital for sterilization, and all their loaner trays were delivered
to University of Louisville Hospital for assembly and sterilization."
The capabilities and skills of Jewish’s SPD team not only to
support its facility’s Operating Room department but also the needs of other
facilities within its IDN is just as important as how it arrived at its
position to deliver high-quality, reliable service. Their five-year journey
to self-discovery and self-improvement proved challenging but ultimately
successful as they established and solidified a strong bond of trust with
the OR. To add an "extra layer of customer service," SPD created a dedicated
OR Liaison position to bridge the gap. They started small, bobbed and weaved
through choppy operational waters, and positioned themselves to expand with
perhaps less intense growing pains than they would have experienced
For these reasons, Healthcare Purchasing News named
Jewish Hospital’s SPD team its 2016 SPD Department of the Year.
Parker, Onur Tekin. Next Row: Daniel Gnagy, Ross Crump, Yourney
Castillo. 4th Row:
Joseph Thomas, Patricia Richardson, Tyler Hayden, Erendira Zuniga,
Junior Peralta-Pena. 3rd Row:
John Rowe, Miles Brinley, Yasmin Tumbarell Arguelles, Abigail Henderson,
Brittani Humphrey, Christopher Coupland.
2nd Row: Laura
Machado, Luis Barsallo, Shirley Raque, Arlene Scisney, Milka Nenadovic,
Odessa Macklin. Front Row:
Jennifer Hay-Fernandez, Karen Owens, Korpo Cooper, Kelsey
Ferguson. Not Pictured:
Joel Benge, Bekira Mehmedovic, Irvin Francis Kyle III, Stephen Morris,
Elma Mustic, Bruce Pawley, Derrick Daniels, David McBath.
Historically, a large number of HPN’s award-winning SPD
departments during the last 23 years earned accolades after undergoing
massive construction/renovation and/or process re-engineering. A larger
footprint for breathing room as well as the installation of new technology
and tools can inspire and motivate just about any SPD crew.
Jewish’s SPD team upended that trend. Their construction
project, several years in the making, should be complete next month, which
enables them to shift more of their focus toward integrating with their
downtown Louisville partner, according to Parker.
The new SPD area at Jewish will expand its storage capacity and
increase its throughput capacity as well, Parker noted. "The plan for the
new department is to centralize more of the instrument storage in SPD, and
for SPD to begin pulling case carts for all surgical areas in the hospital.
This will free up time in the OR, hopefully improving room turnover and
first case on time starts, and it will give SPD more information for
prioritizing instrument processing for our Hand and Outpatient Care Center.
"The increased processing capacity will also open up the option
for us to function as a processing center for neighboring KentuckyOne
facilities, if necessary," Parker continued. "Our current department has
already successfully taken on sterilizing instruments for another
KentuckyOne facility, Saints Mary and Elizabeth Hospital, during their
recent Sterile Processing renovation project, so the potential for
optimization and efficiency will greatly improve with the new Sterile
Processing department at Jewish Hospital."
Fast Facts on Jewish Hospital’s SPD team
% FTEs certified
78% (Will be 100% after new employees
complete certification within 1 year)
Acute care facilities serviced
Nonacute care facilities serviced
Total annual patient volume*
Emergency department volume*
Annual Performance and Production
2016 to date
Number of surgical cases*
Number of sets/trays assembled/processed
Inventory line items
Yet acquisitions, mergers and even "integration" tend to
conjure up layoff fears and departmental downsizing.
Not for Jewish or even University of Louisville’s SPD team,
"The goal for most multi-site to single-site processing centers
follows the 80/20 rule, with 80 percent of instrumentation processed at the
integrated ‘hub,’ and 20 percent of critical instrumentation kept on-site
and processed in the department’s satellite center," Balch told HPN.
"Although workload will be reallocated and streamlined under this integrated
model, there will be additional logistical staffing related to packaging,
transport and data management that would ensure no positions are on the
line. There is also a long-term vision to move our instrument repair program
in-house, which would provide additional opportunity to our team for career
Parker identified several strategies and tactics necessary for
"First, our staff needs to be competent to work at both
locations," he stated. "We have already begun doing some cross-training
between hospitals, and it is becoming part of our orientation process for
new employees to spend a couple weeks at the other facility. Second, our
processes need to be aligned. Both hospitals are looking at their processes
to make sure they are both AAMI compliant and match as closely as possible
with each other."
The third and greatest challenge, Parker continued, is the
standardization and optimization of instrument sets. "From a processing
standpoint, the instrument trays would be much easier for technicians to
process if the most commonly used trays were identical at both facilities,"
he indicated. "Additionally, surgeons who work at both campuses would
benefit from having the exact same instrument setup during procedures."
Jewish’s SPD recruited
Surgical Asset Management team with their "CliniFiscal Model" to facilitate
optimization meetings between service line specialists and surgeons at each
hospital for standardizing instrument trays, he said. They also work with
Materials Management Microsystems’ SPM team for data management and
device tracking and are formulating loaner management, labor management and
supplier-SPD relations with such companies as
Surgical, he added.
"With the integration of the two campuses, the Sterile
Processing Departments would have the ability to float staff between
campuses depending upon surgical schedules, vacations and callouts, and
staffing shortages without the use of travelling agency staff or high
overtime rates," Parker noted. "Surgeons would find it easier to work at
both facilities because of the uniformity of surgical instruments, and so
the two KentuckyOne facilities would have greater capacity and flexibility
for scheduling cases. Finally, the campuses could more effectively utilize
their instrument assets, since they could be used at either facility when
To achieve such a seemingly lofty goal, Jewish’s SPD team had
to achieve another lofty goal: producing the "highest-quality sterile goods
possible," according to Parker.
"Our goal is for there to never be an instrument set returned
because of a defect," he said. "Achieving perfect quality is a struggle,
however, because we are human beings prone to error. No matter how much
education, training, and resources a person is given, they will still make
So Parker and his group strove to "create processes that are
workflow conducive and make it impossible — or at least difficult — to make
an error." For an example of a "tweaked" process,visit
www.hpnonline.com/inside/2016-05/1605-SF-LiveLinks.html and click on the
"Rigid container redress" live link.
To achieve unity within the department before unification with
any other departments, Balch, his predecessor Karen Owens, RN, MSN, CRCST,
CIS, CHL, FCS, and Parker had to build the team and empower each staffer to
accept additional responsibility to help one another versus claim something
"isn’t my job." To promote teamwork and avoid a segmented staff specialized
in one particular area, they rotate responsibilities. The OR Liaison, who
reports to Parker, remains constant as the dedicated channel between the two
departments. For more on Joel Benge, CRCST, CIS, CHL, SPD’s OR Liaison,
Odessa Macklin (front) and Joseph Thomas
(rear) processing instrument sets in
Prep & Pack.
Jewish SPD responsibilities include four primary assignments:
Decontamination, Prep & Pack (Assembly), Sterilization and Dispatch. The
Sterilization Tech operates the four steam and two low-temperature
sterilizers as well as helps process smaller sets in Prep & Pack. The
Dispatcher is primarily responsible for answering phones, pulling cases,
unloading washers, tracking loaner instruments and managing the
"Employees are rotated almost every day to keep their skills
sharp and to keep people from getting burned out on a particular task"
Parker said. "Our team is happy that their rotation through decontamination
is spread out. For those employees who look to excel above their expected
standard, we work with them to find additional responsibilities, like
helping with supply ordering and tracking instrument data."
Because they rotate the dispatch position, too, "each of our
techs is comfortable delegating responsibilities to their peers and
functioning as the ‘quarterback’ of the department," he added.
Daniel Gnagy building a sterilizer load.
While the dispatcher may serve as the SPD quarterback, each
team member participates in the staff-led handoff.
As a 24-hour department whose staff remains on call, any shift
change can lead to dropped balls. In the hustle and bustle, maybe some
important information might not get passed along to the right person on the
next shift. In past years, the shift supervisor would come in before the
shift starts, gather all the data from all the processing areas, and try to
communicate all the information in a staff huddle at the beginning of the
next shift, according to Parker.
So this year Jewish SPD tried something different. They altered
their staffing structure to allow a 30-minute overlap on all three shifts
(6:30 a.m.-3:00 p.m., 2:30 p.m.-11 p.m., 10:30 p.m.-7 a.m.), and created
structured lists for employees to communicate, Parker explained. "The
oncoming shift still huddles briefly with the supervisor to get assignments
and any educational in-services, then the staff disperse to their assignment
to get a one-on-one handoff with the previous shift," he continued. "We have
found that the one-on-one employee-led handoffs have increased our level of
detail in handoffs and provide the opportunity for questions and feedback.
The handoffs are good for our team culture as well, as it further reinforces
the ‘passing of the baton’ from one shift to the next."
Recognizing a 30-minute overlap per staffer means twice the
staff is active for any one shift, number crunchers may wonder how this
strategy affects budgets, employee compensation and productivity.
"The productivity impact was considered when making the
switch," Parker responded. "Prior to the change, staff still had a 10-15
minute huddle with their supervisor. Now, staff come in and huddle with
their supervisor for 10 minutes while the previous shift is still working on
the floor. After the huddle, the oncoming shift disperses to the
workstations to receive a staff handoff that is no more than five minutes
long. Then the two employees work together for the remaining 10-15 minutes.
This overlap allows for us to catch up on tasks such as processing peel
packs, organizing decontamination during the busy 2:30 p.m.-3 p.m. shift
change, and pulling cases. The staff have been diligent to make the most of
this ‘super-staffed’ 15 minutes, and it has been a productive time to help
boost our shifts off to a great start."
Today, the SPD crew of 32 employees (roughly 27 full-time
equivalents) at the 462-bed Jewish Hospital reprocesses surgical instruments
for the facility’s four surgical centers, including Main Surgery, the Rudd
Heart & Lung Surgery, and the Hand and Outpatient Surgery Center. SPD also
reprocesses and delivers instruments to other departments, including the
Emergency Department, Cath Lab, Endoscopy and Vascular Radiology. Beyond
sterilizing surgical instruments, SPD houses the majority of sterile storage
for the hospital in its department and manages the distribution of
instruments for case carts for surgery.
"SPD initiated the change to move sterile storage," he said.
"We saw the benefits of having sterile storage in one place, handled by one
team of trained staff. The process took place in stages over a number of
years, as little-by-little more teams began to trust the excellent work of
Sterile Processing." One SPD side benefit? Staff became more familiar with
tray names, inventory levels and service lines, he added.
Four years ago, that would have been unfathomable by the OR. In
2011, hiding instruments was commonplace, Parker admitted.
Back then SPD faced an ever-growing list of instruments missing
from sets, compounded by a disorganized supply of back-up instrumentation,
according to Parker. In fact, they recorded nearly 1,000 instruments as
missing from sets facility-wide.
Since then, however, the instrument missing-in-action list has
"dwindled to fewer than 10 on most days," Parker noted, even dropping to
zero several times last year. Improved accountability with the OR made them
"This was not possible until SPD was able to consistently show
that we could take care of their needs and that trust was built with the OR
staff and OR management," said Karen Owens, RN, MSN, CRCST, CIS, CHL, FCS,
former System Director of Sterile Processing (Balch’s predecessor), who
initiated performance improvement initiatives and process changes when she
joined the organization in 2011. "This also occurred in baby steps, taking a
little at a time and making sure that the staff were well-educated on the
new instruments being stored and what cases they would be used for. With
that success then we would move a bit more, and so on. Overall, we were able
to give the OR back 2,000 square feet of storage space that they could use
for their own equipment as well as reopen an OR suite that had only been
used for instrument storage for several years. Now they find things they
don’t want to keep and bring them to us!"
In March 2015, Owens joined STERIS Corp. as an SPD consultant.
Bennie Thornton, Clinical Nurse Manager of Heart & Lung
Surgery, remembered the tension between OR and SPD.
"It took many months for the SPD management team to gain the
trust of the OR and only because of their hard work and proving themselves
time and time again did we allow it to happen," Thornton told HPN.
"This was a very hard transition for the OR because of the years of mistrust
that the OR had with SPD. When I look back there were many, many sets and
instruments that were processed here in the OR. There was no trust between
the OR and SPD. There were many times that the OR would send down
instruments to SPD never to see them again. A story that comes to my mind is
when we very first started do liver transplants. We had ordered a special
clamp to be used for the procedure. The surgeon had to keep it in his
locker, just to ensure that we would have it every time for his cases.
"It’s totally different now," she added. "We feel like we can
trust SPD to get us the right instruments when we need them."
The OR Liaison (Joel Benge), who reports to SPD and works
closely with the supervisors, OR managers, coordinators and the OR rooms as
well, represented an additional boost, according to Parker.
"Big strides had already been made with gaining OR trust before
the OR Liaison position was created," he said. "SPD was already storing most
of the sterile instruments, already pulling the cases and was making big
strides in improving quality. The OR Liaison position did not start the
process of gaining OR trust, but it certainly helped advance it. The OR
began to feel like they had an ‘expert’ they could call on, who has advanced
knowledge of SPD’s inventory and has some knowledge of the OR cases. The
position has also been crucial in making sure that the day’s case carts are
100 percent correct every time."
Because SPD’s backup instrument bins were generally sorted, but
not labeled or able to be easily seen, techs had to open dozens of small
pull drawers to find a replacement for a broken or missing instrument.
Parker called the manual process disorganized. So they created a "backup
instrument wall" that includes open bins behind glass doors, grouped
categorically and alphabetically with name labels and bin location numbers.
"We were receiving multiple complaints from the OR needing
instrumentation that was marked missing in sets," said John Rowe, CRCST,
CIS, CHL, Instrument Coordinator. "The OR continually called for additional
sets in order to have the required instrumentation which increased the
workload on SPD dramatically. After becoming aware that locating replacement
instrumentation was one of the main factors in not having complete sets, the
instrument backup wall was reorganized in a fashion that made it easier for
techs to locate the necessary replacement instrumentation. And after this
reorganization, the instrument storage locations were entered into the
electronic tracking system and are now available as a quick reference to
locate replacement instrumentation easily."
Parker raved about the wall.
Jennifer Hay-Fernandez putting away instruments
on the backup instrument wall.
"What sets our backup wall apart from most other departments is that
each of those backup bins has a designated location code," Parker noted.
"For example, the Mayo Scissors are located in bin UC309 (Unsterile Cabinet
C, 3rd shelf, 9 bins over from the left). Those location bin codes have been
put into the instrument database in our inventory tracking system, SPM. When
techs are working on an instrument set and an instrument is broken or
missing, the backup bin location is listed for them in on-screen assembly."
For an example on how the new backup instrument wall helps SPD, visit
www.hpnonline.com/inside/2016-05/1605-SF-LiveLinks.html and click on the
"Backup Instrument Wall" live link.
Rowe admitted they had used an electronic tracking system for
years but it was "poorly maintained." Four years ago, they initiated a
"massive data clean-up" so that inventory and instrumentation were
reorganized in databases, count sheets, sterile sets on shelves and
instruments on the backup wall.
SPD limited the number of people with editing capabilities in
the tracking system, which eliminated data duplication. Then they
reorganized the count-sheets in a standard format and photographed
instrumentation to speed up completion and enhance workflow. They also
refined the instrumentation names and classifications in the database to
allow for easier cross-referencing and the construction of equivalency
groups. Finally, they laid out a physical organizational plan that allowed
staff to locate both sterile sets and unsterile backup instrumentation
quickly with just a few clicks in the electronic tracking system, according
Rowe diligently worked with clinical coordinators, scrub techs
and doctors in the OR to find out exactly what the surgeons need in each
set. He learned that they routinely were purchasing replacements for
instruments that the OR did not even use. If a particular instrument only
was used by one surgeon, and there was a limited amount of that instrument
on hand, Rowe removed the instrument from the sets and peel-packed it for
the one surgeon.
Techs also started recording every time instruments were marked
missing and initial that they looked for a replacement in backup inventory
and in peel pack inventory, according to Parker. This accountability check
helped drive compliance in an important way, he added.
SPD also improved instrument repair service levels as a measure
of preventive maintenance. STERIS Corp.’s Integrated Medical Systems
International handles repairs under contract on site in repair vans or
off-site at repair labs, Rowe said. "This keeps our training expenses to a
minimum and also does not require us to manage a supply of replacement
parts, screws, springs, etc., for the multitude of instrumentation used at
our facility," he added.
Laura Machado pulling instruments from a
To prepare sets for the surgery cases the next day, SPD
techs check the library of digital physician preference cards in the
OR’s electronic medical record, which is Cerner’s Surginet. "The
preference cards for the next day’s surgery cases automatically print to
Sterile Processing in the early afternoon, giving SPD adequate time to
pull cases for the next morning and identify the exact sets needing to
be prioritized," Parker said. "In the event of schedule changes or
add-on cases, Sterile Processing techs are trained in Cerner to be able
to go and print off updated schedules and any added preference cards."
Parker acknowledged that SPD’s SPM system can interface with
Cerner to eliminate the need to manually print preference cards, and they
hope to implement that feature in the near future.
SPD’s efforts, however, freed up the OR to focus on patient
care and turning over rooms, according to Owens.
"The savings in OR turnover time has come in the form of the OR
staff not having to pick some of their own instruments, constantly look for
missing items and calling for things that did not get on their case cart,"
she noted. "An OR improvement project focused on decreasing turnover times
also added to a total overall reduction of 26 percent in turnover time. Some
of this was due to other factors as well as SPD having control of the
instruments and OR nurses and techs not having to spend their time pulling
instruments that were stored in the OR."
Jewish’s SPD recognized that to improve productivity they
needed to standardize the workflow, according to Parker, reducing the amount
of time it takes to find supplies and move products.
Consequently, SPD is standardizing all workstations to look
exactly the same and be organized in a "left-to right" order, Parker
"This will help us spend less time looking for set indicators,
as the technician’s muscle memory knows exactly where it is on every work
station," he said. "Also, the organized process helps our quality, since a
‘left-to-right’ organization of supplies makes it more difficult to
accidently skip a step, leaving an indicator out of the tray."
Parker called SPD’s commitment to continuing education and
certification one of the department’s "proudest achievements." It’s easy to
SPD requires that all of its employees earn their CRCST
certification within the first 12 months of the hire date, not only to
promote professionalism but also to set a standard of knowledge for the
staff, according to Parker. Of 32 SPD employees, 25 are CRCST certified,
seven are in the process of earning their CRCST designation, but nine also
have earned their CIS and CHL designations through IAHCSMM, too. This
reinforces their reputation within the hospital as instrument and
"Our technicians gain exposure to industry standards, and
they’re given the bigger picture of what it takes to be a great department,"
Parker said. "We are excited as a team to continue gaining certifications;
we’re out to be the best-trained, most-certified department of Sterile
Processing Technicians in the country."
Jewish SPD also prides itself in engaging employees to show
that their work makes a difference, Parker insisted.
They discuss quality improvements at weekly staff meetings and
during vendor inservices with such companies as Aesculap, CareFusion, IMS,
Integra, Karl Storz, Stryker and Symmetry Surgical.
SPD provides "Process Improvement Forms" for techs to submit
ideas on how to make the department better. Staffers compete in the
department’s annual Sterile Processing Olympics. They can attend
"Professional Development Day" events hosted by Balch and can enroll in
SPD’s Leadership and Practical Experience (LeaPE) training program for
career growth and professional development. For details on all of these
initiatives, visit www.hpnonline.com/inside/2016-05/1605-SF-Sidebar2.html.
SPD’s transformation from the inside out convinced its OR
customers to extend their support.
"As with any culture change, it happened with small wins adding
up over many months," Balch said. "Although there were many drivers to this
increase in OR accountability, the biggest breakthrough came when the OR
team started to see a change in our department’s commitment to
professionalism. As we began owning our own service challenges and offering
creative solutions to better serve the OR, their teams began responding in
kind. The mentality of ‘us vs. them’ that is so often present between SPD
and OR departments began to take a back seat to a philosophy of ‘better
"When nurses and scrub techs began to realize how much quicker our teams
could turn around sets, they began to take the initiative of restringing
upon themselves," he continued. "When they understood how safe scope
transport drastically reduced the number of scopes taken out of service for
repair, service line coordinators began owning this care and handling
compliance with their own staff. From there, it just snowballed."