www.hpnonline.com

Search our website

Self Study Series
White Papers
Webinar Series
Special Reports
Resources & Agency Listings
Show Calendar
HPN Hall of Fame
HPN Buyers Guides
HPN ProductLink
Issue Archives
Advertise
About Us
Contact Us
Subscribe

Receive our

HOME
KSR Publishing, Inc.
Copyright © 2016
 
Header
 

         Clinical intelligence for supply chain leadership

 
 
 

INSIDE THE CURRENT ISSUE

May 2016

Special Focus
 
 
 
 
 
 

Jewish SPD bolsters package deal
within regional IDN

Winning team weathers past, present and future in positive flux

Jewish Hospital SPD staff

Department Manager:
Robert Parker, CRCST, CIS, CHL

System Director:
Weston "Hank" Balch, CRCST, CIS, CHL

Former System Director of Sterile Processing: Karen Owens, RN, MSN, CRCST, CIS, CHL, FCS

1st Shift Supervisor:
Yourney Castillo, CRCST, CIS, CHL

2nd Shift Supervisor:
Ross Crump, CRCST, CIS, CHL

3rd Shift Supervisor:
Bruce Pawley, CRCST

Instrument Coordinator:
John Rowe, CRCST, CIS, CHL

OR Liaison:
Joel Benge, CRCST, CIS, CHL

Quality Assurance Tech:
Shirley Raque, CRCST, CIS, CHL

Staff:
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
Kelsey Frederick
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
Korpo Cooper
Milka Nenadovic
Elma Mustic, CRCST
Abigail Henderson
Erendira Zuniga
Patricia Richardson, CRCST
Derrick Daniels, CRCST
David McBath
Laura Machado, CRCST
Joseph Thomas

by Rick Dana Barlow

After 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 years away.

"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 otherwise.

For these reasons, Healthcare Purchasing News named Jewish Hospital’s SPD team its 2016 SPD Department of the Year.

Back Row: Robert 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.

Full-service SPD

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

SPD FTE

26.9

% FTEs certified

78% (Will be 100% after new employees complete certification within 1 year)

Acute care facilities serviced

1

Inpatient volume*

16,488

Nonacute care facilities serviced

0

Baby deliveries

0

OR suites*

22

Surgical cases*

13,277

Total annual patient volume*

129,914

Outpatient procedures*

113,466

Emergency department volume*

84,445

Annual Performance and Production

2013

2014

2015

2016 to date

Number of surgical cases*

15,303

15,044

13,277

8,869

Number of sets/trays assembled/processed

123,914

122,243

131,334

28,490

Error rates

0.34%

0.18%

0.22%

0.15%

Inventory line items

n/a

1,819

2,156

2,191

*FY15 Data

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, Balch assured.

"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 advancement."

Parker identified several strategies and tactics necessary for successful integration.

"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 Aesculap’s 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 CaseChek and ReadySet 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 needed."

Process-driven quality

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 mistakes."

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, visit www.hpnonline.com/inside/2016-05/1605-SF-sidebar1.html.

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 prioritization.

"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.

Super-staffed

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."

Gaining trust

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 SPD advocates.

"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."

Detective work

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.

Digital digging

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 to Rowe.

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 preference card.

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."

Redesigning workflow

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 indicated.

"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."

SPD also reorganized their rigid container collection to improve workflow. To read what they did, visit www.hpnonline.com/inside/2016-05/1605-SF-LiveLinks.html and click on the "Island on wheels" live link.

Working smarter

Parker called SPD’s commitment to continuing education and certification one of the department’s "proudest achievements." It’s easy to see why.

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 sterilization experts.

"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 together.’

"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." HPN