How to Develop Sustainability in Sterile Processing Departments
Written by Angela Lewellyn and Jhmeid Billingslea
For many years, our Advantage Support Services team has been invited to bring solutions to sterile processing departments to develop and initiate sustainability. Some of our solutions to create continuous process improvement is all about the numbers. The number of staff and the level of expertise they deliver to their patients and customers, a customer satisfaction rating and developing inter-disciplinary / multidisciplinary team involvement and strategies.
Sustainability defined by the UN World Commission on Environment and Development is “… development that meets the needs of the present without compromising the ability of future generations to meet their own needs.” 1
To apply this principle in SPD for technicians and leaders with respect to high job performance, the department must meet the needs for present job satisfaction and thus create a sustainable culture for future staff members. Our model strategies are Process, Process, Process and Communication. Both are key to meet these principles of sustainability.
Process and Communication
Pros and Cons for Sustainability
Department leaders should be aware of the pros and cons for developing sustainability.
The pros, according to investment developers, is sustainability encourages departments to frame decisions in terms of years and decades rather than on the next quarter's earnings report and to consider more factors than simply the profit or loss involved. Applying this business model to an SPD, decision-makers must decide on the numbers of staff and the cost value of consumable products utilized in a department. In our evaluation, some products just can’t hold a candle to others in terms of performance value and providing “best practice” according to ANSI/AAMI standards. The evaluation should be scored according to how the product delivers the best results according to the science of sterilization.
For example, the value of having inspection products available for team members to access functionality and bioburden of an instrument delivers long term effects on many levels. It delivers job satisfaction for the user, allows the technician to assure their patient and customer a better product, the customer satisfaction rate increases due to fewer errors per tray and it assures the facility a good review from surveyors, but most importantly, it assures all invested that the patient outcomes are optimal. A good way to achieve these valued and cost-effective products can be by assessing all current products utilized and developing some sustainability goals. 2
However, a con of moving toward sustainable production is often a complex process for healthcare systems. By basing decisions on longer timelines, some of the higher upfront investments in efficiency and renewable sources are easier to justify. Decision-makers have had to adjust their expectations for returns because a company that commits to the sustainable development of resources may have more modest earnings results in the near term.
The investment for process changes can be daunting initially, but in time they can be achieved and adapted to a department culture. These changes may be decided by management, leaders and a multi-disciplinary. Our Advantage model recommends that the end-users be engaged in the development of what can become the final decision. To gain the end-users participation ensures buy-in at the start of process change. The users can aid the decision and process changes by providing real-time information. At times, what looks achievable on paper may not be in real-time.
Once the final process is established on paper, then begins the process of education and practice. This process should be given a trial timeline, we recommend 2 weeks. Feedback provided by users assure best practice. Training the change should be via communication provided by 2nd level leaders on all shifts. Communication should be consistent and constant throughout the trial period via department huddles, visual aids, and a communication book for all staff to account for the information received. The leaders should demonstrate and receive return demonstrations from all team members while gathering data and feedback for all edits to make.
Once the final change has been decided by all, it should be part of an orientation program for all incoming staff new to the department. The investment of time, education, and training, maybe lengthy and daunting, but will ensure long-term success.
Number of Staff and the Level of Expertise
We all know the value of a good sterile processing technician. SPD technicians are the hardest working individuals in our industry. The rationale for technicians that commit to a department is partly due to the culture developed by leadership. A good culture encompasses encouragement, positive feedback from managers and customers and possibilities for growth.
According to an article in the New York Times, a department can develop a culture of high job performance, per employees interviewed, “We feel better and perform better when core energy needs are met: sufficient rest, feeling valued and appreciated and having the freedom to focus in an absorbed way on the highest priorities …” 3
Positive feedback sustains a well-cared-for staff. Positive accolades are sometimes lacking in SPD. As Advantage Supports initiates a department assessment, we usually find that cultures may communicate “what went wrong”. Our approach to building CS professionals is to communicate staff value during huddle times and individually throughout the shift. Some of the tools we use to achieve the building up of a team member are rewards for the same information we are obtaining to deliver Key Performance Indicators to our internal customers. Some examples are weekly or monthly awards for the most trays processed, lowest error rates and the number of days without an error.
We find that sufficient rest coincides with the freedom to focus on the highest priorities of the day. The frustration of staff is usually demonstrated when there are not enough team members, and one has to do the job of two or three. Having an adequate amount of staff per shift allows each team member to have the feeling of satisfaction of a job well done. It allows them to perform designated assigned tasks at their best for their patients and customers.
Possibilities for growth is provided by IAHCSMM for management and technicians by way of a certification ladder. These CRCST and CHL levels encourage professionals to not only gain knowledge to the highest level but to gain higher positions in an organization. A healthcare system can provide these opportunities by investing in staff to attend local, state, and national chapter conferences.
These conferences and IAHCSMM provides educational opportunities. Education and training are key investments to sustain the current number of team members and to create stability for the organization for years to come. To in-service products utilized for sterilization has been a go-to for education and we agree. Yet, a formalized education platform is a consistent method to aid the technician to perfect their craft.
This education should provide current information from ANSI/AAMI recommendations, as well as train staff to practice those principles in day to day processes for instrumentation. Training models may include testing, practice demonstrations provided by educators receiving a return demonstration from the technician.
Practice, practice, practice is key.
These staffing initiatives provide improved customer satisfaction rating, which promotes more positive reports and feedback. Developing a culture of excellence promotes sustainability due to the department providing an environment that team members look forward to being part of.
A customer satisfaction rating is initiated by gathering data via interviewing surgeons, service coordinators and surgical team members. Again, this investment of time and resources provides an opportunity to achieve sustainability goals.
An interview process by service is a good way to begin. Our Advantage team suggests interviewing the service line that has the highest levels of instrumentation challenges. Some of these challenges can be summed up into categories. Some categories we suggest maybe delivery of instrumentation on time, clean and sterile and complete trays and delivering of items requested on a count sheet or case cart.
When reacting to the initial survey, concentrate on educating and quality auditing the top three trays per service. Attempting to quality audit every tray in every service is an impossible task, destined to fail.
Repeat this same customer service survey every three months, and you will see a drastic and documentable reduction in “problem” trays.
The final critical tool in sustaining achieved process improvements is developing a Multidisciplinary (Interdisciplinary) team, tasked with best practice-based problem solving for Sterile Processing opportunities. The Team at the very least should include Infection Prevention, the Operating Room team and the Sterile Processing Leaders-the “big three”. 4 Having physicians and team members from the healthcare facilities operation’s team is ideal but should not be a deal-breaker. The Environmental Services and Maintenance (Facilities) are great permanent or ad hoc members of the team.
Starting this team may be easier than you think. Your facility may already have a meeting with two of the “big three” which means you only need to invite the third to make it a formal Multidisciplinary team. The team’s main focus is on listing opportunities from both the Operating Room and Sterile Processing sides, then solving them one by one.
Another focus is selecting and reporting and analyzing a limited number of agreed-upon Key Performance Indicators that speak to the opportunities at that facility. 5 This team should also do rounds on a regularly scheduled basis (we recommend at least quarterly). They should also convene to address nonprogrammed decisions such as major product recalls, FDA warnings or changes in recommended standards or internal policies and procedures.
In conclusion, sustainability is achievable over time. Although prioritizing instrumentation and customer challenges may be a visual daunting list, there are some items that your facility’s multi-disciplinary team can achieve by identifying low hanging fruit. Department staff, customer satisfaction and developing a multi-disciplinary team ensures stability for years to come.
Angela Lewellyn, Director of Development and Research, Advantage Support Services
Jhmeid Billingslea, Managing Director of Surgical Services, Advantage Support Services
- ANSI/AAMI ST79:2017 Comprehensive Guide to Steam Sterilization
- Central Service Leadership Manual, 2010
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