BY TONY THURMOND, CRCST, CIS, CHL, FCS
Time can seem fleeting when balanced against the many time-consuming tasks that sterile processing (SP) professionals must complete each day. Thankfully, there are some prudent ways to help make the best use of every available minute and, at the same time, improve processes, service and employee satisfaction.
The effects of too little time (or misallocated time) in sterile processing departments (SPDs) coupled with pressures to turn instruments around more quickly to meet heavy procedural volume can lead to rushed or skipped steps. How SP professionals respond to those challenges can also lead them to question their own integrity and that of their co-workers. The word “time” is mentioned more than 240 times in ANSI/AAMI ST79:2017/(R)2022, Comprehensive guide to steam sterilization and sterility assurance in healthcare facilities. Surely, time is a critical resource that must be valued, evaluated and prioritized.
In some facilities, the value of staffing and productivity are not prioritized enough, which makes it difficult to measure time and productivity most effectively. In the past, SP productivity was largely based on surgical procedures or surgical minutes – a measurement that failed to examine true resource needs of the department. There was also a lack of detailed manufacturer instructions for use (IFU) to detail proper steps for processing devices. Further, because the SPD is not a revenue-generating department, many organizations failed to explore SP staffing, inventory and other resource needs, which meant employees had to keep up with demand any way possible.
Process flow maps identify waste
Among the best methods for identifying inefficiencies is using a process flow map, such as a spaghetti diagram, to follow the path of an item or activity throughout an entire process. The diagram shows the movement of employees in a particular area and throughout a process, with the goal of improving workflow and eliminating wasted time and effort.
Let’s use the decontamination area as an example. After mapping the space, one would incorporate into the drawing all pieces of equipment – such as sinks, ultrasonic machines, computers for instrument tracking, elevators, and door entryways – and assign a number or name to the location of the aforementioned items. From there, a line is drawn from the receiving point of soiled instruments to the location of the first process and then continues until the instrument tray is placed inside the washer. It is also helpful to track and document the time spent in each location and per task as well as the distance technicians must travel to perform each step. When drawing the process map, consider using assorted colors for different processes or employees. Note: SP leaders are encouraged to map processes across multiple employees to identify missed or rushed process steps or other challenges and bottlenecks technicians might be facing.
After diagrams are created for various tasks and employees, the findings are analyzed. The diagram will identify opportunities for improving or standardizing workflows and demonstrate the possible need for additional equipment, staffing and other critical resources to ensure that processes follow standards, IFU and internal policies and procedures.
It is essential to draw another spaghetti diagram after changes are made. Not only is a second diagram helpful for providing a before-and-after comparison, but it also identifies where additional improvements can be made. Remember: Each SPD has its own setup and layout that will need to be reviewed. What works for one department and its team may not work well for another – and even what worked for an SPD in the past may not be the best approach over time. It is crucial that spaghetti diagrams and other types of process flow mapping be conducted routinely and as needed. It is beneficial to seek employee input about process challenges and perceived bottlenecks and resource deficiencies. It is also helpful to collaborate with the organization’s learning and development team (or LEAN representatives) when preparing to engage in a time study or flow map because these individuals can offer other means of measuring productivity and resource requirements.
Many SP professionals seek ways to streamline efficiencies and make the most of all available resources. Process flow maps are effective for identifying process bottlenecks, reducing redundant or unnecessary steps and making the most of available time, while ensuring that quality and safety remain the top priority.
Tony Thurmond, CRCST, CIS, CHL, FCS, is an HSPA Past-President, Fellow and columnist and serves as sterile processing manager for Dayton Children’s Hospital.
