Reducing Costs and Improving Performance in the Sterile Processing Department

The operation of a healthcare provider organization differs from that of most other businesses in three important ways:

1. The most important outcomes are not measured in dollars, but in terms of patient survival and quality of life.
2. They cannot fully control their revenues—rates are often subject to influence by HMOs, insurance companies, and Medicare/Medicaid.
3. They cannot control major components of their costs. For example, the number of staff, such as nurses, is often dictated by state or national regulations.

These factors make it imperative that healthcare providers use the best methods available that will let them improve patient outcomes while controlling the parts of the cost equation that they can control.

This article is one in a series from Strong America Now that illustrate how forward-thinking healthcare providers are using quality improvement methods to meet the dual goals of improving patient outcomes and controlling the costs.

Overview


Use of waste reduction methods focused on process improvements help the University of California–San Francisco (UCSF) Medical Center
The UCSF Medical Center Sterile Processing Department (SPD), which prepares 100 Case Carts of sterilized surgical instruments every day, experienced high labor costs as compared to their allowed budget. Application of waste reduction methods saved approximately $1 million/year and improved a core department quality metric by over 17% at a time when the case volume increased 5%.

Problem


The Sterile Processing Department at USCF has a high-demand for its services. The department provides sterilized surgical instruments and Case Carts to the operating rooms and to 23 non-operating room units (clinics and non-surgical units), auditing 100% of the Cases daily. The volume of instruments handled each day is more than 37,000 (or over 11 million per year).
Preliminary analysis showed that:
Sterile instrument carts were not complete 28% of the time. That means more than a quarter of the first-scheduled surgeries each day could not start on time
Although data was collected regarding inaccuracies, no one was charged with reviewing or acting on that data.
Assembly of the case carts began 24 hours before they were needed.

Overall, the SPD had high labor costs as compared to budget, which could not be continued at a sustained pace.

Approach


A management engineer and the department manager for SPD systematically and methodically reviewed work processes. They observed the processes and worked with the staff to reengineer the Case Cart assembly processes while reducing costs and improve the accuracy.
As result of what they found, the engineer and manager made a number of process improvements, including:
Changing the start time of Case Cart preparation from 11 a.m. to 11 p.m. The later start time meant that all instruments used during one day could be ready for sterilization and repacked into case carts for the next day's surgeries all at the same time. (Some staff are always available during other shifts to respond to last-minute requests.)
Assigning each case cart to a single employee for assembly. Originally, any one cart could be worked on by multiple employees at different times of day. Having one person in charge of each cart reduces the confusion around what's been done and improves accuracy.
Creating an on-line issue tracking system . Instant alerts are now sent out when inaccuracies occur—allowing the Quality Assurance staff to take action immediately.

They also established time standards for each of the jobs in the department in order to properly allocate resources to the various departmental functions.

Results
The lean methods made the Case Cart assembly process much easier to use, which enabled the quality to improve 17% and the process to require fewer staff to perform the tasks. The Case Cart staffing was reduced by 14 people, thereby achieving labor savings. (See Figure 1).

The combined results from these projects led to cost savings of $1 million annually.

Lessons Learned
The potential to improve is built in to every individual in every department, no matter what the skill or level of education.
Never be afraid to make changes.  Most, if not all changes, can easily be reversed. 
Give staff feedback "real time" if and when a mistake is discovered so they can learn faster and fix the problem immediately. Don't wait for monthly or quarterly performance reports to give feedback.

Credits
Thanks to Karen Rago, Executive Director and Alfio Levy, Project Manager Operations Improvement Department, for their assistance in completing this case study.