Canary in the Coal Mine
By Shawn Flynn
In 2016, a headline about Detroit Medical Center (DMC) read, “DMC dirty instruments escaped ’15 probe, records show.”1 Fast forward four years and the headline is, “Lawsuit: DMC cost-cutting, fraud led to patient deaths.”2 With the amount of information that we receive on a daily basis, it is hard for the public and our patients to connect the dots of root cause of these healthcare failures, but many industry insiders see how and where these dots connect and where they lead.
The Detroit Medical Center example is one of many that have made headlines over the past five years. This story was exposed through investigative journalism, including the Detroit media receiving more than 200 pages of internal emails dating back 11 years. These internal emails illuminated pandemic issues within DMC and how staff were raising their voices about improperly cleaned, broken, and missing surgical instruments. Detroit Medical Center is not alone. With 5,000 hospitals and 6,000 surgery centers in the United States, these stories are unfortunately all too common. In this case, DMC has been the canary in the coal mine, and as healthcare professionals we need to listen and learn from these examples, connect the dots in our own institutions, and make the needed investments to keep patient safety at the forefront.
Invest in the SPD
Lack of investment and the ensuing issues that follow in SPD aren’t the responsibility of a single stakeholder or department. This problem can only be solved by all of the institutions’ healthcare stakeholders, who are intrinsically connected to sterile processing, paying attention. The first place those dots lead to is the C-suites.
Our C-suite executives must invest in sterile processing at the same rate that they are investing in other aspects of our healthcare institutions. The current model of investing in additional surgical suites, da Vinci robots, hybrid operating rooms, and ambulatory surgery centers without investing in sterile processing is shortsighted and it is potentially harming our patients. While investment is needed in many areas, my belief is that there are five key areas that every C-suite stakeholder must review in their own institutions: staffing and compensation, infrastructure and facilities, education and retention, technology and innovation, and cross-departmental collaboration.
People are the lifeblood of our institutions, and SPD investment starts with adequate staffing and compensation. Too many places are inadequately staffed and SPD technicians are severely underpaid commensurate with the complicated and detailed work that they face. I know some experienced SPD techs making $10–15 an hour. In many cases this is less than or equal to what someone will make at a fast food chain. The complexity of the work and responsibility SPD techs hold makes this inexcusable. C-suite executives should partner with SPD and human resources to right size the pay inequity. Investing in SPD and paying them commensurate with their expertise will increase retention rates, quality of outcomes, and ultimately impact all aspects of the hospital where reusable medical devices are used.
Additionally, you can’t continue to grow your surgical suites’ capacity without simultaneously scaling the SPD’s capacity/square footage. This is a symbiotic relationship with perioperative services and out-of-balance inefficiencies will manifest in a cascading effect from surgical delays related to dirty or broken instruments, inadequate inventory, high turnover times, and first case starts delays, to name a few. More alarming is how this can manifest into surgical site infections (SSIs) due to increases in immediate use steam sterilization. The facilities that get this right can optimize their block time use, consolidate reprocessing, and plan for future service line growth.
Support your technicians
There is also a lack of equity in continuing education support in our healthcare institutions. Countless hospitals pay for nursing education but won’t reimburse sterile processing professionals. With an industry changing at light speed, SPD technicians need to keep pace with that change or else the system will break. Without that support from our C-suites, we are sending an indirect message that our techs’ education in our healthcare institution is not valued. The successful hospitals recognize this disparity and support their technicians by providing reimbursement for training and certifications. In some cases leaders in this area provide tuition reimbursement if they are taking courses that relate to their current or future position..
We need our C-suite executives to lead the charge in embracing technology to transform their sterile processing departments to meet the demands of the future. Many have created solutions only to be turned away because the institution’s culture was that of a laggard in the product adoption curve. The current state of healthcare can no longer allow for a laggard mentality.
When I was given the opportunity to lead my current organization’s SPD, my senior leadership assured me they would support bringing in the technology needed to create the best facility that could deliver the best reprocessing outcomes achievable. One example was bringing in laser technology that could mark our instruments with a QRL 2D mark and text. This allowed us to track our sets at the instrument level and easily identify the instrument’s owner. This gave us the ability to repatriate 24 clinics’ instrument inventory in our sterile processing department more efficiently, saving the organization roughly $450,000 in year one. The investment for the laser was less than 10% of the cost of the savings.
Take an active role
Our C-suite executives also need to take an active role in our sterile processing departments by asking real questions. How can we help with process improvement? What are we doing to create waste in our healthcare institution? How can we reduce that waste? Physicians want and need what they think is best for them to deliver the best patient care possible, and they typically receive the approval from their C-suite executives. However, with roughly 80% of surgical instrumentation ever being used during a procedure, we can easily drive instrument set optimization which effects everything from on-time case starts to instrument assembly turnover times.
Our executives also need to be more involved in driving preference card optimization. I can’t count how many instrument sets are returned daily, and the cost associated with processing and redelivering those sets, only to be returned unused. In many cases, if that set is wrapped, you have just increased the odds of that set’s wrapper having a hole in it when it’s actually needed. Now you have a delay in surgery and in many cases the patient is under anesthesia. Increased anesthesia time creates additional cost and increased and preventable risk to the patient.
As an industry insider, I have worked with many executives who had their own unique style of leadership. The more successful executives actually walked their departments to granularly understand what really goes on versus what’s being reported to them via spreadsheets, emails, and direct report meetings. In doing so, they saw firsthand the daily struggles associated with an underpaid, understaffed, inefficient sterile processing department and how it impacted their overall operations. They also drove a culture of collaboration between nursing, OR, and SPD with the sole focus on optimizing patient care to produce the best patient outcomes possible.
Create change to ward off danger
A canary in a coal mine is an advance warning of danger. The metaphor originated when miners used to carry caged canaries while in the mines to detect gasses which would be toxic to humans. The canary would die before the gas levels became hazardous to humans. Are we living in an era where hospitals like DMC are the canaries in the coal mine? I believe we are but it’s not for the lack of our talented and caring SPD professionals who are in the struggle every day doing the best they can with the limited resources made available to them. It’s the lack of investment and it’s time for our C-suite executives to recognize this by elevating sterile processing out of the proverbial basement via proper investment. Again, this conversation can’t happen solely within the sterile processing community. We have to broaden it to include other stakeholders like our C-suite executives who have the ability and the levers to pull to create the change we need to keep our patients we serve safe.
Shawn Flynn, CRCST, CIS, CHL, has more than 27 years of combined experience as a clinician, technician, manager, director, and senior-level executive in the perioperative/SPD/tissue banking and medical device industry. As president and cofounder of a medical device manufacturing company, he led the company’s efforts in obtaining 510(k) clearance along with ISO 13485 with CAMDCAS designation.