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How Treating a Hospital Like a Successful Business Can Help It Run Like One
It may be forgotten over the course of a day of saving lives and treating patients, but a hospital or medical facility is indeed a business. There are employees (the doctors, nurses, support staff, the maintenance crew) and there are customers (the patients, their family members, and even other departments). There are standards to uphold, feedback to take in, and processes to refine. As patients (and even employees) increasingly do their research before committing to a facility, it is imperative that hospital leaders do what they can to make sure that the experience is positive for all involved.

Sometimes that even means looking outside of our own industry.

In the 1970s, automaker Toyota developed and fine-tuned a manufacturing process that would ultimately allow the company to deliver what customers wanted, when they needed it, and at the highest quality possible. There were two keys to the process: eliminating waste from the production line and building flexibility into the process so the company could find efficiencies among staff, equipment, and space. These principles became known as The Toyota Way or the Toyota Production System (TPS) and they are the foundation for Toyota’s manufacturing best practices that are respected and implemented the world over.

The goals of the sterile processing department in any healthcare organization are not, or shouldn’t be, any different from Toyota’s: we aim to provide excellent care to our customers (patients), we strive to deliver a safe and quality product when our customer needs it, and we do all of it in the shadow of our very own production line (instrument reprocessing). And while a goal of 100% cleaned, completed, and on-time instrument trays may seem lofty, it is achievable with the right process in place.

Here are five ways The Toyota Way can transform your SPD:

1. Eliminate waste by eliminating what does not add value.
Taiichi Ohno, the Toyota executive who is credited with the development of TPS, described waste as any production activity that incurs resources but does not add value in the process or for the customer. In the hospital setting, waste can fall into categories, such as:

  • Overproduction: Review the next day’s surgical schedule to determine what types of surgical trays are needed to fulfill demand without interruption and without excess production.
  • Unused instruments: Select your most frequently used trays and analyze their contents for frequency of use among the surgeons. Ask the surgical scrub technicians, the service line nurses, and the physicians involved which instruments can be removed from the sets.
  • Unforced errors: A defective tray is any tray that does not meet the quality standard set forth by the hospital and is not in safe, working order the first time it is opened. Defective trays cause wasted time and waste energy.
  • Excess motion: Excess movement within a workstation can contribute to delays in reprocessing trays by adding unnecessary (literal) steps to a task. Use a spaghetti chart to analyze the workflow and redundancies in your current setup. This visual representation shows every move a technician must make to complete a task and can help identify opportunities for improvement.
  • Lag times in transport: Moving contaminated or sterile instrument trays to the end user can be incredibly challenging for SPDs that do not have a case cart dumbwaiter, and unattended workstations during peak hours, different buildings, and long rounds can complicate matters. Identify opportunities to do the job better and find the right people to do it.
  • Lax maintenance: Regular, proper maintenance of all processing equipment can help you avoid major issues that do not have immediate fixes. Maintenance can also take care of smaller, less costly issues before they become bigger, more expensive ones. Most equipment IFUs contain a table for scheduled maintenance. Follow it.

2. Keep inventory low but have backups.
Keep your finance department happy and excess spending in check by practicing inventory control principles that are in line with organizational goals, but be sure that you have enough inventory of the right kinds of instruments that may be needed in an emergency. To eliminate any doubt, stock every workstation with replacement basic instrumentation and place it within hand’s reach to minimize motion and improve productivity.

3. Embrace technology.
The use of new technology in the SPD has improved processes and increased throughput, and most SPDs now use reprocessing equipment like higher-capacity washer-decontaminators that reduce water consumption while still cleaning vigorously and effectively. Robotic technology can aid movement and tray loading in the decontaminators, and tracking systems can locate and identify instrument trays using a barcode and scanning systems. Robots are even assembling instrument sets.

4. Value employees and develop your team.
Your team is the most valuable asset of your organization. A lot of time and finances is invested in training employees, and a culture of safety and quality is crucial to keeping your best employees around. Instead of creating processes without the feedback of the technicians, collaborate. Make time for brainstorming sessions in which everyone provides their ideas for how to complete a task. Develop your team’s skills through continuous education. An educated technician is confident, and a confident technician is happy, and a happy technician is productive and committed to process quality.

5. To continually improve, focus on root causes.
We must continuously improve the quality of care we offer our patients; it’s the only thing that will increase the chances of them getting better. When a problem occurs, focus on solving the problem by performing a root cause analysis, prepare an action plan, and immediately implement corrective action.  

The similarities between manufacturing a product and the process for assembly and sterilization of surgical instrument trays are myriad. We must raise the bar in our departments, enhance the knowledge and skills of our technicians, and continuously aim for assembling trays that are 100% cleaned, 100% completed, 100% of the time. And while we do, let’s remember the words of Taiichi Ohno: “Progress cannot be generated when we are satisfied with existing situations.”


Mary Olivera, MHA, CRCST, CHL, FCS has over 30 years of experience in numerous roles in healthcare sterile processing, distribution, and materials management. Ms. Olivera participates in monitoring, surveying, and training interdepartmental staff in the proper cleaning, decontamination, and sterilization practices, and has been highly committed to the standardization of interdepartmental processes. A regular recruit on expert panels regarding sterile processing and a past president of the New York State Central Service organization, she continues to play a major role in promoting higher educational requirements for central service professionals to increase patient safety.

Ms. Olivera brings to the table extensive knowledge of Joint Commission, DNV-GL, AAMI, OSHA, CDC, and DoH regulations. She specializes in budgeting, change management, inventory management, process re-engineering, program and project management, vendor relationships, quality control, Six Sigma, supply chain, and total quality management.

Ms. Olivera is an educator and has published numerous articles related to sterile processing, surgical services, process improvement, and guides to achieve successful accreditation surveys.

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