Workflow Hpn 11 05

3 0 November 2005 • HEALTHCARE Purchasing NEWS® • www.hpnonline.com

November 2005This series of self-study lessons on central servicetopics was developed by STERIS.

Earn CEUsThe series can assist readers in maintaining theirCS certification. After careful study of the lesson,complete the examination at the end of this sec-tion. Mail the complete examination and scoring feeto Healthcare Purchasing News for grading. We willnotify you if you have a passing score of 70 percentor higher, and you will receive a certificate of comple-tion within 30 days. Previous lessons are availableon the Internet at www.hpnonline.com.

CertificationThis in-service has been pre-approved by theCBSPD for 1 Contact Hour. Follow the CBSPD CEUProtocols for pre-approved in-services. The proto-cols can be found on CBSPD websitesterileprocessing.org or by calling CBSPD office at908-788-3847.

Learning objectives1. Understand the importance of

workflow optimization for sterileprocessing departments.

2. Understand the potential benefitsof implementing a workflowoptimization program.

3. Understand how managersshould approach anoptimization program.

4. Learn how to use some of thebasic tools used to identifyprocess waste and optimizeworkflow.

5. Understand the benefits andmechanics of how to map theSPD process.

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A roadmap to optimizingsterile processing workflowby Dan Johnson, SterilTek Inc.

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SELF-STUDY Series

There are a number of trends that are pressuringsterile processing departments (SPDs) in today’shealthcare industry. Here are just a few of them:• Higher surgery volumes• Overburdened process capacities• Inadequate instrumentation availability• Reduced or under-skilled staff• Viable sterile processing outsourcing alter-

nativesNone of these are going away soon, and in-

creasing spending on capital equipment, space,instrumentation and human resources is notnecessarily going to buy the long-term answersneeded to effectively address these concerns.However, there are some proven methods thatcan be borrowed from other industries to im-prove healthcare operations.

Some healthcare industry administrators arebeginning to view their SPDs in the same waythat manufacturing executives view their facto-ries. They are embracing concepts long adheredto by manufacturing firms to deal with similartypes of concerns. Among the concepts gaininga foothold is the process improvement methodknown as Lean. Lean concentrates improve-ment effort along the workflow, known as thevalue stream, to identify and drive out wasteand variability from the processes.

Increasingly, efforts are being directed towardimproving the circular flow of reprocessingwork from the O.R. through the SPD and back.The goal is to produce more and higher qualitywork with the same resources by improvingprocess efficiency throughout the operation.

Workflow optimization is all about develop-ing processes to promote a rational, logical andefficient flow of work. In a hospital SPD, theprocess is about determining what is of value toyour customers, how to deliver more value tothem, how to accomplish more with the re-sources available, and how to satisfy the supplyneeds of the operating room.

Why does workflow matter?Workflow optimization relieves your staff fromperforming non-productive repetitive tasks andhelps you to cultivate an environment that seeksto improve efficiency, strengthen customer re-lationships and reengineer processes to be leanerand more productive. Workflow optimizationpositions a sterile processing department forgrowth.

Costs associated with ineffective and ineffi-cient workflows often go unexamined, unmea-sured and therefore, unmanaged. In anincreasingly competitive world, poor workflowcompromises the effectiveness of the operationand impacts the level of customer service thatyou can provide. Conversely, open, efficientand effective workflow positions you for growth,operational cost savings and a competitive ad-vantage. In addition, workflow can affect manyparts of your healthcare organization, includingcentral sterile staff, O.R. nurses, your processesand even your technologies.

In a hospital, an effective sterile processingworkflow incorporates the specifics of your re-processing operation and related systems, auto-mates wherever possible, and eliminatesredundancy and process variability. This all helpsto reduce errors and improve speed and quality.Workflow is a valuable tool and it lies at theheart of your healthcare organization.

Eli Goldratt’s business objective in his book,“The Goal,” is “to reduce operational expenseand reduce inventory while simultaneously in-creasing throughput.” This statement aligns verywell with the goals for a sterile processing de-partment. Ultimately the goal of your workflowshould be to provide your customer with thebest quality product, at the volume required, atthe proper time, at the proper cost. This trans-lates into a central sterile customer service goalthat has been defined by a leading sterile pro-cessing consultant as 100%3; 100% clean andsterile instruments, 100% complete instrumentsets, delivered to the O.R. 100% on time.

Characteristics of optimalworkflowsThere are three key characteristics of effectiveworkflows:1.They are compatible with current systems and

they streamline existing methods. This limitsthe additional investments that must be madeand the systems that must be learned by youremployees.

2.They can be applied across similar functionaldepartments. The same workflow should beeffective in an on-site sterile processing de-partment, an off-site reprocessing center or anO.R. reprocessing room.

3.They are consistent. Reprocessing tasks aresimple, repeatable, reliable and efficient.

www.hpnonline.com • HEALTHCARE Purchasing NEWS® • November 2005 3 1

OR Sets Up Case

Instruments Placed In Transport Cart

CP Decontamination

CP Assembly

Instrument Storage

OR Performs Procedure

OR Breaks Down Case

CP Sterilization

Process Control

• Policies

• Procedures

• Work Instructions

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What managers should knowTo ensure process improvement success, thereare three recommendations that sterile pro-cessing management should follow. First,take action: don’t be paralyzed by what youdon’t know, or think you don’t know. Thekey is to gather all the information thatyou can within a reasonable time, ana-lyze it, determine the action steps andimplement them. Then do it again. Tryas you might, first results will seldom beperfect, but change has been made in theright direction. To quote an axiom bor-rowed from manufacturing, “Now and bet-ter is better than perfect and never,” or in thefabled words of Taiichi Ohno, former vice presi-dent of Toyota Motor Corporation, “Just do it.”

Secondly, it is wise to actively involve youremployees and customers in your improvementefforts. No one knows the pitfalls and makeshiftoperations that have been developed over theyears better than the people who do the workevery day and no creative source is more readilyavailable or willing. Your hospital customer willalso be happy to help you improve your prod-uct or service level and to identify where a po-tential change will have impact. These are yourmost creative resources. Make good use of them.

Finally, be prepared for resistance. Makingchanges within an organization is hard workand people have a natural reluctance to changesince it challenges their comfort zone. Somepeople feel threatened when change is proposed.You must work to help people understand what,why and how, and remove the fear - or makenot moving forward a greater negative conse-quence. Show that you are a strong leader dedi-cated to the improvement process. Leadingchange is not a part-time job. It requires dailyattention from leaders who fully understand thescope of the project and who won’t get caughtup in each day’s distractions. I recommend en-gaging the services of a knowledgeable changeagent to facilitate the improvement process, planand lead improvement activities, and demon-strate and teach effective techniques.

Step 1: Mapping your CentralSterile workflowOptimizing your sterile processing functions be-gins with understanding your workflow; the pathyour instruments take as they cycle through theirdaily routine. The first step in this process is todevelop a process flow and map. The processmap is a visual representation of the surgical in-strument reprocessing cycle. The key to success-ful process mapping is to first get the primaryprocess steps down, then dive deeper into eachpiece of the map, ultimately uncovering each stepand layer of complexity. A sample process map inits initial simplified state is shown in Figure 1.

Performing this mapping activity will helpyou to identify all of the actions required to

bring an instrument set through its entire repro-cessing cycle. It will also help you to analyzethese activities to determine if they are value-added functions or are not. Activities that addvalue to the product or service are those that thecustomer would be willing to pay for, that physi-cally improve the fit, form or function of anitem, or that are done correctly the first time.Non-value-added activities take time, resourcesor space but do not add value to the product.Typical examples are rework at any point in theprocess, searching or waiting for instruments orsupplies, waiting on machine cycles, or doublehandling.

In creating the process map each of the ac-tivities identified in the map is timed andcharted. This enables you to clearly identifyactions that are non-value-added and thereforewasteful. Waste is anything that impedes theflow of product as it is being transformed in thevalue stream. This means anything that mayprevent central sterile from efficiently deliver-ing 100% clean, sterile and complete instru-ments to the O.R. on time, every time. Processmapping also highlights constraints or bottle-necks (areas where current demand is greaterthan the current ability to supply) in your pro-cesses. The process map becomes the launchpad for additional improvement activities. Amore detailed subsection of the process map isshown in Figure 2.

Step 2: Improving functions andworkflowOnce the process and value stream maps arecompleted, you can begin the improvementprocesses. There are a number of activities thatare instrumental to effective workflow optimiza-tion. These activities include:• Streamlining; eliminating or mini-mizing non-value-adding steps: Al-though the order in which these activities areperformed is not critical to your success, there issome logic to streamlining and simplifying thework processes before moving on. By stream-lining and simplifying first, you avoid factoring

steps into the other activities that you may findunnecessary.

It is important to note that not all non-value-adding activities can or should be eliminated.These are activities that may be essential to theoperation of your department. Examples in-

clude in-service training, safety meetings,inspections, etc. Your goal is to identifyand eliminate unnecessary non-value-add-ing activity.

• Identifying waste: Experienced sterileprocessing consultants routinely reveal wastein the process flow and work that helps manag-ers streamline activities. Some typical examplesof waste that have been identified in SPDs are:1. Labor•Quality inspections after the set is completedversus IT solutions and certification to ensureproper set preparation•Time spent looking for an item that should bereadily available• Improperly staffed SPDs or O.R. reprocess-ing rooms2. Overproduction•Excessive stat washes or flash sterilization inthe O.R. (done frequently but not used only foran immediate procedure)3. Space•Non-linear workflow from decontamination tosterile storage, requiring storage racks and trans-portation routes•Non-reprocessing supplies stored in workareas4. Defects•Sets put up with missing instruments, extra in-struments or wrong instruments•Improper count sheets or documentation•Instruments not returned to decontaminationin their original container•Sets returned with instruments missing5. Time•Improper staff scheduling doesn’t meetworkload demand•Assemblers waiting for a set from the decon-tamination area• Miscellaneous material (linens) arriving in con-tainers from the O.R. that slow decontamination6. Safety•Ergonomically poor workstation layouts cre-ate reaching and excessive movement•Sharps, fluid and other hazardous material incontainers at the decontamination stage• Work process simplification: The in-tent of simplification is to promote the utiliza-tion of equipment and facilities to their fullcapacity by reducing bottlenecks and develop-ing a smooth flow of materials, work and com-munication. Simplification focuses on theelimination or reduction of unnecessary work,

Answ

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rework, fatiguing motions, long trans-ports, and complicated paperworkby using easier methods and mecha-nization. It im-proves qualityby improvingwork practicesand inspectiontechniques,and reducesaccidents andinfections byeliminating hazards, reviewing workconditions and encouraging propercleaning within the SPD.

To determine the priority for worksimplification, look first at your bottle-neck operation, the one for which anyimprovement will help a whole groupor speed up the entire process. Second,select a job on which a lot of time isspent. Improvements will be greater forthese than for smaller tasks. Any taskthat involves a lot of chasing around,hard work or inspection steps is a primecandidate for simplification. Instrumentassembly often offers simplificationopportunities, from providing allneeded materials within the technician’sreach to eliminating unnecessary ma-terials and instruments from the set. Situ-ations in which the working conditionsare undesirable are also ripe for simpli-fication.

Work simplification can only be ac-complished with an open mind, andno work process can be taken forgranted. The steps to work simplification arestraightforward:1. Select the job or function to be improved.2. Break the job down in detail. Make a process chart.

Similar to the process map discussed earlier, the processchart is a picture of all the steps; operations, transporta-tions, inspections, storage and delays that occur for a particular instru-ment set. When developing the process chart follow the instrument setthrough its entire cycle. Be certain to note the time and distance associ-ated with each step in the process. Only then can you account forimprovement.

3. Question each detail; is it necessary and does it add value for thecustomer?

4. Develop the new method. The basic principles in developing a newprocess chart include:

•Reduce the number of steps (ask why is it done, why is equipment used,where is it done?)

•Arrange the steps in the best order (ask why is done there, why in thisorder, why is it designed this way?)

•Make the steps as efficient as possible•Reduce handling•Combine steps•Shorten moves•Provide the most economical means to move the set through the process

5. Implement the new process, ensuring that all involved persons areadequately trained in the new process and have the opportunity toprovide feedback on the changes.

6. Review, measure and repeat. Continuous improvement is a never-ending cycle.

• Capacity line balancing: Reprocessing capacity refers to the abil-ity of the process to handle the workload that is expected of it, matching theoutput of the preceding operation and the requirements of the next. SPDprocess flows can show capacity variations of 100% or more, meaning thatone step in the process can handle twice as much, or more, as the othersteps. This imbalance causes waste in the over-capacity areas and backlogs,clutter, and late deliveries in the under-capacity areas.

Too often managers think in terms of maximizing the utilization of apiece of equipment rather than optimizing capacity for the entire process.For example, the production capacity of an SPD’s washer-disinfectors andsterilizers is often found to greatly exceed the capacity of the assemblytechnicians working between the disinfection and sterilization processes.


Many CS managers neglect to address the grow-ing backlog of work in the assembly area.

There are two linked elements to the capacitypicture. The first element is the capacity analy-sis, which will tell you the number of pieces ofequipment (washers, sterilizers, etc.) and instru-ment set assembly workstations that are requiredto meet a given level of demand. The secondelement is the identification and proper utiliza-tion of the process constraint or bottleneck.

Capacity analysis: A capacity plan or modelfor an SPD begins with an accurate workloadpicture. In most cases this workload is the directresult of a given number of O.R. procedures.The steps taken to determine workload are:1. Identify the sources of instrument reprocess-

ing for the SPD.2. Determine the number of procedures within

these identified sources.3. Determine the number of instrument sets,

ridged containers, single instruments, etc.commonly associated with these cases.

4. Establish the timing of the workload arrivalat CS.This information can then be analyzed in con-

junction with data on the SPD’s reprocessingequipment load capacities, cycle times, etc. Ul-timately the capacity analysis provides you witha picture of your SPD’s washer, assembly sta-tion and sterilizer requirements.The bottleneck: In ‘The Goal’, the bottleneck isdefined as “any resource whose capacity is equalto or less than the demand placed upon it. A nonbottleneck is any resource whose capacity isgreater than the demand placed on it. Bottle-neck flow should be on par with demand. Thekey is to balance flow, not capacity.”

We need to identify the process point that isleast capable of meeting demand, the bottle-neck, and manage that point. The first step is toensure that the bottleneck operation is properlyscheduled and staffed to handle the reprocess-ing workload that is coming into it. This in-cludes having needed supplies available. Next,ensure that the operation and its equipment isfunctioning at its peak performance. The lastplace in your process that you want mechanicaltroubles is at your bottleneck. Thirdly, acquireadditional pieces of equipment or staff to meetdemand, if it is determined from the capacityanalysis.

Manage the remaining process to the level ofthroughput you are capable of at the bottleneckoperation. Balancing flow is much like conduct-ing an orchestra. All parts need to be in synch.No musician gets extra credit for finishing first.

Step 3: Workstation andoperations sequence layoutIn general, the most effective SPD is laid out ina somewhat departmentalized, linear flow. Thisis contrary to the thinking of Lean proponents,

but is necessary in order to separate the cleanand dirty areas within the SPD environment.Therefore, we typically set up a decontamina-tion room, containing the handling of any dirtyinstruments and supplies, followed by partition-ing walls that provide the separation betweendirty and clean areas, within which the mechani-cal washers are placed. The assembly area isnormally set up as a separate department, andthe quality check and sterilization functions fol-low it in line.

Further, each workstation, whether in the semi-automated decontamination area or in the morelabor-intensive assembly area, must be set upand arranged so that all necessary, frequentlyused items are easily accessible (within arm’sreach) and always available. Items that are lessfrequently used can be placed in cabinets or draw-ers or on shelves at the work station and any itemthat is not used routinely can be removed andplaced in an easily accessible storage area.

Properly designed seating, floor fatigue mats,and ergonomically arranged workstations helpcreate a safe, clean and relatively pleasant workenvironment. These elements, in conjunctionwith well-defined processes and expectations andmanagement support, help to ensure that em-ployees are consistently productive and efficientin their processes.

Step 4: Standardized workpracticesStandardized work practices define how a taskshould be performed and lets everyone involvedin the process know the most efficient way tocomplete the task. It is impossible to establish abaseline or best practice and make consistent,across-the-board changes when people performthe same task differently. Without standardizedwork practices, continuous improvement is notattainable and abnormal events go undetected.

Standardized work practices must be devel-oped by those performing the tasks. These prac-tices should then be documented in proceduresand work instructions, with applicable detail todiagrams and training aides. All employeesshould then be trained in the acceptable practiceand management should follow up to ensurethat the practices are adhered to.

This approach helps to ensure flexibility andresponsiveness to the O.R.’s ever-changing needsby providing clearly written instructions thatcan be followed by even the most inexperiencedCS technician. It also helps with identifying prob-lems in the process or practice and leads to con-tinuous improvement. Process changes andimprovements are continually encouraged, andthey are documented and trained as they occur.Rather than stifling creativity, the continuousimprovement process empowers employees tooffer solutions and make choices within optimalboundaries.

Step 5: Scheduling processThe sequence of the SPD operation must belogical and easily understood, and must flowwithout interruption or delay. It is important to“push” instrumentation through the decontami-nation function as quickly as possible on a first-come first-served basis due to the need to cleanbio-hazards from instruments as quickly as pos-sible. However, once the instruments have beenpushed through the decontamination process,the assembly technicians can apply the “pull”method to prioritize their work according tocustomer demands. At this point, they have theoption to choose which instruments to processand thereby pull them through the process basedon the O.R. schedule, their order of priority andany missing instrument needs from the O.R.

Step 6: Measuring processperformanceProcesses must be supported with strong metricsthat align with a hospital’s values. We all mea-sure what we value. On a personal level, wevalue financial solvency. Therefore we measuremoney; our income and bank account levels,and we adjust our activities and expenses ac-cordingly. Measures like this create a link be-tween what we value and our action.

Organizations need to measure what theyvalue as well. In this case, they need to measurewhat matters to the SPD and its customers. Ef-fective metrics for SPD processes help us toestablish the differences between perception andreality, gather facts that lead to sound decisionmaking, identify process bottlenecks, and evalu-ate our customer’s satisfaction level. Metrics alsoprovide a baseline against which we can mea-sure our performance and notice improvementsand whether the gains are being sustained.

There are two purposes for developing con-sistent metrics and measures within an organiza-tion. First, there is a need to measure the impactof any improvement. Successful improvementrequires a measurement system to track progress.This weaves accountability into the initiativeand provides a tangible picture of theorganization’s efforts. In order to accomplishthis task a baseline must be determined, so mea-surement must begin at the start of the improve-ment effort or it must be ascertained by methodicalreview of past records.

The second purpose is to sustain and thendrive additional improvements within the sameprocesses. According to the authors of “SixSigma,” the breakthrough management strat-egy, organizations “need to establish improve-ment goals, referred to as Stretch Goals, whichfocus people on changing the process ratherthan tweaking the existing processes. This canlead to exponential improvement.”

There is a rule of process improvement thatstates, “We can’t change what we don’t mea-

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See SELF-STUDY SERIES on page 34


sure,” and its corollary: “Don’t measure whatyou won’t change.” It is important that mea-sures be properly focused on elements of theoperation that reflect what you value and wantto improve. For example, if customer satisfac-tion is valued by your SPD, then there must bea way to continually measure that value. First,identify what steps in your processes are criticalto customer satisfaction. Next, correlate yourprocess map to the elements that are critical toimproving customer satisfaction. This will helpyou to focus improvement efforts on the rightparts of the process.

It is also important to understand the impact ofthe measures you introduce, since organizationsand individuals have a natural tendency to per-form in accordance to how they are measured:•If efficiency is your primary measure, thenpeople will be efficient at specific tasks that theyperform, but will not necessarily perform con-sistently all day long or complete the tasks thatare a departmental priority.•If piece count is used as a measure of produc-tivity, they may select work that is less difficultor time-consuming, unless this workload is prop-erly assigned and controlled by management.•If equipment utilization is the key measure thenfocus will be on running cycles, regardless ofhow filled to capacity the equipment is or thepriority of the job.

The right selections of measures accuratelycapture department and individual performance.Performance factors should be tracked, posted,discussed and corrective action taken to adjustless-than-desirable trends. Timeliness of the mea-sure is important as well. A manager or em-ployee who is aware of poor trends early canmake appropriate corrections and impact resultsearly. Too often, managers look at performanceindicators once each month and react with “that’sold news”, and “I have this month to worryabout”. The same is true of employees. Employ-ees should have a clear understanding of what isexpected of them and productivity should beplainly defined as output or results per hour.

Some key metrics that can be used within anSPD are:•Customer satisfaction and quality, defined inthe goal of 100%3. This includes measures ofcleanliness and sterility of instruments presentedto the O.R. and completeness and timeliness ofsets delivered.•Demand; what is the workload amount andtiming to CS. This metric assists you in under-standing bottlenecks and staffing requirements.•SPD hours per procedure; this is a benchmarkby which you can compare your staff perfor-mance level against that of other institutions. Acaution about using this performance indicatoras a staffing level determinant is that not all SPDsperform identical tasks, and therefore the metricmay not be exact. For example, one SPD we

encountered during a project employed SPDstaff as runners, to collect instrumentation anddurable medical equipment from 5 O.R. floors,bring it to CS, clean the durable medical equip-ment, and then return the items to central sup-ply. This represented a considerable workloadexpansion that we have not observed in otherhospitals.•Productivity; defined as items or tasks completedwithin a given time-frame. This measure en-sures that your department is performing effec-tively and requires that reasonable expectancies(standards) be established for each key task in-cluded in the workload.•Skill mix and competency; is a measure of skillattainment, both individually and organization-ally. Identifying skill sets required for the suc-cessful operation of an SPD and the competencyrating of each employee provides powerful in-sight to training needs and your ability to movecross-trained employees to understaffed areasduring peak demand.

There are variations of these metrics, as well asadditional measures that can be used. Select thosethat best suit your organization and its objectives.

Step 7: Active management/supervisory techniques• CommunicationManagement’s daily interaction with theirworkforce is often undervalued or neglected.Typical rationalizations and excuses given toexplain why supervisors are not spending ad-equate time and energy in the midst of theirpeople and processes include: “I don’t have timeto spend with my people;” “my people all knowwhat to do, I don’t need to follow-up;” and“that’s micro-managing.”

A cycle of supervisor-to-employee communi-cation, especially effective assignment-giving androutine follow-up, is critical to the success of theSPD. Regular interaction ensures that the pro-cesses that have been established and the practicesthat have been standardized are being followedand that problems are being identified and actedupon quickly. Nothing in the process or practiceshould be taken for granted by supervisors oremployees. The frequent result of neglecting su-pervisory interaction is that SPD staff, with thevery best of intentions, will begin to do thingstheir own way, deviating from accepted, standardprocedure and causing the process to drift.• Problem resolution and documentationBeginning with the waste and bottlenecks dis-covered by process mapping and workflowoptimization activities, it is paramount that theimprovement tasks be set down in a documentthat provides for effective control and follow-up. Another process improvement rule states:“If it isn’t written, it isn’t done.” This simplymeans that far too many things are on our plateseach day and if the task isn’t important enough

to write down and follow up on, it likely isn’timportant enough to complete. An action item listcontaining a description of the problem, the nameof the person who brought it to the improvementteam’s attention, planned resolution steps, assign-ment of responsibility and due date should be cre-ated. This tool provides the necessaryinformation to ensure effective and timelycompletion of the improvement task and feedbackto the employee who initiated the action item.

In summary, it doesn’t take acrisis, but it helps…We’ve discussed many elements for optimizingworkflow and have looked at what it takes toemploy these elements in your own SPDs. Itoften takes considerable stress and strong out-side forces for a hospital to begin making majorchanges to its processes and practices. Theseforces may stem from an inability to perform atexpected service levels, or growth rates that arelimited by space, equipment and other resources,or infection rates that are out of control, just toname a few. Any of these can motivate yourhospital to look at how it conducts business andforce it to make substantial changes.

But it doesn’t have to take a crisis. Forward-thinking managers can drive the change effortby recognizing that their current processes areless than perfect. Organizations that are healthyare often in a better position to make dramaticimprovements simply because the resources areavailable and the process can move forwardwithout an extreme sense of urgency. Take thefirst step by understanding your process as itexists today and identify the first opportunityfor improvement. Now you are on your waydown the workflow optimization road. HPN HPN HPN HPN HPN

Dan Johnson is a senior professional services consult-ant for SterilTek Inc., a wholly owned subsidiary ofSTERIS Corporation that specializes in process improve-ment and management consulting. He works with hos-pitals nationwide to improve their CS operations andsupport O.R. growth. Johnson has more than elevenyears of consulting experience in healthcare and otherindustries. His resume includes Lean Process facilita-tion, process design, capacity planning, managementtraining and organizational development. He is certi-fied in Production and Inventory Control, APICS, andholds a Masters degree in Operation Managementfrom the University of Arkansas.

References:1) Jeffrey Liker, Becoming Lean, Productivity Press, 1998.2) Womack, J.P. and D.T. Jones, Lean Thinking: Banish Waste and

Create Wealth in Your Corporation, New York, N.Y.: Simon &Schuster, 1996.

3) Eliyahu M. Goldratt, The Goal, North River Press, 2nd edition,1992.

4) John Kimsey and Jim Barton, The Sterile Processing FactoryGoal: 100% Cubed. Infection Control Today, April 2005.

5) Mikel Harry, Ph.D., Richard Schroeder, Six Sigma, The Break-through Management Strategy, Currency / Doubleday, 2000.

6) Yasuhiro Monden, Toyota Production System, Industrial Engi-neering and Management Press, Norcross, Ga., 1983.

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A roadmap to optimizing sterile processingworkflow

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1. Workflow optimization in the SPDcan help address which of thefollowing challenges?a) Process inefficienciesb) Varying reprocessing demandc) Poor resource utilizationd) All the above

2. Two of the best sources of ideas forprocess improvement are:a) CS supervisors and techniciansb) CS technicians and O.R. staffc) Instrument vendors and hospital

managementd) a and c

3. Value-Added activities are thosethat take time, resources or space,but do not add value to theproduct.a) Trueb) False

4. Assembly of sets missing instrumentsis an example of value-added worka) Trueb) False

5. Which of the following SPDworkload functions are bestscheduled and prioritized using aPull system?a) Transport of dirty instruments to the

SPD and decontaminationb) Assembly and sterilizationc) Decontamination and sterilizationd) Case cart assembly and

decontamination

6. A process map is: a) A map showing transportation routes

from the O.R. to CSb) A visual representation of the surgical

instrument reprocessing cycle c) A document providing work

instruction to the CS technician d) None of the above

7. SterilTek Inc.’s 100%3 SPD goalincludes: a) 100% clean and sterile instruments b) 100% complete instrument sets c) 100% on time delivery to the O.R. d) All of the above

8. Primary tools used to optimizeworkflow include:a) Streamlining and work process

simplificationb) Capacity line balancing and

standardized work practicesc) Workstation layout and staff

schedulingd) All the above

9. A bottleneck is any resource whosecapacity is equal to or less than thedemand placed upon it.a) Trueb) False

10. Why are metrics and performancemeasures important in SPD? a) To measure the impact of

improvements b) To identify tasks that may be

eliminated c) To sustain gains made and encourage

additional improvement d) a and c

Workflow Hpn 11 05

Health & Medicine

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