10 a.m., when the morning cases were finished, carts started coming in
and they had to start turning things over quickly. They needed more
people from 10 a.m. to 2 p.m. when they were busiest. So, some early-
shift employees started coming in later and evening-shift workers start-
ed earlier. This shift in staffing to mirror the workload made huge
improvements very quickly.
When do the case carts start backing up at your facility? Do you
need more people first thing in the morning to take care of instru-
ments used the day before, or do you need more during crunch times
during the day? Adapt.
Consider adding a runner during your busiest times, someone to
make sure everyone has what they need when they need it. If your
SPD staff has complained about having to leave their stations to
retrieve something, a runner might be the solution.
3. Work toward one-piece flow.
The hospital's 10 a.m.-to-2
p.m. crunch wasn't solely because that's when the first group of cases
ended. As in many facilities, the OR staff was "batching" the instru-
ments and carts, waiting until they had several used instrument trays
before they took them to SPD. This seemingly made sense. They only
had to make one trip instead of several when they could be doing
other things. They also well-meaningly thought it would be easier for
SPD to process more than one cart at one time.
Nothing could be further from the truth. Batching generates waste.
One-piece flow, although it may be counterintuitive, makes sterile pro-
cessing more efficient. One-piece flow means that when the cart or
instrument is ready for SPD, it goes to SPD and gets processed as it
arrives. You might get some initial pushback from insisting that the
OR staff make more trips, but once employees see that it works and
the result is fewer case delays while waiting for sterile instruments,
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