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INFECTION CONTROL
To do it, we used a process called value stream mapping. That may
sound complicated — it's the term they use in lean and Six Sigma projects — but it's not rocket science. You just need a general understanding of the basic idea, which is to use observation to pinpoint
value- vs. non-value-adding types of activities. It's logical and practical
and chances are it's a tool your facility could use to unearth a lot of
opportunities for improvement. As statistician W. Edwards Deming
says, "If you can't describe what you're doing as a process, then you
don't know what you're doing."
What we knew was that there were a lot of delays, bottlenecks and
work inefficiencies between central sterile and the OR. So the first
thing we did was bring people together from the different departments, feed them breakfast and start to evaluate all the steps there are
in cleaning an instrument tray. It was kind of like putting a puzzle
together. We used a lot of sticky notes to document the process and
map it out on a wall — all the nuanced steps involved in getting a
dirty instrument back from the OR and returning it to the OR clean,
and how long each step takes. That was how we began to uncover
and eliminate the wasted time and energy that were gumming up the
works.
One fix at a time
Eventually we had a complete draft of the process, which we then put
through a period of validation. We said, "This is what we learned,
this is what you told us. Do you agree?"
Incidentally, we knew you don't go into the process with the idea
that you'll fix everything immediately. First, you look for low-hanging
fruit — things that are easy to improve. For us, that meant removing 4
large carts full of unused, extra or unusable equipment along with 7
large empty carts that were taking up lots of space. Then, by focusing
