You Cannot Manage What You Cannot Measure—Developing Central Sterilizing Performance Metrics

Abstract

Background: Metrics are critical to healthcare, particularly in areas that are highly process oriented. Our hospital’s central sterilizing department functions on standardized processes that have almost no industry specific measurements. Furthermore, the department had no formal internal method for process performance evaluation. A multiphase 6 Sigma DMAIC project was initiated in February 2019 in the central sterilizing department, with ‘phase 1’ being the development of performance metrics to evaluate current state and track future improvement. Methods: A DMAIC team was formed and completed a data inventory that included identifying all existing data sources pertaining to central sterilizing. Sources identified as reliable included count of daily surgical cases, counts of defects based on surgical services communication logs, number of surgical trays processed in the central sterilizing department, and the number of unsterile trays in the department at the start of each 7:00 a.m. shift. Results: A multidisciplinary team including surgeons and senior leadership formed the DMAIC team. Using identified data sources and input from frontline staff and leadership, official metric definitions were created. Weekly defect rates were chosen as a measurement and translated into the number of ready-for-use surgical trays at the time of case setup for every 100 surgical cases. Data from November 2018 through January 20, 2019, demonstrated the mean ready-for-use surgical trays at the time of case setup: for every 100 surgical cases, 96 the surgical trays was ready for use. Further analysis of the data over time demonstrated that variability was out of control. Defects were stratified into 12 categories. Moreover, 6 defects were creating 80% of the issues in trays not being ready: ‘hole in wrapper,’ ‘biohazardous debris,’ ‘nonbiohazardous debris,’ ‘missing instrument,’ ‘incorrect/mislabeled instrument trays,’ and ‘missing indicators.’ Results for unsterile trays at 7:00 a.m. showed that, on average, the central sterilizing department had 100 or more trays at the start of each 7:00 a.m. shift. Conclusions: Without a formal method for data collection, defined metrics, and ongoing analysis, evaluation of performance is based on anecdotal conclusions resulting in missed opportunities for improvement and, subsequently, opportunities for improved patient safety. Regularly published visible dashboards provide a true picture of performance, allowing staff to identify unwanted variation and to put interventions in place so that future variation is better controlled and or prevented. Additionally, having solid metrics, even when no industry ones exist, aid in measuring the effectiveness of improvement efforts, such as the DMAIC project, as they move into subsequent phases.

Funding: None

Disclosures: None