Help! SPD Needs More Staff!!

We need more people!! We can’t possibly get all this work done!! Why won’t anyone listen? We need help! 

These are words resonating through the prep and pack areas of Sterile Processing across the country. The real question is... How do you know if you have enough staff?   

When I talk to other SPD Leaders, they are frustrated because their department is backlogged. There are never enough people to get the work done. The C-Suite says the department is over staffed and it is time to cut FTE’s (Full Time Equivalents). Staff complain because they are over worked and underpaid. The Operating Room is frustrated because all the trays are down unsterile. Worse, the Operating Room is frustrated because the trays that are up and sterile are missing instruments, have wrong instruments, are labeled wrong, or have some other major tray defect.  

Sound familiar? This story has been told across the country from Miami to Seattle, from California to Maine, and everywhere in between. But what is the truth? 

The truth is no one agrees on how to determine the right number of staff. Some common methods of determining a Sterile Processing Department’s productivity are adjusted discharges, number of operating room procedures, how many trays are sterilized, and benchmarking. Let’s look a little deeper into these methods to see if they really work. 

Adjusted Discharges 

Using adjusted discharges as a standard for unit of service is unfortunately common. This is a common methodology for support service departments like distribution, environmental services, linen, and dietary. The idea is that for every patient discharge there is an associated number of hours that the ancillary department needed to perform to support each patient.   

The problem with this method is that a patient can stay for 2 days or 10 but the department gets the same number of allocated hours. Other problems are when there are more surgical patients than medical patients or vice versa. For a Sterile Processing Department there is no correlation between medical patients discharging and the work that Sterile Processing does to support surgery. It just does not make sense. 

Typical Operating Room case load patterns show that there is an increase in surgical case volume from October to December and a decrease from January to April. People tend to have elective surgeries at the end of the year before their deductibles are about to reset or because they were newly insured at the beginning of the year and had to go through the appointments and processes to have surgery by the end of the year. Medical patient admits tend to go up January to April because of flu season.  

What does this variation mean for SPD? Using adjusted discharges for a staffing model, from January to April means that SPD will get more people but have less surgeries. The department will likely “flex” staff down because of the low surgical case volumes. When it becomes budget planning time during the summer the Finance Department will see that SPD met the operational need with less people and will likely cut the budget for staffing for SPD. The year-end rush starts in October, and SPD cannot staff the department to support surgery. Staff work long hours, push work through the department, take short cuts, and this hospital’s surgery department starts having near misses for patient harm. Things like bioburden in trays or wrong instruments start occurring. Is this something you’ve seen happen in your organization? 

This lack of correlation between adjusted discharges/adjusted patient days and SPD staffing has led many organizations to move towards allocating hours to the Sterile Processing department based off of operating room minutes or cases. 

Operating Room Procedures 

Measuring the number of staff needed based on operating room procedures or minutes sounds smart, at least smarter than adjusted discharges. Many Sterile Processing leaders have advocated strongly to move to this model to get a better association or correlation for their staffing model.   

On the face of it, it makes sense. The more surgeries you do, the more staff you need. The fewer surgeries you do, the fewer staff you need. Sounds great, we have a solution? Unfortunately, not quite. 

Not every surgery is the same. A simple eye procedure does not use the same number of instruments as a simple knee procedure. Here is an example: 

General Hospital historically has 50 surgeries per day. They are allowed 4 hours of labor per surgical procedures. This is a total of 200 hours of labor per day, or 25 full time equivalent (FTE). Their case mix and number of trays breaks down as follows. 

This department has 50 surgeries per day, 190 tray, and 25 employees. The average daily work load is 7.6 trays per person. This does not account for any case picking, distribution, crash carts, mobile medical equipment, or any of the other hodge-podge of activities that get placed on Sterile Processing Departments. Overall, not a bad work load for the Sterile Processing Technicians at General Hospital. 

Over a five-year period, the hospital’s case mix changes. They purchase another robot for urology, and they have invested heavily in orthopedics and spine. Administration stays convinced that the case load has not changed. The Sterile Processing Department still gets 4 hours of labor per surgical procedure. The SPD Manager is asking for more staff, and no one understands why? The SPD staff feel overworked and are frustrated and leaving. Five years ago, they had enough staff? What happened?   

Here is how the workload breaks down now: 

The work load of the Sterile Processing Department has more than doubled without any change in the number of hours allocated per surgical procedure. The techs are processing15.8 trays per tech compared to 7.6 before, still not including all the other activities performed in the department. 

This example does not take in to consideration the added complexity of increasing orthopedics, spine, and robotics. Each of these service lines have highly complex instrumentation with intricate difficult to follow instructions for use, which increases the amount of time needed to process each tray.   

The added complexity and increased work load with no change in the number of SPD staff has pushed the department to the breaking point. We will probably see General Hospital on the news soon for an outbreak or immediate jeopardy finding by a regulatory agency. 

Adjusted discharges does not work. Using Operating Room cases or minutes while its better than adjusted discharges, it does not work. So, what is left?   

Productivity Based on Work Performed 

It’s a novel concept, but how about basing the number of employees needed based on the actual work performed? Yes, this sounds like the perfect solution! Well yes, and no. 

The truth is this type of system works well when there is data. Many Sterile Processing Departments are still using paper menus and no tracking systems. Often hospitals that are using tracking systems are using systems with inaccurate information or are underutilizing the technology. 

Several years ago, I worked in an organization where every pay period we counted by hand the number peel packs and trays processed. These numbers then went to finance who gave us our allocated number of staff that we should have used the prior pay period. The delay made the data useless for proactive staffing. This type of system is also easily manipulated. Is the operating room volume down this week, well that’s okay, just peel pack 1000 peel packs? Even with these challenges, we had a better correlation between work performed and finance’s calculation of the number of staff needed. 

Benchmarking 

Now for departments that are using their tracking systems to their full functionality, these departments have the actural measured average amount of time it takes to process each tray. They know how many trays get produced by the hour, by the shift, and by the day. This data allows an innovative leader to staff to the work needed. Finance has the ability to export this data or to interface to the data for real time metrics showing how well the department is performing. 

All work can be captured in these systems including case carts, mobile medical equipment, distribution, and even phone calls.   

Enterprise organizations can benchmark themselves against their sister facilities to determine staffing targets based on real work performed. At Orthopedic Hospital, their trays are more complex and numerous per case, the system provides the data showing the need for more staff. For the General Hospital performing simple surgeries, the data shows the need for the right amount of staff. 

Where do we go from here? 

The bottom line is change is hard. We need to think differently and be more innovative as leaders. Data and benchmarking are the best way to determine proper staffing levels. As leaders we need to learn how to analyze data and present it to Administration and Finance to justify and build business cases to ensure we are adequately staffed to get the work done. 

Data is how we know we have the staff we need. 

*Please note the contents of this article represent my own opinion and does not represent any organization that I am affiliated with.