Part 3: State of the Union for Sterile Processing and Technology

Welcome to consensus, a podcast from census technologies. All right, everyone, welcome to the third and final episode here in our series talking about census squared productivity. We appreciate you joining us here today very, very much. If you missed the previous two episodes, you can always go back and check those out. They should be in the podcast feed. They're on Apple podcasts, Spotify or on the census website. So make sure to check out those episodes for an introduction into our conversation today. But here in the third and final installment today, we're going to be talking about the importance of optimized speed staff utilization, as well as creating tray efficiencies through data analysis and advice for hospitals, considering or evaluating using census squared. So you want to go back and check out those previous episodes, but that's what's coming up here on the third and final installment of this podcast series. So let's get right to it. Let's dive into our conversation. You know, we've talked a lot about staffing throughout this conversation, but that's really a thing, right? Is you're able to put staff in a place where you're going to need them most, which increases efficiency. Oh, absolutely. And we had when I first got here, we had kind of the standard, if you will, schedules laid out for a US Department. And they were adequate, they were working. There were labor hours being wasted on the front end by multiples of employees. And then there were shortcomings at lunch and in the hours the. The schedules of the employees will work and they work in a pretty standard that were pretty normal across the industry. And that leads me back to what I was saying earlier. You know, one, I ask x number of employees that just tweak your schedule a little bit, an hour up two hours back. Whatever the case may be. And so when we started, probably, I would say probably 60 days into seeing the data come out of the square was that's when we started moving. Moving they started looking at it and almost immediately we actually started making changes, probably 60 days in and we made those changes around the data that we were seeing based on scans. And so we were back and employees, you know, an hour and an hour doesn't seem like it would make that big of a change. But, you know, that takes me back to, you know, I changed an employee stock about one hour. Now they're here the same amount of time, debatably working just as hard, but they're doing more than the same amount of time with the same amount of effort. And all it was a tweak of their schedule. And so, you know, we don't have everybody starts here, everybody ends here, and then the next one comes in, everybody starts here, everybody else. And so it's a lot more staff steps and it's built around the throughput of surgery or the expected throughput of surgery instead of. Me being a manager. And it's a lot easier to say. I got 10 people starting nine. I got 15 start in the loan. I got 20 coming in at three, you know, whatever your numbers are. So now I've got to start starting early, coming in, make sure we've got multiple. People that have that same skill set with testing, all those things and any emergencies from overnight, that type thing. And we don't really see people start coming in. So 10:00 or later because, you know, some of those people drop in the end of the day in town. And there's not really work waiting on them until the cases start. Then stop, then go through the entire decon time process and then a 20 to 30 minute answer cycle. And then the trees are out and they can be assembled. No point in hiring staff who waiting on that process to happen. And typically, you know, this is December, we're late fourth quarter, so everything's different. But typically we start the day off fresh and cold, you know, almost no trees down, very little to no trees down. And so I would literally have staff. We would be looking for stuff for them to do on a regular basis. Yeah, I think if I could jump in for a second, I had recently seen an article where it said like only 20% of all insurance entrees are actually used in the operating room. And, you know, and I get why the other 80% need to be there. You know, surgeons may or may not. Different surgeons need different things. But for the most part, only 20% of instruments are being used for surgeries. And the reason I bring that up is because one thing that Seamus and I have talked about a lot is complexity of trays and standardization. And this is one thing that Seamus I talked about in the early days where we looked at we had a tertiary care facility. We have to level one, level two trauma centers. And then when we have other bunch of other facilities that may do small things like our one facility, the top three trays are our 2r and D trays. The third is a dermatology like most trays. And so it's unfair to compare one facility to the other. And then one thing that we looked at was the complexity of the trays is, OK, well, these trays are very, very heavy. We're only getting one unit to service for a tray that might have 200 instruments in it, whereas these other trays or we're getting one year a service for maybe a tray, it has 15 elements in it and it, you know, so we look at that complexity and we work with our OR partners, our coordinators, and we're actually looking at, you know, how we can streamline trays or maybe break trays into two because maybe they're overweight, that kind of thing. So the standardization function and the sense as air square is amazing is Jeff, I actually had in my notes here, I was going to ask you if you guys took advantage of that complexity option when they roll that out to us, I'm like, man, that is going to be great. And then like the reality set of the reality of it saying, and I'm like, seamus, that, that's awesome. That's an amazing tool. But I don't have hours to go through and assign complexities to all these trends. I was like, you know what? We got you. Here's the plan. Here's how. Here's how we'll do it. And this is the best way. And so we took Sam's plan. We we executed it. I don't know. That's our investment. Maybe it will be generous in a three hour investment. And, man, the vision that was obscured. I mean, it really was eye opening, not only to me that to my staff as well. And so if you've ever heard me speak, you know, I've say almost every time I speak, not all trades are equal because they're not all trades are equal. I've got I've got techs that are cranking out 50 trades. And that's great for camera trades. And then other techs that are cranking out, you know, 12 and 15 trades for those are slightly more complex trades. Those are not the same things when you're cranking out 10 trades that have a complexity of a 5 on a 1 to 5 scale that is that's impressive. And come back and have it coupled with an error rate or, you know, whatever, whatever terminology you're going to use for that, it's better to be able to. Yeah the other area where the complexity helped us is with the, you know, covid, with the supply chain shortages and things like that. We we actually had opposed that. We're over a year old that's still not been fulfilled. I mean, we're talking a couple of POs for insurance, just that one site. The estimates just weren't coming in. So what folks were doing. Were they were looking at alternative companies with mid-grade insurance, even though they're still surgical quality and are still mid-grade. Our policy here at our facility, you know, we stress quality so much. We, we only allow premium grade instrumentation into our operating room. No mid-grade, even though it's operating room allowed, but we only allow premium grade. So what we had to do is with that complexity and then updated count sheets is we looked at how we could best use the available resources that we had at the time, which trays were not being used. I love that ability. I mean, our major Trey's obviously, if anybody has made are probably our number one used Trey but our soft tissue trays for example you I think we had like 11 of them at one site but we are needing like 13 every time we used them. So, you know, we either had to borrow from a different site or we had to figure out a way to accommodate the operating room that for that day. So a standard is I can't say enough about standardization across the board, no matter whether it's your supply chain, whether it's your staffing, it's whether it's speedy functions. And I cannot say enough about maintenance, which, you know, falls in that category of complexity of trays just to trace to complex your error rates are just going to go way up. You know, it's too difficult, especially when you have staffing coming on board with no prior experience, open heart trays. You know there are notorious for be happened to be perfect not only perfect as according to the County but the way it's set up, you know, I mean, you know, our folks that are doing open hearts, they want that wire cutter in a specific spot. They want to sternal retractor in a certain spot, ready to go. Some facilities want their sternal retractor separate it. But most open heart facilities, especially trauma, they want that finished over, retractor assembled and in the position of function. And they want it right on top because when they crack a chest, they're going to need those certain types of things. So even though the couching might be correct, the way the tray is set up, if it the trays too complicated, it's not advantageous for a throughput workflows and those new folks it just upset I want to say I've said it just doesn't help them to put out a quality product when it's too complex. Too complex. So, seamus, from your perspective, Jeff and Cody have worked with them with this for a while and have been using this solution for quite some time. What are you hearing from other customers? What are you hearing from the rest of the market? Good question. Two similar stories. We've you know, as you know, we launched this officially a month ago, got quite a bit of interest from lots of customers across the industry and very, very similar stories. You know, the key points are, you know, really having visibility data and being able to communicate with data, having those data driven conversations, you know, like, like Cody was talking about when you make changes, there's a downstream impact. Those changes, you know, you change somebody's schedule that. That's a big deal for a person. And so there's making changes in a lot of cases is expensive, and you want to have data to back that up before you make those kinds of decisions. So yeah, lots of very similar stories, lots of it, lots of interesting things in the data, too. You know, I think so. Jeff said, you know, he thought maybe major trees were the most commonly used phrase. I think what we see is the striker Cameron like or trays the most commonly used approach because there's so many of them, which is kind of interesting that some of the other things we're looking at now or are related to quality looking for, you know, what correlates what correlates to higher defect rates. One of the things that we've actually found, which is kind of interesting, is the number of different kinds of trees a technician routinely assembles correlates with defect rates. So technicians who assemble lots of different kinds of trees on a regular basis have lower defect rates, which is really interesting. One of our hypotheses. Yeah, right. Our hypothesis, though, is that was a proxy for experience. That the more experienced technicians are probably the ones working on more things. Probably a lower complacency to either the same handful of trees all the time. A certain amount of comfort that comes with it. So I guess maybe. Yeah Yeah. So it's all kinds of really interesting insights. Yeah and seamus, when you and I were talking, we were talking about bottlenecks and whip work in progress to trace the number trees that are down, you know, directly correlates to defects or quality issues. Because now what we have, we have disorganization, right? The bottlenecks, people are rushing, taking shortcuts. You know, one of my phrases I look they live and die by is no shortcuts there. There are no shortcuts. There's no middle ground between sterile non-sterile. Right the whip, you know, same thing with a whip. You know, there are a number of trees that are down. We now we have folks rushing to get trays done. And that's when the mistakes happen. Like you ask yourself, how can somebody miss an indicator? You know, how come this person could miss five indicators in less than a month? You know, it's just seem so simple and so repetitious. They should never forget an indicator or a filter, but it's because, you know, we're rushing because there's a problem with the workflow or there's bottlenecks or there's just a lot of work, cleanliness and organization and workflow. Those top those are top three areas on my list of things to do to make sure are working correctly. And unless I, I mean with so many sites that I have, unless I have some kind of dashboard that tells me, you know, that those are all those three objectives are being met. You know, it's hard for me to lead from afar. And that's what this that's what this solves for me, that while it doesn't solve the 100% of problem, but it gets pretty close to 100% because you still have to go to the area and observe. Right you still have to meet the people and those types of things. But I tell you what, I go to bed at night and I get good sleep knowing that I made the right decisions that day. And Jeff, you were talking about your dashboard. So let's say pre since this air, did you have any kind of dashboard? Did you did you did you have a presentation of data to your team? You know, the only thing that I had really was charts that I was doing in Excel pivot tables like the line charts, like when you do that, how long, how long, how much time were you spending on that to present the information to your team? Well, you know, it's funny you asked that because it took about two, 2 and 1/2 days of our per week, you know, same thing for me. So I like the raw numbers. But a lot of my staff, yes, they like they like the visual. Right and so then in the months to come, the third or fourth day in, I got I got I got all these numbers. I'm putting all these reports together and then putting Excel and manipulating it. And then you got to make it somewhat presentable, right? So hours and hours. But I didn't get any interruption. It would take me a few days dedication. Well, I don't know about you. It's pretty rare that I don't get in a rush, but, I mean. So what is your. How much time do you dedicate to it now that you've got to say, Ah, compared to, compared to when you, when you were like producing your own like hours. Probably an hour. I mean, I'm not even kidding. So the biggest problem with putting charts together and all this probably notice already is, is that it's not really putting the chart together. You know, that may take two or three hours, you know, for you to use in Excel. The problem is getting the data, finding the data. I mean, you know, census has great reports all but you you have had to pull multiple reports. I might have to go into our timekeeper system and pull out, you know, time data from there. Those I might go back into our schedule, pull out data from there on that. And then once you get all that data and, you know, it's kind of like, OK, is, is this data really correct? And then it's is my math is my math right? Or am I putting the right formulas together? That was one problem I have with the Excel is, you know, formula is, you know, is always going to. But now, like you were saying, I go in, adjusts the filter's footprint and they'll stick it on the communication board. I mean, it's. And I saw the ability to create my own charts with the drill Downs and I can export to Excel. Those types of things I that's the nice thing about it. You know, I can pick and choose the data I need when I need it. And, you know, even though the reports are available, you know, for, you know, going really deep into a topic or subject, you know, it's nice to have that information right to your fingertips. I think that's really, really well put. And we've covered a lot of ground here. And I think I think a lot of what we've said kind of. Lends itself to this. This last question that I'll ask here, but what would you woman, Jeff and Cody, what would you guys say to other hospitals that might be evaluating this tool? Well, I would say to other hospitals, you know, sometimes it's tough to for any hospital, especially maybe now post post-covid supply chain issues. Everyone's worried about a recession. You know, you have to invest. You have to, you know, pay it forward sometimes kind of thing. At least give new technology a look. You know, we can pay consultants to we can pay consultants hundreds of thousands of dollars to tell us we have problems. Well, we are know, we have communication problems. We already know we have technology problems. I don't need to spend a couple dollars for someone to tell me that we have to identify the problems. And the problems are, like I said earlier, is poor communication and, you know, not having the right data at the right time. And so I think if somebody gave you a crystal ball and, you know, the crystal ball gave you the answers, I mean, why not take a look at it or why not try it? That's that's the key is trying it and, you know, and talk to others who have used it and, you know, you know, coding. I have a passion for this type of stuff because we've seen that work. I mean, I'm getting 5,000 more trays a month now with the same amount of staff. I'm going from 150 whip to zero whip or 10 trays for whip. No longer seeing the bottlenecks. When I asked for staff, I asked for four additional staff and I was shocked. When the president approved it. I asked for two ice, four float positions. I had a build out program from the ground up. I got it. I asked for a quality coordinator educator and a database resource coordinator. I got it. I mean I mean you don't things because you had the data to support it right and so exactly have to be able to. So your question, Tyler was about presenting the c-suite and you have to be able to. Demonstrate to them a return on investment. It doesn't matter if you work for profit hospital or a not for profit hospital, even not for profit hospitals. They're not for a long season. And so they have a bottom line. And so, you know, as leaders in the world, you know, when you get to a certain point, you have to study the business side of it as much or more than the clinical side. There's an expectation that if you're here that if you're having these conversations, you've got the clinical knowhow, the clinical skill set, and at least the ability to find the information if you already have. But now we're going to challenge you with a business aspect, business acumen of it. And if you want a new toy, that's fine. Come sell it to me and tell me how it's going to make me money or how I'm going to break even on it, or how it's going to benefit the facility in the long run. And some of the ways everything has dollars on side to it. Right it doesn't matter if we're talking about tracking systems, containers, instruments themselves, surgeries, they've all that labor. So the most expensive thing in your department is probably labor. It might be capital, but it's probably the highest cost. Definitely usually between 45 and 65%, depending on market and a whole bunch of other things that we don't get into. But when you can say that this program or this addendum or this add on is x amount of dollars, and then I can say, look, I can take and spend this money here. And then with it, I've seen where it's demonstrated. I've made a few tweaks. That didn't cost anything. I mean, there was a certain amount of risk in making the changes, but there was no cost in making the changes. Now, all of a sudden, I'm getting more for the money I'm already spending. There's your return on investment. And then and then you come back. And one of the things, Jeff, you may have looked at this. I don't know that it just hit me. The reminder date is this also allows you to look at. Future capital purchases. And so that's one of the things that I remember as we were going through early in on the sense that, you know, correct me if I'm wrong, but one of the things that we looked at is the throughput, the time the season allowed us to determine or the number of sterilizers we got. Are they really, truly adequate? We weren't breaking and we weren't tracking like when the sterilizers were down or anything like that. But we were tracking the possible throughput and the throughput. Based on when it was all happening. And so there are certain things that will allow us to. Better make those decisions. You know what I mean? We don't really didn't to make that investment or not make that investment. And then, you know, like I said, we'll go everything's got $1 attached to it. So error rates have dollars tied to them, trees that were supposedly stolen or not. Those have dollars assigned to them because trade was supposed to be up. And it's not the case. How much is over per minute? You had a trade that was received that was contaminated. Right and so how, you know, you've either started a domino effect on so your staff or a percentage of people stop everything, take care of this tray so everything starts, take care of this trade, you can say improperly and then to get it sterilized properly. But they had to stop everything else. Well, you know, it happens to that domino. It goes down the Hill. All right. So all that stuff can be measured. And, you know, you've almost, almost been given a predictive tool, if nothing else, an inside. To now see these things could if I had you had a good thought there to maybe think about something every speed manager has always been called in to the operating room to speak to a surgeon, sometimes doing a case. I know I have a couple of times I never do what they say to you. Right so what I've commonly hear is I want to know how this happened. I want to know how it happened. I want to know why it happened. I want to know what you're going to do about it. Right so to I'll say I want to know why it happened. I want to know how it happened. And I want to know what you're going to do about it. And you're standing there on the carpet in a dark room with bright lights facing on the patient. And you've got 10 people staring at you, wondering what you're going to say. And so those are difficult positions for new leaders, especially to be in, but even for seasoned leaders to be in that position. And, you know, I always wanted I always I've learned that, you know, the best answer I can give is, is, you know, I can't tell you that right at this moment, but I promise you, I'll investigate. I'll find out where the problems are and I'll develop an action plan. But the key to that is, you know, it's all a journey, right? You can take you can take an hour to get to the journey or you can take a week to get the journey. You still get the same results. But the fact is, the sooner you get it, this that proactive part that's higher and I were talking about earlier, instead of being retroactive and that kind of thing is can get an answer for that surge and hopefully be ready before the time they leave the operating room. I think that goes a long way. I did have one leader yesterday. She reached out to a doctor with something and followed up on something. And he goes, he said, you know what? You're the first person that's ever reached out to me from speed. And he really appreciated it and gave her his cell phone number and these phone numbers. So that's relationship building right there, man. These are this is incredible stuff. And just a lot of, I think, fantastic testament to the power of this platform and what it can provide for organizations. We're going to have to wrap it up there because we've covered a lot of ground here today. So, guys, Thank you again so much for joining us here on this episode of consensus, Jeff long, Cody Trout and Seamus Johnson. Guys, Thank you again so much for being here. My pleasure. Thanks, guys. My pleasure to be here. All right, everyone, that's going to do it. This was the third and final installment here in this is in this series talking about census squared productivity. We appreciate you joining us for all three episodes for more. Of course, you can always subscribe to the podcast to stay up to date with the latest. And of course, more podcast episodes are coming your way very shortly from myself and the team at census. So you want to make sure to subscribe, to stay up to date with the latest for those. But for this series, these three episodes, we are signing off. And so Thank you again for joining us and we'll see you next time.