Business Resilience In The SPD

Introduction

Business resiliency refers to an organization's ability to adapt, recover, and thrive in the face of unexpected disruptions or challenges. It involves developing strategies, processes, and systems that enable a business to withstand and recover from various threats. Business resilience and the Sterile Processing Department (SPD) are not usually words one sees in the same sentence, but it’s time for hospital administration to start looking at the SPD through a different lens – one that reflects a department that contributes to revenue vs. purely a cost center to the operating room (OR). Business resilience encompasses more than continuity or disaster preparedness; it is the ability to respond, adapt, and keep the operation running in the event of any planned or unplanned challenge or disruption. This article looks at the important role the SPD plays in helping the OR and the facility to remain nimble and able to adapt to sudden changes and how proactive investments in equipment and staff can help ensure a culture of safety and a healthy revenue stream.

Applying Business Resilience to the SPD

The responsibility for cleaning, sterilizing, and maintaining medical devices and instruments lies with the SPD. Any deviation from normal operations, such as a poorly cleaned instrument reaching the operating room and causing harm to a patient, or a malfunctioning sterilization or endoscope reprocessing unit leading to the cancellation of a procedure, has a direct impact on patient safety, quality of care, and the financial stability of the healthcare facility. These can cause a case to be delayed or cancelled. In fact, The Joint Commission cited adherence to high-level disinfection and sterilization procedures for medical equipment and devices as one of the five areas noted for non-compliance during its recent survey.¹

Business resilience in the SPD is imperative to ensure that there are no interruptions to patient care and safety. This encompasses maintaining compliance with regulations, policies, and procedures and contributing to overall facility performance. Four specific areas where business resilience is essential to the SPD include:

Patient Safety: Effective business resilience policies play a crucial role in safeguarding patient well-being by mitigating interruptions and disturbances in the provision of sterile instruments and medical devices to the operating room. A resilient SPD should be adequately prepared and equipped to handle unforeseen events such as natural disasters, equipment malfunctions, or emergencies, all while ensuring a continuous supply of materials for the operating room. By guaranteeing the availability of sterile equipment, the likelihood of hospital-acquired infections (HAIs) or surgical site infections (SSIs) is significantly reduced, thereby enhancing patient safety and overall outcomes.²
Regulatory Compliance: The SPD must adhere to strict regulations and standards as well as policies and procedures set forth by the facility and as directed by Infection Prevention. A business resilient SPD ensures full compliance by having the right processes, reliable equipment, and competent, well-trained staff in place.
Operational Continuity: A well-prepared SPD that prioritizes business resilience implements various strategies and approaches such as thorough contingency and disaster preparedness plans, redundant systems for crucial operations, and a staff trained in multiple areas. This ensures minimal downtime and enables the department to swiftly recover and resume regular operations, thereby minimizing disruptions to the operating room, patients, surgeons, and the facility. By maintaining operational continuity, the department reduces delays and cancellations in the operating room, enhances patient safety, and mitigates financial losses for both the facility and surgeons.³
Risk Management: What can possibly go wrong in the SPD? Plenty! SPD risks include equipment malfunctions and break down, equipment in need of replacement because it can no longer be repaired or has reached its end of life, HAIs or SSIs from medical devices and equipment that are not properly sterilized or reprocessed, staff shortages, and poorly trained staff. A risk averse SPD is one that proactively identifies and assesses risks, has a plan in place to mitigate or prevent risks, and collaborates with Infection Control to regularly review and update response plans. The SPD that effectively manages risk minimizes disruptions and ensures sterile instruments and medical devices are available when needed or requested to keep patients safe and the operating room running.

The Relationship Between Capital Expenditures and Business Resiliency

Business resiliency includes having equipment that meets changing market conditions and physician and patient preferences. The delivery of safe and exceptional patient care requires having the right equipment and supplies, including terminal sterilization and high-level disinfection machines in the sterile processing department, that are compliant and compatible with manufacturers’ instruction for use (IFU) to protect your investments. Modern and technologically advanced equipment enhances the ability of a facility to be resilient. This means that it can easily adjust and endure any disruptions or challenges that may arise, while still ensuring the smooth running of business operations. Additionally, such equipment allows the facility to thrive and expand, even in unfavorable or changing circumstances.

For example, what do you do if older, critical equipment is reaching its end of life and will no longer be supported by the manufacturer? Does waiting until service and parts are no longer available save money or does it potentially jeopardize patient care and the facility’s reputation, which ultimately harm the facility’s financial health?

In the case of the SPD, delaying the replacement of equipment that is no longer eligible for parts and service provided by the manufacturer can cost more in the long run. If instruments are not properly sterilized or ready on demand, the case might be delayed or cancelled, causing a domino effect for the rest of the OR schedule for that day. It also can affect patient and staff safety, surgeon satisfaction, the facility’s reputation, and the ability to compete in the market.

Purchasing new sterilization equipment can be expensive and may not be planned for in a healthcare facility's current budget. However, financing this type of capital expense allows the facility to invest in important infrastructure, equipment, and technology to ensure the business remains strong. By financing equipment, the facility can obtain and upkeep state-of-the-art equipment, which can impact a surgeon's choice of where to perform procedures. Replacing outdated equipment with well-maintained modern equipment can decrease the likelihood of breakdowns, minimize disruptions, help ensure the safety of patients and staff, and keep the business running smoothly.

By purchasing new equipment before disaster strikes, staff can be scheduled for training in alignment with the SPD’s and OR’s needs, reducing unplanned scheduling interruptions and making the process appear seamless to surgeons who depend on an on-time OR. Additionally, if members of the SPD team are resistant to change, the department supervisor has time to educate staff about the benefits of a new machine and alleviate the apprehension that comes with learning how to use new equipment.

Capital Expenditure Decisions for the SPD from the Top Down and the Bottom Up

The decision to buy capital equipment doesn’t necessarily start within the SPD. Often, the medical staff (along with hospital managers) insert themselves into the buying process.⁴ This “top down” approach would initiate at the OR level. Meanwhile the “bottoms up” approach includes the SPD director in partnership with Infection Control as the two departments responsible for creating and implementing protocols and procedures to ensure that instruments are properly sterilized or reprocessed and tracked as one of the most important steps in preventing SSIs (Figure 1). Administration and finance personnel should visit their SPDs to gain a better understanding of its daily operations and the impact it has on the OR and surgeon satisfaction.

It’s important for the OR, medical staff, infection control, and the SPD to align toward a common goal and work with Administration and Finance using a data driven approach5 that demonstrates equipment that is “good enough” really isn’t good at all for the patients, staff, and the facility.

Diagram showing the top down, bottom up approach to capital expenditure decisions — Figure 1: Understanding capital equipment decision-making from the top down and the bottom up

Conclusion

Business resiliency for healthcare facilities encompasses many facets. When it comes to capital equipment, settling for the status quo can cost more in the long run. For example, one study found that surgical site infections can account for up to 20 percent of HAIs for hospitalized patients⁶, potentially resulting in an additional 7-11 bed days beyond the average length of stay for the initial procedure.⁷ Use capital financing to stay in lockstep with healthcare innovation and advances and have the peace of mind knowing that the facility is compliant, maintains staff and patient safety, maintains high levels of patient care despite an unforeseen event, and has a reputation for successful outcomes. The SPD should be considered at the same level of importance as the OR and other critical areas of the hospital. An investment in future-proof sterilization and reprocessing equipment for the SPD today maximizes uptime to help keep the OR running efficiently and the facility resilient and financially healthy.

References

Top 5 most challenging requirements for 2022. The Joint Commission. (n.d.). https://www.jointcommission.org/resources/news-and-multimedia/newsletters/newsletters/joint-commission-online/april-19-2023/top-5-most-challenging-requirements-for-2022/
Centers for Disease Control and Prevention. (2019, May 24). Disinfection & Sterilization Guidelines. Centers for Disease Control and Prevention. https://www.cdc.gov/infectioncontrol/guidelines/disinfection/index.html
Akinleye, D. D., McNutt, L.-A., Lazariu, V., & McLaughlin, C. C. (2019, August 16). Correlation between hospital finances and quality and safety of patient care. PloS one. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6697357/#:~:text=Strong%20financial%20performance%20is%20associated,ongoing%20resources%20for%20quality%20improvement
Mukherjee, Tarun & Al Rahahleh, Naseem & Lane, Walter. (2016). The Capital Budgeting Process of Healthcare Organizations: A Review of Surveys. Journal of Healthcare Management. 61. 58-76. 10.1097/00115514-201601000-00011. https://www.researchgate.net/profile/Tarun-Mukherjee/publication/317774421_The_Capital_Budgeting_Process_of_Healthcare_Organizations_A_Review_of_Surveys/links/5bfa1293458515a69e39ca16/The-Capital-Budgeting-Process-of-Healthcare-Organizations-A-Review-of-Surveys.pdf
Centers for Disease Control and Prevention. (n.d.). Data. Centers for Disease Control and Prevention. https://data.cdc.gov/
Klevens, R. M., Edwards, J. R., Richards, C. L., Horan, T. C., Gaynes, R. P., Pollock, D. A., & Cardo, D. M. (2007). Estimating health care-associated infections and deaths in U.S. hospitals, 2002. Public health reports (Washington, D.C. : 1974). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1820440/
Anderson, D. J., Podgorny, K., Berríos-Torres, S. I., Bratzler, D. W., Dellinger, E. P., Greene, L., Nyquist, A.-C., Saiman, L., Yokoe, D. S., Maragakis, L. L., & Kaye, K. S. (2014, June). Strategies to prevent surgical site infections in Acute Care Hospitals: 2014 update. Infection control and hospital epidemiology.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4267723/

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