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Process Improvement Sustainability in Sterile Processing

By: Angela Lewellyn, LPN, CRCST, CHL & Jhmeid Billingslea, CST, CMRP, CRCST, CIS, CHL

For many years, the Advantage Support Services team has been invited to bring solutions to Sterile Processing departments (SPDs) to develop and initiate process change and ensure the change is sustainable. Often, numbers lie at the heart of our solutions to create sustainable continuous process improvement: the number of staff members and the level of expertise they deliver to their patients and customers; a customer satisfaction rating; and the need for interdisciplinary/multidisciplinary team involvement and strategies.

Sustainability, as defined by the UN World Commission on Environment and Development. is “…development that meets the needs of the present without compromising the ability of future generations to meet their own needs.”1 To apply this principle in the SPD in respect to high job performance for technicians and leaders and effective, efficient processes that are rooted in best practice, the department must meet the needs for present job satisfaction, which also creating a sustainable culture for future staff members. Process and communication are key model strategies for meeting those principles of sustainability.

Project pros and cons

Departmental leaders should be aware of the pros and cons for initiating process change and ensuring its sustainability. The pros, according to some leading experts, is that sustainability encourages departments to frame decisions in terms of years and decades rather than on the next quarter's earnings report and to consider more factors than simply the profit or loss involved. When applying this business model to an SPD, decision makers must decide on the number of staff members and the cost value of consumable products utilized in a department. In our evaluation, some products can’t hold a candle to others in terms of performance value and aligning with “best practice” in regard to ANSI/AAMI standards.

When considering a product change in the SPD, a product’s evaluation should be scored on how it delivers the best results according to the science of sterilization. For example, having inspection products available so team members can assess instrument functionality and bioburden delivers long-term benefits on many levels; it promotes job satisfaction for the user; allows the technician to provide a better product for the customer and patient; leads to increased customer satisfaction and, potentially, better survey scores; and, most importantly, helps promote better patient outcomes. Assessing all current products used and developing sustainability goals is an effective way to ensure the SPD has the most effective products available to serve their customers and patients.

One con of moving toward change and sustainability is that the process is often a complex one for healthcare organizations. By basing decisions on longer timelines, some of the higher upfront investments in efficiency and renewable sources are easier to justify. Because the SPD is not a revenue center, some departments may have fewer dollars to invest in sustainability at the onset of process improvements.

Investing in process (or product) change can also be initially daunting; however, in time, it can be achieved and adapted become part of the department’s culture. Process or product changes may be decided by management, leaders and a multidisciplinary team. Advantage Support Services’ model recommends that end users be engaged in the process and on all steps leading to a final decision. To gain end-user participation, buy-in at the onset of the change is essential.

Once the final process is established on paper, education and practice come into play. This process should be given a trial timeline (Advantage Support Services recommends two weeks. Feedback provided by users helps ensure best practice). Training on the change involves communication provided by second-level leaders on all shifts. Communication should be consistent and constant throughout the trial period and delivered via departmental huddles, visual aids and a communication book for all staff members to ensure and document that the information was received. Leaders should demonstrate the process change and then receive return demonstrations from all team members, while gathering data and feedback that can help ensure any additional and necessary edits to the process are made.

Once the final change has been decided by all, it should become part of an orientation program for all staff members who are new to the department. The investment of time, education and training may seem lengthy and daunting, but it will help ensure long-term success.

Staffing - number of staff members and their level of expertise

We all know the value of a good Sterile Processing (SP) technician. They are among the hardest working individuals in healthcare. Effective leadership plays a key role in attracting and maintaining quality-focused technicians who commit to the department and creating a positive departmental culture that promotes encouragement and positive feedback from managers and customers and provides growth opportunities.

Positive feedback sustains a well-cared for staff. Positive accolades are sometimes lacking in SPD. During initial assessment, Advantage Support Services often finds that departments focus on communicating “what went wrong.” Although departments certainly need to address incidents that went wrong, our approach is to also communicate things that are done right, and to provide that positive feedback during team huddles and when appropriate (with individual employees) throughout each shift. Some of the tools we use to achieve this “building up” of team members includes offering weekly or monthly awards for the most trays processes and with the fewest error rates, and the number of consecutive days without an error, for example. Often, we determine these awards with the same information we obtain to deliver Key Performance Indicators to our internal customers.

We find that, not surprisingly, the best departmental outcomes come when staffing ratios are adequate to manage the day’s role and responsibilities effectively. Staff frustration and diminished job satisfaction are usually seen when there are not enough team members and one has to do the job of two or more other employees. Having an adequate and appropriate number of staff members per shift helps give each team member confidence and satisfaction that they are doing the very best job possible for their customers and patients. When staff members are confident and take pride in their work each day, customer satisfaction ratings also improve.

A word about certification and education: IAHCSMM certification and continuing education offerings can lead to career ladder growth opportunities for SP technicians and managers. The CRCST certification serves as a great foundation for technicians to become Certified Instrument Specialists (CIS) and the healthcare leadership certification (CHL) is beneficial for current and would-be managers. Many healthcare organizations have established certification-related career ladder programs and are encouraging their SP professionals to further advance their knowledge by attending IAHCSMM Annual Conferences and local/regional IAHCSMM chapter events throughout the year.

Continuing education and training are key investments that help develop and strengthen existing team members and improve their job satisfaction. This, in turn, helps build stability for the organization for years to come. Inservicing new and existing SP-related products and equipment is an effective go-to education strategy that Advantage Support Services advocates; however, we strongly advocate its use in conjunction with a formalized education platform (certification and focused continuing education efforts) to perfect staff members’ craft.

Education should be based on current information from ANSI/AAMI standards, with employees trained to practice those principles in their day-to-day roles and responsibilities. Training models may include testing and practice demonstrations provided by educators who then receive a return demonstration from the technician. Practice is the key to success.

Interviews drive a customer satisfaction rating

A customer satisfaction rating is initiated by gathering data attained during interviews with surgeons, service coordinators and surgical team members. Again, this investment of time and resources provides an opportunity to achieve sustainability goals.

An interview process by service is a good way to begin. Our Advantage team suggests interviewing the service line with the highest level of instrumentation challenges. Some of these challenges can be summed up into categories. Some categories we suggest may be: 1) delivery of instrumentation on time, 2) clean, sterile and complete trays and 3) delivering items requested on a count sheet or case cart.

When reacting to the initial survey, it is helpful to focus on educating and quality auditing the top three trays per service. Attempting to quality audit every tray in every service is an impossible task that will be destined to fail. When this same customer service survey is repeated every three months, a drastic and documentable reduction in “problem” trays will typically result.

Develop a multidisciplinary team

The final critical tool in attaining sustainable process improvement is developing an interdisciplinary/multidisciplinary team that is tasked with best practice-based problem solving for SP-specific opportunities. This team should include (at the very least) leaders from SP, Infection Prevention and the Operating Room (OR). This is otherwise known as the “big three”).2 Having physicians and team members from the healthcare facilities operation’s team is also ideal, whenever possible, and representatives from Environmental Services and Facilities/Maintenance are also beneficial as permanent or ad hoc members of the team. Note: Developing a strong interdisciplinary/multidisciplinary team might be easier than you think. Your facility may already have a meeting with two of the “big three,” which means you only need to invite the third to make it a formal multidisciplinary team. The team’s main focus will be listing process improvement opportunities from both the SP and OR sides, and then setting out to tackle them one by one.

Another team focus will be selecting, reporting and analyzing a limited number of agreed upon Key Performance Indicators that speak to the opportunities at that facility.3 This team should also do rounds on a regularly scheduled basis (we recommend at least quarterly). The team should also convene to address non-programmed decisions such as major product recalls, US Food and Drug Administration warnings, or changes in recommended standards or internal policies and procedures.


Ensuring sustainability of process improvement projects and product/practice changes requires time, training, teamwork and practice. Although prioritizing instrumentation and customer challenges to determine which projects to tackle first may initially seem daunting, having multidisciplinary involvement in the process will help ensure success and long-term stability.


  1. UCLA. What is sustainability? https://www.sustain.ucla.edu/about-us/what-is-sustainability/
  2. ANSI/AAMI ST79:2017, Comprehensive Guide to Steam Sterilization and Sterility Assurance
  3. IAHCSMM. Central Service Leadership Manual. 2010.

Angela Lewellyn, LPN, CRCST, CHL, is Director of Development and Research for Advantage Support Services Inc.

Jhmeid Billingslea, CST, CMPR, CRCST, CIS, CHL, serves as Sterile Processing Regional Manager for Advantage Support Services Inc.