Taking The Supply Chain Pulse
ENGINEERING A BETTER HEALTHCARE SYSTEM
Taking The Supply Chain Pulse
Kim Jones: Transforming Sterile Processing and Enhancing OR Efficiency
Discover the fascinating world of sterile processing with our special guest, Kim Jones, a nationally recognized expert who transitioned from human resources to revolutionizing the field of central sterile supply. Listen to Kim's captivating journey, where her role as a recruiter ignited a passion for sterile processing, leading her to become an SPD educator and manager. She shares her transformative experiences in team certification, operational leadership, and the creation of an offsite reprocessing center, underscoring the vital link between sterile processing and operating room efficiency.
Explore the nuanced challenges within sterile processing departments, even in top-tier healthcare organizations, as Kim sheds light on inadequacies in compensation, education, and resources for SPD staff. We discuss the potential of robotics and AI in alleviating the physical strain on workers while highlighting the irreplaceable value of human expertise. Additionally, the episode tackles the increasing reliance on traveling sterile processing technicians post-pandemic and the systemic issues hindering the retention of essential workers. Join us in raising awareness of the pivotal yet often overlooked role of sterile processing in healthcare.
Hello again everybody. This is Fred Crans from St Onge. We're here today with another episode of Taking the Supply Chain Pulse. Today we have a first. Today we have the first time that I've ever had someone on the podcast for the second time, but there has to be an asterisk by it, because you could not possibly have heard the first recording because I forgot to press the record button. So today, two days after our first attempt, kim Jones, who is a nationally recognized central sterile supply expert, is going to be talking with us about her experiences in life and central sterile supply, starting out in human resources and all kinds of good things, and she's well rehearsed because we did this for 30 minutes two days ago. Kim, thanks for coming back and giving me a second chance.
Kim Jones :Well, thank you, fred, and thank you for you setting me up there. I better not make any mistakes, since everybody knows that I already had one try at this. So, we'll both try to do our best, but I appreciate the opportunity to join you today. Thank you.
Fred Crans :Yep, and if you're not making mistakes, you're not trying. Okay, You've got to get out there and get in the fray. So I'm glad to have had that was a great conversation the other day and I really learned a lot talking to you about central sterile. So why don't you tell us about yourself, your background, how you got started and how you've worked to where you are today?
Kim Jones :Sure Well, thank you. I obviously started my career not in sterile processing but, as you mentioned, I had the good fortune right out of college to find a position in human resources with a very well-known organization here in central Ohio. I got that position as a recruiter in HR and my areas of accountability were sterile processing in the operating room. So I always say of my 30-year career, the majority of it has been spent in sterile processing in the operating room in or around those areas. So you may ask how that goal or how that position in human resources ended me up in sterile processing. I worked for a few years supporting the operating room and sterile processing from an HR recruitment perspective, as well as some employee relations mixed in there. I went out on maternity leave to have my first baby and when I came back there was an SPD educator position that had been writing my position roster the entire time I was out. So I met with the director, who I had a great relationship with, and we walked through the department. I was trying to get from her what exactly she was looking for so that it would help me to better recruit for them, and by the end of that visit you know I was pretty fascinated by all of this reprocessing that happened. I obviously knew part of the job because I recruited for it, but at the magnitude and the volume that facility was a 32-room OR and so it was just an immense operation. And so at the end of that visit, at the end of that conversation, the director pitched the idea hey, why don't you take this position? People respond well to you, you're teachable, we can teach you the business. You have the people skills. So that's how it kind of started.
Kim Jones :So my first position was an educator. That was back in around 2005, 2006. There was a big push, lots of lobbying going on to make certification mandatory in New York and New Jersey at that time, and so we were leading the pack in central Ohio. I became certified, wrote an education program and we were able to get about 70% of the staff certified at that time and I really, really enjoyed watching people respond, as they were learning why we do the things we do, not just how we do the things that we do in sterile processing.
Kim Jones :So I held that position for several years and then I really started to get interested in operational leadership.
Kim Jones :So a manager position in that very department became available, so I threw my hat in the ring and I was given that position.
Kim Jones :I had a large number of FTEs about 80 full-time FTEs that reported up through me and I held that position for a few years three to five years I believe and then I was actually invited to join the OR team as a non-clinical manager in the operating room, and that was really a gift to me being able to see the full cycle of how the patients come in and how the work that we do in sterile processing can affect the metrics that the operating room uses to remain efficient. And so I was really able to see how that ecosystem of perioperative services includes sterile processing and I ended up having the non-clinical team, at first anesthesia techs, or techs you know anything non-clinical in the operating room reported to me. And then halfway through my tenure there I was given the clinical staff and then halfway through my tenure there, I was given the clinical staff. I had off shift clinical teams, afternoon, evenings and weekend clinical teams, and that was great because you know, as a sterile processing leader, we often hear the complaints of the operating room.
Kim Jones :But once I was able to lead those clinical staff I was able to understand how five minutes of a wait affects their entire process in the operating room or how delays from a sterile processing perspective can back the schedule up and the surgeons then have to operate with a whole new team because their first shift team leaves. And so all of that just kind of helped to enable my thought process and also continue to feed even though I wasn't in sterile processing anymore. Just the importance of sterile processing and a fluid, efficient process in sterile processing will then translate to the same in the operating room. I held that position for a few years and then I was actually recruited to another central Ohio health system who is quite large. There I was accountable for 49 ORs and for major hospitals under one roof, if you will, and then acquired a community hospital and several same day surgery hospitals. And while I had my tenure there I was able to work with the St Ange team and we developed an offsite reprocessing center. And that was really kind of taking all of my experience and putting it into something new and innovative, and that was a really great experience being able to see that process from start to finish. So then I left that organization and thought you know what am I going to do with all of this experience that I've gathered? And I threw my hat in the ring for some consulting and I started my own consulting firm.
Kim Jones :And you know I've had the good fortune of working with several large IDNs across the country over the last year and a half.
Kim Jones :Projects ranging from process improvement with high-level disinfection, team building, leadership, mentoring, leadership development, change management, had some opportunity in the last year and a half out on my own to be able to contribute to equipment planning and some standard operating procedure writing for a very large IDN looking at building an off-site reprocessing center.
Kim Jones :And then I most recently finished up again with the good fortune of being partnered with St Onge to work for another very prestigious IDN that's mostly here in Ohio doing audits on process improvements, taking a look at opportunities to standardize, and that was a very large project. We had a tight timeline and, you know, continued to just be able to use the skills that I have in partnership really has just helped me take all of my experience. And what I enjoy the most about what I do now is when I go into a new place and there's perhaps a director that's struggling or a director that feels like they're at the end of their rope. They've tried everything. It's really gratifying to be able to say you know, I've been in your seat and I've sat in your chair and I know how you're feeling, and to be able to contribute to their success has been something that I've really enjoyed over the last year and a half. So that's where I am now.
Fred Crans :Great. Well, you have a unique collection of experiences. Starting out, the HR experience really comes into play here, because paid lowest appreciated, least appreciated folks in the hospital. And when you see that, there's another thing that you understand that many people don't, and that is that the dependencies. The OR can't do surgery unless CS does its job. Cs can't do its job unless the supply chain fulfills their needs to get CS the equipment and supplies they need to do their job.
Fred Crans :There are these relationships and yet my experience, and as I said the other day, my friend Ed Hiscock said there are many supply chains in health care, not just one. There's a supply chain, there's a pharmacy supply chain, there's a food service supply chain, there's an environmental service supply chain. Every department or every function likes to be standalone and take care of its own problems and my observation I'll take this off your shoulders my observation over the years is that OR is always fighting with CS, OR is always fighting with the regular supply chain. What do you see as the most frequent disconnects among these three organizations OR, CS and the regular supply chain and how do you go about working to improve those?
Kim Jones :I can 100% agree with you and I do feel like my experience has given me the opportunity to see different veins of this supply chain, you know, when they're highly functioning and the communication is high functioning, and then I've had the opportunity to see where there's lacking. And again to your point, where there's the finger pointing and everyone wants to pass the buck, which is human nature. And I think that my time in the operating room gave me the opportunity, as I mentioned earlier, to see how important all of the supporting departments for the operating room truly are, and I was able to also see the pressure that the OR was under to make things happen and to make them happen on time. To answer your question simply, Fred, I believe that a lack of understanding of what our independent roles actually are accountable for and some of the barriers that within those independent entities sterile processing, operating rooms, supply chain some of the barriers that exist within our own personal sets of accountability, are often not articulated out. So what I mean by that is what I've seen in organizations is a lack of partnership in those three major entities so the operating room, the sterile processing department and supply chain and I believe that that happens from the top down. So if you have collaboration among the leaders with operating rooms, sterile processing and supply chain, as leaders we are accountable to push that down. And there we are accountable then to stop the blaming, stop the finger pointing. And how that happens is frequent meetings, frequent touch bases, open lines of communication, being able to have a mechanism to proactively let the departments that enable our success know hey, we've had a ton of call offs in the last 24 hours. We're going to have your first cases ready for you. Our manager will keep in close contact with you throughout the day to let you know what it's looking like for us. And then having an operating room leader that understands and respects that and says what can we do to help you? We get that. You're having some issues today.
Kim Jones :The same thing that and that's on the frontline level. The same thing can happen. The that's on the frontline level, the same thing can happen and I've seen it function very well. Supply chain, having a adequate mechanism to inform when we have back stocks, when something's been replaced, when locations have been moved. And again, I believe that all of that comes from the top down. So organizations must task their leaders with open lines of communication, support and when and where a toxic environment exists. Sadly, everyone from the top down feels that toxic environment and that just contributes to the lack of accountability and the blame game. So I believe that the largest disconnect is communication, as well as education about what the enabling departments are accountable for, and an openness and a willingness to support one another in times when we're overtasked, we're stressed, we have, you know, a lack of resources. From a people perspective, I think that you know we can't be afraid to just reach out and say, hey, I need some help.
Fred Crans :Yeah, you know I'm listening to that and I'm thinking of the OR environment, if you will, and I'm probably showing my age when I talk about this, but when I first came into supply chain, you know, the OR nurse was sort of at the tip of the spear, if you will. The OR produces a significant amount of revenue. Many of the highest and best reimbursed procedures are done in the OR, so they got to get them done. That OR director is working with people who have egos that don't fit in most buildings and who historically, up until recent years, have always had the leverage to get what they want when they want it, not get what they need when they need it, which is an entirely different thing. So it becomes really important to build relationships and to educate the clinicians and the doctors. How have you gone about doing that?
Kim Jones :You know I've had the good fortune in the organizations that I worked for that you know, the sterile processing managers sterile processing director, you know, is the first line of defense really for the team. So I've had the good fortune that in both of the organizations I spent my entire tenure, surgeons were very vocal when they had an issue. You know, in one experience I had vocal surgeons who would, to your point, go to the OR manager, or director, and the OR director would come to me give me the opportunity to fix it, and there was that open line of communication and so the surgeons, we partnered together and that didn't start off in the very beginning. I think you have to earn that, you have to earn their trust and I think by in so doing you are then able to have their trust that you're handling an issue. What is very important to make sure that that cohesive relationship and that trust factor is created in a very authentic way is that the operating room leaders have to support the sterile processing leaders, otherwise the surgeons, to your point, you know it takes a huge ego to take somebody into a room and essentially have them, you know, dead on the table really to fix their problem, patch them up, sew them back up. That takes a huge amount of confidence and ego. So that that takes a huge amount of confidence and ego. So you know, it kind of goes with the territory.
Kim Jones :However, I believe that they're still human beings and they still need to understand the why behind something. If I don't have the support of an operating room leader, when I go to a surgeon and try to explain the why in my department, he feels that I'm just not taking accountability because it hasn't been. There's not a cohesive relationship between the seroprocessing leader and the OR and the trust is there. When that surgeon goes and he is complaining again to the OR leader, I get the call hey, dr So-and-so is upset about such and such. We backed him off, but hopefully you can look into this and let me know what's going on. End of story.
Kim Jones :And so I think that you know that in and of itself is a huge challenge. And when I'm out in, you know, across the country, working with sterile processing leaders, one of the first questions I ask them is what is the, what's your support like from the OR? Because without that support we've got a lot of work to do in sterile processing and as a sterile processing leader. But when, when a leader is able to tell me that they do have tremendous support, then you know half the battle is won then, because then it becomes process improvement, team building within our own entity. That takes a lot of time, it takes a lot of, you know, accountability, it takes a lot of education.
Fred Crans :So you know, I think the sheer nature of what I do and that that question being a primary question, shows you how important communication is and and just trust and collaboration, yeah, but that's that's the problem that's got to be solved, that's for sure. So, when you work with St Onge on a couple of really large projects one was the development of an off-site processing center and the other one was an audit of a very prestigious systems sterile processing function when you work on, when you walked into these places, places who we mentioned their name we go, oh my God, that's really something. What did you discover in there that surprised you? And what stuff did you discover that didn't surprise you?
Kim Jones :I think that what surprised me was that these prestigious organizations are still working under a very archaic assumption that sterile processing is simply washing items. You know Toyota Lean, six Sigma. You know, if we implement Lean processes then we should be perfect. And I believe that in one scenario that was the belief of one of the health systems. And what happened in that scenario was, you know, making a car with the Toyota Six Sigma prescription is much different than getting a tray down from the operating room with 100 parts and pieces and having to sift through that. There's no assembly line because there's no taking into account that the peripheral processes that enable sterile processing success have not been addressed prior to implementing such a system. That is believed to be assembly and foolproof. And if we just do it the way it's prescribed, then we should be able to be deemed successful. And I was surprised that one of those organizations still felt that that was the answer to the issue, without looking at the peripheral processes. Was point of use cleaning happening in the OR? Was the OR sending trays back complete to sterile processing? That was not a consideration, and so sterile processing was set up to fail in that scenario because we had not made sure that our customers were held accountable to do what they needed to do. And the other idea and I was surprised to see that, you know, compensation rates are still so low.
Kim Jones :The infrastructure of the department is lacking in the areas of education, onboarding, educational programs, adequate numbers of FTEs being assigned to a singular leader, and that still many of the departments did not have the adequate resources to handle the daily volume. Use a metric of procedures performed in surgery. That will dictate how many FTE we need to process instrumentation and sterile processing. And what I have struggled with for years to try to help administrators understand is volume does not equal volume. So if have 30 GI cases or general GU cases and I have 30 ortho cases, there is a vast difference in the amount of parts and pieces that sterile processing is going to be accountable for, and so it just surprises me.
Kim Jones :I think, that across the country we see that while surgery has advanced and become very technical and very complex, and instrumentation has also become very complex and very innovative, we have not taken a look at the educational component for our serial processing techs. We have not taken into consideration how much they're actually making. These people are under a tremendous amount of pressure, tremendous and they're still making an entry level wage that's not much higher than the housekeeper in the hospital environment. So I think those are the things that surprised me. I believe that you know, working with these two very prestigious organizations, that I would see oh, you know they got it. They understand that. You know, in order to have a successful operation, we have to appreciate and retain and incentivize our sterile processing team, and that just was not the case. So I think, in a nutshell, that was my experience.
Fred Crans :Yeah, and you know, the other day in our conversation, when you're talking about the low level of pay and the low level of appreciation for the difficulty of the task in sterile processing, you mentioned the fact that folks are going outside for other jobs, one of which was you can make $19 an hour at the car wash and you're lucky to make $15 an hour at the cart wash, which is only one letter difference when you look at it. But the difference is if you screw up at the car wash, which is only one letter difference when you look at it. But the difference is if you screw up at the car wash, you may put a scrape on the side of a car. If you screw up in the cart wash, you can kill people, and it's that simple. So that sort of transitions to two things, sort of last part of this conversation. Number one is where do you see robotics coming into sterile processing to assist the people there? Do you see that something that's happening?
Kim Jones :You know I do a lot of reading, I try to stay up on the latest technologies and so on and you know, in my experience I think I shared with you the other day I have never managed a small operation or directed a small operation. I believe that you know the vast variation in tray size and weight and movement of our own human resources, people actually doing the job. I have seen where, especially in decontamination, where there's lots of twisting and turning to get things in the sink out of the sink, get things in the sink out of the sink Some of that automation using robotics. You know there's opportunity to move trays using robots. There's automation for trays entering into the washer and coming out of the washer. I think those types of ergonomic robotic assistance is going to really take off over the next few years.
Kim Jones :You know, as an operational leader with a lot of years under my belt, seen so many injuries or so many ongoing, you know individuals that can't work in a certain place because they've hurt their back too many times, so on and so forth.
Kim Jones :So I do believe that that component is taking off and I think larger facilities are going to start using that because ultimately it saves the human resources from injury and harm.
Kim Jones :From an AI perspective and I don't know if that's kind of what we're thinking as well being able to dump an entire tray out on a pad of technology, if you will, and it's able to sort of spit out if all the contents of the tray are there, that's all well and good is advanced to this degree, but they'll, in my mind, never be in my lifetime a replacement for actual human expertise to take a look at these instruments to see if their efficacy of the instrument is adequate, if the cleanliness is adequate. I think that we will always rely on people to do that job. But I do think that technology and robotics have grown leaps and bounds, and so I make that statement loosely and could very likely be proven wrong in my lifetime, that there would be, you know, a robot that could do anything that a human can do. It's, you know, at this point in our history we're seeing so many advances, but right now I believe strongly that the human element of sterile processing is very important from an inspection perspective.
Fred Crans :So would it be fair to say that the shortest list in the world might be healthcare systems that have sterile processing, in which the sterile processing operational process couldn't be improved? And would it also be fair to say that if you're considering doing anything, you start with an assessment and get a real good look at what the options are, what the opportunities are where your organization's going with a strategic plan, and tie all that together? Would that be fair to say?
Kim Jones :Absolutely, and I think that there are technologies that could you know, for the benefit and the bottom line of an organization, if they're going to invest, you know, several hundred thousand dollars in robotics and a sterile processing department, would that yield any savings as far as human resources.
Kim Jones :I believe that that is certainly something that, from a strategic plan, would come into play. Come into play, I do believe that, exactly what you said research, and you know doing some, you know true, evidence-based research. Who's using this, how's it working for them? What's the repair rates look like? You know all of that because we know that when we rely on, even when we rely on our electricity and we're hit with a thunderstorm, we got to figure it out. Well, when you're running an operation that's feeding forty, nine, fifty, two, thirty two operating rooms, and you have a piece of equipment go out and sterile processing, it's not as easy as just running to find a candle, you know. So I think that all of that has to be taken into consideration when we go with with new technologies and new advances in technology. I think we really need to take a look at what's that downtime look like and how are we going to compensate for that If we cut healthcare, human resources.
Fred Crans :The traveling nurses had saved the day in many places, quite honestly, depending on where the pandemic went, they sort of followed that. How are travelers showing up in sterile processing, and is that a thing that needs to be dealt with? Could you talk about that?
Kim Jones :I sure can. So you know, I believe that the travelers, the amount of travelers that we saw across the country after the pandemic and the years that have followed, have largely increased for sterile processing techs, and that is really in part due to and I think in large part due to the compensation. You know they can go and they can do this job and they can feed their families. They can make enough money to pay down debt. They may make enough money to put their kids through college. They can, in some very sad situations, get off government assistance when they go and do traveling jobs. So I really believe that this is very cyclical. Did the pandemic highlight it? Very much so. However, I believe that the biggest problem with retaining, retention and recruitment is how much these people are being paid. They're being asked to be certified or to become certified and again they're just making a few dollars more than the guy that's sweeping the floor in housekeeping, than the guy that's sweeping the floor in housekeeping. So when they're asked to, when they join in with a travel agency, the travel agency is sending them to places where they're very needed and they can go there and they can make money. And you know, my hope is that they feel appreciated when they're there. So they feel appreciated and they continue to extend their contracts.
Kim Jones :I believe that this problem, the root of the problem, is that administrators within healthcare have never caught up with. If surgery is going to be the revenue generating engine of your health system, then what are you doing for the people that are feeding that revenue generating engine of the hospital? The surgeon can come to work and he can have 10 cases lined up for that day. That's going to yield the hospital hundreds of thousands of dollars. But if he doesn't have his basic tools in working order and in sterile and ready for those patients, he's not making anybody any money. And in sterile and ready for those patients, he's not making anybody any money. And the OR staff? They're not educated to do the work of a sterile processing tech. So I believe that the disconnect between the people that are actually providing the tools for the clinical team to do their job to then be the revenue generating engine of the health system so that the administrators can make their bottom line, I think where they are lacking is that fundamental first step of making sure that your sterile processing techs are adequately paid. They're appreciated, there's a retention program in place for them. There's an education program in place for them and so many facilities just see it as just do more. You have a manager in the department, so the manager can take an assignment today. The supervisor can take an assignment today.
Kim Jones :I believe wholeheartedly that sterile processing is the place where many administrators look at where are we going to cut some expense so that we can then, you know, get more scrub techs to scrub these additional cases that we're going to put on? We can get more nurses to scrub and to circulate. They're taking from the wrong place, because what happens, as you all know with the history in sterile processing, we get behind in sterile processing and who ultimately suffers? Ultimately, our patients suffer, but the metrics in the operating room start to crash the minute we don't have adequate resources in sterile processing.
Kim Jones :So I believe that organizations that spend hundreds of thousands of dollars on travelers it amazes me if they would look inward and they would take a look and dive deeper into why do we have 30% travelers in our organization? Why can't we retain people? You know, if you have adequate leadership in place, the question doesn't. The blame doesn't fall on the leader, it falls on the leader can only do what they are equipped to do what the organization has given them the resources to be successful. If you are not given the really the respect by the organization as their sterile processing leader, when you go to your administration and you say, I see what you're telling me on paper, but that's not the scenario, I think that's where they're shooting themselves in the foot and I think that's why the traveler, the traveling population has exploded. Population has exploded. They're not paid enough, they don't feel appreciated and it's a never ending cycle in some organizations and sadly I've seen that.
Fred Crans :Yeah well, just to sum up, because once again we get back to this whole idea of an assessment. You know most of my experience in health care and probably most of yours has been people that our cases are made narratively, without data. I need more people in CFs and you try to tell a doctor hey, you don't understand. There's a difference between this case and this case is what it requires, between this case and this case is what it requires, Unless you have someone in to help you gather the data and build the case. All you appear to be doing to the people in the C-suite is making excuses and whining and what your recommendation that I've gotten out of what we've just been talking about is number one for the organization to respect the function about. Is number one for the organization to respect the function, uh, number two, to provide enough resources to do the job and number three, to pay those resources enough so that they won't have to become travelers to make money to live their life normally. Is that, was that fair to say?
Kim Jones :very fair to say and you know, I understand that. You know from an administrative C-suite perspective, they feel that they should not be in the weeds. That you know, sterile processing leaders should be able to tell the story and, to your point, you know, have data to back that up. In my experience that's 100% true. Data is wonderful to tell the story. It tells part of the story. It doesn't tell the part of the story that point of use, cleaning is lacking in our operating room, which requires additional resources in SPD 80 percent, 30 percent of what we sent you, you sent it right back to us and that took 30 percent of our resources to develop those trays and create that case card and then it was just basically, you know, all for naught, it wasn't needed.
Kim Jones :And so I believe that the more we can advocate for change and assessments and engage our administrative C-suite people to understand that, while some organizations probably you know it would be naive to say there aren't leaders, that would just, you know, pass the buck or blame their team or so on there are leaders. If somebody has achieved a level of director of sterile processing, they care about what they're doing and they know what they're doing and I believe that they need to have the respect of the C-suite to sit down and listen the minute the problems present and they're outside of the realm of that director's control or that manager's control. The C-suite needs to humble themselves and sit and listen and not just make those assessments from their data or historical benchmarking. You know all the buzzwords that we hear in our industry.
Fred Crans :Well, jim, thank you for coming back for the second time Before we go. I did a big on-site project at an organization in the south. It must have been around 2000, 2002. They were returning 45% of the stuff that was sent up to surgery back unused and that was the stuff that came back was sent up to surgery back unused and that was the stuff that came back. Remember, what you haven't talked about is the stuff that got thrown away because it got opened and had to be thrown away, couldn't be used again.
Fred Crans :But 45% was coming back and I was talking to those people about three years ago and they said that they've worked really hard to implement the stuff that we talked about and they've got it down to 42% now. So they've really made a vast improvement. So that's still. The problems are still there. But, kim, thanks so much for shining the light on sterile processing. This has been a great conversation and I appreciate the fact that you put up with an old guy who is too stupid to press the record button and we hope to have you back again in the future. Thank you so much.
Kim Jones :I would be honored, fred, and thank you, have a great day and we'll talk soon.
Fred Crans :Okay, take care, see you Bye.
