Rebounding from near rock bottom: extreme makeover preps Indiana's Reid Hospital for success

Healthcare Purchasing News, Dec, 2005 by Rick Dana Barlow

When Michael Mancebo joined Reid Hospital & Health Care Services as the new manager of material processing in March 2004, he actually welcomed the challenge that lay ahead.

The 234-bed hospital, located in Richmond, IN, about 75 miles due east of Indianapolis and abutting the state line with western central Ohio, was outgrowing its outdated facility so it was building a new $260-million hospital a mile away, set to open in late 2007. That new construction project gave him the unique opportunity to design a sterile processing department from scratch. Plus, a group of doctors were launching an ambulatory surgery center as a joint venture with Reid at the new campus, scheduled for opening next year. Because those doctors would need reprocessing services Mancebo would be able to bid on the "outsourcing" project.

What he didn't fully realize was the extent of the existing problems. He was walking into a pressure cooker, on the brink of hitting rock bottom, in terms of customer satisfaction and service, efficiency and organization and most of all, communication. The professional relation ship with the operating room, typically sterile processing's top customer, was tempestuous at best. In fact, surgery clearly lacked faith in the department, which had little confidence in itself to do anything about it but seethe and simmer. Even material processing's three shifts competed against each other when they should have been cooperating.

With a directive to turn material processing around in 12 months, Mancebo clearly had his work cut out for him. After all, Reid prided itself on implementing best practices and technological advances that resulted in high quality patient care and financial success for approximately 280,000 residents of five counties in East Central Indiana and two counties in West Central Ohio. Consequently, the current atmosphere wouldn't be acceptable in the new facility. Early on he faced stiff resistance from the staff he was charged with helping even as he battled with O.R.'s misperceptions and preconceived notions to right the ship.

Through the hardship and pain during the last 18 months, however, Mancebo and what evolved into his cohesive team of 20 sterile processing professionals actually accomplished their mission. They not only redesigned their department space but they revamped their processes with the help of ingenuity and technology, and rebuilt the fractured relationship with the O.R. as well as the fragile relationships with each other. And they did it the hard way. By, themselves and using only internal assistance, and not outside consulting (even though their group purchasing organization--VHA/ Novation--and distributor--Owens & Minor Inc.--offered. For these reasons, Reid Hospital & Health Care Services' material processing department earned the coveted 2005 Central Service/Sterile Processing and Distribution Department of the Year Award by Healthcare Purchasing News.

A fresh restart

Repairing the damage with the O.R. was as daunting as conducting an extreme makeover of material processing's operations. Mancebo and his team had to balance damage control and prevention with operational efficiency and high-quality customer service. They had to fix what was wrong, ensure it didn't happen again and proceed with further improvements.

"We knew things were going to change and that they had to change," Mancebo said. "We were growing as an organization but also dealing with severe customer satisfaction problems. But the staff deserves this award because they realized the need to change and went through the pain in order to accomplish it."

Mancebo and his team merely took a step back and looked at what they were doing, how they were doing it and how they could improve it as if they were on the outside. His assessment was frank: "What we found was that what we were doing left room for significant improvement," he said. "So we went into [our reorganization process] with an open mind."

Mancebo and his crew identified a six-point battle plan to reinvigorate the department. It included reorganizing decontamination, prep and pack, sterilization and storage and dispatch for better process flow; identifying obvious cost savings and inventory flaws; implementing a computer tracking system; improving processes and communication with the O.R.; creating an instrument sorter position; and constantly evaluating progress.

Because material processing was running low on space in its fully stocked two-room sterile storage area, it started there. Compounding the problem: Each room contained 26 InterMetro wire carts, and the layout had disposables, peel packs and trays mixed together. "The system as it stood had no real defining characteristic other than placing items where space allowed," he said.

The group decided to mimic the storage patterns of any major manufacturing and retail businesses. They split the two rooms into two sections. The first room contained all of the disposable supplies and linen with like items placed together; the second room housed all of the bundles, peel packs and trays, the latter of which were organized by service.