Improving the Central Sterile Supply Department (CSSD) service process using the LEAN concept

Abstract

The objective of this study was to establish a sterile medical equipment disbursement based on the LEAN concept. By collecting data from the previous process (Pre-Lean), it was possible to transform the waste into value in the new process (Post-Lean). The conventional service provision process was found to entail waste in the forms of transportation waste, inventory waste, and excessive processing waste.

Prior to the implementation of the Lean study (Pre-Lean), the nursing assistant experienced a loss of 366 minutes per day as a result of their time spent transporting contaminated devices and receiving sterile supplies in the morning and afternoon. This comprised 181 minutes per day spent on travel time (49.4% of Pre-Lean time) and 185 minutes per day spent waiting for the delivery of contaminated goods and waiting to receive sterile goods at the CSSD (50.6% of the Pre-Lean time). The morning and afternoon round-trip distance was also 2,740 meters. The service process was improved (Post-Lean) by assigning two CSSD staff members to perform these tasks instead of the nursing assistant, leading to a decrease in travel time to an average of 207 minutes and a reduced distance of 1,840 meters due to the coordination of the units, allowing them to receive and supply medical equipment at the same time, without the need for repetitive travel of the nursing assistant. The new process allowed the nursing assistant to keep pace with the work cycle of the CSSD, which starts before 9:30 a.m. daily. By designing a new service process using the Lean concept (Post Lean), the previous waste of 366 minutes in the pre-Lean phase can be transformed into value for the nursing assistant. The nursing assistant is now able to focus on their basic nursing duties and provide care to patients in the ward. With the additional time, they can regularly check the balance of sterile medical equipment inventory, ensure the availability of necessary equipment according to daily needs, and properly manage the use of medical equipment. Furthermore, the orderly storage of sterile medical equipment reduces the frequency of expired inventory returns, thereby reducing the costs incurred by the hospital for re-sterilizing equipment. This can also minimize waste in terms of inventory. Additionally, the issue of redundant record-keeping (excessive processing), which was previously caused by double-recording expired sterile items by both the CSSD and each unit, can be addressed by having only the CSSD maintain records and provide information to each unit. The CSSD was adjusted using the Lean concept, resulting in a reduction of waste in terms of inventory and redundant records. The nursing management team has adopted this new process as a guideline for determining the job description of nursing assistants, leading to cost savings for the organization and increased focus on providing quality care to patients.