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Our Productivity Metrics Are Broken: An Argument for Usable Units of Service

Updated: Jul 12, 2023

“I can get it to you quick or I can get it to you sterile, but I can’t do both.”

Herein lies the challenge of sterile processing productivity. On one side stands quantity (speed) and on the other side stands quality (sterility). But there is another glaring issue with how we measure productivity in our industry today to which no one seems to have found a solution. How do we measure productivity in a way that actually makes sense for what it is that sterile processing is responsible for?

Going nowhere without changing our approach to units of service The majority of contemporary conversations and debates around productivity tend to focus on the concept of units of services (UOS). This is what administrators and chief finance officers place alongside department worked hours and full-time equivalents (FTEs) to determine how productive a department is from pay period to pay period. For example, if your UOS is trays processed, then administrators want to see that you were able to meet or beat your target of .25 worked hours to process one tray. Likewise, if your UOS is surgical cases, then administrators want to see that sterile processing used the targeted number of worked hours (or less) to support the pay period’s surgical volume.

Almost no one in our industry is happy with the current state of affairs when it comes to the lack of granularity and nuance provided by most UOS options. This explains why so many sterile processing managers, directors, and perioperative leaders try so hard to find out what other hospitals are using for UOS, how their labor standards are set, and whether it is working for them. The reality is that no one has yet found a measurement or model that is reasonable, consistent, and scalable out to a national level. Thus, we are left with few comparisons, lots of frustration, and frontline personnel carrying the weight of unrealistic productivity standards placed on their shoulders from administrators who can’t understand why the numbers on their spreadsheets aren’t adding up. Without a new approach to units of service, this cycle will likely continue to spiral out of control.

An argument for usable units of service Part of the solution to this systemic challenge of productivity, in my opinion, must be found in how and what we measure to begin with. In today’s traditional UOS examples of instruments processed or loads processed, there is no accounting for quality whatsoever. A department could process 35,000 instruments over a two-week period, with a rejection/error rate of 30%, and still meet or beat a predetermined target UOS formula. This would mean that 10,500 of those instruments were not and could not be used by the operating room customer they were processed for—either due to residual debris, failed monitoring indicators, or perforated filters or wraps—but there would be no reflection of this in the final productivity numbers.

What has been outlined above is one of the most striking shortcomings of our current approach to sterile processing UOS. Why would we measure blind output of a process without ever stopping to question whether that output is even usable by the customer? Especially if the output is something as critical as surgical instruments, and the customer is as constrained by resource availability as an operating room—in both time and inventory.

A shift to a model of usable units of service (UUOS) for the sterile processing industry would bring quality standards back into the productivity conversation where they truly belong. The concept of UUOS is simple.

Instead of measuring productivity as worked hours vs. UOS (traditional UOS), the formula would change to account for quality of output, looking more like worked hours vs. usable units of service (UOS minus [–] rejection/error rate; proposed UUOS).

To pick back up on the example used above, instead of measuring pure output of 35,000 instruments, the UUOS model would remove the 10,500 unusable instruments out of the equation and use the remaining 24,500 quality instruments as the actual productive number for the pay period. For the first time in our industry, our departments, leaders, and frontline professionals would actually be incentivized and rewarded for quality of production, and not just incentivized to process as much we can, as quickly as possible.

Real-life implications of a UUOS model What would this really look like? What would need to happen for your facility to implement this model into your productivity system? First and foremost, you would need a means of tracking and recording your department rejection/error rate. Even though every department should already be measuring this critical key performance indicator, it is likely that your team will need to spend additional time ensuring you are appropriately documenting reported errors and have a streamlined process in place to capture any fallouts that may occur. With this standard rejection/error reporting process in place, the rest is simple math that can be built into any formula based in Excel worksheets or internal software you happen to use.

With this new UUOS, you will finally gain transparency into the impact that staffing changes can have on your quality output. Did the spike in overtime last pay period result in a lower UUOS for the same period? Should we be surprised that people who have already worked a hard 40 hours for the week might be prone to more errors and mistakes than they would under normal productive circumstances? Perhaps you start to see the impact your second-shift PRN employee has on producing high-quality trays for your team, thus pushing your UUOS even further than the original target. Now you have to tool to see it in black and white.

This conversation, or something like it, gets our departments thinking about what we should be thinking about: productivity that has real value for the patient. That is productivity that assumes quality output. And unless we are accounting for that quality in our UOS, we are missing out on one of the most powerful measurements our departments have at their disposal.

Quality should matter to our productivity.

What say you?


Hank Balch is the Founder & President of Beyond Clean. He began his career in instrument reprocessing as a frontline technician in 2009, and has served as an Instrument Database Specialist, Department Manager, and System Director for various SPD departments across the country. Hank is an award winning Sterile Processing leader (2016 Healthcare Purchasing News "CS/SPD Department of the Year"), twice nominated for IAHCSMM President, founder of two state-wide IAHCSMM chapters, conference speaker, and well-known industry writer, blogger, and social media connoisseur. He has written over 150 Sterile Processing articles, with his work being published in Becker's Hospital Review, Infection Control Today, Healthcare Purchasing News, Communique, Outpatient Surgery Magazine, AAMI BI&T Journal, SteriWorld, and other publications across the globe. His passion is seeing frontline Sterile Processing professionals equipped to #FightDirty, every instrument, every time.


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