This year’s Young Innovator Award recipient, Enterprise Sterile Processing Assistant Administrator Becca Urban, has a bright future ahead of her. Joining the enterprise in 2015 after her mother’s extended hospital stay, Urban sought employment in Cleveland Clinic’s Lerner Research Institute. After stints in Lerner and Protective Services, Urban switched to a role in Surgical Nursing as a Project Manager – one she held for a mere two weeks before receiving the largest project of her career to date. Passed down to Mark Taylor, MD, and Carol Pehotsky, DNP, RN, from Cleveland Clinic CEO & President, Tomislav Mihaljevic, MD, Urban’s focus became Cleveland Clinic’s instrument standardization initiative.
Hospitals nationwide have thousands of unique instrument trays that take up valuable space and are extremely costly. Many trays are cluttered with rarely used instruments that are there “just in case.” The problem can be particularly acute in large health systems like Cleveland Clinic. With more than 66,000 instruments processed daily (approximately 2 million per month) across the enterprise’s northeast Ohio locations alone, diverse, growing instrument sets limit our clinicians’ ability to be the best stewards of resources. To decrease variability, eliminate waste, free up storage and improve quality control, a select team within Surgical Operations and Surgical Nursing, led by Urban, was tasked to standardize surgical instrument sets, by procedure, across the entire enterprise.
To accomplish this task, it was critical to assemble the right team, and surgeons, surgical technologists, clinical nurses, sterile processing technicians and nurse managers for each particular service line were engaged. Different personalities and experiences lent different perspectives, ensuring that the new “standard” would work for every procedure, regardless of where it was performed. Management of the personnel throughout the project fell on Urban. Within 15 months, the team reviewed 3,683 trays, decreased content per tray by 30%, removed 51,419 instruments, eliminated 672 unique trays and reduced new instrument spend by 19% at Cleveland Clinic’s Main Campus.
A secondary opportunity – one the team had not considered in the beginning of the project – was the fate of instruments that were removed from the trays. The standardization team created an instrument depot, managed by Urban, where the extra instruments could be stored and redeployed when a similar instrument became unusable. Redeployment of these instruments resulted in new instrument purchase savings of more than $4 million for the enterprise.
Largely rolled out in 2019 and 2020, Cleveland Clinic’s instrument standardization process has inspired much of the organization to adopt lean practices – including Cleveland Clinic Florida. The team has repeated the process with similar savings at other regional hospitals. Urban foresees further work on the project for herself. Since joining Cleveland Clinic’s team, though changing roles and departments, Urban’s responsibilities have followed her, only increasing her opportunity for impact. Says Urban on the experience, “I’m incredibly thankful for the support of so many leaders across Cleveland Clinic. I’m looking forward to the work that we’ll continue to do with this initiative to improve the lives of the patients that we serve.”