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Cedar Rapids, Iowa 52401
IOWA CITY - Early in the pandemic last spring, University of Iowa Health Care undertook the monumental task of moving its operation for cleaning, inspecting, packaging and sterilizing instruments - nearly 10 million a year - off site to the UI Oakdale Campus in Coralville.
The transition has been rocky, according to a critical internal audit on UIHC's Central Sterilizing Services.
Robots designed for the new 48,000-square-foot facility don't work; a machine meant to wash instruments can't. High staff turnover, call-offs and position vacancies have slowed productivity.
Education and training are lacking. And lacks a consultant hired to plan and implement the new facility and process wasn't involved in its final implementation.
'We had a consultant in here for two years to help us get this new facility and these systems up and running,” according to Debra Johnston, who became the Board of Regents' interim chief audit executive in November.
'That consultant rolled off the project just as COVID hit,” she said. 'And so the proposed or recommended processes were not implemented yet to evaluate their effectiveness, and there was no consultant there during the period of adjustment.”
She reported UIHC was 'a bit dissatisfied with the consultant.”
'But they really do need some external help here,” Johnston told the board during a recent meeting, reporting UIHC management is seeking consulting assistance in a one-year contract.
The internal audit of UIHC's central sterilizing operation - which moved into its new Integrated Services Center in Coralville in early 2020 - spanned July 1 to the present.
Justifying the imperative to evaluate whether UIHC's central sterilizing services is operating efficiently and effectively, auditors noted its 'critical” role in ensuring health care providers 'have all the necessary instruments to provide safe and timely care.”
'Demand for sterilization services continues to increase in conjunction with hospital volumes,” according to the audit, noting the new off-site facility aimed to replace multiple aged and disconnected sterilizing operations in the main hospital campus.
But UIHC needed to establish new operational processes to enable timely work completion at the new facility - given it is 20 minutes from the main hospital, which is experiencing a swelling workload.
'The new facility, combined with an increased demand for services, have highlighted weaknesses within (central sterilizing services) processes, procedures and operations, which will continue to exacerbate problems if not addressed,” according to the audit, which reported managers have taken some action. 'However, additional work is needed.”
One 'significant issue” hampering optimal functioning at the new facility - 'designed for the use of robots” - is that its robots don't work.
'The inability to utilize the robots has changed workflow processes and staffing resource needs from the initial facility plans and projections,” according to the audit.
Although the inoperable machines were returned, UIHC still is paying the contractor for the robots, 'despite the failure to meet contractual terms.”
'So the action here is to contact a leasing company or a vendor to discuss a robotic system line and renegotiate a new lease and obtain quotes for additional equipment that may be needed for the ISC facility to function appropriately,” Johnston said.
The facility also was supposed to have a 'cart washer” capable of cleaning not only carts but instruments, too. Machine failures, however, have inhibited the washer's ability to clean instruments, delaying operations, 'especially during high workload volumes.”
Compounding equipment failures - or perhaps compelled by them - are 'high levels of staffing issues including turnover, call-offs and numerous open technician lines.”
At the time the audit was published in late February, 15 full-time technician positions of about 140 were open, 'which adversely affects production” by forcing other employees to do more work.
'High work volumes often mean required overtime, work is not completed timely or quality events occur,” according to the audit. 'Unfilled positions remain a constant challenge and are largely attributed to a high level of staff turnover.”
Among those who are on the payroll, many show up late, call in sick or skip work.
'The work is very stressful,” Johnston told regents.
Although staffing concerns present 'significant risks,” she said, 'the risks were not being monitored or managed appropriately.”
In hopes of improving job and operation performance and curtailing turnover, UIHC managers are implementing a staffing plan and hiring strategy and working to 'accurately” track employee attendance.
The high turnover has created challenges in 'providing effective orientation and training oversight,” especially given the system has just one educator.
'Compounding the problem is that many of the new technicians are working third shift, which has limited coverage from the education department,” according to the audit. 'Staffing resources in the education department will continue to be a concern with the possible hiring of up to 48 new staff members, if hiring plans are approved.”
UIHC management has vowed to hire a second educator this year and make training a focus - establishing departmentwide competencies for technicians to be tested on annually.
And the university plans to create 'key performance indicators” - the lack of which now leaves workers with unclear expectations, 'negatively affecting operational efficiency and effectiveness.”
Lacking data collection in the new central sterilizing operation has created 'inefficiencies, weaknesses, and errors that are not addressed.”
Regarding information that is collected, 'They're not using the data to monitor and increase processes,” Johnston said.
'In fact, they're not using much of it at all,” she said. 'The data could be used to identify process errors or weaknesses or inefficiencies.”
And the operation has no formal process to prioritize cart transportation through the main hospital and to the Coralville site, 'causing delays for instrument cleaning and sterilization processes.”
'Currently, the average cart takes just over two hours to be transported through the hospital and to the (Integrated Services Center,” according to the audit. 'However, carts are not taken in any particular order, creating an issue with delays in the cleaning and decontamination process.”
Specifically, according to auditors, carts that sit too long allow debris to dry on instruments, 'causing cleaning to be more difficult and possible instrument damage.”
And Johnston noted the lack of prioritization could be an issue 'if key instruments are needed quickly for upcoming procedures.”
UIHC management, according to the audit, plan to address all the issues this year - with some expected results in March, April, or May and others taking longer.
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