America’s First Hospital Sets the Stage for a New Era of SPD with Ryan Cashman
When Penn Medicine established an off-site centralized sterile processing facility in 2021, it was the first institution in Pennsylvania to do so. Going into its fifth year of operation, Associate Director of Central Processing Ryan Cashman offers five nuggets of wisdom from the change.
Philadelphia, Pennsylvania – It’s a tale as old as healthcare itself. The demand on Penn Medicine: The University of Pennsylvania Health System was growing yearly, and its sterile processing departments (SPDs) felt it. Hospitals in the system were understaffed, staff were overworked, and hospital inventory was bursting at the seams and running out of space entirely. What began as a small annoyance grew into a problem that couldn’t go unaddressed.
Penn Medicine saw this happening early and decided this wasn’t a band-aid kind of issue. It needed to be addressed on a structural level – literally.
“Pennsylvania Hospital is the nation’s first hospital,” said Ryan Cashman, member of the AAMI committee for ST79 and Associate Director of the Central Processing Department at Pennsylvania Hospital, which was founded in 1751 by Benjamin Franklin and Dr. Thomas Bond. “As a centuries-old institution, we only have so much real estate to work with, but we desperately needed the space. So, we started to wonder, how are we going to expand?”
To create more space in hospitals and foster an environment of efficiency and organization for SPD, Penn Medicine opened Pennsylvania’s very first off-site Interventional Support Center in February 2021. Upon opening, the ISC became the nation’s largest instrument processing and surgical supply preparation facility, absorbing the sterile instrument processing capabilities of two hospitals and three outpatient facilities under the Penn Medicine umbrella. The ISC covers 110,000-square feet in southwest Philadelphia, right in the heart of University City. It’s one of the first in the nation and can process up to 200 surgical cases each day.
“As far as facilities go, the ISC is state-of-the-art, second to none,” said Cashman. “In contrast to a traditional Sterile Processing Department (SPD) in a hospital setting, this facility was built from the ground up with sterile processing in mind.”
Indeed, according to the press release announcing the new Center, “It is designed with a one-way forward flow approach that enables efficient instrument processing. The facility includes features that enhance sterilization efficiency, such as the use of clean steam using reverse osmosis water. The ISC will be a nearly dust-free facility thanks to increased air changes and filtration. Airlocks throughout the building also prevent cross-contamination of air between areas where dirty instruments are processed, and clean ones are repackaged.”
Penn Medicine is one of several health systems at the forefront of this major industry change. According to Cashman, though the shift is largely unprecedented, it’s becoming more and more popular for hospitals to centralize sterile processing – and the payoff is worth it.
“I absolutely see Penn Medicine as an example for future offsite sterile processing centers across the country and the world,” said Cashman. “The ISC is a magnificent facility and hosts many tours. Many different organizations come in to see how we do things here, which is great because we’ve learned a lot of lessons that we are happy to share. We continue to improve.”
How To Centralize – And Do it Well
As with any major structural change, the centralization endeavor exposed a few pain points in the early years of its development – and no, they don’t only have to do with transporting sterile instruments through the “unkind” streets of Philadelphia. Here are five lessons learned from the journey to centralization:
Lesson #1: Don’t under (or over-) estimate your inventory – “Something we worked on very aggressively in the first year was getting our inventory levels up,” said Cashman. “We really had to take a good hard look at what we had and account for turnover time. For example, if one set of instruments is in use on a Tuesday morning, the set likely will not be available by Tuesday afternoon for SPD to process for a case on Wednesday morning. Taking that into account was a necessary first step for us.”
Lesson #2: Hone a well-defined workflow – Similarly, Cashman recognizes that thinking ahead and acknowledging different work schedules is key to keeping things flowing and easy. “We work 24 hours a day, seven days a week here in the hospital,” said Cashman. “The ISC is open Monday through Friday. So, if we need instruments processed for the weekend or on Monday, a lot of planning goes into it. Streamlining and planning ahead as much as possible is much more efficient in the long run.”
Lesson #3: Utilize the best tools available – “My job is to get my team the tools that they need to do their jobs well and to invest in the staff. That’s what we do as leaders,” said Cashman.
One tool Cashman recommends is instrument protector cards by SterileBits (distributed via Healthmark and Steris). “We absolutely love them. After years of using the old little rubber tip protectors, the difference is huge. The cards keep the instrument open and they don’t fall off. The robotic arms cards have been fantastic. They allow us to hang the arms in a row and the card keeps it nice and rigid, safe and organized.”
Lesson #4: Communication and trust are everything – Since there are so many moving parts, communication must be impeccable. That’s why, in addition to day-to-day calls, texts, meetings, and emails, Cashman implemented a monthly appreciative inquiry (AI) meeting. AI meetings dedicate space and time for staff to speak up on problems they have or things they need to do their job better. Many AIs center around one topic. After introducing the topic or problem, the team has the floor.
“AIs have been so powerful for us. It really gives the team an opportunity to be heard. Most of the time, I sit back, listen, and take notes,” said Cashman. “Sometimes the solutions are as simple as learning that the team could use another scanner. That’s a simple fix. If it makes your job easier, I can get that.”
According to Cashman, it takes time to earn the trust of one’s team. The goal is to create an environment in which criticism and problem-solving are celebrated as constructive and helpful rather than something to be used against those who speak out.
“We have come a complete 180 from when I first stepped foot into this role,” said Cashman. “It’s great when you have a colleague who has worked at the hospital for 30-plus years that never would’ve spoken up before, now be so engaged. It’s all about communicating that we actually want to hear everyone’s feedback, and we want to make things better.”
Lesson #5: On-the-job training is golden – Anyone who has ever worked in healthcare knows that hiring and retaining staff is always a pain point. It’s no different for centralized SPD, especially with increasingly specialized jobs and more required certifications to complete those jobs on the rise. To make sure that Penn Medicine SPD has the right people in the right jobs, Cashman helped implement in-house training programs. In 2024 alone, the department has had four sterile technicians receive their Certified Endoscope Reprocessor (CER) certifications.
“We’ve seen one of our techs come in with a provisional certification and advance to a technician, to receive a CER certification and become a reprocessor. Then, he moved on to a scrub technician program that we do locally,” said Cashman. “And that’s just one example. Providing opportunities for growth from within helps foster a well-rounded department. Investing in your team allows them to do the best job that they can do.”
The Vision
With four years of centralization under his belt, Cashman’s vision is to continue to modernize and bring this historic hospital up to modern times.
“It’s an exciting time in sterile processing. It’s a growing industry and there’s a lot of great technology coming down the pike. I have a vision. I have a place that I’m trying to take us where we upgrade our equipment and continue to foster a strong team,” said Cashman. “Finding what fits your workflow is so important because it’s not one size fits all for everyone. It’s about finding what will make the job easier, and what will make things safer for the patient.”
SterileBits: SPD for the Modern Era
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