Apr 14, 2023 | Article

The People & Patients Behind the Great Productivity vs. Quality Debate

  1. Learn about how productivity & quality relate to each other.
  2. Identify reasons why productivity is undervalued.
  3. Understand the impact of connecting productivity to patient care.

It’s one of the most debated topics in all of Sterile Processing: Is greater productivity possible without ultimately sacrificing quality?

This question is posed in countless different variations, but the main point remains the same. Sterile Processing professionals want to know, is there a tipping point where an emphasis on productivity begins negatively impacting our surgical instrument quality? And if so, where is that tipping point and how do we identify how close we are coming to it in a particular department?

If the answers to these questions were easy, there would be no debate.

This article will address a few of the important considerations that each of us should work through as we seek to fulfill our fundamental goal of providing safe surgical care to the patients in our hospitals. Whether you are a frontline technician, education, team lead, department manager, or system director, these concepts will help you better understand what exactly is at stake in these important industry conversations.


When Sterile Processing technicians are first going through their onboarding and orientation into our industry, the concept of quality is drilled into them.

We describe how one little crack on a surgical scissor, if not caught during the inspection stage of assembly, could cause catastrophic results if it were to cause a failure of the device in the middle of a surgical procedure.

We educate these new technicians on the dangers of microscopic biofilm within surgical instruments, that can harbor and protect life-threatening microbes whose sole purpose is to infect and kill other living organisms.

We highlight the critical differences between dirty, clean, and sterile, and the implications these concepts have on patient safety when our reprocessed devices are used.

And then there is productivity.

During most of our training programs, the word productivity is rarely, if ever, used. Perhaps toward the end of a ninety (90) day orientation period, once a technician has been trained in all areas of the reprocessing department, there is a mention of this expectation to produce a certain amount of work throughout the day, but even then, the emphasis is low. These are new technicians after all, so their ability to produce is understandably low.

Intentionally or not, this absence of training and insight around productivity in the early days of the Sterile Processing experience can give a false impression to technicians of productivity’s true importance to a department’s ultimate mission.

While it is absolutely true that every instrument flaw, every speck of infectious material, and every defect in the reprocessing workflow must be caught in order to protect our patients (i.e., quality), another critical truth is that we will have more than one patient on the schedule tomorrow.

Much like the numbers we throw around in discussions of productivity standards and metrics, the real people behind the numbers represented by “cases” and “surgical schedule” easily get lost.

Whether or not our technicians are currently connecting the dots between their focus on quality and the multiple names on the next day surgery schedule, the link is there. Each patient deserves the highest quality of surgical trays, no doubt – but if enough of those trays are not produced (i.e., productivity) then they will get neither quality nor productivity.

In fact, without both of these, our patients won’t even get a surgery.



Knowing that focusing on productivity means that our teams are ensuring that every patient has the same access to surgery as the next person, this brings us back to a practical question: What does this actually look like in our everyday reprocessing duties?

First, we should introduce and explain the “why” behind productivity to new technicians at the same time we are introducing quality concepts. . The sooner our teams can begin thinking about how their production impacts real patients behind the numbers on a surgery schedule, the more commitment they will have to pursue efficiencies in their daily duties.

Secondly, we should work to break down this idea that we can only focus on either quality OR productivity, but not both. In reality, both of these must share in our priorities – from the moment a dirty surgical instrument tray leaves a case, to the moment it is placed sterile on a case cart to begin the process all over again.

However, breaking down the traditional understanding of quality as the only priority of our Sterile Processing teams is going to be no easy feat. Keep in mind that generations of our technicians have been hired, trained, promoted, and reinforced in this “quality-only” mindset.

Many of our team members inherently believe that the only way to “go faster” or increase productivity in SPD is to sacrifice quality. In their minds quality & productivity is a zero-sum game – to increase one, you must by necessity decrease the other. While there is no truth in this belief, it is a powerful psychological hurdle for any leader or coworker to overcome.



Regardless of where we may land on these debates, we should all be willing to look at, and be convinced by, our own department data.

We should be asking questions such as:

  • How many trays is it reasonable to expect one of our technicians to decontaminate in an 8-hour shift?
  • What kind of error rate is acceptable from the technician assigned to the sterilization area?
  • If it currently takes the average technician 22 minutes to assemble a standard Major Tray, but we average one error per week in our Major Trays, what does this mean? How should we respond?

All of these questions pull us into the larger debate we’ve been discussing in this article, but behind each of them stands at least two people: the Sterile Processing professional AND the patient. Both of these people desire and deserve high quality instruments, but it’s only through the productive work of the SPD professional that each and every patient on the schedule will get access to the instruments necessary for their individual procedures.

To get to where patients need us to be, Sterile Processing professionals must commit to thinking differently about productivity – not as some annoying metric that leadership uses to judge us by – but as a connection point to the patients behind those numbers.

We need to start feeling differently about increasing productivity – not as some demand to work harder – but as a challenge to find creative ways to identify waste, streamline processes, and standardize complex workflows, thus producing more with the same (or less) effort.

Ultimately this means we will all work differently – not only focused on the quality of the one – but also focused on the quality of the many who will be receiving each one of those quality trays that make it through our workflows.

While these ideas and insights will not settle the debate once and for all, they should help each of us better train, communicate, and encourage each other as we put on our scrubs to save lives – every instrument, every time.


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