Session: Bridge the gap—Finding a common mission between the OR and SPD

Editor's Note

Rebuilding trust and redefining teamwork between the OR and sterile processing department (SPD) turned a near-failure into a high-functioning system at UCLA Health, according to Ronald Perez, JD, MSN, RN, NEA-BC, CNOR, executive director of perioperative services, and Jasmine Briones, MSN, RN, CNOR, director of perioperative services. What began as an urgent recovery effort—hundreds of incomplete trays, delayed cases, and demoralized staff—evolved into a cultural and operational overhaul anchored in transparency, structure, and accountability.

Perez said the crisis forced leaders “to get everyone in the same room, be honest about what was broken, and rebuild trust.” The team’s first step was a joint gap analysis using performance-excellence tools to pinpoint failures in five categories: staffing skill gaps, poor communication, chaotic workflows, outdated policies, and lack of data tracking. From there, the group conducted a fishbone root-cause analysis that surfaced the most painful truth: “SPD and OR didn’t understand each other’s worlds.”

The turnaround focused on achievable, measurable goals such as proactive communication, clear metrics, standardized workflows, and visible morale gains. Partnering with a third-party vendor, UCLA launched structured daily management with supervisors, educators, and operational “architects” who helped redesign processes and coach leaders. Resistance was expected. “Staff asked, ‘How can I manage 50 cases and attend meetings?’” Briones recalled. “But the message was consistent—these processes are ours, and they are not going away.”

A new OR-SPD partnership model took shape. SPD was repositioned as integral to surgical operations, not ancillary. Daily huddles, weekly touchpoints, and feedback loops linked both units. The creation of an OR liaison role bridged communication in real time, coordinating instrument needs, rounding on trays, and coaching staff. “SPD is the kitchen, OR is the front of the house,” Briones said. “If SPD doesn’t function well, surgery stops.”

Role clarity followed. The team established standard operating procedures detailing expectations for both SPD technicians and OR staff—how trays are handled, sprayed, and inspected post-case, and what defines readiness for sterilization. Educating OR personnel on decontamination timelines helped eliminate frustration about delays and fostered mutual respect.

To lock in improvements, UCLA standardized SPD operations through Kaizen-based process mapping. Staff deconstructed every step of decontamination, assembly, and sterilization, producing written “standard work” guides and visual aids. Competencies were updated and reinforced through hands-on sessions and return demonstrations. Visual management tools, including colored tags and daily checklists, helped staff quickly identify tray priorities and progress.

Metrics became the backbone of accountability. Daily quality audits, productivity dashboards, and shared key performance indicators tracked missing instruments, tray defects, immediate-use steam sterilization (IUSS) cycles, and turnaround time. Missing instruments dropped below 5%; tray defects and IUSS usage declined sharply after implementing audits, clear replacement pathways, and education on proper approval chains. “You don’t collect data just to gather it,” Briones said. “You use it to create action and change.”

Perez added that sustaining gains required a culture of vulnerability-based trust, where staff could admit weaknesses and ask for help. “We can’t fix everything ourselves,” he said. “It requires a team.” That culture evolved into shared ownership, visible accountability routines, and data-driven conversations across all levels. System-wide, UCLA is now scaling the model through an SPD Council to standardize metrics and best practices across campuses. Each site adapts key performance indicators to its scope while maintaining alignment. The effort, Perez said, is less about technology than about “one team, one mission.”

Briones summarized the outcome succinctly: “Teamwork is the key to success, and it starts with trust.” Sustainable progress, she added, depends on frontline ownership, recognition, and constant reassessment of the OR-SPD relationship. “You can’t take it for granted. Revisit it, realign it, and keep designing your future together.”