From the Derby to the Decontam Room: Leadership Lessons for Sterile Processing

At this year’s HSPA conference, one standout presentation draws an unexpected yet powerful parallel between the Kentucky Derby and the daily operations of sterile processing departments (SPD). The speaker, Elizabeth (Betty) Casey, MSN, RN, CNOR, CRCST, CHL, the senior vice president of operations and chief nursing officer at Surgical Solutions in Overland, Kansas, and a seasoned SPD leader, uses the Derby’s meticulous preparation and high-stakes performance as a metaphor for the dynamic, fast-paced world of surgical services. Like the Derby, SPD relies on coordinated efforts from behind-the-scenes experts to ensure seamless, high-quality outcomes where lives are at stake.

The presentation highlights how managing an SPD resembles preparing for a large-scale event. Crowd management at the Derby equates to case volume management in SPD. Variables like trauma cases can disrupt even the most carefully crafted OR schedule—just as unpredictable weather can affect race day. The speaker emphasizes that while huddles and planning tools help, flexibility and resilience are equally essential.

“We're there, SPD and the ORs and stuff like that have been doing a long time, but I had to learn,” Casey said. “How could you compare it to another, another world, right? And so that took a lot of studying and understanding, it from just the enjoyment of an event and how much work takes place. And I would certainly shout out to the HSPA team for putting on a conference of this magnitude and size, which is right for it. And if you think about it, I could have easily done that as a comparison of preparing for the day [in] SPD. We're all challenged, and the different thing is that it's not a comfortable environment. And the one thing I wanted to challenge myself and, hopefully, the people I'm speaking to is that sometimes we're managing and doing things that are not always comfortable, right? And so, how could that learning be? But when it comes down to it, there's still something at the end that we're responsible for ensuring they have the very best outcome, whether it's our patients or the horse, the jockey, or the environment.”

Drawing comparisons also helps underscore universal themes: preparation, communication, and adaptability. Just as the Derby’s success depends on trainers, jockeys, and support teams, surgical success also relies on collaboration across departments. The speaker encourages leaders to learn from other industries and apply those lessons to improve SPD workflows, staff engagement, and crisis management.

The presentation further explores leadership challenges in SPD, including staffing shortages, outdated equipment, and underrepresentation at decision-making tables. Without frontline voices advocating for necessary investments, facilities risk delays, poor outcomes, and employee burnout. The speaker calls for stronger advocacy, cross-department collaboration, and real-time staff recognition to bridge gaps in communication and resources.

By using the Derby as an allegory, the speaker offers a fresh lens to examine long-standing challenges. This creative approach aims to inspire and drive action, with the ultimate goal of enhancing patient outcomes and reinforcing SPD's vital role in modern health care.

Casey’s presentation is on Tuesday, April 29, 2025, at 3:00 PM. “I hope everybody has an opportunity to come by and listen to the comparison between if you're trying to run an event or a derby and you're trying just to run your SPD or the ORs, love to share some of that," Casey said. "Hear your stories. I think it's important, the more we talk and network and bond, the more we'll continue to be stronger, and we will be at those [corporate] tables.”