Interview with Dr. Martin Koyle: From 96 Instruments to 28, and How to Scale Tray Standardization

August 5, 2020 - Koyle et al. published a clear demonstration of tray reduction and standardization in pediatric inguinal hernia repair: fewer instruments, lighter trays, faster sterile processing, and minimal “we need the old set” moments. We spoke with Dr. Martin Koyle after reading the paper, and the conversation made the work feel less like a tidy quality improvement vignette and more like a playbook for scaling.

This post is the first in a short series where we use the same structure each time: what the paper shows, what the conversation adds, a practical playbook, and how Mente makes it faster and stickier.

What the Paper Showed

The headline from Koyle et al.: standardization can work across surgeon groups, and you do not need to guess.

At The Hospital for Sick Children, the team targeted a common procedure performed by two subspecialty groups and compared what was on the preference cards vs what was actually used. Here’s what changed:

• Pre-standardization, one set listed 96 instruments and another listed 51.
• They built a single standardized tray using a simple cutoff rule (keep instruments used in more than half of cases), resulting in a 28-instrument set.
• After rollout, only 6% of cases required additional instrumentation, with old trays available as backup.
• Central Supply cycle time dropped substantially for the standardized tray compared to the previous sets.

The method is also worth copying: trained observers counted instrument “use” from induction through closure, defining “used” as any instrument held at least once. The authors are candid about what remains hard: long-term sustainability was not measured.

What we Found in the Interview

The manuscript includes stakeholder engagement and governance at “paper altitude”: presentations, weekly meetings, and mechanisms for staff input. In our conversation, Dr. Koyle drilled into the gritty parts that determine whether a tray project spreads or stalls. Buy-in is a workflow, not a kickoff. The work requires repeated touch points, not just an initial announcement.

Exceptions are inevitable, but they do not have to become a veto. A small number of outlier needs can dominate the emotional tone of a project if you do not plan an exception path up front, like peel packs, defined add-ons, and clear escalation rules. Leadership sponsorship matters more than most teams admit. Momentum can fade quickly when champions move on and priorities shift. Measurement is the hidden scaling cost. The study’s observation method is rigorous, but staffing it and maintaining consistency becomes the bottleneck when you try to expand beyond a single tray. The study proves the upside. The interview reveals the constraint: measurement and governance that survive the next month,not just the next 52 cases

To repeat Koyle-style results, you want a repeatable approach for any service line, here’s our takeaway:

• Pick a narrow first target. Choose one high-volume tray where stakeholders already feel the pain.
• Define “use” and measure it consistently. The exact definition matters less than consistency and trust in the process.
• Use a simple decision rule and defend it. Simple rules scale because they are explainable.
• Design the exception path before rollout. Keep a backup option and define how additional instruments will be made available without reopening the entire debate.
• Measure a balancing metric, not just reduction. Track how often additional instruments are required after rollout, and why.
• Plan for sustainability explicitly. Assign ownership, set a cadence, and build a mechanism to revisit decisions when the surgeon mix, staffing, or leadership changes.

How Mente Helps

Koyle’s work shows tray optimization works when teams do the hard work: careful measurement, stakeholder engagement, and a safe exception pathway. Our conversation highlighted the two blockers to scaling that approach across dozens of trays.

• Measurement does not scale well when it depends on humans watching cases. We found that many physicians don't believe this data.
• Improvements decay without continuous visibility and clear ownership.

Mente is built around those constraints. We capture instrument usage automatically and generate procedure and surgeon-level utilization evidence without requiring manual observers for every case. This approach delivers several benefits.

First: faster expansion beyond the first tray. You can start with one tray type and defined coverage, then scale to additional trays as you build confidence.

Second, we are able to deliver longer-lasting impact. Continuous usage data helps detect drift, quantify outlier needs, and revisit decisions when surgeon mix and leadership change, so standardization is not a one-time project binder that gathers dust. The manuscript includes stakeholder engagement and governance at “paper altitude”: presentations, weekly meetings, and mechanisms for staff input. In our conversation, Dr. Koyle drilled into the gritty parts that determine whether a tray project spreads or stalls. Buy-in is a workflow, not a kickoff. The work requires repeated touch points, not just an initial announcement.

About Mente

Mente is a surgeon-founded company building a data-driven operating room. We capture instrument usage automatically, then use that evidence to help hospitals and sterile processing teams supply fewer instruments while preserving clinical functionality and surgeon satisfaction.

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