Infection Control Today - 09/2004: Perspectives

The Best Kept Secret in the South

By Becki Jenkins, CST, RCST, CRCST, FEL

That is the credo of the North Mississippi Medical Center (NMMC) in Tupelo, Miss. Janet Tidwell, RN, MSN, CNOR, administrative director of surgical services, aims many accolades toward her colleagues. Kim Davis, who is the department manager of the central sterile (CS) department at NMMC, recognizes her staff as the “stars” they are in infection control and sterile processing customer service.

As a consultant to healthcare and to industry, I am often faced with having to tell my colleagues that some of their processes are erroneous or need work to get them up to standards of practice, and this is not the fun part of the job. It is often met with opposition and although recommendations are accepted for the most part, it is with a degree of perceived personal offense — rather than raising the consciousness to the best practice that best supports the common positive patient safety goals.

I was asked to help NMMC with a few of their process issues they felt needed tweaking. I was expecting the usual initial hesitancy to allow an outsider to come in and dissect daily processes one by one to see where it could be improved, stay the same or completely changed.

I was unexpectedly surprised by the anticipated reception.

Tidwell’s attitude of “let’s work together” makes a consultant’s job much easier. As Tidwell and Davis took me through each process and discussed openly with me the different areas of concern, I began to realize that this was a group of dedicated, team-oriented people. As the visit progressed there was opportunity to speak with the central service staff, operating room (OR) nurses and the surgical technologist. Each area of expertise seemed to express the same team concept in word and in deed.

At the end of the first day I realized that this hospital was awesome. The job of addressing their issues would be much easier because of their obvious support of one another as they embarked upon caring for their patients each day. I realized this hospital indeed was the best-kept secret in the South as I pored over the processes that NMMC wanted me to look at: prep and pack; instrument usage, damage and loss; communication development between OR and CS; staff education; and record-keeping for CS.

The organization of departments was impeccable; this included two areas that were off-site but supported by this very large hospital. Prep and pack had a tremendous tracking system in place which allowed for a complete view of the daily workings in CS, on-site and off-site. The infection control concepts that were implemented daily seemed effortless to this CS staff. It was clear they were looking for a way to increase their level of patient care rather than trying to get to a basic standard. This was a family working together for a common goal — patient safety.

In the investigation period there were only two areas that needed more intensive attention — instrument damage and communication between OR and CS that included issue resolution. These are very common needs in many OR/CS departments across the country. The OR does communicate with CS, but usually on a need level rather than working together to solve issues on both sides. All too quickly, this kind of relationship can foster feelings of frustration and an overall opinion that CS is there to be seen, not heard, an attitude of “Give me what I need but don’t talk to me about it.” In addition, instrument damage or loss is thought to happen only in CS. These are erroneous views that can be costly in:

• Lost revenue in replacement or repair of instrumentation
• Lost morale and decreased productivity related to lack of appreciation and recognition, leading to frustration and bad attitudes
• Higher rates of hire related to low job satisfaction
• Overall decrease in patient safety directives or concerns

There was a meeting set to discuss how to solve the main issues of concern. Each area of service – orthopedics, general surgery, neurology, plastic surgery, ophthalmology, and ENT — had a team leader that was asked to attend. The expectation was that there would be the need to mediate between the two factions in the OR and CS – a common occurrence where processes need to change on both sides to get the job done. With great surprise, this wonderful group of people came to work with attitudes that made working with each other very easy. They asked many questions and heard the answers. The process toward making their already wonderful programs work better was underway. These individuals believe in working together to obtain a common goal of the very best patient care. They came together and began to employ facets of the recommendations for better communication and instrument care/handling that would make their operations run much more smoothly, such as:

• Development of a survey form between OR and CS so that issues could be addressed without pointing fingers, but stayed along the lines of positive moving resolution of processes that needed improvement in CS that would help the OR.
• Development of a survey form between CS and OR that would be used to help OR complete their processes with CS processing requirements in mind.
• Development of CS team specialist that would mirror those in OR so the OR leaders had specific expert go-to persons when they needed help. This is critical to reducing frustration and lost time in trying to find someone who knows what you need to know. The CS team would remain universal but be expert in one area as a resource to OR and to CS.
• Development of a physician forum that would allow OR, CS and surgeons to work together concerning realistic turnaround and case block times.
• CS team tours of OR so the CS can understand the processes that are needed to make the operations in OR go smoother. It is recommended that each CS employee see a surgical case so that the CS employee can see how critical it is that sets are ready, put together correctly and with all pieces functioning properly. It is important that CS staff see how their work can positively or negatively impact patients. If this were truly understood, there would only be certified registered central service technicians (CRCSTs) in CS. CS personnel are not the glorified “dishwashers” that infection control and productivity managers think they are. CS is the single most ignored and least understood department in hospitals today, but it is the most critically needed for all patient care. This cycle of ignorance must change.

It was a joy to work with this spectacular healthcare team. Its members care about their patients, each other and their doctors. Any administrator would be proud to have them on their team.

Additionally, it was good to hear that those in CS who were not certified were studying for or getting ready to be certified as central service technicians. This was largely due to members of management that supported their staff’s efforts, and celebrated and appreciated their excellent work. Now, these staff members have certification as a part of their professional development, coinciding with the goal of the best possible patient care.

I left NMMC wondering how I could bottle them and show them to as many healthcare systems as possible as the shining example of positive patient and interpersonal relationships between staff and departments that they were.

It was a pleasure to work with this great staff of professionals. I share them with you so everyone can see that if we work together, our patients can receive the very best care we can deliver. If we could get on the same page with positive patient-care directives, what a wonderful thing that would be.