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One cannot deny the purpose and role of the sterile processing department (SPD) in the hospital. This is especially true if you work in the operating room (OR). Still, the importance of SPD is often forgotten until a problem during a surgical case arises.
Healthcare workers know that no single department within a healthcare system can stand alone and function well independently. This is especially true of both the sterile processing and surgical services departments. This relationship is paramount to successful patient outcomes for several reasons: patient outcomes can be affected, productive hours can be lost for numerous reasons, quality in projects can become compromised, and relationships can be damaged.
The SPD and the OR is a pair of unique departments with each having certain inherent qualities. Some characteristics that are only owned by one, the other or both is another truth. Each has personnel with varying levels of education and experience. Each faces challenges in retaining highly skilled members. Each has the ability to influence the outcomes of many other units within the hospital setting. Each is directly affected by the successes and failures of the other. Yet rarely do these two teams see eye-to-eye.
Unfortunately, these departments often have old history and baggage between them. The relationship can be tumultuous at times and barriers may seem to abound. This does not have to be the case. It may take re-building the relationship to establish new norms, but it will be well worth the effort. Fixing and re-establishing a healthy working relationship requires recognizing facts. This means shedding some long-lingering and usually wrong assumptions and acquiring accurate information concerning each to build better mutual understanding and respect.
The path to a better relationship begins with a willingness to improve, followed by the realization that neither entity will fully grasp the other’s responsibilities without constructive dialogue and active listening. This takes time and effort; however, once this process starts the rest comes a bit more easily. Establishing empathy and beginning a healthy dialogue can be the most difficult part of the process. So, where do you begin?
It begins when someone initiates the first move. Breaking down barriers and trying to effectively remove old perceptions is challenging. It requires constructing a healthy amount of trust between both entities. A few things must occur:
• If your sterile processing manager or surgical director has not initiated an initial conversation, reach out to them and make the first move; keep in mind there may be some initial resistance or defensiveness.
• For the first collaborative meeting, make sure it is conducted in a neutral location to try to reduce misperceived or actual power dynamic issues that may currently exist.
• Set the tone of the first session for open communication. This meeting’s purpose should not be used to solve long-established problems, but rather to show a willingness to be open to future collaborative corrective action and/or new objectives.
• Set the ground rules early and communicate them before the start of the meeting; this will help set the expectations and aleviate some preliminary tension.
Objectively looking at each entity’s strengths and weaknesses is a helpful part of building a strong future. Along with reviewing departmental strengths and weaknesses it is critical to establish an understanding of the equally important threats and opportunities that will inevitably be present. They often parallel each other, so doing this requires an analysis.
Mitigating each department’s risks is pivotal. Organizational structures that are in place will vary from facility to facility and this can sometimes complicate reducing risk. While communication is one example that may be affected, it can be improved more readily than other concerns. Without an assessment of SPD and surgical services it will be difficult to fully ascertain the extent and type of re-building that may need to occur for the departments to function better both independently and collectively. Communication issues can be both a symptom and a cause for other concerns, usually. It is a good place to start, but it is not the sole thingto address.
During the analysis formation, additional areas for concentration may become apparent. Resulting in opportunities for the units to further correct, expand or improve services or functions that may extend past the immediate or initial identified opportunities. This process forces a candid look at the most obvious areas as well as the more subtle functions of both the SPD and the OR. Often it highlights the crux of what might be contributing to the hampering of the interdepartmental relationship as a whole.
Setting up an initial meeting and conducting a SWOT analysis is not all that will be required to solve historical issues. Actually, they are simply the beginning steps in the process needed to construct the structural framework needed to re-build the relationship. If all parties do not have a clear understanding of the current circumstances (clinical, technical, political, financial, etc), empathy for the historical details, and a good grasp of the future assumptions and needs, any amount of conversation and analysis will be for nothing and fruitful next steps may not be possible.
With the initial conversation and analysis complete, the next step will be collaboratively setting the two teams’ operational initiatives, jointly. Together, the departments will be most likely able to accomplish some goals, even far reaching ones. Some initiatives, by design or nature, will need to remain solely with one unit or another in terms of responsibility. However, many others are interdependent of the other unit or at the very least influenced by them. Without collaboration, the sometimes subtle and not-so-subtle interdependencies may become lost. When this happens, reaching set goals becomes much harder and sometimes impossible.
At first, it may feel uncomfortable to sit with your colleagues to set mutual goals and new objectives together, especially if your workplace style and communication methods differ greatly. This initial awkwardness will dissipate as soon as the work begins. Having a clear understanding of where each department stands in terms of operational functioning and where it ought to be and being able to articulate this to peers is imperative. To get started, have each entity’s participants outline what is believed to be the current state of affairs for each of the departments. Putting to paper where the unit should be is a natural next step, followed by voicing ideas on how to achieve it and coming to agreement, through compromise, on what and how it should happen. By sharing perspectives, it can help to highlight the unknowns to colleagues that each might have assumed was an understood fact.
The next step includes creatively visualizing what each department’s potential threats and the causes or effects of them. Tagging along with these threats is usually a host of other known or unknown potential ramifications. It is critical to understand these threats in their entirety. Otherwise, a series of “domino effects” is possible for the department you either service or support, because it is easy to start to work outside of the parameters that define the teams abilities. Acceptable limits must be agreed to by major stakeholders for any substantial change and improvement to be noticed.
Lastly, with strengths and weaknesses identified and potential threats acknowledged it is now possible to look at your opportunities together. The beauty of working as a team is the passive benefit of exposure to new and unique skills found in members outside of your immediate team. The full benefit of this is only realized when talents are exploited as wisely and as often as possible. Identifying potential operational or strategic options is only as good as your ability to actualize them. This becomes more plausible when teams look beyond their own set of abilities and look to uncover what it will take to surface real results and reviewing who owns the ability to make all of the individual tasks happen collectively.
Bridging gaps between these areas of expertise will result in better patient outcomes and smoother work operations. By sharing information, understanding differences, working collaboratively, the right thing at the right time with the right materials and resources will be done for each patient that will pass through the operating rooms doors. The SPD plays a massive part in direct outcomes. The surgical suite can directly impact the SPD’s ability to produce quality goods. The circle of instrumentation and surgery are interwoven. With these described techniques understanding and communication can be the foundation for real improvement and growth on both sides for the departmental relationship. Better results clinically, financially, psychologically becomes more possible when departments coordinate efforts and keep interdependencies in mind. Avoiding re-work, fixing miss-steps, correcting communication failures and creating work-arounds to the other units’ “process-improvement” projects become a natural fall-out of proactive interdepartmental re-design.
If the two units already work well together, benefits from trying new or slightly different approaches with the goal of strengthening departmental ties still may have a positive impact. With well running teams, there can still sometimes be some incorrect information or a lack of some important details that can be uncovered by applying a few of these suggestions.
It never hurts to try to improve “good,” because that is when “great” becomes possible.
Michele DeMeo is the sterile processing manager at Memorial Hospital in York, Pa. She has written several articles for industry trade journals. She is a voting member for technical working committees for AAMI as an independent expert in sterile processing. In addition, she is the clinical consultant for General Hospital Supply Corporation. DeMeo has 18 years of experience in the management of sterile processing, supply distribution, purchasing and materials handling.