Give an Inch, They’ll Take a Mile: How Compromising Kills your Quality Culture & How to Get it Back

“Just this one time can you hand wash this, so we can flash it?”

“Dr. Laio really needs it for her next case, even though it’s cracked.”

“We don’t have IFUs, but it should be fine in low temp.”

Opportunities to compromise our quality standards in Sterile Processing and Endoscopy departments confront us on a daily basis. Sometimes the requests come directly from the mouths of our surgeons. Other times it comes in the form of pressure from surgical assistants and nurses trying to cover themselves for the next case. Often it shows up in conversations with vendor representatives who overslept, forgot about a case, or were simply dealt a bad logistical hand.

No matter the cause, when frontline technicians and department leaders are being asked to compromise their quality processes all kinds of different emotions and responses can be stirred up. Are you frustrated to be put in this situation (again)? Are you offended that someone feels like your department policies are optional, and based on convenience? Do you feel bullied and helpless because your only options are to anger the surgeon or take a short cut? Unfortunately these experiences are not unique in our industry. Departments and Sterile Processing professionals from around the country have these experiences on an almost daily basis. To stand a chance, you need to understand the potential implications of your decisions and realize that every day is a new day. We’ll take a look at both of these ideas below.

No Decision is an Island

In John Donne’s iconic poem, “For Whom the Bell Tolls,” the poet makes a powerful argument for the inter-connectedness of man. Since it’s short, take a moment to read it here:

No man is an island, Entire of itself. Each is a piece of the continent, A part of the main. If a clod be washed away by the sea, Europe is the less. As well as if a promontory were. As well as if a manor of thine own Or of thine friend's were. Each man's death diminishes me, For I am involved in mankind. Therefore, send not to know For whom the bell tolls, It tolls for thee.

(Published 1624)

For Donne, everything that happens to an individual ultimately has an impact on the rest of us, even if in very small ways. This concept is no less true in our Sterile Processing departments, where the decisions of individual technicians ultimately have ripple effects on the rest of the team and all of our customers in the Operating Room and clinic settings.

Strong Sterile Processing managers understand how this idea plays out. Imagine the following scenario: a 3rd shift technician has a huge workload to complete overnight and is receiving pressure from the nursing team to finish all of the following day’s case carts prior to 7am. To make time for this, the technician decides not to inspect any Kerrison rongeurs during their shift. Instead, they simply take them out of the washer, let them cool a little, place them in a container with an indicator and send them through the autoclaves. However, over the next few days, the Sterile Processing manager begins getting multiple reports from Neurosurgeons complaining about residual debris in various Kerrison sets being pulled for their cases. These bioburden discoveries are causing case delays and cancellations, and quickly eroding trust between this service line and the entire SPD department.

How many technicians decided to compromise in the above scenario? Only one. But how many people were impacted by it? Every technician and leader in the department, and multiple surgeons, patients, nurse, surgical technicians, anesthesiologists, vendors, etc. And that was from a single decision to compromise. No one knew the technician had compromised until the issues had already begun causing quality problems in the rest of the workflow. And this is one of the many reasons that compromising quality processes in Sterile Processing is so dangerous – many of these decisions are not obvious to anyone except the individual who took a short cut – until it’s too late. No decision is really made in isolation. Every compromise involves the entire team. To paraphrase the poet Donne: Ask not for whom the phone rings / it rings for thee.

Put the Past Behind You

Some of you may be reading this and thinking, “Yes, that’s horrible, but we’ve been compromising on some things for so long, it will be impossible to change it now.” This comment, or something like it, is probably one of the most common responses I hear from department leaders and frontline technicians who care about quality but feel like their hands are tied by past compromises.

If this describes your situation, don’t give up hope. And don’t be held hostage by historical decisions to compromise. Every time the sun rises over your hospital, ambulatory surgery center, or endoscopy suite that means you have a new day – with new opportunity to stop the line and protect your patients. This is true for department leaders as well as front line technicians. To free yourself of the mistakes of yesterday, you must first own the compromises of your entire team – whether or not you were personally involved in them (remember, no decision is an island). Admit and explain to your team and customers where the compromise occurred, why it happened, what the potential implications were, and what the compliant decision should have been. Then make it clear through education, communication, and policy updates that future quality compromises should not be requested and will not be given. Have these conversations as a team, and set expectations for your team to encourage each other in those moments when compromising is most likely (eg. High stress situations, nights & weekends, no leader present, etc).

Although it only takes one compromise to lead to widespread quality issues, it will take an entire team to create a culture where compromise is a dirty word. But there is no greater purpose for a Sterile Processing team than to band together around this unwillingness to compromise and to protect the one person who would stand to gain the most from our commitment to quality – and that’s the patient. Do it for them.