Winning the OR Culture Wars: Sterile Processing & Surgeons . . . How You Can Spread the Love


One bad apple can spoil the bunch. And one mad surgeon can, well, we all know what one mad surgeon can do . . .


And there are few better ways to set off a stressed out surgeon than to consistently fail him or her in the area of surgical instrumentation. Whether it's a set that's unsterile for her first case, a scope that is cloudy for the umpteenth time, or an untimely delay in delivering the additional needleholders he needs to replace the ones that aren't locking properly -- understandable frustration is sure to follow. You may not hear the grumbles down in SPD, but the cultural damage is certainly done and it runs deep.


But there's good news. There's light at the end of this gloomy OR hallway. Frustrated surgeons can be won over, and when they are, they can be one of the most powerful agents of change to propel your Sterile Processing department to the forefront of cultural excellence in the minds of the OR team. Let's talk about some key ways your SPD team can get this done . . .


1) Reality Affirming


It's no secret that in most facilities across the country, there is no love lost between the OR and SPD. There are as many reason for this as there are individual departments, but some common threads include: unrealistic expectations between the two departments, high levels of stress on frontline staff to keep productivity high without enough manpower to get it all done, and a somewhat ubiquitous "us vs. them" mentality between OR nurses and SPD technicians. This is reality for most of us, and SPD leaders ignore it at their peril. But just because it's where we start, doesn't mean it's where we must remain.


2) Commit to Earning


Once you let the reality of the current state of affairs settle in, one thing should become strikingly clear. These OR/SPD challenges are not fundamentally about one department or the other winning or losing. It's actually a cultural battle between excellent patient careand stagnant territorialism that forgets the patients and focuses on the others' failures. Against this backdrop stands your shadow, the driven SPD or OR leader who is committed to earning the trust of your respective teammates once again. One group in particular deserves special focus: frustrated physicians.


As an SPD leader, you must be able to communicate to your facility's surgeons your commitment to overcome the present challenges and how you intend to give them the highest level of customer service. Just come right out and tell them you are committed to regaining their trust. Maybe they believe you at this point, maybe they don't. At this stage it doesn't matter. You just need them to know that you know that it's broken. Only then can you get to work on fixing it.


3) Bring on the Learning 


So that was the easy part. Now we get to hammer our swords into plowshares and get to the real work of becoming the kind of SPD department that surgeons love and respect. In Sterile Processing, as with anything else, you have to know to grow. The world outside your facility is increasingly becoming a certified and credentialed world, both by law and by choice.


If your team doesn't already require an industry certification, doing so will signal to your surgical team that you're serious about bringing a level of professionalism to your department's ranks. In addition to that, make sure you are intentionally carving out time each week to inservice your staff on service/quality issues that impact your physicians. Set a goal each month to invite a surgeon to come speak for 10 - 15 minutes about one of his instrument sets, how it's used, why it includes certain instruments, and what sets are used in conjunction with it. Not only will this give your team critical insider information as to what this physician finds valuable, but it will also give the physician an opportunity to interact with your team in a supportive, rather than frustrated, manner. This can do wonders for instilling confidence in your SPD techs and provide a level of ownership to the physicians for the positive changes that come out of these in-services.


4) Stop Rome from Burning


So you've committed to your physicians that your team is going to put out the service-fires smoldering in the OR, and you've undergirded that commitment with service/quality orientated education that gives your people the tools they need to meet these expectations. But guess what? You're still going to have failures. If you're lucky it won't be the particular issue Dr. Smith covered with your staff last week, but it very well could be. And you will need to be prepared to outlast these flare ups by providing a consistent, long-term context for how -- eventually -- this problem will really be stamped out. Thankfully there are a couple of tools that can help you at this point.


First, key in on your external vendors (reps for the Strykers, Zimmers, Medtronics of the world). These guys and gals work very closely with physicians and see your team on a regular basis. This means they can be a great conduit for communicating real cultural changes directly into the OR suite -- before the culture has concretely shifted across the teams. For instance, if your reps begin commenting on how much easier it is to drop-off/sign in loaner instrumentation or how much more streamlined the communication is with your team, this will further confirm that your commitment toward change is actually taking root.


Secondly, take a proactive approach to communicating improvements in your department to the watching world. A great way to start this is by publishing a regular department newsletter -- and sending it directly to physician's inboxes. Here you can highlight new certifications, new quality related equipment (such as inspection scopes for orthopedic shavers or laparoscopic testing units), and instrument updates that impact particular service lines. You'd be surprised how many surgeons will read it and the power it has to reframe the narrative of department growth you are trying to tell. 


Finally, find a way to be in constant communication with your surgeons about issues you are preempting or following-up on to ensure they are taken care of on the day of their surgical procedures. One of my facilities rolled out an "Instrument Excellence Initiative," which utilizes an email form letter describing their commitment to documenting instrument concerns, quickly finding clinical solutions, and notifying surgeons when the issue has been resolved. They complete and send this email any time a surgeon or his representative requests a change to a set or instrument repair. It's just another way to demonstrate the level of intention you have for serving surgeons well.


5) See the Tides Turning


When you're able to overcome the cultural challenges of an OR/SPD relationship and win over a surgeon, something dramatic happens. The ripples of trust begin to spread throughout the rest of the OR, touching not only other physicians, but RNs, Scrub Techs, and facility leadership. Breakdowns in service begin to be seen as outliers, and not demonstrative of your broader culture. Mutual respect and understanding begins to grow as both departments display their commitment to ensuring safe patients and happy surgeons. It's not instant. Less like a lightning strike and more like a sunrise. But it happens. Cultures really do change. And when they do, be sure your team takes some time to enjoy it.


Because they've definitely earned it.

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Hank Balch is the co-founder and Principal of Beyond Clean, a next generation Sterile Processing consulting firm with focus on operational improvement, accreditation survey preparedness, interim-leadership placement, and brand consulting for CS/SPD vendors. He is also the Co-Founder & Host of the Beyond Clean Podcast, a weekly international podcast discussing industry topics with the biggest names in Sterile Processing. You can find over 100 other Sterile Processing articles and commentary here, along with published articles in Becker's Hospital ReviewInfection Control TodayAAMI NewsAAMI BI&T JournalOutpatient Surgery Magazine, and contributions to Healthcare Purchasing News. Hank's CS/SPD team in Louisville, KY was named the "2016 CS/SPD Department of the Year" by HPN, he's served as the President of the South Texas Association of Sterile Processing Services and President of the Kentuckiana IAHCSMM Chapter, and was nominated for the 2017 President-Elect & 2018 President-Elect of the International Association of Healthcare Central Service Materiel Management.

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