Conquering the Blame Game: How to Rescue Your OR/SPD Relationship . . . Before It's Too Late

Team work is hard work. If it weren't, there wouldn't be a half a trillion dollar industry of consulting around the globe just to show us how to play well with others.

It's one thing to have friction on a team dealing with multi-million dollar mergers or huge government defense contracts, but when it comes to friction between Operating Room nurses/technicians and their Sterile Processing counterparts, there is often much more than money on the line. Distrust, back-biting, and blame-shifting across surgical services can create scenarios where the safety of our patients and staff are put at grave risk by dangerous OR delays, process breakdowns, and communication oversights. While no healthcare provider wakes up in the morning wanting to hurt a patient, long-running cultural "battles" between these departments can seriously inhibit the ability of our teams to consistently serve each other in a manner that our community expects and our patients deserve. 

While there are no magic bullets to solve this kind of accountability challenge in your facility, there are at least four "life rafts" that could pull your team out of this dangerous deluge before it's too late:

1) Pride Goes Before the Fall: The Power of Professional Apology

Rather than saving this gem for the end, I want to get us all started off on the right, humble foot. Here it is: Pride goes before the professional fall. I believe a great many ongoing cultural battles in our OR/SPDs could be overcome with two simple words, "I'm sorry." But in order to muster up the super-human strength to admit our failures, we must first come to terms with the fact that our patients are more important than our pride. The only perfect human beings are cardiac surgeons (just ask one of them...), so unless that's you, it's quite possible that you have had a hand to play in the current issues and challenges wrecking your OR/SPD relationship. Whatever responsibility you can own up to, do it. Help wipe the slate clean with humble acknowledgement and ownership of each of your failures, and see the power of professional apology at work.

2) Give up the 'Gotcha' Journalism: Learn from Your Mistakes and Move Forward

One of the first decisions I made as a Sterile Processing leader in my new facility was to put a moratorium on photographic "evidence" gathered by my team. As I explained to them, I know what a hole in a wrapper looks like, I don't need a picture of it emailed to me and 20 others on the periOperative leadership team. In fact, nearly every "issue" that could occur can be communicated quite well without a picture. Crack in a retractor handle? Yep, I can imagine that. Mislabeled tray? I can see it in my mind's eye. A set full of unstrung instruments? I could paint one of those from memory.

So what's the big deal regarding pics? Well, more often than not, a photographic culture among OR/SPD teams tends to lead a facility down the road of periOperative gotcha journalism, rather than dispassionate issue reporting, root cause analysis, and team-driven performance improvement. Pictures begin to be used as weapons to shame and degrade the other team, rather than information simply being shared to better the service quality to each other and our patients. A much better course of action is to communicate the issue, agree on a follow-up, and move forward. It's almost always better to skip the pics.

3) Dig a Little Deeper: Moving from People to Processes

If there were one refrain that I use in nearly every conversation I have with the OR when something has gone wrong, it's this: "What can we do so that no else makes this same mistake in the future?" Or put another way, "How can we make it easier for our teams to do the right thing?" A normal gut-reaction to any kind of issue between the CS/SPD team and the OR is to ask the question "Who's responsible?" And, in one sense, that is an important question to answer. But the blame-game is only enflamed when the follow-up stops at the who-dun-it stage. Throwing people under the bus for their mistakes is one of the most counterproductive decisions a facility can make, because it replaces learning with fear and opportunities for improvement with a feeling of hopelessness.

Instead, when issues occur we must commit to dig a little deeper into the problem and seek to move from the people at fault, to the processes at play. Was it too easy for your technician to put the wrong indicator in that tray? Was your storage too overstocked to prevent ripping the bottom of a container wrap? Was the preference card too outdated to notify the case cart builder of the need for a priority turnover? When our focus is on answering these kinds of questions instead of assigning blame, not only will we build stronger processes, we'll build smarter, process-conscious people.

4) Expect Professionalism and Deal with Existing Problem-Makers

Perhaps the most obvious yet most daunting of these cultural life-rafts is the absolute need to expect and demand professionalism on all sides of this periOperative coin. If you want to stop the blame game before the seeds of distrust really take root, you must encourage your teams to treat each member of the surgical service team as professional equals. This means no break room bashing of so-and-so upstairs, no eye-rolls when hanging up the phone after a last minute request, no snide comments about difficult OR/SPD counterparts. When a professional tone becomes the ambiance of your department, blame becomes as unwelcomed as fingernails on a chalkboard - unnatural and unwanted.

And finally, many of you will not be surprised to hear that much of a facility's blaming/shaming culture can be tracked back to certain individuals who see it as their mission in life to burn their periOperative counterparts. These folks must be dealt with. I don't say they must be identified because everyone in the department already knows who they are. They must be confronted by their leaders and their peers with the expectation of teamwork and professionalism that is critical for your team's success. If you need any help finding these folks, they will be the ones who care more about tearing people down than bringing processes up. Show them the door before they burn the house down.

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In facilities struggling with CS/SPD and OR accountability, the river of blame can seem overpowering at times, threatening to wash away every attempt to bring good out of challenging situations. But take it from me, there is hope to overcome the undercurrents of blame such as pride, gotcha journalism, people-focusing, and problem-makers. I hope some of the life-rafts discussed above can help float your team into the safe harbors of honesty, accountability, and periOperative professionalism. After all, there are no winners in the blame-game -- everyone, including the patient, loses. And that's not an outcome worth fighting for . . .

What say you?

W. Hank Balch ? September 2016

This article is the sole opinion of the author and in no way reflects the position of any employer or facility. You can find over 50 other Sterile Processing articles and commentary here.