It Takes a Village to Raise a Department: Why Facilities Fail Without CS/SPD Support Staff

Join me on a short thought experiment. 

Imagine boarding a plane for your next business trip. You find seat 7B (ugh! another middle seat!), stow your carry-on luggage under the seat in front of you, and settle in for the flight. So far, so good. Nothing out of the ordinary. Looks to be a full flight. Most seats around you are being claimed. 

And then it happens. You realize the only employee you've seen so far on this entire 747 is the pilot. After he's helped all the passengers board the plane, he runs outside to finish pumping in jet fuel and throwing in the last remaining checked bags into the cargo hold. He hurriedly finishes and rushes back inside before he shuts the hatch. Then, a little sweaty and a little out of breath, the pilot grabs the intercom system...

"Attention passengers, welcome to flight #874 to Pleasantville, USA. We had two earlier flights today with a full crew of pilot, co-pilot, flight attendants, fueling team, and baggage handlers, but they only work on 1st shift, so they've asked me to fill in for them all this evening. Don't worry, as soon as we hit 10,000 feet, I'll put her on auto-pilot and start the drink service. We're saving a lot of money by doing this, and I usually don't forget much, so these flights typically go very smooth. Now sit back, buckle up, and enjoy the 3 hour flight to Pleasantville..."

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What do you think? Does that little story evoke much confidence? Or does it make you a little sick to your stomach? The truth is, we all instinctively know that some responsibilities are just too big, too complex, and too dangerous to be dropped on one person. I'm not saying that having one person do these kinds of things is physically or mentally impossible, but doing all those jobs excellently certainly is. One misstep could mean life or death for passengers, so airline companies ensure that every plane has a full crew or the bird doesn't even take off. Unfortunately, the same can often not be said about your local CS/SPD department.

The State of the SPD Union is . . . Overworked

The application to CS/SPD is almost so obvious I'm embarrassed to have to spell it out -- but I will, primarily because so many C-Suite leaders in our nation's hospitals don't get it. While there are countless reasons that a Sterile Processing department can fail, one of the most common causes for CS struggles in facilities across the country is the lack of adequate support staff for CS leaders. We are trying to fly our 747s of Sterile Processing with hundreds of surgical trays from point A (point of use/decontamination) to point B (sterile storage) perfectly, every time, every day -- often with only a pilot. If your department more resembles a single engine Cessna, than a 747 jumbo jet, it may make sense to have a single leader for 5 or 6 technicians. But as volume increases, and staff grows, so too should your CS leadership team. Unfortunately, this is often not the case. I believe there are at least three false assumptions that lead facilities to fall into these dangerous staffing-traps:

False Assumption #1: Trust in a CS Renaissance Man (or Woman)

A common misconception about creating an excellent Sterile Processing department is that they revolve around one leader who "has all the answers." The truth is, there are no Lone Ranger superstars in the CS/SPD industry. Behind every leadership accolade, every department recognition, every publicized process improvement event -- is a team of SPD experts who ensured that the hundred steps it takes to properly process a surgical tray got done on time and in good order.

Facilities who place the entire responsibility for hiring, firing, on-boarding, training, coaching, development, supply ordering, process improving, vision-casting, shift supervising, budgeting, quality-assuring, OR communicating, etc., on the shoulders of a CS Manager or Supervisor are setting themselves up for a quality disaster. There are many jack-of-all-trades in the SPD world, but none rise to the level of master. There is no such thing as an SPD polymath. Facilities who refuse to acknowledge the necessity of a supporting cast of leaders in their SPDs will consistently experience service breakdowns, quality challenges, and leadership burnout. SPD excellence is a team sport.

False Assumption #2: Cost-Cutting Through SPD Leadership Overlap

You don't have to work long in a Sterile Processing leadership position before you get questions like these posed to you: "Do you really need a day-shift supervisor if you already have a manager there?" / "Can we just create a Lead Tech position instead of supervisor on third shift?" / "Why do you need a specialist to do your instrument ordering for you, can't the manager do that?," and on and on. In the world of Surgical Services (with admittedly critical OR-RN positions in play), the SPD list of FTEs looks mighty enticing for number crunching CFOs who are looking for cost-saving "opportunities" in your hospital. After all, we're just cleaning instruments, right? How many leaders do you need for that? Well, going back to our 747 analogy, the answer is: as many as it takes to ensure quality, service, and safety to our patients. Because, in actuality, we are not "just cleaning instruments" (but more on that in assumption #3).

The point is, there is no magic number or fool-proof organizational chart that can be used here, but the days of viewing SPD as the field from which excess positions are harvested must end. One manager by themselves can not lead a 3-shift, 24/7 department well.  Heck, one supervisor by themselves can not even lead two shifts well, without having additional support staff. Think of it this way: each set of surgical instrumentation is like a patient for us. Imagine the uproar if your hospital announced tomorrow that there would no longer be charge nurses on the patient floors for third shift. No nurse to nurse handoff from the evening to the morning. It would be a complete disaster. And that is the everyday disaster that many SPD departments are forced to overcome because their support positions were sniped away in the name of cost-savings. I need not even mention the cost of one HAI or SSI to prove this point. 

False Assumption #3: The Myth of CS/SPD Simplicity

The third common assumption that keeps facilities from providing appropriate levels of CS support staff is the myth of CS/SPD simplicity. In other words, many in healthcare leadership still don't get that we are not living in the bygone age of Sterile Processing. Our decontamination rooms are not like the dish room in the cafeteria. Our washers are not manufactured by Maytag. Our teams are not automatons and our instrumentation is not like a bulk order of simple widgets. There is hard science that goes into the chemistries of our detergents and sterilants. There are complex standard operating procedures that have to be supervised when processing small diameter bronchoscopes and delicate eye instrumentation. Data has to be managed, quality assurance programs have to be tracked, on-going education has to be coordinated, documented, and distributed. Frontline experts have to be developed. We are not flipping burgers and we're not standing on an assembly line. Because of all this, we need specialists to ensure the highest standards and the most consistent quality. We need educators. We need instrument coordinators, OR liaisons, quality assurance and database specialists. In short, because of the complexity of our age, we need support. 

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There are few challenges as widespread in our industry as the unsupported SPD leader being forced to fight the battle for quality, safety, and service by themselves. And although there are many assumptions behind such facility decisions, most of them are dangerously mistaken. If you want to have the kind of Sterile Processing department that is defined by excellence -- which, in turn, provides the safest patient care -- then it must be supported by enough CS/SPD leaders to get the quality plane off the ground. Don't believe the lies of the one-man-band, the leadership overlap, or the penny pinchers. It only takes one person to take a stand, but it takes a village to raise a department.

W. Hank Balch ? July 2016

This article is the sole opinion of the author and in no way reflects the position of any employer or facility.