By Don Sadler
Safe patient care hinges on solid and productive interdisciplinary relationships between the different departments involved in delivering care. When it comes to safe instrument processing, the operating room, sterile processing department and infection prevention department form a “patient safety trifecta” that must work together to ensure that patient safety remains the top priority.
“These are unique departments that are dependent on one another to ensure that patients receive safe and efficient care,” says Executive Leadership and Management Consultant Ruth Plotkin Shumaker, RN, BSN, CNOR. “No single department can stand alone and function well independently. Instead, they each play a critical role in sustaining a positive culture of patient safety.”
Forming a patient safety trifecta also helps standardize processes between departments. “This lowers the chance for errors, helps eliminate waste and creates optimal workflow, which leads to less fatigue and greater staff satisfaction,” says Karen deKay, MSN, RN, CNOR, CIC, senior perioperative practice specialist with the Association of periOperative Registered Nurses (AORN).
Collaboration is Key
When surveyed, perioperative leaders have identified multiple concerns that have a correlation with the operating room and the sterile processing department. Among them, says Shumaker, are communication, collaboration, cancellation rates, start times and lack of equipment.
Collaboration between departments is especially critical, says Shumaker: “This leads to better problem solving, peer learning, shared purpose and innovative ideas. Department leaders should schedule frequent joint meetings where staff can discuss issues, concerns and successes. The more everyone works together, the easier it is to form good relationships.”
Shumaker believes that many perioperative leaders don’t understand the complexity of sterile processing. “Some are fearful of what they don’t know,” she says. “Leaders should strive for a working knowledge of the areas they lead and be well informed on the latest work processes in sterile processing, as well as AAMI and AORN standards.”
Early in her career, Shumaker had an opportunity to rotate in SPD and later as a clinical nurse specialist working with ORs and SPDs across the country. “This increased and reinforced my awareness of the importance of collaboration between the OR and SPD,” she says. “However, it also showed a great divide between the two areas.”
“Unfortunately, these departments have a history where a lack of communication and understanding is prevalent,” says Shumaker. “Disrespectful behavior has flourished between the OR and SPD for years, often rationalized because of the high demands and stressful work environments. If leaders are involved in this behavior, it intensifies the divide.”
Instead, perioperative leaders should intervene early and let staff know there will be consequences to creating a hostile work environment. “There’s a clear link between adverse patient outcomes and disrespectful behavior between departments,” says Shumaker.
Another problem at many health care facilities is that the sterile processing department is physically isolated from the operating room. According to Shumaker, this physical separation can create communication problems and inhibit understanding of the critical role each department plays in patient safety.
Marjorie Wall, EDBA ABD, CRCST, CIS, CHL, CSSBB, associate director, sterile processing for the Healthcare Sterile Processing Association and the HSPA’s immediate past president, believes that open communication is critical for creating a collaborative interdisciplinary team.
“This may seem simple, but it’s often the foundation of a successful and productive team dynamic,” says Wall. “Increasing team interactions through activities like huddles and exchange programs is an excellent way to foster a culture of openness and safety. It provides team members with the opportunity to learn from one another, share experiences and gain a deeper understanding of each other’s challenges and perspectives.”
Shadowing programs whereby team members spend time in each other’s environments can be especially valuable.
“Walking a day in each other’s shoes can help break down barriers and encourage empathy and mutual respect,” says Wall. “This allows individuals to witness firsthand the complexities and nuances of different roles, which leads to a greater appreciation for the work each team member contributes to the overall process.”
Wall suggests that SPD team members reach out to infection control to see if they would be willing to do an audit of the SPD.
“These often turn educational for both SPD and infection control and can be an excellent way to start building the relationship,” she says.
Spend Time Together
As the manager of the infection prevention department at Emory University Hospital Midtown in Atlanta, Ga., Jill Holdsworth, MS, CIC, FAPIC, NREMT, CRCST, says that infection prevention team members must spend time in the sterile processing department if they want to build a better relationship with them.
“Our IP team members routinely spend time in the sterile processing department to learn from the technicians,” says Holdsworth. “Then, they come back and present an education session to the rest of the IP department. This allows the IP team to partner with SPD, as well as for SPD technicians to feel some ownership with what they do and their expertise.”
At Emory University Hospital Midtown, an interdisciplinary team looks at all initiatives for SSI prevention.
“Team members from the OR, SPD and IP who are key stakeholders are all present at this meeting,” says Holdsworth. “It’s imperative to have all these representatives together as part of a group that reviews SSIs because we all play an important role in this process.”
The team starts with a risk assessment, or gap analysis, for projects in SPD or the OR.
“We invite all parties to the table who may be involved,” says Holdsworth. “Starting with a risk assessment and working through action items together is a great way to work together, collaborate and track progress to present to senior leaders in an organized way.”
Holdsworth recommends that sterile processing department team members invite infection prevention team members to spend time in the SPD. “Sometimes it just takes an invitation to start a great relationship,” she says. “You could also ask them if they’d be willing to help teach some sessions on microbiology or infection prevention for certification preparation.”
Infection prevention team members, meanwhile, should work their way through the sterilization process alongside a technician, starting with decontamination.
“It’s also helpful for IP team members to follow an instrument set from the OR suite setup through sterilization,” says Holdsworth. “IP staff can learn a great deal from this, especially if the IFU can be pulled ahead of time.”
Shumaker suggests developing a rotation that facilitates OR and SPD staff spending time in each other’s areas. “I recommend that this be done monthly and be a part of every new employee’s orientation,” she says. “Also, joint staff meetings should be scheduled frequently to allow the departments to meet face to face and share ideas.”
“As infection preventionists, we have to learn the best ways to communicate and engage with various departments and team members,” says Holdsworth. “I have learned that email is usually not the best method to communicate with surgical areas and sterile processing because they are usually in the procedure room or department doing the work.
“Fliers and posters are sometimes effective, but they can easily get overlooked,” says Holdsworth. “Remember that one size doesn’t fit all when communicating with any particular department, so you have to figure out what works best in each situation.”
Addressing the Human Relationship Aspects
Damien Berg, BA, BS, CRCST, AAMIF, vice president of strategic initiatives for HSPA and a past president, believes that to create a more effective interdisciplinary team, one must dive deeply into the human relationship aspects of work and communication.
“Often, we miss the opportunity to create a more collaborative team relationship due to looking from one’s own point of view and what’s in it for one’s own department or career,” says Berg. “When we only look at ourselves and what we do, we will falter.”
“Instead, we must foster a proper understanding of what others do and how we can assist them,” says Berg. “Focusing on others often builds a better team and starts the collaborative approach.”
At AnMed in Anderson, South Carolina, there’s a daily huddle between the SPD supervisor and the OR charge nurse to go over the next day’s needs. “This helps make sure that everyone is working toward the same goals for the next day,” says Erin Keeney, MSN, RN, CNOR, AnMed’s director of perioperative services.
“OR staff helps out in SPD when there’s downtime while SPD staff comes and shadows in the OR,” says Keeney. “The assistant vice president of perioperative services and I have monthly town halls with the OR and SPD staff. We make rounds on the staff routinely and ensure we are managing up other areas.”
Holdsworth says that when performing rounds and education, frontline workers typically provide insight and answers you won’t usually get from leadership.
“However, to get to the point where frontline team members will trust you and talk to you, you have to spend time in the department, show interest, ask questions and become part of the team,” Holdsworth says.
Independent Healthcare Consultant Deborah L. Mack, RN, BSN, CAIP, CASC, CNOR, also recommends that the OR charge nurse meet daily with the SPD lead to make sure all the required instruments and equipment are ready for the next day’s cases.
“It’s critical to review the next day’s schedule to promote operational efficiencies,” says Mack. “If you have to borrow instrument sets and implants, make sure they arrive the day before surgery so they can be properly sterilized.”
“If the infection preventionist doesn’t have an OR background, he or she should spend time in the sterile processing department to become familiar with all the steps required to properly disinfect, clean and sterilize various instruments and equipment,” Mack adds.
Berg recommends that sterile processing department team members “go where the work is done and not be a mysterious department without a face, name or personality. SPD leaders or designated liaisons to the OR should visit the OR daily and check on the instruments before the case starts to show they are invested in the case’s success.”
DeKay agrees. “Infection prevention team members should make themselves visible in other departments and ask about their concerns and issues,” she says. “If the facility is having issues with SSIs, form an SSI prevention task force and make sure SPD team members are included.”
The Bugbusters Team
In one facility where she worked, Wall was part of a Six Sigma team called the Bugbusters that included members from infection control, sterile processing, perioperative and a physician. “The team’s goal was to shorten OR turnaround time and reduce SPD errors,” says Berg.
“We had several team meetings with representatives from all the departments to process map, root cause and conduct joint training sessions to promote learning and development,” says Wall. “Through this process, we were able to make a significant clinical impact and build a high-functioning and collaborative multidisciplinary team.”
DeKay suggests initiating a sterile processing department quality assurance project. “Collaborate with the quality department to develop a plan,” she says. “This may include a Lean Six Sigma Black Belt and robust process improvement methodology.”
“To improve processes or SSI rates, IP leaders could partner with their quality department that can help develop a project improvement plan and obtain buy-in from the OR and SPD,” deKay adds.
Get Everyone on the Same Page
Shumaker sums up the importance of collaboration between the OR, SPD and IP departments this way.
“Without everyone on the same page and working toward a common goal, things will fall apart quickly,” Shumaker says. “The settings are different but the message is the same: Working together rather than in silos creates a positive, inclusive work culture that promotes teamwork, collaboration and respect.”
Keeney acknowledges that some of these steps aren’t always easy for OR, SPD and IP team members.
“You have to step outside of your comfort zone,” she says. “Each department plays a critical role in providing excellent care for patients. Without each other, no department would work well.”
