By David Taylor III, MSN, RN, CNOR
Health care leaders who fail to proactively communicate or share decision-making as it relates to sterile processing (SP) operations can lead to culture of divisiveness, lack of trust and a loss of confidence in SP processes. Communication failure is the leading cause of sentinel events in the operation room (OR).1-2 Improving interprofessional collaboration (IPC) and communication can be an essential element to successfully meet quality and safety goals in the perioperative setting.3-4
Health care organizations must continuously focus on improving their SP and OR processes to improve quality, efficiency, customer satisfaction (surgeon, OR staff), and patient care and safety. Specifically, they must recognize the safety, quality, efficiency and satisfaction implications associated with insufficient SP-OR collaboration. Many SPDs are struggling with workforce shortages, which makes it more difficult to safely keep up with customer demand and define and gather key performance indicators that drive quality improvement projects. They may also lack the bandwidth and expertise to prevent procedural delays by proactively addressing workflow issues, bioburden, instrument damage and other issues that are a shared responsibility of the SPD and OR.
Addressing each of these issues hinges on a strong interdisciplinary relationship and someone taking on the role as a champion to help foster work environments and practices that ensure process consistency, quality and enhanced accountability. Interprofessional collaboration (IPC) requires a collaborative relationship between all members of the surgical team (surgeon, nurse, surgical technician, and representation from the SPD). It is important that these team members work together to improve communication and facilitate teamwork to reduce medical errors that contribute to patient harm. Strategies should include improving interdepartmental communication and fostering positive working relationships to ensure compliance with institutional and departmental policies.
Power of service-line coordinators
Service-line coordinators are registered nurses (RN) who are considered subject matter experts (SME) in one or more surgical specialties. They are generally responsible for leading, assessing, planning, delivering, managing, operating, controlling, coordinating and evaluating all facets of nursing practice within their service line. This includes improving safety and care coordination with the SPD. A good service line coordinator effectively meets the full spectrum of operational effectiveness and is perfect for the role of SPD-OR champion. An experienced SP professional or manager can serve as a champion as well – or a facility may opt to designate one champion from each department who work together toward improving teamwork and understanding.
Ideally, a surgical champion will:
- Be familiar with and have knowledge of various aspects of the SPD and OR
- Lead by example and demonstrating an interest in a range of viewpoints
- Be flexible and controlled in the face of stress
- Be collegial and well respected by others, and share knowledge generously with others to support process change
- Maintain a wide peer and social network and have keen insight into how colleagues interact with each other
- Advocate for issues while being respectful of other viewpoints.
Cultivating the relationship
The SPD is a critical component of surgical services and has a direct impact on operational effectiveness, financial management and patient safety; therefore, improving collaboration between the SPD and OR is vital. To fully understand each department’s perspective, it is essential to build a multidisciplinary team with expertise – those who do the jobs every day and possess the knowledge and skills to address challenging operational problems. Begin by creating joint ownership and bringing awareness and joint ownership. Breaking down silos is important but to begin redesigning workflows and new processes, it is necessary to first address the human and sociological components.
This can be done by:
- Building camaraderie and improving communication across teams and departments by engaging in peer-to-peer discussions (CSPD, surgical and procedural areas)
- Boosting confidence, teamwork and awareness
- Addressing instrument set delivery challenges (inventory shortcomings, mixing of instruments, point-of-use treatment practices, storage, maintenance and repair, preference cards and pick lists)
- Assessing and refining SPD and OR processes to increase cross-functional team efficiencies and communication
- Performing huddles and rounding in each other’s departments. A low-cost, high-impact approach is to schedule individual and small group tours that provide an overview of the inner workings of both departments and how processes may affect each department’s practices and outcomes. If the OR fails to do point-of-use treatment or mixes multiple sets together when they are returned to the SPD, for example, they only create unnecessary delays for themselves. Witnessing the problem firsthand puts things into perspective and creates a valuable teaching moment for all individuals. Conversely, it is important for SP technicians to witness their work firsthand and understand how one missing or contaminated instrument can disrupt the flow and place patients at risk.
Conclusion
Shared decision-making and improved collaboration between the SPD and OR teams create opportunities for meaningful process and performance improvement, which can further drive improved outcomes, teamwork and respect.
References
- https://link.springer.com/article/10.1186/1754-9493-5-13
- https://www.researchgate.net/profile/Nejla-Canbulat-Sahiner/publication/316350729_Physicians’_and_nurses’_medical_errors_associated_with_communication_failures/links/59e47660a6fdcc7154e10f79/Physicians-and-nurses-medical-errors-associated-with-communication-failures.pdf
- https://www.tandfonline.com/doi/full/10.3109/13561820.2015.1111052
- https://www.basw.co.uk/system/files/resources/basw_111606-7_0.pdf
