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Breaking the Silence in Sterile Processing

Have you ever felt like no one hears you? Do you have concerns and you try to speak up, but you just get shut down? One of the most dangerous things that can happen in a sterile processing department is when team members do not have a voice. Sterile processing departments are high-pressure, busy departments. They are also high risk for errors and mistakes occurring. When errors and mistakes happen, they lead to employee injury or patient harm. Sterile processing team members need to have a voice to share their thoughts, concerns, and ideas. 

Impact of hierarchical structure
Unfortunately, the healthcare industry continues to have a solidly self-reinforcing hierarchical structure. Doctors, nurses, and techs all align to their assigned place in the pecking order. Sterile processing techs are at the bottom. Many departments have rigid structures where management makes the decisions and staff take orders. Even in departments where management is more participative, there is a pecking order between the long-term team members and the newbies who just started. This hierarchy leads to employee silence. SPD techs do not feel comfortable or safe to speak up and share their concerns. They hold onto their ideas instead of risking ridicule. Or worse, they speak up and share, only to get put back in their place. This process leads to disenchantment, disengagement, and often talented teammates leaving the organization.

Teams need to break away from the pecking order mentality and see each other as the technical experts that they are. The only way we will have a voice as an industry is if we can build the foundation with a voice in our departments. Let us truly hear each other.

What voice is and what voice is not
Voice is being able to speak up and be heard. It is not speaking over everyone to make sure your voice is the loudest or that your point gets across.

Employee voice is when team members can express their ideas, concerns, and perspectives without fear of social or workplace consequences. Voice means team members can help make decisions through feedback to their team members and leadership. 

Imagine department huddles where team members share experiences and ideas for the daily challenges and improvement initiatives. Dr. Debakey always uses this retractor; we should see if we can add it to his tray. We are always turning over the thyroid tray. Maybe we can change the OR schedule or purchase an additional tray? Or maybe we can pull these peel packs with a minor tray, then it is the same as a thyroid tray. I have not cleaned a ureteroscope in a while. Can a preceptor retrain me? I want to make sure I process it right. Imagine feeling safe speaking up and being able to hear your co-worker’s thoughts and ideas. That is a sterile processing department I want to work in!

Building a sterile processing department with voice
To build a sterile processing team with a healthy voice, it needs to start from the ground up.  Leadership needs to be visible and engaging in the department. They need to connect and speak with the team members to understand how the department is operating. What are today’s turnovers? Is there equipment down? Do you have everything you need to do your job? What ideas do you have for improving our department? Monthly staff meetings are not enough to cut it. Leaders need to be with their teams for the day-to-day challenges. They need to be available to hear their teams when they struggle. Leaders need to be present, accessible, and transparent. 

Leaders should communicate more—overcommunicate. Leaders should be transparent with communication. Keep teams in the loop; it builds trust and keeps everyone working toward the same goal. When team members are not given transparency and they feel unheard, they will not have empowerment to contribute. They may have valuable critical-to-mission ideas but not feel confident to speak up. When employees feel heard, they are more likely to feel empowered to do their best work.

Open door policies do not work. As a leader, it is not enough to be in the office waiting on team members to come with their problems. Leaders need to find a way to engage employees for their feedback in real time, and often. This could be surveys or employee rounding. It could also be huddles where team members are given a chance to speak up. If someone is quiet in the huddle, that is a great opportunity to have a sidebar with them to see if everything is okay. Bottom line, put scrubs on and be accessible in the department. Be there with the team.

Active listening is critical to voices being heard. How can you be heard if no one is actively listening? To actively listen, pay attention, withhold judgement, reflect on what was said, ask clarifying questions, summarize, and share. Have authentic empathy to what was said, even when in disagreement. When team members speak up, it’s important for leaders to follow through with action. That does not mean that every idea is implemented. It does mean every idea is heard with an open mind, given authentic consideration, and responded to appropriately. Sometimes that means explaining the dynamics behind why it will take time to replace a washer, as an example. The explanation and education can be meaningful to help the team member understand the situation and their idea or concern better.

Breaking the silence barrier is not easy, but it is worth it. Change is not easy. False starts and dead ends will happen. Be resilient, lean in, and try again. SPD technicians are worth getting to know and hearing their voices. SPD techs have important things to say. Speak up!


Marjorie Wall is a director of sterile processing at Kaiser Permanente and IAHCSMM board of directors member. As a sterile processing leader with over 20 years of industry experience, Marjorie pushes the boundaries for change and innovation in her organization and in the industry. Marjorie built her career turning around underperforming departments and is now an industry change driver as a writer and keynote speaker.

Marjorie has achieved a masters of organizational leadership from Azusa Pacific University, CRCST, CIS, and CHL certifications from IAHCSMM, and Six Sigma Black Belt Certification from the American Society for Quality. Marjorie has personally developed 12 frontline staff into SPD leaders and 13 SPD techs into Six Sigma Yellow Belts. 

Marjorie Wall’s life philosophy is, “Sometimes you have to take a leap and build your wings on the way down.” We have to be willing to change and improve through the toughest challenges. We have to lead SPD.

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