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Conquering the Culture of Catastrophe: Making Changes Before It’s Too Late, part 1

“Nothing will change around here until something explodes. That’s just the way things are.”

If you’ve ever said or heard things like this about your facility, you may be living in a culture of catastrophe in your sterile processing department. And you’re not alone. This kind of cultural complacency with the idea of potential catastrophe is an all-too-common reality in healthcare at large, and sterile processing in particular. Admitting we have a problem is only the first step. The root causes for the culture must be identified and concrete steps outlined for how to restore our facilities to safe places for patient care.

What it is and what it isn’t: Cultural diagnosis
Webster’s Dictionary defines culture as “the set of shared attitudes, values, goals, and practices that characterizes an institution or organization,” and catastrophe as “a momentous tragic event ranging from extreme misfortune to utter overthrow or ruin.” In our context of surgical service, these types of tragic events would be any unnecessary harm to a patient or staff member resulting in injury, suffering, or death. A helpful definition for a culture of catastrophe is “a set of shared attitudes, values, goals, and practices that accepts the potential for momentous tragic events as the status quo.”

There is an important distinction between outright catastrophe (such as a superbug outbreak, cross-contamination of arthroscopic shavers, or laparoscopic organ burns due to compromised insulation) and cultures of catastrophes that accept the potential for these events as part and parcel of the sterile processing industry. Departments don’t have to look like an emergency room at midnight on Friday the 13th to have serious problems brewing just below the surface.

How do departments accept these cultures of catastrophe?
No sterile processing professional wakes up in the morning intending to hurt their patients, co-workers, or themselves, but the pressures of a poor culture that accepts potential risk on a daily basis is a powerful force to contend with. Typically, departments end up here in one of two ways.

They bring the culture on themselves
By this, I’m not talking about the folks who thrive on hustle and bustle, who get energized by solving stressful situations, and who see it as their spiritual gift to talk that frustrated cardiac surgeon off the cliff for the second time in one week. Instead, these are the departments and leaders who have accepted and adopted the culture of catastrophe as their own—making peace with potential catastrophe becoming the status quo. Perhaps it scared them at the beginning. Maybe they gave it some attention every three years as they prepped for a Joint Commission survey. But for the most part, they became comfortable walking around the base of an active volcano telling themselves, “Well, it hasn’t blown yet!”

The culture is thrust upon them
Whether or not the first scenario is true of, the second scenario is almost always true for facilities living in the midst of cultures of catastrophe. In this instance, the culture of catastrophe was thrust upon the department and leader. They were not the ones who designed the department, they did not choose the poor-quality equipment, they have not been allowed to hire as many technicians as they think they really need, and on and on. To use the analogy from scenario one, these departments are chained to the base of an active volcano and told to keep the lid on it as long as possible.

However it happens, once these cultures are in place and accepted as the norm for department life, risk for catastrophe is at an all-time high.

Seeing through the smoke to the causes
To rescue a department from the clutches of catastrophe, the root causes and main drivers behind the attitudes and values of all levels of the team must be evaluated. Here a few of the most common, though not the only, factors that can contribute to this dangerous complacency:

Frontline staff become silent
Frontline staff can stop communicating for all kinds of reasons, including fear, feelings of futility, ignorance, or becoming mentally checked out. When staff members stop taking their concerns up the line, leaders lose all transparency into processing issues, shortcuts, and workarounds that could be fueling a potential catastrophe. When eyes stop seeing and ears stop listening, there is little warning that danger may be close at hand.

Managers suffer from catastrophe fatigue
Potential catastrophes don’t often happen in isolation. It’s usually not the case that no one ever read the instructions for use for the ultrasonic cleaner, so it was never tested. A normal day for CS managers is that they just found out about the ultrasonic IFU thing, they’ve had six technicians quit over the last three months, HR just posted the jobs, and a new surgeon is starting next week. While these things are not all catastrophes themselves, these kinds of events tend to fan the flame of potential danger so that every new event feels like a catastrophe. As the saying goes, when everything is a catastrophe, nothing is a catastrophe. In the same way nursing units struggle with alarm fatigue, the OR/SPD encounters catastrophe fatigue, where folks stop responding to events and start coping instead. This tends to hit supervisors and managers the hardest.

Administrators are responding to insufficient information
If administrators are aware of the potential dangers in their SPDs, the response is often inadequately due to insufficient information about the dangers themselves. They appear to be gambling with their surgical outcomes, but too often they are betting on bad information, like trying to count cards without knowing how many cards are in the deck. They may hear about an SPD issue, require certain changes, follow up with particular leaders, and assume that things are under control. Here’s an example of what that can look like:

  • Your facility lost three SPD technicians over a three-month period. Your administrator knows this and says she will approve replacing them as soon as you get your productivity metric back up. This sounds like a decent bet.
  • What the administrator doesn’t know is the three technicians who left had a combined department experience of 75 years, cutting your total department experience in half overnight. Obviously, this is a bad bet.

Wherever the starting point and whatever the causes, these cultures of catastrophe must be changed. But what does that look like? How do we pick up our departments and move them out of range of Mount St. Helens before it blows? We will discuss these and other answers in the next installment of The Front Line.

Feature articles exclusively for Ultra Clean Systems by Weston “Hank” Balch, BS, MDiv, CRCST, CER, CIS, CHL

Weapon of Mass Microbial Destruction * Professional Clean Freak * Podcast Host * Safety Addict * CS/SPD Consultant

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