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Conquering the Culture of Catastrophe: Making Changes Before It’s Too Late, part 2

It is rare for a sterile processing catastrophe to totally blindside a department or facility. There are almost always warning signs that should have been visible for weeks, months, and even years prior to the emergent eruption of the proverbial Mount St. Helens in the basement of your hospital.

Knowing how we began living inside a culture of catastrophe is only one part of the equation. What do you do once you realize the true dangers your department and your patients are in? How do you turn the ship in time to miss the incoming iceberg? Let’s take a look at two of the most important proactive measures you can take to recover a culture of safety first in your SPD.

From canaries to Paul Reveres
As discussed in part 1, frontline SPD staff often function as canaries in the coal mine, serving as the early warning signal that all is not well with the current processes and cultures in our departments. The problem with the canary model is that when these birds stop singing, leaders lose all transparency into what is actually going on—and everyone else pays the price.

A better approach to this issue is what I call the Paul Revere model of SPD staff development. Best known for his midnight ride in April 1775 to alert the colonial militia that the “British are coming!” ahead of the battles of Lexington and Concord, Paul Revere is one of the most well-known revolutionary war heroes of his time.

Here are the important characteristics of Paul Revere for our current conversation:

He knew what to watch for (the British)
Revere was not just doing his job, oblivious to any potential dangers that may be on the horizon. He knew what the British regular army looked like (redcoats), and he knew they could be arriving at any moment.

He knew what to do if he saw it (ride like heck)
Prior to looking out for the British, Revere had already been trained and was competent in how he was to respond if and when he saw what he was looking for. He didn’t ignore the invasion, or keep the fact that a bunch of redcoats were marching his direction to himself. He knew if the British came into view, he was to mount his horse and head off to warn the countryside.

Everyone else knew what to do when they heard him (ready for battle)
When the townspeople along Paul Revere’s midnight route heard his warning cries that “the British are coming!” they already knew how they were to respond. There had been months of planning put in place, many drills, and clear expectations set on everyone. While they may have been surprised to hear this warning in the middle of the night, there was no question on what they were to do next.

He did it and they listened to it.
Most importantly, Paul Revere was actually watching, he did what he was trained to do when he saw the danger, and everyone else responded accordingly. The early warning signal for catastrophe worked because everyone knew their roles and everyone pulled their weight. If any one of these things did not happen, ruin could very well have been close at hand.

How to have a department of Paul Reveres
Who wouldn’t like to have a department full of Paul Revere technicians warning of any potential dangers in your instrument reprocessing workflow? These types of frontline technicians do not fall from the sky. Department leaders should do at least three things to cultivate this type of proactive warning culture in their departments.

Hire Paul Reveres
During the interview process, ask your candidates about times when they sounded an alarm in their previous positions. Get them to describe how they knew what to look for, and how others responded to it. Have them describe examples of common shortcuts they saw that could lead to dangerous outcomes. Hire the ones who take pride in knowing what to do and are committed to doing it.

Coach Paul Reveres
For these technicians to be successful, they must be taught the specific warning signs to be looking for, be given clear expectations for how to respond quickly and professionally, and be reminded of these things on a regular basis. Because the dangers inherent to sterile processing are many and diverse, there are plenty of educational opportunities to build stronger lookouts for your team.

Reward Paul Reveres (and deal with sleeping watchmen)
Finally, when these Paul Reveres raise a concern and make a good catch, they should be rewarded, recognized, and supported. This reinforces a proactive culture and makes it the example and goal for the entire department. At the same time, technicians who are aware of issues but are taking shortcuts or intentionally accepting the risks should be held accountable. Sleeping watchmen are a danger to their coworkers and our patients.

Making the money argument: gradualism vs. catastrophism
Apart from cultivating a proactive frontline staff, the greatest challenge to overcoming an existing culture of catastrophe in facilities is finding a way to make the money argument. We all know that budgets are finite and we can’t afford to buy everything we may want. We can’t afford to go long periods of time, constantly pushing the envelope on equipment, staffing, and other resources and still, in good conscience, call it safety first. In fact, that is not safety first—it is budget first, and safety hopefully.

Fundamentally, this is a battle between two competing world-views: gradualism vs. catastrophism. Gradualism is the commitment to swim upstream toward safer, better, more efficient processes, gradually improving our departments day by day, year by year. Catastrophism, on the other hand, is assuming there is such a thing as standing still, when in fact the cultural flow of the department is being carried along with the stream toward chaos, higher costs, and potential catastrophe. Adherents to catastrophism believe that as long as nothing blew up today, it’s a good day. Gradualism invests in today so that tomorrow becomes safer.

Solution tunnel vision
The final challenge to overcome in the gradual march toward a budget-friendly, proactive culture is solution tunnel vision, the belief that there is only one solution to your potential catastrophe. This happens when leaders put all their eggs into one solution basket, betting their budget (and patient safety) that it works. This kind of tunnel vision can cause departments to wait multiple years for budget approval of big ticket items when there may have been more immediate and affordable solutions available to them. The problem here is that during the purchase window for this particular solution, surgeries are continuing and risks are remaining unmitigated. Instead of this type of tunnel vision, leaders must free up all possible answers to the challenge in front of them, and select viable options for both short-term and long-term fixes.

Sterile processing professionals must never become content with accepting potential catastrophe as a norm of department life. Frontline technicians must be cultivated and rewarded for signaling early signs of danger, and department leaders all the way up the chain must realize their teams are never merely standing still. Processes are either getting safer by the day, or more precarious. Our burden as healthcare professionals is to see the smoke on the mountain and make the necessary changes before it’s too late. We must make sterile processing catastrophe the real never event.

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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