Recently, I had a conversation with a friend and colleague about the lack of point-of-use cleaning compliance and a consistent theme we have both experienced: the attitude by end users that it’s not their job to remove gross debris during and at the conclusion of a procedure. Having extensive backgrounds in sterile processing operations, we discussed our constant dismay when we hear hospital personnel deflect accountability, especially with the awareness that patient safety may be at stake.
With professional experience at both a Level 1 Trauma Center and an academic teaching institution, this response and attitude has been consistent and isn’t isolated to one department. We all know there are many reasons that these attitudes are endemic in healthcare, yet procedural and operational changes are not the solution. As my friend and I concluded our conversation, I could only think of one prevailing reason—culture. You have probably heard the saying “culture trumps talent” and, through my experiences, I believe culture impacts everything in our industry from attrition, critical steps in the sterilization continuum, communication between departments, distribution of resources, and ultimately, patient safety.
A toxic culture in any department can make great people leave, resulting in skills gaps that sometimes catapult toxic people into management. When you mix that with a siloed environment, which is the norm in healthcare, you have nuclear fission that ultimately impacts patient safety in countless ways. When we continually see certain hospitals in the news for patient safety issues related to instrument reprocessing, I am convinced it isn’t process alone; it’s their culture. I can imagine these hospitals are still having the debate about where devices get damaged or where devices get lost when we know that this is a multifactorial problem that can only be solved by working together and focusing on a cross-departmental culture shift.
Having been a surgical assistant, I know that instruments and devices get thrown away, misplaced, and can be lost at the conclusion of the procedure, prior to it being received by the SPD. More often than not, the blame tends to be cast on the very department with zero interest in losing critical and highly expensive medical devices. I also know that the level of tracking has improved through the years and, in most cases, the data collected in the SPD is superior to the data of the departments making the accusations. This blame game and communication contributes to the negative survivor culture in the SPD, which already has lower-paid professionals. The cascading impact of this communication culture contributes to higher than normal turnover rates leading to temporary labor, which then causes internal departmental compensation-related tension. It’s hard to focus on culture when you are in crisis.
Culture also impacts the sterilization continuum, and I see this in relation to point-of-use cleaning and who is responsible for the first and critical step in this continuum. I do rounds every day and the intel I find when rounding in decon is evidence of how pervasive this is. I routinely inspect how we are receiving used medical devices from our various customers and typically see a varied degree of compliance with point-of-use cleaning. What do I mean by varied degree of compliance? My definition is broader than most because I believe there is a responsibility by the end user to make sure that used inventory is staged appropriately. When I am inspecting scopes, I’m checking to see if the scope was wiped down, flushed at the bedside, and packaged appropriately to minimize damage. When I am auditing case carts, I look to see if things are staged correctly and sprayed with enzymatic or detergent with most of the gross soil removed. What I have seen throughout my career would shock most patients and it always can be traced back to someone not doing what’s right. Patients trust all hospital employees to do what’s right, just like we trust the restaurant kitchen to prepare our food in a sanitary way. We typically don’t visit the kitchen if we want to eat at that restaurant because we trust them. The same trust is extended to us as healthcare professionals by our patients, yet I see blame and negative communication leading to a lack of collaborative responsibility. Again, culture trumps talent.
Inequitable distribution of resources in people and departments also impacts culture. How many times have we heard, “This is the way we’ve always done it” emanating from hospital professionals? We live in an era where devices are getting smaller and more complicated to reprocess and the industry needs to appropriately compensate and invest in the very people who are working to keep pace with this innovation. Healthcare innovation is not stagnant and it amazes me that we still have hospitals, surgery centers, and VA facilities lacking the resources for adequate staffing, tracking systems, equipment, training, quality-centric diagnostic equipment, and compensation. You can’t keep investing in new operating rooms without investing in SPD, which is the engine that drives your healthcare system. It’s like buying a Bugatti but telling them to put a Pinto engine in it to save money or building a house over loose soil without a bedrock. It isn’t uncommon for me to see technicians visually inspecting rigid scopes when there is the technology in the marketplace to comprehensively inspect the lenses, view angle, light transmittance, etc. This technology also provides a diagnostic report, empowering the SPD team to confidently provide a fully functional, quality product back to the physician. But lack of investment is so pervasive that we have to rely on technicians to do their best to diagnose efficiently with the naked eye.
This lack of investment also contributes greatly to staff morale, complacency, and a laissez-faire attitude. It’s imperative for sterile processing professionals to also feel that they are an investment and that administration cares about them and their critical contribution to the healthcare facility. When the culture feels good for my team, they in turn give back by going that extra mile and tenure improves. Culture can help combat high turnover rates, and when turnover rates are minimal, the ROI of retaining institutional knowledge is easy to quantify. There is nothing more valuable than a team that knows exactly how to execute their department’s goals, contributing to the facility’s mission and core values.
Without addressing culture first, we won’t keep pace with the complexities of medical device reprocessing and its growing impact on patient safety. We must invest in our people and the work culture of our institutions.
My friend and I didn’t fix the problem during our long conversation, but at minimum we started the conversation. My hope with future NewSplash contributions is to broaden the conversation and invite you in so together we can create the changes and culture that’s needed to keep our patients we serve safe.
Shawn Flynn, CRCST, CIS, CHL, has more than 27 years of combined experience as a clinician, technician, manager, director, and senior-level executive in the perioperative/SPD/tissue banking and medical device industry. As president and cofounder of a medical device manufacturing company, he led the company’s efforts in obtaining 510(k) clearance along with ISO 13485 with CAMDCAS designation.