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Everything Except the Main Thing: The Crisis of Cross-Training

In the sterile processing industry, it’s often a badge of honor to be cross-trained into every area of the department.

Need someone in decontamination? Great!
It’s time to pull case carts? Awesome!
The oral maxillofacial tray is ready for assembly? No problem!

Baked into our very orientation and onboarding processes is a model of cross-training that exposes new technicians to every aspect of the sterile processing workflow to build both competency and confidence across the team. So far, so good. However, there is also a dark side to cross-training that many encounter every day, even though they may not have connected all the dots.

The staffing challenge
Over the last few years, even prior to the COVID-19 pandemic, sterile processing staffing in general has been headed toward crisis mode. Today, there is no debate—our departments are seriously short-staffed, our turnover numbers are at unsustainable levels, and there doesn’t seem to be an end in sight. In one sense, our commitment to cross-training is one of the reasons our departments have been able to hang in there for as long as they have. Losing a couple of technicians may be a hit to total productivity, but at least everyone else still knows what needs to be done each day and how to do it.

Unless, of course, we’re talking about our specialists and leadership roles. If we lose a department educator in today’s job market, the recruiting challenge is exponentially greater than it was just a few short years ago. The same is true for our quality assurance technicians, instrument coordinators, supervisors, managers, and directors. These roles, when vacated, are remaining open for longer and longer spans of time, leaving critical voids of expertise within our sterile processing teams.

These are just the gaps that we can easily see. Unfortunately, there is an even more common experience our departments are facing today which connects these two themes of specialty/leadership roles and our success at creating a thoroughly cross-trained team, and that gap is the empty office.

An empty office is hard to miss
What happens in your department when you become critically short-staffed? Who are the reinforcements that step into the workflow to ensure the trays keep churning and the cases keep rolling? Well, since all members of our sterile processing team have been cross-trained, we have the luxury of pulling in our specialists for that extra push we need to get through, at least for the short term. This means the quality assurance technician is no longer checking the sterilization logs and is now assigned to a normal shift in decontamination. Or it means our instrument coordinator is no longer updating count sheet information for our new trays and is instead picking case carts for our add-on procedures. Depending on how large the department is, the manager may step in to supplement for turnover instrumentation processing and even fill vacancies across the schedule.

As alluded to above, the ability for our cross-trained specialists and leaders to plug our staffing holes in the short term is a real, tangible benefit of this approach to department training and culture. However, when the short-term fixes become the long-term status quo, this “solution” to staffing crises actually becomes a crisis itself. The empty offices of our specialists and leaders that happen when they are working on the production floor is a telltale sign that all is not well in our departments. Although the critical instrumentation needed for next-day cases may be getting done with these additional hands on deck, there are other real, important tasks that are not getting addressed at the same time.

The myth of the working manager
Our department specialist and leadership positions were created for a reason. Staffing schedules must be made. Vision casting, recognition, and disciplinary actions must be taken for any team to thrive, inside and outside of healthcare. New instrument trays must be ordered and built by someone. Inservices must be organized, planned, and performed or they will never happen. The problem comes when we view these positions as really just elevated technicians, who ultimately are seen as potential fillers for any other member of the team who may be out on vacation or may have permanently vacated their roles during this Great Resignation that we find ourselves in.

While we all can (and do) appreciate when our team leaders jump in elbow to elbow with us to push through a crazy night of loaners and spiking case volumes, we also benefit just as much from their time spent building and maintaining the leadership structure of our departments. Unfortunately, the more these positions turned into working managers or working coordinators, the less often they are able to focus on anything except the crisis of the day. When these leaders are pulled into and become a regular part of our normal staff scheduling, there is no one else behind them getting everything else done that falls under their specialist role.

Practically, this leads to educators who feel like they never have time to actually educate (which many of them don’t). This leads to managers who feel like they never have time to actually manage (which many of them don’t). And on and on down the list. This constant mental and administrative pressure felt by these individuals in our departments cannot be understated. It’s key to understanding why so many of our leaders and specialists are succumbing to burnout and resigning at such a rapid pace.

Is it smart to have a department full of technicians, specialists, and leaders who can all step up when needed to get critical instrumentation over the processing finish line? Absolutely. Is it a sustainable model to expect these same individuals to be full-time technicians and specialists with any long-term success? Absolutely not. If hospital administrators want excellence, they will need to wake up to the reality that our department leaders need time to lead, and they need the people to do it.

What say you?


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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