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In Defense of Oversight:
How Better Supervision Can Guard Your High Performers and Improve Your SPD

It’s hip these days to not be a micromanager. No one likes a boss who is constantly hovering over their shoulder, making sure they cross every “t” and dot every “i,” right?

Believe it or not, close supervision in the world of sterile processing is one of the most important aspects of daily workflow management and staff development. If it’s not happening in your department, it should be.

Don’t just take my word for it. AAMI ST79 recommends that, “All preparation and sterilization activities, including decontamination, inspection, preparation, packaging, sterilization, storage, and distribution, should be supervised by competent, qualified personnel,” (4.2.1). Numerous presentations from the ECRI Institute in recent years have advocated for sterile processing departments to have “…supervision on all shifts to manage work volume and flow.”

Why all this focus on the importance of oversight regarding medical device reprocessing in a hospital setting? Why am I such a defender of the importance of oversight in your SPD? While I can’t speak for AAMI or ECRI, I have two primary reasons to believe supervision in your SPD should be powerful.

High performers have nothing to hide

With industry compensation still a major barrier to recruiting and retention in the CS/SPD space, it is more important than ever to guard high performers who are already working on your reprocessing team. Unfortunately, few things will undermine an SPD technician’s commitment to hard work quicker than unsupervised and unaccountable low performers who skirt the rules, ignore the process, and do less than their share of the daily department workload. Sure, some high-performing technicians are able to ignore these things for a while, but the day-in, day-out pressure of doing their own work, plus the work of unsupervised low performers is enough to discourage even the most committed team players.

What high performers need from their supervisors and managers (in addition to recognition and praise) is to provide oversight and accountability to those technicians who need a little more direction and productivity-centered feedback. Simply put, they need to see you (the boss) acknowledge the realities of who is killing it in regards to high-quality productivity, and identify those who still have some growing (or growing up) to do. This people managing can only happen if there are leaders present, on the floor, to see the people and actually do the management. Not only will you see the power of the Hawthorne effect on many of your low performers, but your high performers will be able to focus more on highlighting their work and less on dragging along the department anchors.

Workflows don’t just manage themselves

I have to come out and say this next point: A schedule doth not a workflow manage. Many issues regarding SPD productivity, prioritization, morale, communication, etc., come down to department confusion between creating a staffing and assignment schedule, and actually managing the daily workflow. Simply knowing that you will have six technicians coming in tonight; that Billy and Judy will be in decontamination; Suzy, Eric, Shawn, and Juanita in assembly; Arlene sterilizing; and Johnny pulling cases is not the same as coordinating the flow of instrumentation from dirty to clean to sterile as efficiently and safely as possible.

Which of those technicians are looking at the big picture for the evening? Who is making the call to put another tech in decontam for two hours to help push the priority items through the washers? Who decides that tonight Arlene is needed in assembly because she is the service line expert for orthopedics and there are three knee revisions on for tomorrow? Did anyone notice the cart wash hasn’t been unloaded for 45 minutes? While these examples are all small things, it’s these kinds of small things that actually add up to big impacts on your department’s bottom line and your quality metrics of functional, available, and sterile trays. They are almost impossible to do well without having dedicated supervision on every shift. Because workflows can’t manage themselves, SPDs need folks whose primary responsibility is to make sure the work is actually flowing.

Whether you are battling against high turnover of your high performers in SPD or trying to figure out why the work still isn’t getting done every night, the absence of qualified, engaged supervision on every shift may be a potential culprit. While there is something to be said for self-directing—self-starters who know what to do and are able to get it done—the complexity of sterile processing equipment, instruments, and general workflow makes competent supervision a necessity for the success of your entire reprocessing team. Effective retention of high performers is possible, and efficient management of daily surgical workflow is more practical when your department’s ship always has a captain at the helm.

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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