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Keep the Change: Seven Steps to Hardwiring Your Sterile Processing Improvements

Change is hard, or perhaps we should say making changes well is hard. Just mixing up the status quo is easy. It doesn’t take a Ph.D. to decide to start putting “Missing” stickers on the outside of sterilization packaging and containers. It doesn’t require a lot of planning to simply tell sterile processing staff members to start prioritizing clinic instruments after 3 p.m. But how do you do these things in a way that doesn’t stress out your staff, gives space for frontline technician input, and has a chance of actually working—not only today, but also three years from now? Here are seven steps to hardwiring your department improvements in a way that can make the changes stick.

  1. Identify the issue
    This first point is self-evident. Before any changes are made, everyone on the team needs to agree on the particular issue that needs addressing. Is it that vendors are delivering their loaner trays too late to safely process for surgery? Then the specific issue is late loaner delivery, and not necessarily the entire loaner workflow. This narrows your scope and makes the rest of these steps make more sense.
  1. Find out the why behind it
    Once the issue is identified, it is important to find out the why behind it, before trying to provide any tangible solutions. For instance, if the issue is late loaner deliveries, there may be multiple different whys that have caused it, each with a totally different solution. If vendors are not being notified of surgeries in a timely manner from the surgery scheduler or doctor’s office, then that will require a different response than if they are not prioritizing delivery for their own reasons. Without the correct why, any change could miss the mark.
  1. Brainstorm an improved process or policy
    The next step is to brainstorm around the potential improvement or process change that would provide the best solution to the issue itself. This is a critical opportunity for department leaders to invite and include the input of frontline staff who are closest to the problem itself. Thinking and talking about the issue as a team not only creates a sense of ownership around the eventual solution, it can also uncover other related issues that may need to be solved at the same time.
  1. Develop education or signage necessary for the change
    After your team has agreed upon the best solution for the problem, it’s critically important to develop appropriate education around the proposed change, including any signage that may be necessary for temporary or permanent posting. This education could be a full PowerPoint presentation, a one-page slide, an illustration on a white board, or a complete in-service.
  1. Communicate to the team
    However the education is created, it must be communicated to the entire sterile processing team and your customers prior to implementation. I emphasize the entire team because this communication step is at the root of much frustration from frontline staff who feel like changes are made to various aspects of the department without their input and without their knowledge. You can imagine the stress of a third-shift technician who comes in on a regular basis, only to be told that “we don’t do it that way anymore,” but without any concrete education or communication to explain the what, why, and how behind the new change. Surprise changes are not fair to our team and not fair to our customers. Proper communication is key.
  1. Schedule a go-live date
    Connected to education and communication is the concept of scheduling a go-live date for any new department changes. Because of the large number of changes that can occur in sterile processing, from new trays to new count sheets, different chemicals, and different policies—it can be helpful to reduce the instances that these changes are implemented with your teams. If at all possible, a good rule is to schedule your go-live dates for changes at the same time you have your department staff meetings. This gives you enough time to develop adequate education and signage, and ensures you have been able to communicate with all members of your team, across all shifts, and all customers who may be impacted by the new process. The stability of go-live dates will also protect the sanity of your team members who may become overwhelmed with too many changes, too often, with no hope for keeping track of them all.
  1. Audit to sustain the change
    Finally, if you put all the time, effort, and energy into implementing a process improvement or policy change in your department, you owe it to yourself and your team to develop an audit process to ensure you sustain the change. These audits need not be time-consuming or intrusive, but they are an essential part of identifying unforeseen challenges with your proposed solutions before staff give up on the change or lose trust in the entire improvement process.

Similar to the brainstorming step, process audits should include feedback from frontline staff to provide insight into their perspective on the success or failure of the change. Audits should continue until the change has become ingrained in the department workflow and any cultural barriers have been overcome.

One of the most common reasons sterile processing changes fail is because we only do Steps 1 (Identify the issue) and 5 (Communicate to the team). We see something is not working and then we tell the people around us that we need to do it differently. This process is repeated again and again until we are surrounded by a fog of ambiguous changes that aren’t written down anywhere, haven’t been thoroughly vetted to ensure they are the best possible improvement for the situation, weren’t properly educated, were implemented on a random Thursday night, and are failing miserably.

There is a better way. It does mean that changes will take more time and thought, and it may mean communicating this to our customers who expect some changes to be made immediately, but over the long haul this will mean the difference in real progress for our departments, or continued frustration for everyone involved.

It’s worth it to take the time so that you can keep the change.

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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