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Present & Accounted For: Building a Department Culture Where Showing Up Matters

One of the first warning signs of a department culture going under is when people stop showing up. There can be a lot of different reasons for why this happens and how sterile processing departments get to this point, but it doesn’t take a rocket scientist to figure out the impact that systemic tardies, regular no-shows, and disappearing acts have on team dynamics and quality in general. First, let’s take a look at the warning signs themselves, then we’ll discuss a few insights for how to create a place where technicians actually want to show up on time, nearly every time.

Better late than never, right?
Many, if not all, hospitals have tardy policies that give a short grace period for employees to make it into work after their appointed time without technically being documented as tardy. Some of my facilities have had as long as seven minutes past a shift start time to clock in without penalty. The background for these kinds of policies makes total sense. Are we really going to bicker about someone running two minutes late after getting through rush hour traffic, down six floors of a parking garage, changed into scrubs, and into the front door? We are working with adults after all; there shouldn’t be a real need to micromanage down to the second.

A warning sign in this area, however, pops up when an employee or employees consistently arrive in the department after their appointed start time but prior to the end of the facility grace period. While there is nothing technically wrong with this scenario, it does signal that something culturally or logistically is not lining up with your department atmosphere. If the shift start time is seen as an option, and the end of the tardy grace period is seen as the real start time, then leaders and co-workers are handcuffed in a way that they cannot begin their shift handoffs until after the grace period ends, wasting valuable time standing around waiting for everyone to finally get in place. Regardless of the good or bad reasons for the late arrivals, the results still send up red flags that should be addressed.

No-Show Jones and the shift scramble
A second warning sign even more obvious than systemic tardies are regular no-shows in your sterile processing department. Depending on how your department or facility defines a true no-show, there may or may not be penalties for staff members who simply do not arrive for a scheduled shift. Oversleeping, family emergencies, and schedule mistakes are just a few examples of the reasons a no-show may occur, but the result is still the same—a last-minute scramble to fill the slot, or an unfortunate short staff for the day. Neither is an option that department leaders or co-workers look forward to.

While some of these no-shows can’t be avoided and have real, valid excuses, the point of this section is to focus on those situations where team members begin leaving each other hanging on nights, weekends, and holidays on a regular basis. Whether it’s that one PRN who is really struggling to make their schedule or starting to notice a trend around last-minute, full-time staffing adjustments on major holidays, these things should cause your team to take a step back and start asking why the no-shows are happening, and what you can do about it.

Department David Copperfields
The last warning sign we’ll address is the issue of disappearing technicians, which I’ll call “department David Copperfields.” These are employees who are physically on site and on time, but have a way of vanishing at various times throughout the day, often leaving their teammates to pick up the slack in production. Typically, these situations can be handled on an individual basis, but when the behavior spreads to multiple members of the team, the impact on total workflow and customer service can be quite drastic.

The problem of disappearing technicians can become more complex when there are multiple areas and duties that require staff to leave the department to make deliveries, pick up instruments, or provide other clinical support. When a five-minute trip consistently turns into a thirty-minute adventure for multiple technicians, then you know that you have a problematic situation on your hands.

Here and happy
So yeah, there are a lot of reasons why sterile processing technicians may be strolling in late, hardly staying around, or not showing up at all. To address these warning signs, leaders and teammates should be willing to transparently confront the challenges through two primary means: logistical and cultural.

On the logistical front, we must first assume good intent on the part of our staff. If Johnny is constantly late for his first-shift job, perhaps we need to consider moving him to a shift that he can arrive on time for. Or, maybe no one has ever sat Johnny down in the office and explained to him the impact of keeping the entire department waiting around for seven minutes while he leisurely gets his scrubs on during his grace period. The same is true for no-shows and disappearing acts. First, find out the facts and address any structural logistics that may be making it harder for the team to meet these requirements. We owe this to our teams.

The cultural piece of being present in the SPD is undoubtedly the most important. Departments that struggle in the areas mentioned above will need ample examples and encouragement, not just education around attendance policies to change the underlying culture. Most employees know the policies, but if they can’t see or haven’t felt the real purpose behind these rules, it may feel like their actions hurt “the man,” when in fact they are hurting their own teammates. Ultimately, it is up to leaders to make the case for why timeliness should be a cultural value for the team, and set clear expectations for how and why we need to make it a continual goal.

We can’t care for patients when we’re not there for our team. 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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