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Specialization on Steroids: Creating & Paying for Real Expertise in Sterile Processing

Have you ever seen a flight attendant step into the cockpit to land a plane? When was the last time you witnessed a pilot go outside to load passenger luggage and refill the peanut stash? To bring things a little closer to home, how often do you see an anesthesiologist perform a laparoscopic appendectomy? These things do not happen (unless it’s a catastrophic emergency) because these industries—airlines and surgery—understand the importance of specialization. It is assumed that individuals in these roles will focus on their specific job responsibilities and operate as critical team members within their particular specialties. Brain surgeons don’t typically perform C-sections, and orthopods don’t often get called in for pediatric heart procedures.

When we turn our gaze to sterile processing, we throw the idea of specialization out of the window. We expect our technicians to be just as competent in the decontamination and cleaning of medical devices as they are in identifying, inspecting, and assembling them. We put a premium on cross-training, while paying lip service (and low rates) for any type of true specialization in our field. Technicians who may be great at reading preference cards and picking case carts are rated as mediocre because they struggle to keep up with the various documentation points required during the sterilization phase. But what if we approached this from a different angle?

An expert for every role
Consider this: Instead of having a department full of staff who are better at certain things than others, but all have to rotate around to different jobs, you could create separate positions for each area of your department that look something like this:

  • Decontamination Specialist – responsible for the intake and processing of all contaminated instrumentation, cleaning, and loading of automated equipment.
  • Assembly Specialist – responsible for unloading of instrumentation, inspection, assembly, and packaging of medical devices.
  • Sterilization Specialist – responsible for loading and unloading of autoclaves, required testing and documentation, and required maintenance of units.
  • Distribution Specialist – responsible for stock of sterile storage areas, picking of surgical case carts, and distribution of trays as needed by the operating room and other customers.

These specialized roles would come with a number of advantages to the sterile processing team. First, with specialization comes the ability to develop true expertise to a level that is nearly unattainable for individuals who are cross-trained on many roles at once. Someone who does the same job every day comes to learn the intricacies of their role, equipment, and process at a far greater level than someone who happens to work in that assignment only a couple of times per month. Second, consistency in these areas gives both the staff and department leader the ability to measure actual productivity, trends, and impacts of process changes in a way that is nearly impossible with constant shuffle of staff that occurs under typical staffing models. How do you measure the speed of an assembly technician against the output of a decontamination worker? You can’t. And that’s one of the problems with the lack of specialization among our SPD teams.

Financial incentives for real expertise
The specialization model would then replace the traditional sterile processing career ladder of Tech I, II, III, etc. Instead of being based on seniority or general knowledge, each specialty would carry its own pay rate based on the complexity involved in the position and the ability to recruit and maintain high-quality staff in those roles.

Assuming your average hourly rate was $18.00 an hour, this specialization model would breakdown to something like this:

  • Decontamination Specialist – $22.00/hour
  • Assembly Specialist – $20.00/hour
  • Sterilization Specialist – $16.00/hour
  • Distribution Specialist – $14.00/hour

I realize these differences may be shocking to an industry that has historically started everyone at the same rate and only given incentives for total experience or possibly certification, but this kind of pay model is completely normal in countless other industries. Instead of fighting the decontamination war with technicians who hate working in there and aren’t very productive even when they do, this model would give department leaders the tools to recruit for those unique souls who prefer to work all day in PPE and look forward to the soundtrack of humming ultrasonic cleaners. It would also incentivize your high-performing assembly technicians to dig into every aspect of surgical instrument knowledge, including identification, substitutions, functionality testing, and tray assembly.

Roles that require less initial training and reduced risk, such as distribution and sterilization, could be staffed by personnel who prefer to be able to move around throughout their workday and enjoy communicating with customers in the operating room and clinics. While just as important as the other team members, these roles are typically easier to recruit for and have the perks of rarely being exposed to contaminated instruments or sharps.

On specialization and certification
The implication of this concept would have a dramatic impact on our certifications and training, as well. If there were such a thing as a decontamination specialist, then it would make sense to have a certification or training program that centers around cleaning concepts, automated reprocessing equipment, chemicals, water quality, etc. Likewise, sterilization specialists would be able to focus their training on the science behind steam and low-temperature sterilization, material compatibility, sterility assurance procedures, and the like. Simply put, we would finally be able to cultivate real, tangible expertise in these areas. Instead of teams that know a little about a lot (or just enough to gain a general entry-level certification), our technicians could pursue knowing everything possible about their primary specialization, and establish themselves as subject matter experts in those particular niches.

Admittedly, this perspective on specialization in sterile processing has its own unique challenges and would only work in facilities that are large enough to support it. But the important point is that it can, indeed, work. It may very well work better than traditional models that are in place—both for frontline staff and the managers who are leading them—to allow us more flexibility in developing the skills of our staff, and more financial resources to properly incentivize them.

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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