Collaboration crucial for CS/OR success

by Julie E. Williamson

Surgical services professionals rely heavily on the Central Service department to provide them with properly processed, well-functioning and expeditiously delivered instruments — and those in CS know that fulfilling those needs is anything but easy.

The degree of discipline, commitment and responsibility each CS professional must bear to meet the many needs of the OR is tremendous. Compounding the challenge further, CS professionals must also shoulder the weight of meeting ongoing needs and requests from other hospital departments, as well.

CS departments are bustling, high-pressure environments. Technicians methodically perform their critical tasks in an assembly-line-type manner to ensure that patient care equipment is properly decontaminated, surgical instruments are cleaned and sterilized, and sterile supplies are dispensed, delivered, and safely stored. CS technicians may not serve as frontline caregivers, but they are undoubtedly a vital contributor to infection prevention and positive surgical outcomes. Despite CS’s critical importance, however, the department and the many hard-working professionals who comprise it often don’t get the acknowledgement and respect they deserve — including from those they serve in the OR.

It’s a topic near and dear to Deborah Spratt, MPA, BSN, RN, CNOR, NEA-BC, CRCST, 2012-2013 President for the Association of periOperative Registered Nurses. Spratt, who currently serves as chief of sterile processing at the Canandaigua VAMC in Canandaigua, NY, addressed the topic of CS/OR collaboration during her educational session at the 2013 IAHCSMM Annual Conference in May.

"I’ve been in the OR for 40 years. When I tell you the OR doesn’t always play nice in the sandbox, I speak from experience," she told a roomful of attendees.

Bridging the gaps

The actions that take place in CS have a very real and significant impact on patient safety. As Spratt explained, interdisciplinary collaboration between CS and the OR goes a long way toward establishing a culture of worker safety, trust and productive team-building. Unfortunately, the "OR hierarchy" can get in the way of teamwork, she reasoned, adding that this can devolve into a trickle-down effect whereby surgeons yell at nurses and nurses then take their frustrations out on CS.

"We need to understand that we’re all there for the same reasons, which is to provide the best patient care and outcomes." She stressed that effective CS/OR teamwork will help promote an environment that respects each department’s unique expertise, capabilities, needs and limitations, while avoiding a culture that passes blame and pushes for unrealistic expectations.

The pressures CS professionals face are many, and must be expertly balanced with the demands of the OR and consistent, to-the-letter adherence to best practice standards. Although technicians themselves are often up against the clock and faced with requests to turn around instruments quickly, it’s their responsibility to ensure that shortcuts don’t happen and that the quality of the devices they process and deliver is never compromised. "Staff should not be throwing anyone under the bus when it comes to speaking up on what is right and what is a realistic schedule," Spratt noted.

Interdepartmental teambuilding delivers many perks, not the least of which includes better quality, products and service. What’s more, effective teams result in better staff education and training, and the ability to attract and maintain the best people for the job, according to Spratt.

Effective teamwork can be easily stalled with ineffective communication. Spratt outlined a number of common communication pitfalls, including advice-giving, making others feel as though they don’t know what they’re doing, and being defensive or judgmental. Her tips for success include keeping conversations casual with each interaction, and sharing thoughts and feelings in a self-revealing way ("I feel…"), as opposed to passing blame. Acknowledgement and praise for the other person also facilitates effective team-building and collaboration, she noted, as does taking responsibility for one’s own contributions to a problem.

"We must suspend judgment, be sensitive and patient, and pay attention, listening between the lines," Spratt explained, adding that actively listening means we must slow down, seek data and try not to interrupt. "To be understood, we must first understand."

This is particularly vital in the realm of CS and OR — two departments with very different roles and responsibilities, but which nonetheless share the same goal, which is to provide the very best service to promote patient care quality. The more each side understands the roles and challenges of the other, the more realistic the requests and the better the outcomes will ultimately be. "We need to put ourselves in other people’s shoes," she noted. CS and OR liaisons that can educate their teammates in the other department is one strategy that many facilities have found effective, as is engaging in team training activities with wide representation from both CS and the OR.

Elevating professionalism and promoting strong ethics through ongoing education and certification is another sure-fire way to improve collaboration, trust and respect across the disciplines. "Certification validates professional credibility and competency," confirmed Spratt.

"If we’re going to elevate ourselves as the professionals we are, we need a mark. Certification helps serve as that mark because it requires lifelong learning. And with that comes a culture of safety."