Progressive Discipline in the SPD: When & Why?

Patient safety is the cornerstone of quality healthcare, and sterile processing (SP) technicians play a crucial role in its delivery. Every patient should expect and receive the highest standard of care, which includes the provision of properly processed medical and surgical devices. When deficiencies or errors occur, the degree of action depends on the underlying issue. For example, if the core cause is unrelated to equipment, resources, or education, behavioral or productivity issues could be to blame. In such cases, SP leaders must determine the cause of the error and devise a plan to prevent its recurrence. 

Every SP technician is a behind-the-scenes caregiver for patients. Although they may not have direct interactions with patients, their work significantly influences the quality of care provided. Therefore, they must consistently strive for excellence, acknowledging that there is no room for error when it comes to safety. But when technicians fail to meet these high professional standards, disciplinary measures are warranted. Disciplinary action typically involves a structured process that addresses behavioral and performance issues in a gradual manner. The objective is to offer employees an opportunity to rectify deficiencies and enhance their performance while ensuring they are aware of the possible outcomes and repercussions if the concerns persist.

Progressive discipline is typically a sequence of steps, although managers can take appropriate action on a case-by-case basis. Certain situations, such as an egregious or deliberate flouting of policies, procedures, and best practices, may warrant immediate termination. Still, the intent of discipline is not to terminate an employee but to mentor and strengthen their performance. Progressive discipline should be fair and structured and give employees an opportunity to address mistakes and shortcomings before they face harsher consequences.  

verbal warning is an initial step in employee discipline. It involves SP leadership communicating concerns with the employee and listening with an intent to understand. A verbal warning should clearly and concisely outline the behavior or performance that requires correction, the steps necessary to be successful, and a reasonable timeframe for the employee to be successful. SP leaders should also document the incident so they can reference it as appropriate. If the issue persists, the next step is a written warning, a formal disciplinary method. It is important to give the employee an opportunity to give their perspective about the problem to shed light on underlying issues that leaders may have overlooked. When warranted, it is also essential that the employee understands their failure to improve their behavior or performance may result in further discipline, which can include termination. Having a witness present during the meeting can be beneficial, as can gathering signatures to ensure all parties understand the issue and any determined next steps.

If unsatisfactory performance continues despite a verbal and initial written warning, a final written warning can be issued. The same process (witness, signatures, etc.) will still be in place; however, it must be stressed that this is the final opportunity for the employee to improve their behavior or performance. Suspension or termination would be the next step.

Suspension without pay can occur if there is no improvement after warnings were issued and steps were taken to correct the problem. Suspension usually precedes termination, the final resort in progressive discipline. The decision to suspend or terminate depends on the error’s severity and frequency as well as facility policy. Often, managers have the flexibility to address each situation and escalate disciplinary action according to the unique circumstances and the resulting risks.

Discipline is a necessary part of effective management. It can improve understanding and performance and help employees more clearly recognize their contributions to patient safety. Appropriate, consistent disciplinary steps also demonstrate to employees that patient safety and service quality always remain the utmost priorities.

About the Author

David Taylor

David L. Taylor, MSN, RN, CNOR is an independent hospital and ambulatory surgery center consultant and the principal of Resolute Advisory Group LLC, in San Antonio, Texas. 

About the Author

Kristina Pirollo-Ketchum | BA, AA, CHL, CRCST

Kristina Pirollo-Ketchum, BA, AA, CHL, CRCST, is a former Sterile Processing leader who currently serves as an independent consultant. 

Photo 77197506 © Korn Vitthayanukarun |
Image courtesy of Kat Velez, LeeSar Regional Service Center, Fort Myers, FL, HPN’s 2017 SPD of the Year