OR and SPD – Why Can’t We Just Get Along?

Can any health care professional deliver effective hands-on patient care in today’s high-technology environment without the backup of countless support people? Of course, the answer is always no. The Sterile Processing Department (SPD) and the Operating Room typically depend on each more than any other departments within a hospital. However, the relationship between OR and SPD is frequently less than ideal.

All healthcare providers should have one goal and one main responsibility, which is safe and effective patient care. The surgical setting is one of the most hazardous environments for a patient. Therefore, the trust between the OR and SPD professionals is extremely important in order to deliver safe patient care. The potential risks that can contribute to unsafe practice consist mostly of human factors such as communication patterns, institutional culture and staffing patterns.

Arguably, the most common reason for unsafe patient care is the breakdown in communication among team members. Inadequate communication often occurs due to competing goals or priorities. Concerns or requests from OR staff members is often regarding one surgical case while SPD is concerned with requests and priorities regarding all surgical procedures. SPD also has other customers, such as emergency room, OB, clinics etc., with priority needs. Consequently, specific individual priorities may become a source of conflict.

Poor verbal or non-verbal communication, unclear instructions and time constraints are often a source of frustration and disagreements. Not knowing each other’s name or understanding, each other’s job responsibilities can harbor poor communications also.

Surgery expects and deserves the right instruments and supplies that are properly reprocessed at the right time every time. SPD has the responsibility to ensure those items are ready when needed. SPD needs to make sure items are processed according to the manufacturers’ written instructions for use (IFU) and best practices. They should not take any short cuts, which can happen when they are “pushed” for instruments or supplies stat. Competing goals, priorities and often misperceptions makes it very challenging for two departments who frequently do not understand or are not respectful of each other’s priorities or responsibilities.

Institution culture is sometimes at fault. Intimidating management styles, lack of knowledge of current standards and guidelines, a blaming culture and the need for constant multitasking can all lead to poor communication, improper procedures and frustration for both departments. In a blaming culture individuals are often blamed for errors when in fact it may be the culture that is to blame. If a staff member is publicly addressed regarding an error, he/she may take it as a personal failure, feel beat up, and lose the enthusiasm that helps him/her to do a good job. Instead, errors should be treated as a learning lesson so that particular mistake does not happen again. Management should not tolerate a blaming culture, but instead build a supportive one. After all, it is difficult to develop and nurture the necessary team concept when you have a blaming culture.

Poor staffing patterns, insufficient staff or incompetent staff is often an issue that can cause conflict. SPD needs to make sure they have staffing that matches the timing of the workload and eliminate possible bottlenecks. The OR is typically busy in the early morning however, instruments may not get down to SPD till late morning or early afternoon. The majority of the SPD staff should be scheduled in the middle portion of the day which is usually when the majority of the work needs to be completed. Staggered shifts, weekend coverage and a call schedule can help eliminate some of the staffing issues. Management should also ensure all staff is competent in their assigned responsibilities and they have coverage at the right time for the expected volume.

Effective team strategies must be founded on a sense of trust and a feeling of safety. We all need to feel appreciated, respected and validated. Managers, it is up to you to help your department earn trust. One very important way is to have the staff walk a “while in the others shoes”. Managers should schedule staff to work side by side or observe in each department. Getting to know the staff and their responsibility, roles and priorities can go a long way in department cohesiveness. Appointing an OR/SPD liaison who is responsible for responding to initial OR requests is another staffing idea that can help with a little communication that is more direct.

SPD is an important part of the OR team and you must work close together even though your departments may be physically separated by a long distance. Knowing and respecting the frustrations each department has can help with quality improvement processes and most importantly safer patient care.

The message here is if managers take care of their employees, their employees will take care of their customers. We are in this together and no matter what your title or roles are we have to remember it is all about safe and effective patient care.

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