The Source | June 18, 2019

Advice from the Field

 CSPD professionals must pay attention to detail and be excellent communicators. These skills need to be developed by attending educational seminars and networking with other CSPD professionals to include CS Technicians, Managers, and vendors.

Lamont, NY

Director, Central Sterile

Conflict Management: How It Improves Culture

Author:  Derek A. Murray | Director of Professional Services

If anything is inevitable in an SPD, it’s conflict. The SPD exists to serve other departments. Its functions profoundly impact the work of other departments, and the work of other departments profoundly impact the SPD. This makes the SPD a striking point of conflict.

Pile on top of that the need for SPD managers to initiate change within their departments—and to proactively advocate for that change to administrators and affected departments—and conflict is nothing short of guaranteed.

Is Conflict Bad?

It’s easy to hear “conflict” and immediately think of knights storming a castle or an argument on the street that turns ugly, but conflict does not have to spell destruction. In fact, if a conflict is managed well, it can serve as an opportunity to improve on processes and relationships that may have otherwise remained inefficient and dysfunctional.

According to an article in Radiology Management, “Conflict provides employees with critical feedback on how things are going. When viewed in a positive context, even personality conflicts may provide information to the healthcare manager about what is not working in the organization.”

Let’s say a conflict arises between the OR and the SPD because, according to the OR, certain surgical instruments aren’t being reprocessed in time for scheduled operations and, according to the SPD, those same instruments aren’t being returned to the SPD with enough time to properly reprocess them. When the conflict is first expressed, it may be by staffers complaining that the other department staff “aren’t doing their job.” But if you take the time to hear both sides, learn the facts of the situation, and trace the process from beginning to end, you may find that there’s actually an instrument shortage, the OR staff change shifts at the exact time they are supposed to return the instruments to the SPD—or another part of the system isn’t set up to operate efficiently.

If you see conflict as inherently harmful, you wouldn’t identify any of these problems because rather than addressing complaints head-on, you’d avoid them altogether.

What Is Conflict Management?

Conflict management is a skill of approaching clashes between people, groups, or priorities, in a way that seeks the most optimal outcomes. Sometimes, this means resolving the conflict (i.e., bringing it to a peaceful end); other times, it means recognizing that the particular conflict won’t go away but there are ways to work around or through it.

There are five typical approaches to conflict management—and all of them have an appropriate time and place:

  • Competing: Also referred to as “forcing,” this is the “my way or the highway” approach that calls everyone to jump onboard with the proclaimed solution. This approach should be used sparingly, if possible, and mainly in situations that require quick action or involve issues of legal compliance or safety. This is where the manager puts his foot down and calls the shots.
  • Accommodating: Think of this as making room for others. This approach to managing conflict is appropriate for differences of approach or opinion that do not jeopardize departmental compliance or the safety of patients or staff.
  • Avoiding: Not everything is worth a confrontation, so choose your battles wisely. Avoiding is appropriate for small annoyances that come up between clashing personalities; they don’t necessarily impact the quality of the work, so let them be.
  • Compromising: When both parties have competing priorities—some of which are necessary and some of which are unnecessary—it’s time to find a way to meet in the middle. For example, if the OR and SPD from our example earlier have found an issue in OR staff scheduling and SPD staff breaks, a compromise might have the managers shifting OR staff schedules and establishing tighter rules around when SPD staff can take their breaks. Each department will have to give something up in order to get what they need to achieve their goals.
  • Collaborating: When all parties’ needs are equally important, collaboration is the appropriate way to manage the conflict. Bring every vested department into the discussion to share ideas and concerns, and work toward a solution that serves everyone.


Why Conflict Management Matters

Good conflict management takes the time to get to the root cause of conflict. If the reason staffers aren’t getting along is because it’s unclear who has jurisdiction over what, the solution can be as simple as defining responsibilities. If departments are butting heads because their goals don’t line up, it might be time to take the problem to upper management.

According to a research article in Clinics in Colon and Rectal Surgery, these are the common causes of conflict:

  • Lack of clear expectations
  • Poor communication
  • Lack of clear jurisdiction
  • Personality differences
  • Conflicts of interest
  • Changes within the organization

Identifying the root cause enables staff to understand and depersonalize conflicts. SPD staff can step back from the ongoing conflict with the OR and see a simple process problem, as opposed to absent-mindedness or a lack of work ethic.

Without good conflict management, conflict can cause (or exacerbate) team dysfunction, decrease patient satisfaction, or increase employee turnover. Good conflict can do the opposite: “training in conflict resolution skills can result in improved teamwork, productivity, and patient and employee satisfaction,” while decreasing stress, improving processes, and multiplying cross-departmental understanding and collaboration.

If a conflict is seen as an opportunity for improvement—and not a soul-sucking inevitability that only impedes the work of your department—managing conflict and its outcomes become an exciting part of each day’s work.

CtUC 2019: What's the Difference Between Pricing?

This year we have two options for registration: Standard and Bundled.   

Standard only covers the conference registration. Bundled pricing is new this year and covers your hotel stay at the Gaylord Opryland Resort & Convention Center, ground transportation, and provides a meal package during your stay.

Registration Pricing

Bundle pricing includes all ground transportation (to/from airport, and offsite events), meals, breaks, and beverages starting at 12:00 PM on Sunday to 4:00 PM on Tuesday, # Nights at the Gaylord Opryland Resort and discounted event registration.

Topics covered include team leadership, loaner management, and more.  There will be four workshops offered, you are limited to one class per block period offered during the conference.

Lean In: A Three-Part Series

In this series of three articles, Rachel Mandel, MD, MHA (OPS) and Marlin D. Minnis, Director of Strategic Initiatives will lay bare some of the common challenges that negatively impact the provision of quality SPD services and patient safety, as well as the benefits of Lean interventions in removing the barriers to process improvement.  We will not only discuss the obstacles themselves, but present them from the perspectives of SPD Leaders, OR Leaders, and Healthcare Senior Leadership.  This team approach is crucial to the success of any Lean engagement that will not only improve and streamline SPD but sustain those improvements over time.

Lean In: Clinical Challenges

Author: Rachel Mandel, M.D., MHA

The primary mission of a healthcare organization is to care for people.  Patients undergoing procedures and surgeries in an operating room suite expect that the entire team will do whatever is necessary to provide excellent quality care and keep them from harm.  Although the patients and families may not think specifically about the Sterile Processing Department (SPD) and its role in their care, they are dependent upon SPD to provide sterile, safe and functional instruments and supplies. 

A well-functioning SPD is a key to achieving positive clinical outcomes. It is the management’s responsibility to provide the team with the resources it requires to do their jobs well.  Each leader has their own perspectives, overviews, and concerns when it comes to the challenges that hinder the ability of the team to operate and sustain an outstanding Sterile Processing Department and culture.

SPD Leadership

Improper routine maintenance of instrumentation It is difficult to maintain a ready inventory when there is improper maintenance of instrumentation. In addition to not providing a fully functional instrument to the operative field, a poorly maintained instrument is at risk of failure and/or breakage. No one wants an inferior clinical outcome or retained foreign body as a result of instrument failure or unavailability.  

Inaccurate sterilization methods or records - When there is a concern regarding post procedure infections or complications, it is critical to be able to trace a specific instrument and it’s handling back to a specific patient, time and date. The inability to trace an instrument’s life cycle is an obstruction to process improvement and increases patient risk.  It is a patient safety issue.

Inability to locate recalled items - There is a regular and consistent stream of notices and recalls that impact SPD items. A patient safety risk is created without the ability to track these items and either remove them from inventory or mitigate the problem with the inventory item. The SPD staff should be able to easily locate every instrument or inventory item placed in their care. The patient should be able to trust that the recalls and regulatory requirements have been reviewed and that practices are up-to-date.

CensiServe-Lean Consulting can assist you with instrument inventory, recall processes, and tracking.  Contact us for more information. 

Perioperative Leadership

Inability to track instruments to a patient – The Perioperative Leadership is responsible for the entire patient experience.  If there is a question about the role an instrument or inventory item played in a complication or inferior clinical outcome, then it is the leader’s responsibility to investigate the clinical episode to look for root causes and opportunities for improvement.  Patients and families are typically focused not only on what happened to them but how the organization can guarantee them that it won’t happen to anyone else. If you can not track your inventory, it is difficult to offer this reassurance.

Improper maintenance of instrumentation – A well run, high capacity operating room typically has a strong instrument maintenance program.  When instruments are not well maintained, or not available because last-minute maintenance must be done or can’t be done, it becomes much more difficult to be efficient.  Inefficiencies in the OR translate into a decrease in available time to perform surgeries and certainly have a clinical impact on the patient population. SPD delays and inefficiencies increase patient anesthesia and infection risks, as well as potentially delaying urgent surgical cases from being scheduled in an expeditious manner. 

Lack of appropriate pre-soaking procedure – The Perioperative Services Leadership has oversight for the entire OR process, including what happens at the surgical field.  If the surgical assistants and technicians do not pre-soak or pre-clean the instruments appropriately and consistently prior to returning them to SPD, the risk of bioburden increases which potentially impacts the safety of the patient. Continuous education and training are requirements.

CensiServe – Lean Consulting can give you the tools you need to streamline instrument management in order to decrease patient risk, decrease complications and improve overall operating room flow.  Contact us for more information.

C-Suite Leadership

Surgeon dissatisfaction with bioburden, defects, and inefficiencies – Surgeons determine where they feel the most comfortable operating based on clinical outcomes, nursing care, efficiencies, and customer service. If an operating room has SPD issues that may contribute to an increase in complications and infections, surgeons will not only complain but may find other hospitals in which to practice that may be more responsive to their clinical and operational concerns. In these competitive and transformational times, the surgeon’s patient safety concerns need to be addressed immediately and a viable, successful action plan put in place.

Surgical site infections – Inefficiencies and instrument processing failures in the operating room and sterile processing may increase the risk of surgical site infections. Your community counts on your organization to do everything possible to keep them safe and mitigate risk.

Non-compliance with recalls, IPAC requirements and regulatory requirements It is the responsibility of all staff, at all levels, to manage the steady flow of regulatory information into the organization.  Recalls, infection control requirements and regulatory requirements must be attended to and acted upon to protect patient safety.  The consistent and universal way in which the organization processes incoming guidance and implements action plans protects patient safety and quality clinical outcomes. Increased infection risk based on deficiencies in both high and low-level disinfection of medical equipment is one of the Joint Commission’s top ten scored findings over the last couple of years.

Malpractice claims due to instrument failure and/or bioburden - The malpractice environment is complex enough without worrying about controllable and preventable factors in the operating room. There are no circumstances under which bioburden is acceptable on an instrument that is brought to the operating room table.  A preventable instrument failure that contributes to an inferior clinical outcome is unacceptable. Pro-active improvement plans in the operating room and SPD decreases the organization’s legal vulnerability.

CensiServe – Lean Consulting can assist your perioperative staff in streamlining their processes and improvement plans, an important step on your way to creating a culture of safety as a high-reliability organization. Contact us for more information.

Where Do I Start?

We’re here to help you identify the necessary strategy for success with CensiServe – Lean Consulting. Reach out today to learn more on what the next steps are to get Lean in your department today!