“That shift is a bunch of lazy bums!”
“They never do anything.”
“We always have to pick up their slack.”
Besides the occasional battle with the OR, internal SPD shift wars are one of the most common culture killers among instrument reprocessing teams. They are often some of the most frustrating challenges out there for department leaders, and one of the greatest sources for poor morale and internal conflict on the part of frontline technicians. Shift friction can undermine even the most intentional new technician onboarding programs and lead the best technicians to make poor decisions in moments when shift conflict sparks out of control.
In the midst of these warring factions, how do you reengage your team to focus on fighting the real enemy, dangerous microbial fire breathers, and not each other? Is there still hope for you to sign a peace agreement and declare a cease-fire in your department? You bet. And here are four secrets to making it happen.
Find the truth, the whole truth, and nothing but the truth
These situations cannot be solved under threat of discipline or casual dismissal alone. Once the seeds of dissension and distrust have sprouted among your team, it must be dealt with in firmness inspired by wisdom. There are reasons that your second shift consistently throws your first shift under the proverbial bus, and you have to determine what those reasons are, both in reality and in perception. Does your third shift think they have unrealistic expectations of productivity put on them? Does your first shift leave their workstations looking like a supply bomb went off when they leave for the day?
These issues have to be dealt with truthfully and not by taking anything on hearsay alone. You must be willing to identify root causes of both behavior and process breakdowns.
Define fairness and slaughter that ubiquitous sacred cow
If we distilled 90% of all shift-war activity down to one word, it could very well be the f-word. Yep, fairness. This is not fair. That is not fair. In the midst of it all, it’s forgotten that bickering over these kinds of things in an SPD causes the real unfairness—patients who aren’t getting 100% of our focus and commitment because we’re too busy comparing our workload or assignment to the workload and assignment of others.
Sterile processing departments and leaders who attempt to worship the mysterious idol of fairness will constantly find themselves in the midst of antagonistic comparisons by staff members or shifts who feel that it is their duty to ensure no one ever does more or less than their fair share. Is that our department’s mission statement? Is that our purpose as sterile processing professionals? This obsession with an ambiguous idea of fairness must be replaced with the larger values of professionalism, teamwork, and patient-centered work. This is the only way to rise above unhelpful comparisons.
Use the language of ownership and oneness: They are we
You’ve handled the truth and left the idol of fairness smoldering in the hospital parking lot. Now what? Now comes the time to flip the department script. Chances are high if you are struggling through shift wars in your department that you are hearing a lot about they. You know, those other people different from us. The weirdos who can get up at 5:30 a.m. and be happy about it. Or those technicians who never work as hard as we do on our shift. It’s a conversation and language of division.
If they are not we, then it’s okay to blame them, shame them, and withhold mutual respect. That is why it’s critical that department leaders take control of this language and require every conversation to be a we conversation. If the work didn’t get finished last night, “We didn’t zero out.” If someone forgot to complete important documentation, “We did not fill out the temp/humidity log.” If your team is forced to own the work of their team members in the way they talk about it, it will go a long way in changing the way they think about it as well.
Clarify expectations and hardwire personal accountability
Let’s assume for the sake of this article that you have a shift that really is slacking off when it comes to productivity, communication, and policy compliance. Before you dust off the corrective action forms and start making calls to HR, you need to deal with two possible scenarios.
First, this shift may not be aware of the specific expectations it should be operating under. Are they supposed to leave decontam totally empty and prepped for the next day of surgical volume? Should they be pulling supplies for every posted case prior to handing off the reins to the next shift? Do they all know that? Are all the shifts aware of each of their particular expectations, especially if they are different from one another? If expectations are unclear, it can be a spark for unnecessary shift conflict.
Second, are individual technicians held accountable for noncompliance with these expectations?Notice here that I said “individuals.” The cause of shift wars can often be tracked back to a handful of individual technicians who are not being held accountable to department standards, and this impact ripples throughout the rest of the team. Remember, your excellent employees will welcome accountability, and your slackers will benefit from it. Everyone wins when standards are clear and personal accountability is hardwired.
Ultimately, the existence of sterile processing shift wars can be a signal that all is not as it should be regarding a department’s underlying culture and mission. There can be many causes for how these divisions occur, but the impact is always the same—the team’s focus is taken off the fundamental goal of excellent patient care by producing functional, sterile, and available surgical instrumentation for every instrument, every time. Department leaders and SPD team members who want to declare a cease-fire in the midst of these wars must make a concerted effort to identify the truth in the existing frustrations, redefine the meaning of fairness, use the language of ownership, and hardwire personal accountability. These are the cornerstones of a lasting department peace, and building blocks of an army of unstoppable weapons of mass microbial destruction.
Go forth and #Conquer.
Hank Balch is the Founder & President of Beyond Clean. He began his career in instrument reprocessing as a frontline technician in 2009, and has served as an Instrument Database Specialist, Department Manager, and System Director for various SPD departments across the country. Hank is an award winning Sterile Processing leader (2016 Healthcare Purchasing News "CS/SPD Department of the Year"), twice nominated for IAHCSMM President (now HSPA), founder of two state-wide IAHCSMM chapters, conference speaker, and well-known industry writer, blogger, and social media connoisseur. He has written over 150 Sterile Processing articles, with his work being published in Becker's Hospital Review, Infection Control Today, Healthcare Purchasing News, Communique, Outpatient Surgery Magazine, AAMI BI&T Journal, SteriWorld, and other publications across the globe. His passion is seeing frontline Sterile Processing professionals equipped to #FightDirty, every instrument, every time.