A few months ago I saw a post floating around Sterile Processing circles asking whether or not technicians should be allowed to talk while on the processing floor. There were a number of comments from CS leaders and technicians on both sides of the debate, and I'm sure a couple of ruffled feathers along the way. After all, the work that's happening in the Prep/Pack area of your CS department is some of the most critical and intricate inspection and testing done during the entire workflow. I mean, we're not hanging out in our backyard shooting the breeze with our best buds. But neither are we pre-programmed automatons, without any need for human interaction and professional relationships.
So what is the answer? How then shall we talk?
Let's briefly discuss the two extremes that commonly show up in CS departments, and then zero in on how we can keep this conversational car on the road to success --between the guardrails of CS professionalism and the reality of relationships.
1) The Clubhouse
This example almost needs no explaining. We've all seen it. Second shift clocks in, gets the shift report, then 30 minutes later they finally begin making their way to their assigned stations, after having caught up on the twenty-four hours of gossip they missed since yesterday. Once logged in and at their Prep/Pack table, they settle in for the remaining seven and a half hours of "Did you see that game last night?" and "I can't believe Johnny hasn't asked Suzy out yet." Instruments? Yeah, I mean their hands are technically moving, but not nearly as fast as their mouths. Depending on how loose the department policies are on personal cell phones, there may be huddles around someone's "cutest grandson ever" video or so-and-so's graduation pictures. Yes, there are sounds of humming sterilizers and clanking stainless steel on nearby tables, but it's the chorus of conversation that pervades the SPD clubhouse in this scenario.
Upside to the SPD Clubhouse: Man, this team gets along GREAT! They love coming into work. Who wouldn't love 8 hours a day of friendship, fun, and a paycheck at the end? The technicians tend to "have each other's back" when work gets out of hand, and there's not a lot of needless turnover of staffing. People like it here. It's kind of like home.
Downside to the SPD Clubhouse: Well, for starters, this clubhouse culture is only sustainable for certain types of personalities. Those who have a strong, inner-drive to produce no matter what the incentives can typically float through these conversations without a big hit to their processing numbers. However, for those folks who value relationship more than self-motivation, constant conversation becomes an overwhelming temptation to stop moving their hands and start moving their mouths. On a similar note, even those with personalities who are driven enough, must also have the ingrained knowledge and muscle memory necessary to carry on in-depth conversations without making a processing error. This means clubhouse cultures are especially dangerous to new employees who lack both the knowledge and the habits to keep them from making needless mistakes. Oh, and did I mention that all this means work takes longer to get done and get done right?
2) The Courtroom
On the flipside, there are some CS departments that eschew the clubhouse culture, and instead, have all the solemnity of a courtroom, with just as much joy. These ships are typically run much tighter than our first example. Folks arrive on time, get their assignments, and then get to work. The clatter of pans and familiar beeps and whistles of machinery fill the air, but very little conversation is heard. Folks take their jobs seriously, give their trays their full attention, and save the chatter for the breakroom. Depending on the context, there may be a department radio controlled by management or by Ms. Margaret, whomever has more seniority. Communication is constrained to the bare essentials - What's the priority for tonight? Which case cart is the Midas Rex needed for? Where is our backup stash of indicators? - but general talk is frowned upon by department leadership.
Upside to the SPD Courtroom: People here are focused on the job at hand. Although lack of conversation does not necessarily mean an increase in speed, it at least takes the conversational slowdown out of the equations for those who can't handle the temptation to go overboard. New hires have the ability to concentrate on the complex tasks of learning instrument names, uses, inspection points, and testing protocol -- without having to tune out large amounts of chatter around them. To an outsider looking in, the courtroom scenario seems to have it going on.
Downside to the SPD Courtroom: But all is not well beneath the surface of this tranquil courtroom of a CS. Yes, there is a veneer of professionalism (or perhaps even a real culture of one), but once you dig a little deeper into the employee engagement numbers, you will start to see the underlying issues at play. On a scale of 1 to 10, how do they answer the question, "I have fun at work"? Typically, teams that live under a silent regime like this will struggle to retain employees or build strong relationships with their coworkers, so when the hard times come (and they ALWAYS come), these are the teams that wilt under the stress of workload and see high levels of employee burnout. Although this team gets it done, many of them don't truly enjoy it.
The Conversational Center: A Tasking Model
So what's the answer? How do we invite Goldilocks into our CS and find a conversational balance that's "just right"?
Never fear, you technicians with the gift of gab, I got your back. And fret not, Mrs. Manager, who's hearing the chatter on the floor and seeing the weak productivity on the books, you don't have to put your team on lockdown to bring them back on course. There is a conversational center out there, a true third way, that doesn't sacrifice quality for camaraderie, and doesn't poo-poo on fun while dispensing with motor-mouthery.
And as much as I would like to make this answer earth-shattering and cutting edge, it's really not. In fact, at the end of the day, it's pretty mundane. I believe the answer to the conversation vs. productivity debate can be solved under a tasking model of CS workflow.
Here's what this model looks like in real life:
CS Supervisor takes the shift report from previous shift and identifies remaining/future workload.
CS Supervisor then divides the workload up (not necessarily equally, but by ability of technicians) and tasks each individual Prep/Pack technician with an expected productivity level for a particular timespan (it could be over the next hour or for the entire shift). For example, "Julie, I need you to complete this cart of instruments before lunch."
CS Supervisor then monitors completion of tasks - and rewards/recognizes those technicians who completed their tasks, while following-up/troubleshooting with those who did not. Note: Just because a technician didn't complete their task doesn't mean they are at fault -- there could be a host of reasons for this, including another technician pulling them into conversation that makes them lose their focus, etc.
This model has two primary implications for how conversation and productivity occur in your department:
Tasking helps break down the ambiguous, amorphous cloud of "work" in your department into clear, concrete, and manageable chunks of work that the entire team understands that certain individuals are now responsible for. While it is easy to get lost in conversation if the work is undefined, with a clear tasked workload for each person, technicians are then taught to self-regulate conversation to ensure tasks are completed.
Additionally, this model provides a context for consistent praise and recognition from CS leadership for those who excel at their tasks, and real-time feedback for those technicians who struggle to complete their work (whether it's due to excessive conversation or something totally unrelated). This engages your CS leadership in true workflow- and worker-management. Tasks can be specifically tailored to grow or challenge individual technicians on a daily basis, and ensure that there is little opportunity for idle hands throughout the night.
In our industry, talk isn't cheap. Too much of it can cripple busy departments who show adequate FTEs according to HR but mysteriously can't keep up with the volume. Inattentive technicians wrapped in conversation can skip critical processing steps that could mean disaster in the Operating Room. On the flip-side, employee engagement and a warm department culture is critical to recruiting, developing, and retaining high performing CS professionals. Our teams must enjoy each other and be encouraged to build strong work relationships, and healthy conversation is a major part of this.
So, for those departments struggling between the two extremes of Clubhouse and Courtroom culture, give this tasking model of CS leadership a chance to provide the balance you're looking for between hard work and happy workers. Your boss and your employees will be glad you did.
What say you?
Hank Balch
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