Weston “Hank” Balch, BS, MDiv, CRCST, CIS, CHL
Director of Sterile Processing
University Health System, TX


It’s printed out and tacked to my office bulletin board, with the exact words that I wanted to remember — highlighted in neon green. And it’s not some deep, encouraging quote overlaying a picture of a peaceful mountain sunrise.

It’s an email from a frustrated surgeon that I never wanted to forget:

I don’t say anything because it is expected sloppiness from Sterile Processing…

Expected sloppiness.

That was the perspective of this surgeon concerning the team of technicians laboring to decontaminate, clean, inspect, test, package, sterilize, and transport their surgical instruments.

This was a customer who had lost faith in the product, who had been failed one too many times, and had written off any hope of internal improvement.

Kind of like that one fast food restaurant that you swear you will “never” go back to because they don’t understand the definition of “fast,” constantly get your order wrong, and always forget to give you napkins.

And who could blame you? Poor quality and service should never become the norm. Sloppiness should never be expected.

The reality for many Sterile Processing departments and leaders is that you have challenges and failures in your past that loom large in the memories of your customers. You got 999 trays right, but the instrument missing from last week’s case was the one that caused the blip on the OR’s radar and created the Monday morning hub-bub. 

You have customers who have lost faith in your ability to ever “get it right.” And yet they remain your customers. Unlike in the real world, surgeons and OR staff (typically) can’t just walk across the street and get the kind of quality and service they want. In one sense, they are a captive audience to your process improvement journey – and when that process fails, they add it to the list of reasons why “nothing will ever change.”

But I want to encourage you today that you do not have to be defined by your failures. You do not have to allow your OR customers to write off your team, your vision, or your commitment to learn, plan, do, check, and act upon your failures.

All that being said, you DO have to improve. Frustrated and hopeless OR customers are a sign that all is not well with your department status quo. Even if the frustrations are mainly from past mistakes (months, and sometimes years ago), there are still ways to chip away at the culture of failure your team may have found themselves in and set a new course for the future. Here are three ways to get started:

1)      Own the Failures Up Front
I know as a CS/SPD leader or technician, it can be scary to own the failures confronting your department. Especially if you don’t control all the variables (low staffing, insufficient equipment, knowledge silos) or if the problems are rooted prior to your time in the department. Either way, your customers need to know the “buck stops here” with your team. You don’t have to make unrealistic promises, or throw yourself under the bus for no reason, but the first step to service recovery is demonstrating you understand the failure and you acknowledge that it includes your processes. This is key to rebuilding trust for you and your team.

2)      Shield and Engage Your Frontline Technicians
There’s a reason that surgeon’s frustrated email is tacked up in my office and not the department break room. Some feedback isn’t well suited for public consumption or encouragement. As a leader, you should be willing to “take the heat” for your department’s process failures up front, and then repackage those process-lessons to engage your frontline staff for solution-oriented conversations. Nothing kills a CS culture quicker than a fear-induced follow-up to process failures. Instead, commit to protect your people, cast a vision for continual improvement, recognize the wins, and then celebrate the victories.

3)      Advertise Your Improvements, Great and Small
Because you are overcoming existing experiences of failures, it is critically important to highlight each improvement as it happens with your processes and on your team. Are your technicians getting certified? Send a recognition email to your surgeons. Are you adding labels to your storage racks? Ask to give a 5 minute update at the weekly OR meeting. Find ways to drown out the naysaying and recover the interest of those customers who may have defensively tuned out of your department news by publicizing that “something is going on” down there in the CS basement. Your customers need to see and hear that your department is, metaphorically speaking, “Under New Management!”

In the world of Sterile Processing, you rarely get the opportunity to build your reputation or the reputation of your departments from scratch. And even if you could, because mistakes are part of human nature, your CS/SPD team will have to overcome a process failure at some point in their professional experience. But those failures should be seen as the exception, not the rule – in the eyes of your teams and your customers. They are opportunities from which to learn.

So, if you feel like your department is locked in a culture of failure, do not lose hope. Do not believe that you cannot change and improve. You may have a surgeon-customer who expects sloppiness from your team, but that is your opportunity to surprise them with excellence. Own the failures, engage your team, and advertise your improvements. 

You got this. Now go out and dominate the Sterile Processing universe!


This article was published in ReadySet Review, a newsletter intended to help educate Surgical Service Professionals on important, topical issues.  The views and opinions in this article are those of the author and do not necessarily reflect those of ReadySet Surgical.