CHL Lesson Plans provide members with ongoing education focusing on supervisory or management issues. These lessons are designed for CHL re-certification, but can be of value to any CRCST in a management or supervisory role.
For Online Grading (www.iahcsmm.org):
To activate a quiz:
Each lesson plan graded online with a passing score of 70% or higher is worth two points (contact hour). You can use these points toward either your re-certification of CRCST (12 points) or CIS (6 points).
Mailed submissions to IAHCSMM will not be graded and will not be granted a point value (paper/pencil grading of the CHL Lesson Plans is not available through IAHCSMM or Purdue University; IAHCSMM accepts only online subscriptions of the CHL Lesson Plans.
Central Sterile Supply managers must make decisions and solve problems as an integral part of their work responsibilities. Fortunately, the basic process to do both involves the same procedures: define the issue (problem), generate and evaluate useful alternatives, and evaluate (select) and implement the chosen alternative. Historically, many managers have elected to undertake this process by themselves because they thought it was their responsibility to do so. Increasingly, however, many managers, while still accepting responsibility for the task, solicit input from their staff members as decisions are made and as problems are resolved.
Benefits of a leadership style emphasizing participative management that encourages group problem-solving and decision-making are well-known. They include:
Tactics to generate alternatives from employee groups go well beyond “open-door” policies and employee suggestion boxes that are frequently ineffective. In this lesson, we will review the basics of two methods to generate participative input and two methods that can help leaders determine their team’s preferences for the alternatives that are generated..
Brainstorming and nominal group tactics are two methods that Central Sterile Supply leaders can use to generate group input about challenges confronting their department.
Most CSS leaders are familiar with the concept of brainstorming. Done correctly, the process enables team members to proactively think about and suggest alternatives in a risk-free environment. However, the approach is sometimes undertaken in a less constructive way in which the group leader does little more than ask, “What are your ideas,” with more vocal members then voicing and defending their opinions and challenging alternatives offered by their peers. This approach to a potentially very useful tactic does little to encourage full-team participation and can actually intimidate some staff members who are then unlikely to respond.
To correctly facilitate the brainstorming process, CSS leaders should use a six step method:
Interestingly, a variation of this decision-making process called “reverse brainstorming” can also be used. It differs from the traditional method because the typical brainstorming process answers a question such as, “What can we do to eliminate the problem?” In contrast, reverse brainstorming asks, “What can we do to make the problem even worse?” While this may, at first, appear to be a strange question, its answer may suggest causes of existing problems. For example, assume that there are too-frequent recalls of sterilized devices. The reverse brainstorming question becomes, “How can we increase the rate of recalls?” Answers may include reducing in-service training for processing new instruments, loading the sterilizer improperly, and failing to follow proper packaging procedures. Analysis of these and other alternatives for increasing the problem may highlight on-going challenges with training, sterilizer loading, and packaging that, indeed, might be contributing to the high rate of recalls.
Nominal Group Decision-Making
The nominal group decision-making method is similar to brainstorming, except that each team member writes down rather than vocalizes possible alternatives. In one method, the group leader discusses the problem at hand and assures that it is understood by all team members. Then, each team member writes down one possible alternative on a piece of paper and passes the paper to the colleague seated next to him/her.
Each person, in turn, then writes down another idea he/she has not written down earlier and passes it to the next colleague. This round robin writing process continues until no team members can think of alternatives to contribute in addition to those they have written or seen on the papers that were passed. The group leader then collects the papers, carefully reviews them to eliminate redundancies and, if necessary, combines similar suggestions into one broader concept. When this task is completed, the group leader will have a comprehensive list of all suggestions made by team members and can review them with the team.
How should the group leader use the list of decision-making or problem-solving alternatives suggested by team members? Historically, the list was reviewed without group input, and the team leader had little or no idea about the team’s perspectives of the alternatives thought to be most useful. Which alternatives do group members believe to be most beneficial to making the decision or resolving the problem? This question could not be answered because group members had not been asked. In this instance, the leader had successfully involved the team members in generating, but not in evaluating, alternatives.
Leaders desiring this additional input can use several methods including “voting with stars” and an alternative evaluation matrix to gain the advantage of team member advice.
Figure 1: Sample Alternative Evaluation Matrix
Voting With Stars
One simple and fun approach to gain consensus about the perceived usefulness of group- generated alternatives involves a technique called “voting with stars.”
With one variation, each group member is given votes equal to approximately 70% of the number of alternatives that were generated. For example, if the team nominated 10 unique suggestions to resolve a problem, each team member is allowed to have seven votes (10 alternatives [x] 70% = 7). The team leader gives each team member seven self-adhesive stars, check marks or other symbols commonly sold at teacher supply or scrap-booking shops. Alternatively, each person could be given a felt-tip pen and be placed on the “honor system” to cast only seven votes.
Rules for voting are simple: there can be no discussion, including conversation in support of specific alternatives. Team members go to the flip chart or chalk board to physically place their votes next to their desired alternative (s). They can cast their allotted votes any way they wish. For example, if they believe one alternative is clearly better than all others, they can cast seven votes for it. Alternatively, they may elect to cast one vote for each of seven alternatives, three votes for one alternative and four votes for another, or split their votes in any other desired combination.
At the end of the voting process, the group leader can tally the number of votes cast for each alternative. Then the ranking of alternatives judged to be best from the perspectives of team members will be available as input to the leader’s decision-making.
Alternative Evaluation Matrix
An alternative evaluation matrix, such as the sample shown in Figure 1, is another way to obtain team member input about alternatives generated during a group decision-making meeting. As you review Figure 1, note that five alternatives (column one) were suggested as potential tactics to best resolve the challenge being discussed. One team member (Gene) provided his opinion about each alternative relative to five evaluation factors:
Gene then tallied the points he gave for each evaluation factor and, in the Figure 1 sample, he believed alternative one was the best overall choice because he gave it the highest number of points. Note: the evaluation factors used in Figure 1 are for illustrative purposes only. The actual factors used to assess alternatives must be determined based upon the specific decision or problem being addressed. There can be more or fewer factors than the five shown in Figure 1. Also, note that the maximum number of points varies for each factor. Those judged to be most important should receive more weight (number of possible points).
The team leader can sum the total points received for each alternative from all team members to assess the entire team’s perspectives of each alternative.
The Central Sterile Supply leader is not obligated to implement any alternative suggested by the team unless this was agreed upon at the beginning of the process. In fact, many times the most desirable alternative is a combination of the concepts addressed in two or more of the nominated alternatives.
Managers must, however, recognize that their previous experience with using employee suggestions is known by team members, and this will likely influence their interest in participating in group decision-making processes that address future challenges. Therefore, if the CSS leader does not decide to implement the most popular alternative or even none of those suggested, it is very important to explain, defend and justify the reasons for not doing so. Team members should be genuinely thanked and informed that their input is important. They must understand that the leader is not “going through the motions” to solicit staff input but, instead, recognizes its importance and utilizes it whenever possible.
This column was written by Jack Ninemeier, Ph.D, CHA of the Eli Broad Graduate School of Management at Michigan State University. Dr. Ninemeier is the editor of Central Service Technical Manual (5th Edition), Supervision Principles: Leadership Strategies for Healthcare Facilities (2nd Edition), and Material Management and the Healthcare Industry, all published by IAHCSMM.