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Effective Central Sterile Supply Department leaders typically facilitate the work of several types of formal work teams. They recognize that “none of us is as smart as all of us,” and the wisdom, creativity and productivity of an effective team always outperforms even the most talented and motivated individual. In this lesson, we’ll discuss several types of formal work teams, and review some tactics that can be helpful in ensuring that they are as effective as they can be.1
Formal work teams are groups of people who cooperate on the job to attain objectives through mutual decision-making, and who hold themselves accountable for their success. A work team is different from a work group whose members tend to look at their jobs in isolation. Work team members share the motto, “We’re all in this together,” while work group members tend to think, “I’ve done my job; good luck to the rest of you.”
A word of caution: while CSSD leaders may be committed to a team concept, the attitude about their importance must begin with top-level administrators. Many work teams generate non-traditional approaches to work, and their efforts may cross departmental lines. Therefore, a team’s performance cannot be maximized unless facility administrators endorse them.
Teams can help CSSD leaders address the sometimes conflicting pressures of minimizing costs while, at the same time, attaining customer satisfaction goals: “How do we meet our budgeted labor cost goals while providing the highest possible service to the Operating Room and our other customers?” One strategy to confront these challenges is to use different types of teams with committed members to address potential problems before they arise and to resolve conflicts that do occur.
There are many ways to classify formal work teams; one way is by their purpose or make-up. Using this approach, teams can be classified as “simple,” “relay,” “integrated,” and “problem-solving.” Let’s look at each of these types of work teams.
Simple Work Teams
A simple work team is a group of staff members with similar skills, brought together because there is more work to do than one person can complete in the required time. During times when there are relatively few surgical cases, a simple team comprised of a minimal number of CSSD technicians handles instrument decontamination duties. However, when there is a greater volume of scheduled procedures, a supervisor must increase the size of the simple work team to process the increased workload.
A simple work team performs best when every member is well-trained. If one of the technicians in the above example is not trained in proper decontamination tasks, he/she may slow work output because re-work and/or because team member assistance is required.
Another potential problem: the health and well-being of other employees and patients can be in jeopardy if improper procedures are used. This underscores one of the most important responsibilities of CSSD leaders: ensuring that their employees are consistently and correctly able to perform all required work tasks. Then, members of simple work teams can be flexible and help their team colleagues whenever assistance is required.
Relay Work Teams
In a relay race, runners on a team take turns sprinting around a race track with a baton. Each runner must hand off the baton to the next runner before the second runner can continue the race. A rely work team is much the same, and all CSSDs have relay work teams because of the way that work flows within the department. For example, while there are numerous intervening steps, soiled goods enter decontamination areas, move through preparation and sterilization work stations, and then enter processed storage areas before they are distributed, and the cycle is repeated. All employees are part of at least one relay team and may be members of more than one. Therefore, their performance takes on added importance because the results of their work—either good or bad—flow throughout the organization along their relay teams.
Some CSSD leaders do not emphasize that, because their employees are members of relay teams, the services they provide impact external customers, as well as their peers. When a member of a relay work team works effectively, he/she properly prepares an instrument that is ready for the next step in the work flow. By contrast, when a relay team member does not meet work standards, the jobs of their team members down the processing line become more challenging.
This illustrates the fact that CSSD personnel who work on simple teams, such as decontamination, are also part of relay teams because their work is an integral part of the larger processing responsibilities of the department. In a large sense, all CSSD employees are members of one large relay team because everyone has an impact, either directly or indirectly, on the services the department provides to its customers.
Integrated Work Teams
While members of a simple work team generally perform the same tasks and possess the same skills, an integrated work team brings together people with various, specialized skills to accomplish an overall task or goal. CSSD personnel interact with staff members from numerous departments throughout the facility, including, among many others, those in the Operating Room and Emergency Department, Environmental Services, Clinical Engineering, and Infection Control. In reality, then, when we recognize that Central CSSD leaders and their staff members are an integral part of the healthcare team, we are referring to an integrated healthcare team. Members of this integrated formal work team must not only be competent in their own areas of expertise, they must also be good communicators.
Problem-Solving Work Teams
As the name implies, members of a problem-solving work team come together to solve a problem. These teams may be formed when a problem is so large or complicated that it is beyond the ability of any one person to solve it. In many instances, problems can be traced to breakdowns in one or more of the tasks that are the responsibilities of simple, relay or integrated work teams. Sometimes the cause of a problem has not been identified, and then the first task of the problem-solving work team is to isolate the cause. The team might brainstorm, list all difficulties people are encountering, and try to determine whether these challenges have an overall theme or lead to one source to lead the team to the core or root problem.
Cross-functional teams are a special type of integrated work team that uses an integrated approach to problem-solving and decision-making in healthcare facilities. They are comprised of members representing different departments whose diverse perspectives are brought together to resolve problems. Consider, for example, an instrument supply problem. A team comprised of only CSSD personnel might view the problem to involve inadequate communication: “Operating Room personnel should give us more notice about their special needs.” Conversely, Operating Room staff might envision the cause to be one of inadequate CSSD processing protocols, or even a lack of cooperation. As team members study the problem from both perspectives, it may possible to look beyond these one-way causes and consider other factors that may be creating the problem. Then, realistic resolution alternatives can be generated, analyzed and implemented.
In contrast to some teams that may take time to become effective and increase productivity, some formal work teams never realize their potential. A team is likely to be in trouble when:
Solutions to improve performance depend upon the type of team experiencing problems. For example, tactics useful when members of a simple team are not performing include the provision of more training and meeting individually with team members to determine what is wrong. Managers can also work with specific employees to observe potential issues, and they can ask behavioral-based questions to spur critical thinking and/or reveal training issues. Example: “Why do you think overtime hours are frequently required?”
When a relay team is experiencing problems, it is important to ensure that employees know that their work quality affects the rest of the team. One way to nurture a relay team is to invite employees from different departments in the facility to a meeting in which they explain how the quality of CSSD products and services affects other employees and departments. For example, perhaps a discussion of instrument flow through the facility would emphasize this point. If team members participate in the activity and still do not understand how their jobs relate to others, more basic training is likely needed. This may also be a good time for an attitude check. Employees who do not care how their job performance affects others should be prime targets for functional turnover procedures, as established by facility policies.
Team-building exercises might be useful to improve the performance of integrated teams. If, for example, some team members do not trust each other, then trust-building exercises may quickly correct the situation. As well, some team members may not be properly trained and, because inadequate communication can always cause a breakdown in an integrated team, basic communication skills training may be helpful.
If a problem-solving team is not effective, a first step is to ensure that the team is using formalized problem-solving procedures, if these have been specified by the facility. If there are no formalized problem-solving procedures or techniques in place, the CSSD leader can take the initiative to provide basic problem-solving training. Personality problems among team members can also inhibit problem-solving teams from working effectively together. Then it is necessary to discover and eliminate the reasons for them.
If the above and related tactics do not correct the problem, it is possible that one or more team members may never perform as desired. It then becomes important to closely follow the facility’s disciplinary procedures that can eventually lead to termination. While no one desires this, functional turnovers emphasize that the facility is concerned about its work standards. Then, employee morale may improve because those who can’t or won’t improve their performance can no longer have a negative impact upon team performance.
CSSD leaders can utilize alternative types of formal work teams as they facilitate their department’s success. In turn, each type of team requires dedicated members to accomplish its purposes. Leaders influence the success of their teams as they determine the types of teams needed, as they provide them with direction and resources, as they recognize indicators of low-performing teams, and as corrective actions are implemented to maximize their teams’ contributions.
1 This lesson is loosely adapted from: LaLopa, J. Team Building. Chapter 9 in: Kavanaugh, R. and Ninemeier, J. Supervision in the Hospitality Industry. Fourth Edition. East Lansing, MI. Educational Institute of the American Hotel & Lodging Association. 2007.
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.