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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.

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Lesson Plan CHL 319
Do Basic Management Principles Change?
[Reprinted from Communiqué: May/June 2010]

The first article in this management series that has now evolved into Certification in Healthcare Leadership (CHL) lessons was published in the June 1985 issue of Communiqué. Therefore, this is the 150th lesson, and this issue marks the 25th anniversary since publication of the first lesson. Interestingly, the first lesson was written when your Association was called the “International Association of Hospital Central Service Management” (the name change to International Association of Healthcare Central Service Materiel Management occurred in 1989).

Articles were much briefer then; the first lesson (No. 1) is published in its entirety below.

Back To The Basics: Practice Basic Management Principles
June 1985

Central Service managers are responsible for a very important department within the hospital. They must have a great deal of technical expertise ranging across several diverse—and complex—disciplines in today’s healthcare environment. Knowledge and use of basic management principles is a thread which ties together the activities undertaken to obtain departmental goals. Today, as never before, the many internal and external pressures impacting upon Central Service require the utilization of basic management and supervisory—along with technical—skills.

Many Central Service supervisors have acquired technical expertise through many years of formal education and on-the-job training and experience. Where, however, do Central Service managers learn about the “art and science” of management and supervision? Can the organizational and operating changes imposed by “DRGs” and cost containment efforts be addressed by those relying upon technical knowledge and skills? Of course not! Today’s Central Service manager must, at the same time, be a technical specialist and a management generalist.

What is management? A succinct definition is: management is the process of using “What you’ve got to do; what you want to do.” Let’s look at the two concepts in this definition.

What does the Central Service manager “have?” Simply stated, he/she has resources of the following types:

1. People
2. Time
3. Money
4. Equipment
5. Energy
6. Basic Procedures
7. Instruments, Supplies, and Products

Each of the above types of resources must be effectively managed.

What does the Central Service manager want to do? It is obvious; there is a need to attain facility and departmental goals. Increasingly, goal statements refer to expense limits, operating surpluses, and cost allocation requirements. All economic objectives, of course, are established under the requirement that quality standards can not suffer as cost objectives are addressed.

As you know, all resources are in limited supply. No Central Service manager has all the time, money, labor, etc., which is desired. The “job” of the manager is, then, to make decisions about how to best use resources allocated to Central Service in order to maximize goal attainment efforts.

It is obvious that the job of the Central Service manager is complex—and the domain of technical and administrative information which must be known and utilized on the job is increasing daily. What should a Central Service manager do to keep up with the increasingly difficult task of learning what is important to be an effective manager?

The International Association of Healthcare Central Service Materiel Management is to be saluted for its efforts to develop and deliver quality management and supervision information to its membership. Its annual meetings and soon-to-be released management and supervision correspondence course offered in conjunction with Purdue University are two examples of the Association’s services which focus on management and supervision concerns.

Do any (or many) Central Service operations have unique problems? Probably not! In fact, at their most basic level, Central Service managers face the same problems confronting managers in many segments of the manufacturing and service industries.

What is a problem? All of us have them. Could it be that a problem is caused by the absence of application of a basic management and/or supervisory principle? Perhaps this statement cannot be defended. However, it is true that many problems confronting Central Service managers today could be eliminated (or reduced) if basic principles were applied.

The Central Service manager must adopt the attitude and philosophy that he/she is, first, a manager. All resources allocated to the Central Service Department must, then, be “managed.” As one applies a broad base of knowledge, experience and “common sense,” decisions become more effective.

Some persons in healthcare have hidden behind semantics (what’s the difference between management and administration?) and/or priorities (how does one put a “value” on healthcare?) when, in fact, the needs of the patient, facility, administration and staff, external publics and Central Service employees can all be addressed concurrently.

It is neither possible nor, probably, desirable to invent and/or practice specific and unique management principles for each business, healthcare, education and other discipline. Rather, a foundation of basic management principles does “work” in any type of organizational environment. Healthcare in the 1980s—and beyond—must look at similarities, not differences between professions. Central Service managers must make use of principles which apply and de-emphasize the need to reinvent the wheel in the search for specific and unique management information. There are, in fact, lots of management ideas out there which will work in Central Service. Let’s educate them, put the good ones to work and get on to the task of leading Central Service programs through the tough operating times now being faced.

In this writer’s opinion, much of the information contained in the article written 25 years ago is still relevant to Central Sterile Supply Department leaders, including:

• Its emphasis on technical expertise
• The concept that management and supervision are both an art and a science
• The impact of internal and external pressures
• The requirement for management skills
• Reactions to organizational changes
• Requirements for cost-containment without sacrificing quality goals
• A requirement to make the best use of limited resources
• The importance of remaining current in technical and management expertise, and the assistance that IAHCSMM provides members in doing so
• A recognition that CSSD leaders are generally confronted with common—not unique—problems
• An observation that the use of basic management principles can assist in resolving many common problems.

Even recognizing the above, however, this writer does not believe that the original article could be used as an acceptable overview of basic management concerns for today’s CSSD leaders. The remainder of this lesson emphasizes six concepts, including two from the earlier lesson, that should be included in any overview discussion about management basics in today’s CSSD operations.

Diverse Skill Sets Are Required

One point to re-emphasize in the first lesson is the need for CSSD leaders to be knowledgeable about and able to use management and technical skills. Today, however, with the increased recognition of the significant assistance from properly facilitated employees, a change in terminology is helpful: CSSD leaders must be able to interact with their staff members and be effective managers to control the non-human resources for which they are responsible.

A second point to carry over from the first lesson in this series relates to the need for on-going professional development opportunities in the technical and management disciplines (discussed in the earlier lesson and now in the leadership domain). Note: It is ironic that IAHCSMM’s first management and supervision program was just about to be released when the first article was written and, today, 25 years later, the Association’s new leadership essentials program is just being released.

Some “New” Basics

What topics should be included in a current discussion about basic management that were not addressed 25 years ago? At least the following four topics would be added to the first lesson if it was being written today:

• The impact of technology – Interestingly, the term “technology” wasn’t even mentioned in the lesson written 25 years ago. Today, the use of technology to manage information, purchase products and services, control inventory, assist with distribution, train technicians, and for numerous other applications is an integral component of CSSD operations. As well, technology employed in modern medical instrumentation creates miracles for patients and, often, significant processing challenges for those in the CSSD.
• Financial concerns and cost minimization efforts, while important in the past, are of heightened importance today. CSSD leaders must be able to develop, control and evaluate budgets with increasing financial limitations. They must be comfortable with their financial management responsibilities, know the financial basics, and recognize that their department cannot be successful unless budget goals are consistently attained. They know that personnel, supply and other costs are managed everyday as they make decisions, and not just when budgets are developed and monthly operating reports are analyzed. Today, financial management skills are not just nice to know; they are a survival necessity.
• Impact of quality management – The term “quality” is used once as an adjective in the 1985 article. Quality was, of course, very important then because it had a direct impact upon patient and employee safety. However, today the term relates to a philosophy that drives programs and processes that impact everything the CSSD does. Its definition, “the consistent production and delivery of products and services according to expected standards,” intersects patient safety, cost, employee concerns, and even the meaning of CSSD professionalism. The extent to which quality processes are benchmarked and quality results are measured is a very significant sign of professional change over the past 25 years.
• The concept of problems versus opportunities has modern applications in CSSD operations. It is true that problems have to be discovered and, fortunately, understanding (if not resolving) them is often relatively easy. For example, budget numbers “speak” to leaders who have financial knowledge, and employees literally make their concerns known. Other problems (i.e., “What is causing our wet packs?”) are more difficult to define before resolution tactics can be implemented. Historically, CSSD leaders were problem-solvers. In addition to routine decision-making, they “fixed” problems and then moved on to others. Problems were often identified very narrowly and were resolved that way. Today, problems are viewed as challenges and opportunities to move closer toward ideal quality goals. Leaders recognize that numerous procedures make up processes that comprise systems, and decision-making must address “big picture” issues that may extend beyond a specific defect.

A Prediction

What does the future hold for the CSSD profession? Guess work in response to this question is beyond this writer’s ability. However, one trend only indirectly addressed above relates to the increased professionalism required for those leading CSSD functions.

This article closes with the first three paragraphs in the Foreword of IAHCSMM’s new leadership manual, which was previously referenced. It summarizes and defends the professionalism of those with responsibilities in this most critical support service department:

“Central Service leaders hold incredibly demanding positions within their healthcare facilities because they have very important but widely diverse responsibilities. They must train and provide professional development opportunities for and facilitate the work of staff members in their labor-intensive department. They must effectively manage numerous resources required for day-to-day operations. They must also interact with within-facility customers such as those in the operating room and other clinical units, and they represent their department and facility to numerous other stakeholders, including those in the community. At the same time, they must be technical specialists with a broad and deep command of processing science.

If these pressures are not enough, Central Service leaders know that, literally, life or death patient outcomes can result from their decisions. In their profession, “short-cuts” don’t save money; instead, they can threaten the health and well-being of patients, and this concern is at the forefront of every decision they make and every alternative they consider.

This broad-based and life-critical focus is very different from that of their top-level peers in other industries. Consider, for example, the automobile and clothing industries where one set of leaders is knowledgeable about manufacturing while other leaders provide customer service in retail outlets. In the agriculture industry, some leaders focus on production of foodstuffs, others move products through the supply chain, and still others interact with customers. Central Service leaders “wear many hats” because they are responsible for production, distribution, customer interaction, and numerous other tasks and cannot specialize in a specific discipline.”

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