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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 331
Integrative Leadership for Central Sterile Supply Departments: Part II
[Reprinted from Communiqué: May/June 2012]

This second in a two-part series discusses integrative leadership in a modified version of the original model. Traditionally, the concept has involved tactics to coordinate the efforts of different department managers in an organization to enable them to work together as a closely knit management team. These two CHL integrative leadership lessons suggest how to apply these same tactics to help make the work of managers and their teams within one department -- in this case, the Central Sterile Supply Department (CSSD) --more harmonious.

There are four key principles that must be implemented to build an integrated team. Two of those principles, teamwork and communication, have already been discussed in the previous lesson.

Workplace Diversity

One definition of diversity identifies the entire population according to six characteristics: age, gender, mental/physical abilities, sexual orientation, race, and ethnic heritage. In other words, the definition addresses a range of human characteristics and dimensions. This definition includes all managers and other employees, and it celebrates the contributions every member of the team can make to the CSSD.

A strong business case can be made for the benefits of diversity. The advantages include:

• A welcoming and rewarding work environment that encourages all employees to perform to the best of their abilities.
• An organizational culture of understanding, respect and cooperation that encourages teamwork with all of its benefits.
• Persons with diverse backgrounds are likely to generate more creative alternatives when decisions are made and as problems must be resolved.
• Entry-level technicians with different backgrounds can see evidence of advancement opportunities within their department and facility as they are led by culturally diverse leaders. This supports the welcoming culture of the work environment and may encourage employees to maximize their contributions to the department.

However, a diversity-valuing environment does not just happen because top-level administrative officials require it, because human resource specialistsrequest it, or because a CSSD manager desires it. It requires a significant organizational culture change with an ongoing commitment from the parties just noted. There must also be buy-in from employees in the CSSD. In fact, there is no quick-fix diversity implementation plan; it often requires a change in the attitudes of the managers and employees, and this can be difficult and time-consuming to achieve.

Those who value diversity have some basic beliefs:

• Diversity cannot occur unless it is supported by the facility’s organizational culture.
• An emphasis on diversity must transcend the entire healthcare facility; it cannot be an “option” for interested departments. The top-level support drives the cultural change within departments.
• Efforts to implement diversity should include every staff member with an interest in doing so.
• The values of diversity accrue to the facility, in general, and its employees, more specifically.
• Changes in organizational culture are difficult and are generally very time consuming to make.

Some CSSD managers may think that affirmative action programs are the same as diversity-valuing efforts. This is not true. Affirmative action programs are implemented to address the several types of discrimination that are forbidden by equal employment opportunity laws. These programs address the prevention and/or correction of employment practices that discriminate against individuals for reasons including age, color, disability, national origin, race, religion, and gender. A goal of affirmative action programs is to close gaps by establishing targets and time frames to modify race and gender profiles in organizations.

In contrast, healthcare facilities that implement diversity-valuing efforts move beyond race, gender, and related concerns in an attempt to provide an environment that is welcoming and rewarding for every staff member. The goal is to move beyond satisfying legal requirements to addressing workplace environment concerns, improving productivity, and increasing employee morale. In other words, these facilities attempt to create an organizational culture in which diversity is desired because it yields the full utilization of the diverse talents of every staff member.

Changes in organizational culture take time. Those supporting diversity believe that all staff members want to be recognized for who they are and appreciated for what they do. Employees want to feel comfortable while they are at work.

When the CSSD management team is comprised of culturally diverse managers, the numerous benefits of integrative management are multiplied. Managers with different ideas and perspectives can focus their creative thoughts on improving the department so it can better serve patients and other stakeholders. To ensure that it is fully integrated, diversity is an important characteristic of a CSSD management team.

Commitment / Accountability

Commitment relates to each CSSD manager’s interest in developing and implementing quality management systems for their area of responsibility and continually improving their area’s effectiveness. Commitment also requires a genuine desire to attain assigned goals, to help department employees find pride and joy in the workplace, and to maximize the usefulness of the resources under their control.

Management accountability in the CSSD involves a sense of responsibility for the quality, quantity and timeliness of the team’s performance. Managers must also ensure that their subordinates meet productivity standards, control costs and help address the requirements of their “customers” who are responsible for meeting patients’ needs.

CSSD managers must be committed to the department’s goals, and they must be held accountable for their actions. They must focus on the concerns of the entire CSSD rather than just the interests of their work sections or their own personal issues. To do this, CSSD directors must help their managers create goals and implement plans that help attain the department’s mission. This tactic will, in turn, help the healthcare facility move towards attainment of its broader mission.

Like all goals, those of CSSD managers and their teams must be measurable, and they must be accepted by the employees who are responsible for attaining them. Progress toward goals should be reviewed at least annually, ideally at each manager’s performance appraisal session. This is an excellent time to formally document any needed changes to plans that can help employees better attain performance and departmental goals.

It is important that each CSSD manager have input to the development of his or her goals that relate to financial performance, patient and other stakeholder services, and other goals, such as those relating to professional development that help the department address its own concerns. As this occurs, the CSSD managers will become more committed to goal attainment, and a more effective department will result.

Performance appraisal sessions,for CSSD managers can consider historical activities to attain goals (were previous goals met?), current activities (are managers presently involved in activities helpful in attaining goals?), and the future (what are the best uses of each manager’s talents to help the CSSD?).

Incentives and rewards for attaining mutually-developed goals are very important. Gestures as simple as a sincere “thank you” and ongoing acknowledgements of a manager’s achievements are a good start. A plaque given at a departmental meeting, a featured write-up in the CSSD newsletter (see Part I in this series), and a “news round-up” on the employee bulletin board are other possibilities.

CSSD leaders are committed to education. They understand its role in helping all CSSD employees more effectively complete their daily operational responsibilities. Leaders also know that education contributes to better planning and implementation of tactics that help the CSSD achieve its mission. Educational opportunities sponsored by the International Association of Healthcare Central Service Materiel Management (IAHCSMM) are among the numerous opportunities that are increasingly available to CSSD managers.

The attainment of challenging goals, ongoing and focused feedback from the CSSD director, and an emphasis on professional development can yield a solid foundation for each manager’s commitment and accountability to the department. These efforts also build trust and provide evidence that each manager is respected and is a contributing member of the CSSD management team.

Visibility

CSSD leaders know that they are always “on stage.”  Managers and all others in the department observe what the leader says and does, and they often compare this to what the leader says should be done. There must be a close correlation between a leader’s words and his or her actions. If they match, there is a great chance for the team’s success; if not, there is little chance that the department’s goals can be attained.

The best CSSD leaders and managers model desired attitudes and behaviors for those whom they supervise because they know that doing so impacts the performance of their subordinates. Some CSSD leaders may not realize that they act as a role model whether they do it consciously or not! They can exhibit the desired behavior and be a positive role model, or they can “do what I say, not what I do,” and exhibit undesirable traits that make them a negative role model.

There are two things that every CSSD leader can do in an effort to be a positive role model:

• Lead by example – everything that exemplary CSSD leaders do is something that their subordinates should also do. They express concern for the patients and do whatever is reasonably possible to help those in the surgical suites who use their products and services. They also treat their employees the same way they want to be treated by their own bosses.
• They follow the rules – the best CSSD leaders do not take “short-cuts” because they are the boss and have a right to do sobecause they are in a hurry. They know all applicable policies and standard operating procedures, and they follow them to the letter all of the time. They seek out good ideas from their employees, implement them when possible, and praise them for the contributions they make to the CSSD.

CSSD leaders “manage by walking around” and, as they do so, they have opportunities to coach, encourage, thank, and learn from their other managers. In exactly the same way, managers should expand their definitions of employee supervision to include these opportunities to interact with and obtain ideas from those whom they supervise. Leaders who treat others the way they would like to be treated by their own boss are teaching others great lessons about how to help employees be successful. These actions will not go unnoticed by the employees. They may inspire team members to help each other in expanded ways, which could result in a more integrated team that can achieve loftier goals that might appear unattainable for less integrated departments.

These activities are likely to provide valuable feedback of many types that will help the department improve. The old saying that “none of us knows as much as all of us,” is relevant here. As teams of managers apply their diverse knowledge and skills with a can-do attitude, it will create significant force to move the CSSD towards success.

In Conclusion

CSSD leaders who desire to implement an integrated management approach within their departments can start with an understanding that the CSSD management team and its teams have a significant amount of collective knowledge, experience and creativity. Tactics that make use of these resources in ways that benefit a department’s patients and staff, and the department itself, are very important. CSSD leaders cannot be successful unless their department attains its goals, and doing so requires the participation of all managers and other employees with the department, and the thoughtful application of teamwork, communication, accountability, and visibility by department leaders.

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