This series of self-study lessons on Central Service topics was developed by the International Association of Healthcare Central Service Materiel Management (IAHCSMM). The lessons are administered by Purdue University’s Continuing Education Division.
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The Operating Room is typically the Central Sterile Supply Department’s largest and most demanding customer. In the fast-paced atmosphere of today’s healthcare facilities, the need for excellent communication between CSSD and the OR is critical. When a problem exists, the root cause is frequently traced to a communication breakdown and, just as commonly, that problem creates additional challenges. For example, if the wrong tray or case cart is sent, the surgical procedure may be delayed and this, in turn, can create schedule delays in subsequent procedures.
While both parties influence the relationship, CSSD personnel can begin the journey toward excellent communication with their OR counterparts. As well, with practice and the use of appropriate techniques, good communication can turn into excellent communication that yields the greatest benefits for those in both departments, as well as the physicians and patients they serve.
It is often said that “perception is reality.” The term “perception” relates to one’s understanding about something, and a person’s beliefs frequently do influence his/her reactions (behavior). Numerous differences make it difficult for CSSD and OR staff to understand each other, and these differences must be understood and reconciled. As this occurs, they will begin to realize how different perceptions can impact the success of their relationship and the effectiveness of their communication.
Figure 1 highlights some factors common to CSSD and OR personnel, and how their perceptions differ.
Once the above and related differences are dealt with, methods to assure that the common goal of both departments (consistent patient satisfaction) can be planned and implemented.
Knowledge of each other’s perceptions can provide a foundation for meaningful and mutual communication. However, more than just “talking” is needed. CSSD personnel must consistently meet and, hopefully exceed, the needs of OR personnel. As they do so, they eliminate the cause of many communication challenges and minimize the “us versus them” relationship that even the best communication sometimes cannot avoid. Three essential factors help to create an atmosphere in which communication can be successful:
Talking is the most popular, but also one of the most difficult forms of communication. Be aware of your volume, tone and voice inflections when speaking to anyone, especially when at least one party in the conversation is upset. Do not use jargon (slang) because the person listening may not fully understand the message. Do not speak while the other person is speaking because interrupting a speaker may upset him/her and may further confuse an issue. Remaining calm during serious disagreements can help defuse anger, and it also illustrates your confidence. These conversations should be conducted in a private area and/or, if necessary, make an appointment to resume the conversation at a later time. Always answer every question honestly; don’t just tell customers what you think they want to hear.
Listening is the most difficult and most important communication skill, and practicing good listening techniques will quickly make you a better communicator. Most people want their opinion to be known, and an effective way to do so is to listen carefully, ask questions and clarify points, as necessary. The reason: active listening often helps to uncover the root cause of an issue. Then, when the other party has finished speaking, you can add necessary facts that have not been presented.
The concept of body language relates to the gestures, mannerisms, expressions, and other non-verbal methods that people use to communicate with each other. Understanding body language can often help you to learn more about what speakers say than the words they actually use. For example, folded arms, hands on one’s hips, and rolling eyes can tell a speaker that the other party is not listening, that he/she doesn’t care about what is being said, and/or that the listener’s mind is already made up. Continuing to work while someone is talking is another message that suggests “I don’t care what you are saying” or “You are not important.” Practicing these learnable skills by looking at yourself in front of a mirror or with a friend or co-worker can help you master appropriate body language.
Effective written communication is a difficult process, although many of us prefer to communicate by memo or e-mail. Typically, these methods should be back-up forms of communication to review a conversation or to follow-up on an issue. As with oral communication, avoid slang and keep the writing factual-based and non-threatening. Never put anything in writing that you would not say to the other party face-to-face. Ensure that your grammar and spelling are correct before sending any form of written communication.
Identifying common departmental goals is an important first step in assuring that mutual perceptions build effective communication. Ongoing discussions can help identify issues that can hinder open and honest communication between the departments. For example, if OR personnel identify problems with missing or wrong case carts or instrumentation, don’t assume you already have the answer or believe they are wrong because you know all case carts and instruments were sent. The OR schedule or the type of case may have changed without the knowledge of the Circulating Nurse or CSSD personnel. The common goal is to have the correct case cart and instrumentation available at the proper room at the correct time. Teamwork between both departments will help to resolve these and other short-term issues.
Cross-functional teams can be used to resolve longer-term issues such as determining how all parties can learn about OR schedule changes on a timely basis. Team members with an interest in resolving this issue should be selected from both departments. Utilizing a third-party person not involved with the issue can also be helpful to bring new perceptions to the analysis and subsequent problem-solving discussion. Do not overload the team, and use a few members from each department while assuring that a manager is present only to watch or facilitate. The best results come from the people who must achieve the outcomes.
Team members from both departments must clearly understand restraints of both departments relating to the issue being discussed. When all parties understand what can and cannot be done, discussions tend to be reasonable and productive. For example, OR personnel who do not understand why it takes so long for instruments to be processed may learn much from a tour of CSSD work areas and explanations about appropriate processing steps. The reverse is also true: when CSSD personnel are shown how cases are set up in the OR, they will gain a clearer understanding about instrument concerns from another perspective.
Be creative during issue resolution. Don’t try to solve problems by doing what has always been done. Einstein once said, “You cannot solve a problem with the same thinking that created it.” Thinking differently to develop new and innovative ways to resolve issues can be very useful. Don’t disregard ideas that seem far-fetched because, many times, they are the best ideas that can be implemented with little or no modification.
When strong egos and/or personality conflicts are involved, mediation that involves someone rendering a non-binding opinion or arbitration in which someone makes a decision may be needed. If a process you designed is not working, allow others to analyze it. The process may still be useful with some minor modifications or, alternatively, a new process may be in order. The best advice: step back, listen, learn, and do not take criticisms or modifications personally. Remember that a process is just a process, and neither you nor any other person can have the best ideas all the time.
Establish priorities for change so everyone will stay focused. Trying to resolve too many challenges at one time typically results in poor resolution for all of them. Use a realistic priority list to ensure that you remain on target. Remember to keep priorities and related goals realistic. For example, committing to a two-hour instrument turnover time that cannot be consistently met and then trying to do so will yield anxiety, stress and failure for CSSD staff and frustration and, perhaps, anger from those in the OR.
Use consensus when communicating about issues. Trying to get everyone to agree on everything is almost impossible and very time consuming. Most people don’t mind implementing a group decision as long as they have had input to the resolution process.
All process changes should be monitored to ensure that their stated purpose is achieved. Ongoing monitoring may yield additional but, hopefully, minor changes to better meet requirements. Suggestion: visit the OR and ask questions about ongoing challenges, while using your best listening skills. Determine what, if anything, may need adjustment. Also, remember that those who are working on different shifts will also have ideas and concerns.
Attend OR shift report meetings. Listening to reports will provide information about the day’s cases that, otherwise, you may not have obtained. Then, you can be proactive and make adjustments before OR personnel experience problems.
Develop a quality checklist and make it readily available. Perhaps, for example, it can routinely or randomly be sent with case carts or instrument trays. Collect the data, analyze it regularly, and report on progress.
Be visible and approachable, and communicate honestly in a timely manner. When everyone knows you will listen attentively and respond appropriately, conversations will begin before issues are created.
Improving your communication skills will help you to improve your relationships with everyone, including OR personnel. The best way to resolve issues is to effectively communicate. Although these skills are difficult to master, the rewards are easily worth the effort to do so.
1. This Figure and information relative to Objective 2 is adapted from: Enhancing Cooperation between Central Service and Operating Room Personnel. IAHCSMM Self-Study Lesson No. 57. April, 2001.
See Chapter Five in: Central Service Leadership Manual (Working Title). Chicago, IL. International Association of Healthcare Central Service Materiel Management. (In production.)
Scott Davis, CMRP, CRCST, CHMMC
Susan Klacik, ACE, CHL, CRCST, FCS
Patti Koncur, CRCST, CHMMC, ACE
Natalie Lind, CRCST, CHL
David Narance, RN, CRCST
Carol Petro, CRCST, RN, BSN
Patti Koncur, CRCST, CHMMC, ACE
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