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Variations due to interpretation Standard operating procedures define what success is. They do so by removing emotional biases and preconceived notions of expertise and creating a foundation for application. Variations in SOP application are typically the result of the SP profes- sional’s interpretation of the process and its expectations. The SP professional will interpret how to achieve the SOP outcome through their own scope of job skills formed by workplace tenure, experience levels, and learned habits. Thus, SOPs level the playing field and give every SP professional the same foundation for evaluation. It is possible to create SOPs that consider different professional levels and are only applied to those levels. However, using a high caliber SOP as the baseline for profes- sionals with less experience is only setting up the department and our patients for failure. SOPs must be tangible; their tangi- bility measured by the success rate of those performing them.
One indication that an SOP should be evaluated is that the result isn’t being achieved due to multiple observed process deviations. The key term in that sentence is “observed”. Assumptions have no place in SOP creation, implementation, manage- ment, or assessment. Process observation can be performed through direct observa- tion of the process, data analysis, and even conversations with the frontline SP profes- sional performing their duties. While a good hypothesis can serve as the starting point for investigation, it must remain that until proven true or false. This proposed assump- tion was based on the limited evidence made available and easily becomes true if we allow our bias to lead its investigation.
Niche training
Another way to tell if SOPs need to be cre- ated or evaluated in a Sterile Processing department is by the awareness of niche training. “Niche” defines the area in which one can offer a tremendous amount of insight on a certain topic¹. Niche training is the concept that only a few individuals can perform a certain duty because they have excelled in the tasks outlined in said area. As a result, they are the only ones assigned those duties. This is common in facilities experiencing a high employee turnover rate. As profes- sionals come and go, the desired outcomes still need to be achieved. This results in the designated tasks and applicable knowledge becoming stagnant in one or a few specific individuals. Thus, the information and skills specific to these areas are not transferred
to new professionals. While these particu- lar assignments in the department have become suitable for one or few profession- als, niche training has caused information and professional knowledge to become limited to those expert(s). This perpetu- ates the cycle of insufficient training of new professionals due to the time necessary to hone these skills.
Let’s observe niche training in the case
cart SP assignment. In this area, the pro- fessional is responsible for interpreting a preference card based on the surgical pro- cedure it is intended for. For this example, we’ll focus on the instrumentation that is requested. The preference card lists every single type of set that may be necessary for the procedure, including multiple dupli- cated sets that are to be provided by differ- ent instrument companies. An experienced SP professional may be able to see the doc- tor’s name and know what company they use due to their accumulated knowledge on the case cart assignment. A new SP pro- fessional may pick every single instrument set that is itemized on the preference card, resulting in excessive equipment. The case cart is hence assembled incorrectly. The experienced professional reviews the cart and tells the new technician to remem- ber that this doctor only uses this specific equipment. Time goes by and the inaccu- rate case cart assembly happens again but for a different doctor. The trainer says that they went over this with the trainee and the trainee only recalls the previous event with a different doctor. Unfortunately, this will cause the trainer and trainee to become frustrated and impatient. The trainee views the trainer as incapable of teaching because they are only being corrected after the error and told to remember yet another fact amongst hundreds. The trainer will think “they just don’t get it” and that they may not care about the job responsibilities or take them seriously.
SOPs will help limit niche training because the process outlined is based on the overarching task. They undermine the niching process by depersonalizing the actions used to achieve the outcomes. The professionals experiencing the effects of niche training have taken the job duties and made them apply to how they perform the task. Hence intertwining their personal perception, professional experience, and even their own view on workplace success. The trainer in this example looks to their learned subject matter expertise; a wealth of knowledge that has taken them their entire professional career to acquire. The expecta- tions for the new technician are not only to
SELF-STUDY SERIES
gain and retain this vast amount of knowl- edge during the short training period, but also demonstrate it in all the new moments that require it. The end results will vary in accuracy and consistency when a new technician is expected to achieve the same results the way their trainer has. The trainee and their manager may also begin to expect the desired outcome, based on the trainer’s success measurements. Instead of allowing this to happen, an SOP can clearly define the goals, tasks, and resources required and leave no room for ambiguity. Create Valid Expectations
SOPs are necessary to create a clearly defined expectation. However, we would do no justice to our SP team or the patient if we just grab an outcome out of thin air. Like in our previous example of inspecting ten sets an hour on assembly: Where did we get the number ten from? How did we determine that ten was a benchmark num- ber we should use to measure productivity? These benchmarks must have a sound basis in logic. This is what makes them reasonable and therefore tangible. Without this, per- formance expectations can be perceived as biased, unrealistic, and frankly unfounded. Hence, several regulatory, industry, and facility-based requirements and recom- mendations must be considered in SOP creation. For a Sterile Processing depart- ment, this includes: ● Hospital policies ● Regulatory agencies ● Recommendations through accred ited sources
● Facility documents ● Interdisciplinary groups Determining key players, as in the FDA,
AAMI, and even the facility’s Infection Prevention and OR team, is important in SOP creation. As we have come to expe- rience, industry benchmarks in Sterile Processing vary and may not even exist in some areas. Because of this, the specific department’s data and workflow become even more vital when determining and cre- ating credible figures used in SOPs. Most importantly, do not forget to include SP leadership in the creation of Sterile Processing SOPs. Frontline contribution is vital to the implementation and continued practice of SOPs. If the bar is set based on a perceived workflow or half understanding of department responsibilities, the contin- ued success of the SOP is in danger. Poor implementation of an SOP can be the result of a lackluster creation phase. Therefore, setting quality expectations and founda- tions is of the utmost importance and will affect the positive patient safety outcome.
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Self-Study Test Answers: 1. B, 2. A, 3. B, 4. D, 5. B, 6. D, 7. B, 8. A, 9. A, 10. C
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