CRCST
Technical Continuing Education (TCE)
SELF-STUDY PLANS

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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Lesson Plan CRCST 88
Enhancing Cooperation Between the Central Service and Operating Room Departments
[Reprinted from Communiqué: May/June 2006]

No two departments in a typical healthcare facility work more closely together than do Operating Room (Surgery) and Central Service. The outcome of every patient procedure depends on effective communication and cooperation between these two departments. Because both departments work within a fast-paced, ever-changing environment, communication between them may break down and relationships can become strained. The structure and processes required to maintain quality surgical protocols are then likely to be undermined. This Self-Study Lesson will examine some factors that affect the relationship between these two departments.

Objective 1: Discuss the history of Central Service and Operating Room relationships.

Historically, Operating Room personnel in many facilities were responsible for cleaning, inspecting, assembling, and packaging their instruments. They also performed many other duties now commonly performed by Central Service technicians, including supply management, instrument assembly, implant inventory control, and procedure preparation, such as case cart assembly. Central Service
personnel simply received instrument packages, sterilized them, and returned them to the Operating Room.

As the scope and volume of Operating Room services increased, space limitations, labor costs, and, in many cases, the time constraints caused by greater workloads created pressure to move many traditional Operating Room duties to the Central Service department. Although the transition was gradual, many Operating Room staff eventually had to relinquish control over the items needed for surgical procedures. When the transitions were well-planned, training was adequate, and there was adequate instrumentation and staffing, these changes usually evolved with relatively little disruption in service. On the other hand, if the transition wasn't adequately planned or supported, serious service and quality issues occurred, creating relationship problems between the two departments that were very difficult to resolve.

The frustrations caused by poorly-planned transitions can lead to fractured systems and poor working relationships between departments that can last for years. A lack of trust can arise from this situation, which may manifest itself as a refusal to delegate specific work processes. For example, Operating Room staff might retain responsibility for specific medical devices that, they may say, "might get lost in the Central Service department." An attitude of mistrust between the two departments can easily lead to negative feelings and an adversarial relationship that is difficult to repair.

Objective 2: Identify common roadblocks to successful Central Service and Operating Room relationships, and suggest tactics to address them.

The first step in repairing or enhancing the relationship between the Central Service and Operating Room departments is to identify issues that can cause problems or perpetuate negative feelings between the two. Common roadblocks to effective working relationships between these staff members include:

• Disagreements about task priorities
• Timelines for completing tasks
• Communication "disconnects"
• Lack of training
• Uncertainty about each others' duties and responsibilities
• Ego ("My department is most important.")
• Lack of adequate procedures
• Failure to follow established protocols

Most issues such as these, which can damage Central Service—Operating Room
relationships, can be addressed with education, training, and procedures and work plans that are constructed and communicated well. When the actions of staff from either, or both of the departments are harmful to the work environment, those staff members must be managed on a case-by-case basis. Stereotypes about a specific workgroup and negative attitudes hinder teamwork and disrupt the work environment, and cannot be tolerated.

After issues are identified, it becomes important to work together to explore options and possible solutions. Staff from both departments should make a sincere effort to understand the other department's work processes and requirements. Both workgroups should then mutually agree on an attainable solution to improve the situation.

Much of the relationship between Central Service and Operating Room staff relies on mutual trust. Staff in both departments must realize that trust is earned, and their actions and responses to issues will build or erode the trust that is necessary to reduce communication roadblocks.

Objective 3: Describe communication challenges that confront the Central Service and Operating Room departments.

Although staff from both departments work together closely and share the common goal of providing quality patient care, differences between the departments' systems can create communication challenges. For example, Operating Room staffs are trained to view their patients as their most important responsibility, and to put the patient's needs before everything else. When an instrument is needed for a patient, the Operating Room staff's primary focus is on obtaining that device in a timely manner. While Central Service staff share the goal of meeting patient needs, however, they often deal with these needs on a broader scale. For example, Central Service may be supporting 15 operating rooms (procedures) at one time, and they may need to respond to two or more simultaneous requests from Operating Room staff at once. When there are multiple needs requiring equal attention, effective communication between both workgroups is necessary to address them.

Another type of communication problem—terminology—also arises. Slang terms, jargon, and nicknames used to describe medical instruments and supplies may not be familiar to all staff working in both departments. The lack of common terminology can cause mistakes and service delays, while creating stress and frustration for both workgroups. When slang terms and nicknames are used, everyone—even experienced staff who are new to the specific healthcare facility-must relearn basic
information. Use of slang also makes it difficult to search for items in computer systems and to place orders for replacement items or supplies. Eliminating the use of slang and nicknames can reduce numerous problems and improve patient service.

Finally, in the rapidly-changing surgical environment, instruments and supplies may need to be ordered and recorded as schedules, timelines, and cases change, often several times daily. If requisition information doesn't travel smoothly, frustrations can increase, and relationships can be damaged. It is, therefore, important to establish and maintain communication systems that enable, not disable, effective information flow.

Objective 4: Discuss the impact of poor Central Service and Operating Room
relationships.

Poorly maintained relationships between Central Service and Operating Room staff can impact much more than just the work environments of these two departments. Poor communication, distrust, efforts to circumvent established processes, and inappropriate behaviors can directly affect patient safety. Such symptoms of poor working relationships between the two departments can result in delays, insufficient supplies, unsafe instruments, and other dangers to their patients.

oor relationships between Central Service and Operating Room personnel can also
negatively impact departmental budgets when, for example, errors or miscommunication cause supply shortages or stock outs. System inefficiencies affect patients, cost money, and increase frustrations within both workgroups. These same issues can also directly impact surgeon satisfaction. In extreme situations, department turnover rates may be affected as employees seek a less-stressful work environment elsewhere. Each of these factors supports the need to build and maintain a positive relationship between staff in both work areas.

Objective 5: Discuss methods to enhance communications between the Central Service and Operating Room departments.

Most healthcare facilities can improve their interdepartmental communications, but some systems need more improvement than others. There are several ways to enhance communications between the Central Service and Operating Room departments. Sometimes, a specific issue should first be addressed. At other times, a broader tactic-such as a survey to identify and prioritize communication
roadblocks—may be the best approach.

Regardless of the method used, the most important thing to remember is the goal of improving communications and building relationships. If a specific issue is selected, it should be addressed without assigning blame to individuals or workgroups. Instead, the focus should be on identifying and correcting
problems. A questioning process can often be used to help identify problems:

• Is adequate training provided for the task?
• Does everyone involved in the process understand their role?
• Is there adequate equipment to perform the task?
• Are expectations realistic?
• Are there other factors that interfere with the process?

After problems are identified, staff from both departments can work together to resolve them. By taking the personal element out of the process, both workgroups can focus on the issues without allowing personal frustrations and feelings to impede the problem-solving.

Communication between Central Service and Operating Room staff should not just occur when an incident has occurred or an issue has been identified. Instead, it should be on-going and should recognize successes such as completing a joint project or identifying of a solution that addresses mutual concerns. Also, simple actions such as showing appreciation for the efforts and assistance of personnel in the other department can go a long way toward establishing a bond between both groups.

When systems are working well, and there are no obvious issues to resolve, the focus of the workgroups should shift to a preventive mentality that searches for ways to improve communications and systems before issues develop.

Objective 6: Review the need for proper behavior and personal responsibility when Central Service and Operating Room departments interact with each other.

The main focus of any collaboration between Central Service and Operating Room personnel should be developing a system that works seamlessly to provide quality patient care. There may be times, however, when the system itself isn't the problem. When employees' personalities or attitudes create problems, the resulting behaviors should be addressed. Clear expectations for professional conduct should be defined, and each employee must consistently be required to meet the established standards. In addition to treating all members of both workgroups with respect and courtesy, other behaviors—such as efforts to avoid established procedures-should be addressed. Actions that disregard established guidelines can damage the integrity of the overall system and will, over time, contribute to process and communication failures and frustration.

Objective 7: Describe tactics that Central Service staff can use to improve their
customer service skills.

Customer satisfaction is important.¹ Central Service personnel must be committed to providing excellent support service to Operating Room personnel so they, in turn, can provide excellent service and care to the patient who is the ultimate customer.

Providing top-quality service requires being consistent in performance standards throughout the department. Each employee must share the same professional values, beliefs, and work ethic. These qualities should be developed from and supportive of the department's goals and the organization's overall mission.

Each functional area and work shift in Central Service is closely dependent on the
others; the quality of each step in the reprocessing cycle is greatly affected by previous and subsequent steps. If decontamination and cleaning procedures are not done effectively or in a timely manner, the sterilization process may not be effective or the product may not be available when needed for patient use. Just as the quality of a finely crafted watch is dependent upon the detailed working
mechanisms of each tiny part, Central Service is dependent on the performance and
contribution of each team member. Central Service personnel must function as a team to achieve quality customer service.

With practice, customer relations skills can be improved. Self-discipline and control are very important in Central Service, especially in difficult encounters. Stay focused on real issues, always maintain composure, and do not let emotions or personalities influence performance goals. Be objective when it is necessary to refuse an Operating Room request, explain the reasoning, and offer alternatives. Honesty is always the best policy; never make excuses. If an error has been made, admit it and work toward a resolution. Credibility and trust are essential to a support unit, and trust must never be betrayed. It helps to personalize the Operating Room staff by getting acquainted with them and using their names. This will convey that they are important to you. Give them your full attention and find ways to handle special requests. A cheerful, courteous, friendly demeanor projects a good image and promotes positive human relations.

Conclusion

In today's fast-paced and demanding surgical environment, it is impossible to foresee or to prevent every issue or potential problem that may arise. As in all relationships, establishing and maintaining cooperation between Operating Room and Central Service personnel requires effort. If the relationship is fractured from past events, repairing it will take time, and may not be easy, but it can be done. The result will be a more positive workplace for both departments and, ultimately, a better, safer environment for patients.

Endnotes

1. This section is adapted from: Central Service Technical Manual. International Association of Central Service Healthcare Materiel Management. Chicago, Illinois. Reprinted August, 2005. (pp. 360-361)