The flowers are blooming, the bees are buzzing, and spring has sprung. It is around this time of year when the process improvement initiatives planned at the new year are hitting the floor. For administrators, it’s a time of nervous energy, waiting to see if the crop of key performance indicators will go to market. For frontline staff in the sterile processing department (SPD) and the operating room (OR), it can feel like a load of fertilizer was dropped at their feet.

In the complex and interdependent world of healthcare, the partnership between the OR and the SPD is vital for patient safety and quality care. Despite the importance of these initiatives, collaborations between the two departments frequently encounter significant hurdles. These obstacles can range from lack of engagement from staff to infrastructure issues around space and capital resources.

When the barriers become insurmountable, these vital partnerships can fail, leading to further disengagement, missed performance targets, and above all, a lower standard of care for the patient. This article provides a framework for understanding the root causes behind why collaboration between the operating room and sterile processing struggle to bear fruit.

Insufficient planting time

When seedlings are planted too early, they may not be sturdy enough to survive the transition to the great outdoors. Seeds that are started inside are fostered in an ideal environment with the right light, space, and temperature to begin their journey. If these little seedlings are moved outside too soon, they are unlikely to succeed. Similarly, in the perioperative setting, interventions introduced in haste, without allowing adequate time for staff to understand and adapt to them, are prone to failure.

We see this most often when a new piece of equipment is introduced in the OR, either on a trial basis or as a permanent fixture. If the OR staff have not been sufficiently oriented to how to use the equipment, or if they have only used it with the assistance of the rep, we risk delays and extended time under anesthesia. Likewise, if a new instrument or piece of equipment is sent to decontamination without in-servicing the sterile processing team, there is an increased likelihood that the item will be damaged or improperly reprocessed.

The frustration this causes is like a cold snap for new plants. It’s essential to allocate enough time for staff to become familiar with new processes, understand their importance, and integrate them into their routines. This ensures these “seedlings” are hardy enough to withstand the initial resistance.

Facilities should establish processes to determine how new products are introduced. This can be measured by the percentage of staff that need to be in-serviced on a device (for example, 90% of OR and SPD personnel) or a minimum number of education and practice sessions before the instrument is used on a patient. This go-live is like a last-frost date that tells you your initiative is safe to go out into the real world.

The soil isn’t right

The success of any collaboration between the OR and SPD is heavily dependent on the soil or foundation it’s built upon. In this case, the soil refers to the planning, preparation, and alignment with broader organizational goals. Initiatives that involve early and comprehensive planning phases, including input from all relevant stakeholders, are significantly more likely to be successful. Process improvement projects must be planned with a deep understanding of the workflow, staff needs, and potential obstacles. This is the type of in-depth knowledge that only frontline staff may possess.

Proper preparation involves understanding the specific needs of the departments and the project’s workflow impacts, and ensuring that the initiative aligns with the overall goals of the institution. For leaders in sterile processing and the operating room, this can mean that even simple improvements may take time to be accepted by stakeholders. Only then can the “soil” facilitate change.


Just as plants crowded too closely together compete for sunlight, water, and nutrients, leading to stunted growth, competing projects or initiatives can stifle the success of any single collaboration. Let’s take the example of a key interest for sterile processing technicians: the pretreatment of instruments. Both the OR and SPD know that it is an AORN, AST, and AAMI standard to remove gross soil, flush lumens, and spray with a pretreatment solution at the end of the case. If we poll technicians about how often it happens, the success rate is unfortunately low. While this can be frustrating to the sterile processing technician in decontamination, we aren’t necessarily privy to the whole picture.

If a facility decides to improve the rate of pretreating instruments, it won’t be the only task that the OR team has to accomplish. At the same time, your infection preventionist will be trying to increase compliance to dry times for skin prep, your Safety Committee will be pushing proper positioning, and your surgeon will be prioritizing the case start time.

Each of these elements takes mental bandwidth and space in the garden. When too many initiatives are introduced simultaneously or without considering their impact on each other, they can create confusion, dilute focus, and reduce the effectiveness of each intervention. Staff may feel overwhelmed by the sheer volume of changes, leading to resistance or half-hearted implementation. The solution is collaboration early and often.

Operational leaders need to determine the priorities that are most important to the organizational goals. They also need to determine which changes are short-term victories (i.e., low-hanging fruit) and which ones need to be permanent workflow adjustments. We improve the harvest by nurturing one priority at a time rather than trying to get everything to grow at once.


One of the most common, and thankfully most treatable, problems in the field of OR/SPD collaboration is the presence of pests. Naysayers or individuals resistant to change can jeopardize the success of new interventions in the healthcare setting. These aphids against improvement often prefer the comfort of the status quo and may actively or passively resist changes, especially if they feel excluded from the planning process or unconvinced of the benefits.

The strategy to mitigate this challenge involves inclusivity and engagement. By involving all stakeholders in the change process from the beginning, resistance can be minimized. When our family started prepping our garden beds last year, my four-year-old son was less than enthused at the prospect of pulling out weeds and spreading manure. That was until he was told that he was in charge of deciding where the seeds went. We set parameters and left him to it.

Provided we are compliant to standards, the placement of squash seeds or the order of needle holders on a stringer are not as important as getting buy-in from the staff responsible for the work. Making my son an active participant helped him feel ownership of the outcome and the sense that his work was worth the effort. Overcoming resistance requires showing how the intervention enhances the ability to provide care.

No appetite for what you are growing

Finally, the success of any new process is contingent upon its acceptance and perceived value. The choice of what to plant in your garden is influenced by personal preference; vegetables that you enjoy eating are tended to with more care. Similarly, if the staff perceive an intervention as burdensome, unnecessary, or irrelevant to their primary duties, they are less likely to engage with it fully.

Take, for instance, the ever-present challenge of incomplete instrument sets. To the technician in prep and pack, it may not be readily evident why nine out of ten clamps in the ECMO tray isn’t good enough. Nothing will change this mentality faster than allowing the technician to observe the next cardiac procedure. Educating staff on the importance of each intervention and how it contributes to patient safety can help cultivate an appetite for the change. Understanding the why behind an action can transform perception.

There will also be times where we just have to grin, bear it, and eat the veggies whether we like them or not. Regulatory requirements and sentinel events may prompt a change that require all hands on deck. When that happens, we impact the safety of the next patient by doing the right thing regardless of the additional burden on your understaffed SPD or the preference of the surgeon.

For collaborations between the OR and SPD to be successful, it is essential to understand and address these five key challenges. Each step from soil preparation to pest control plays a critical role in the harvest. In healthcare, each factor from planning to stakeholder engagement is crucial for the successful implementation of interventions. By drawing lessons from the harvest, healthcare professionals can enhance their collaborative efforts in meaningful ways, leading to improved patient care and safety outcomes.