Inside telescopes, cameras, and microscopes is a specialized piece of glass called a convex lens. Its purpose is to invert the position of the object, focus the image, and gather as much light as possible. Without these customized lenses, it would be impossible to get a clear view of what is being observed. In sterile processing, there is a valuable analog in understanding that without a self-reflective lens, leadership styles can become inverted, unfocused, or lack perspective.

Over the course of a sterile processing technician’s career, they will likely serve in either formal (i.e., supervisor, manager, lead) or informal (i.e., preceptor, trainer, subject matter expert) leadership roles. In either case, they will establish the culture, tone, and tenor of the team. True leaders are required to have enough introspection and emotional intelligence to know the difference between where they would like to be and where they are now.

What kind of leader?

A common question to come up during training meetings or leadership development courses is, “What kind of leader are you?” Invariably, we hear some of the stock responses:

  • I am a servant leader.
  • I am an authoritative leader.
  • I am a bureaucratic leader.
  • I am a coach.

And my personal favorite:

  • I am a transformational leader.

Each of these leadership styles is made up of core components that will positively impact your team. However, if a person fails to apply a self-reflective lens to their work, they can instead become a photonegative of the leader they were trying to become. We will explore three  leadership styles we see in sterile processing, along with the inverse image to avoid.

Are you bureaucratic or dogmatic?

In healthcare, policies, regulations, and best practices are the law of the land, and technicians who know those standards will rise to leadership positions for two reasons. The first is that a person who takes the time to absorb and apply AAMI standards or hospital policies demonstrates a level of discipline that serves leaders well. The second reason is that technicians who consistently follow procedures provide a prime example for other team members.

This combination can yield what is referred to as a bureaucratic leader, or one that places a high value on formal policies, hierarchical structure, and conformity to established practices. Some of the best leaders I have worked for have been cast from this mold. They are reliable, consistent, and because of their reliance on prescribed policies, exceptionally fair to staff.

Resistant to change

The negative, mirror image of a bureaucratic leader is a dogmatic leader. Dogma is “a principle or set of principles laid down by an authority and held to be incontrovertibly true.”1 The hallmark of this type of leader is the phrase “that’s the way we’ve always done it.” Dogmatic leaders can be resistant to change and might prefer the letter over the spirit of the law. While this can be useful in certain situations, any central sterile department is full of people with complicated lives, personalities, and talents. Failing to see this omits the opportunity to leverage the best of your team.

One example of this is employee retention. From time to time, a technician will submit two weeks’ notice. We have a retention meeting and find out more about their situation. On more than one occasion the technician’s reason for leaving had nothing to do with the work environment, but came down to a family medical situation or a childcare concern.

We made it our practice to offer them six weeks of as-needed work status, or PRN, to give them increased flexibility and to reduce the risk of accruing additional points due to absences. This was well within our facility policy and, in almost all cases, the technician returned to full-time status, often with a renewed energy and an increased appreciation for our department. Had our approach been dogmatic, it may have resulted in the complete loss of the employee and their talents. Being a bureaucratic leader means knowing where the lines are drawn well enough to help your team thrive without penalties.

Are you a servant leader, or a servile leader?

Striking the right balance between empathy and accountability in a leadership role can be challenging. Good leaders understand that our employees do not work in a vacuum, and we do our best to balance the needs of the individual with the needs of the department. A servant leader is one who works alongside their team, is not afraid to put in a shift at the decontamination sink when needed, and provides opportunities for their team members to grow. Serving those you work with means developing them into future leaders rather than ardent followers.

Some servant leaders can turn into servile leaders and begin to show “a strong urge to please others.”2 We sometimes see this when technicians are promoted to leadership positions after working in the department for years. The prior week, they were shoulder to shoulder with staff, and now they are expected to approve or deny PTO, monitor their training, and coach them when they make mistakes.

Bending rules

When I became a manager, the technician who had trained me as a new hire was still working in the department. It was a challenge to provide correction to them when an incident with the OR occurred. Not wanting to rock the boat or appear like a big shot, I erred on the side of a servile leader, and unfortunately was not clear in my communication. A few weeks later, a similar mistake occurred that could have been avoided had I spoken to them as a leader, not as their former trainee.

Being a servile leader can manifest in bending rules for staff that perform well or are our favorites. It can also show itself when we cover work that should have been performed by other team members or give passes when they fail to meet deadlines.

Servant leaders will feel invigorated by the development of their teams, while servile leaders will start to feel burnt out as they draw from their own time and energy to cover gaps. When required to correct, hold staff accountable, or make an unpopular executive decision, servant leaders ask themselves a fundamental question: “Will this improve patient safety?” Once that designation is made, the information can be delivered in a way that is kind, empowering, and supportive.

Are you transformational or aspirational?

A transformational leader is one that “…emphasizes change and transformation. Leaders who adopt this approach strive to inspire their followers to achieve more than they ever thought possible by tapping into their potential.”3 Many of us strive to be this type of person. In hospitals with mentorship programs, there is nothing more meaningful than taking a new leader under your wing, giving them successive challenges, and watching them develop confidence.

In my own experience, I benefited greatly from a director who was willing to let me tackle, and sometimes fail, at new projects. They allowed me to run meetings, build agendas, and lead process improvement groups, all while being there as a support if things went sideways or if I needed to reevaluate my progress. The clear image of a transformational leader is one with the ability to delegate responsibility without abdicating accountability.

However, some leaders can fall into the trap of being aspirational rather than transformational. Aspirational leaders dream up lofty projects or key performance indicators that are disconnected from the patient or department needs. They may say that they want to have the best sterile processing department in the world but give no direction on what that means or how to get there.

Incremental progress

We know that sustainable progress in sterile processing happens incrementally, with buy-in from end users and front line staff. True transformation of individuals and teams requires concrete goals, benchmarks, and milestones along the way. It is not enough to give a vision and a pep talk. Aspirational leaders may favor feel good slogans over honest conversations and may undermine previous progress in favor of work that aligns with their prerogative.

One of the best ways to avoid being aspirational rather than transformational is to start with a needs assessment. Knowing what the genuine gaps are for your team allows your work to truly impact the patient. Transformation entails a journey with an accurate starting point, reliable direction, and enough flexibility to change routes, or modes of transportation, on the way to the destination. A thorough needs assessment is the roadmap in that journey.

Right style for the right perspective

In hospitals around the world, patients rely on an often-unseen group of sterile processing professionals to keep them safe. To create the best outcome for the friends, family, and loved ones that undergo surgical procedures, leaders in central sterile are tasked with building cohesive teams, complying with stringent regulations, and providing customer service to end users. Their approach, efficacy, and leadership style will have an outsized influence on the momentum of a department and the safety of the patient.

To have a clear vision for your team, successful leaders should be well versed in different leadership styles. They must also be able to discern what is appropriate to the situation. This takes time, adjustment, and above all, the self-reflective lens that will allow you to gain your unique leadership perspective.


  1. “Dogmas, paradigms and proving hypotheses.” Nat Immunol 11, 455 (2010).
  2. Villines, Zawn. “People pleaser: What it means and how to stop.” Medical News Today, May 27, 2022. Accessed June 23, 2023.
  3. “The 6 most common leadership styles & how to find yours.” IMD – International Institute for Management Development. Accessed June 23, 2023.